Abstract TMP73: Intra-arterial Transfer Time Metrics Study—Southern California Kaiser Permanente and University of Texas Houston Telestroke Network Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Tzu-Ching Wu ◽  
Navdeep Sangha ◽  
Feryal N Elorr ◽  
Edgar Olivas ◽  
Christy M Ankrom ◽  
...  
Keyword(s):  
Health Systems ◽  
Best Practice ◽  
Data Transfer ◽  
Symptom Improvement ◽  
Transfer Time ◽  
Kaiser Permanente ◽  
University Of Texas ◽  
Integrated Health Care System ◽  
A Prospective Study ◽  
Practice Time

Background: The transfer process for patients with large vessel occlusions from a community hospital to an intra-arterial therapy (IAT)-capable center often involves multiple teams of physicians and administrative personnel, leading to delays in care. Objective We compared time metrics for spoke drip-and-ship telemedicine (TM) patients transferred for IAT to comprehensive stroke centers (CSC) in two different health systems: Kaiser Permanente (KP) with an integrated health care system of spokes and a 50 mile range using ambulances for transfer vs UTHealth (UTH), where patients are transferred by helicopter from varying health systems ranging up to 200 miles from the hub. Methods: We retrospectively identified patients in the KP and UTH networks transferred from TM spokes to the CSC (KP—6 spokes and UTH -17 spokes). From 9/15 to 4/16, a total of 79 TM patients (KP-28 patients, UTH-51 patients) were transferred to the respective hubs for evaluation of IAT. Baseline clinical data, transfer, and IAT metrics were abstracted. Results: On average, it takes ~90 minutes for a TM patient to arrive at the CSC hub once accepted by the transfer center. Patients in the KP Network arrive at the hub faster than UTH patients, but IAT metrics/outcomes are comparable. Over 50% of the patients did not undergo IAT on hub arrival mostly due to lack of clot on CTA (20/45) or symptom improvement (9/45). Conclusion: In two large, yet different TM networks, the transfer time from spoke to hub needs to be shortened. Areas for improvement include spoke arrival to transfer acceptance and transfer acceptance to hub arrival. A prospective study is underway to develop best practice time parameters for this complex process of identifying and transferring patients eligible for IAT.

Presurgical Nasoalveolar Molding Therapy for the Treatment of Bilateral Cleft Lip and Palate: A Preliminary Study

2006 ◽  
Vol 43 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Adam L. Spengler ◽  
Carmen Chavarria ◽  
John F. Teichgraeber ◽  
Jaime Gateno ◽  
James J. Xia
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Average Length ◽  
University Of Texas ◽  
Bilateral Cleft Lip ◽  
Before And After ◽  
Nasal Tip Projection ◽  
A Prospective Study ◽  
The University ◽  
Nasoalveolar Molding

Objective To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate. Design A prospective study with blinded measurements. Setting The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas. Patients Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004. Interventions The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days. Main Outcome Measures Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy. Results Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased. Conclusion The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.

Pareto frontier for job execution and data transfer time in hybrid clouds

2014 ◽  
Vol 37 ◽  
pp. 321-334 ◽  
Author(s):  
Javid Taheri ◽  
Albert Y. Zomaya ◽  
Howard Jay Siegel ◽  
Zahir Tari
Keyword(s):  
Data Transfer ◽  
Pareto Frontier ◽  
Transfer Time ◽  
Hybrid Clouds

scholarly journals The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California

2008 ◽  
Vol 19 (10) ◽  
pp. 1065-1076 ◽  
Author(s):  
Marilyn L. Kwan ◽  
Christine B. Ambrosone ◽  
Marion M. Lee ◽  
Janice Barlow ◽  
Sarah E. Krathwohl ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Cancer Survivorship ◽  
Northern California ◽  
Breast Cancer Survivorship ◽  
Kaiser Permanente ◽  
A Prospective Study

21 Identification and management of delirium in the palliative inpatient unit

2018 ◽  
Vol 8 (3) ◽  
pp. 367.3-367
Author(s):  
Andrew Gill ◽  
Clare Rayment ◽  
Chris Kane
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Management Plan ◽  
List Type ◽  
Acute Confusional State ◽  
Pharmacological Management ◽  
Assessment And Treatment ◽  
Inpatient Settings ◽  
Palliative Care Units ◽  
A Prospective Study

IntroductionDelirium is an acute confusional state. The incidence of delirium in palliative care units is estimated between 13% and 42% (Hosie 2014). Delirium is associated with an increase in mortality and length of hospice stay yet it is poorly identified. Up to 50% of cases of delirium are reversible (Lawlor 2000) as such early identification and impeccable assessment and treatment could relieve the suffering.AimTo assess identification and management of delirium in two hospices.MethodsRetrospective notes analysis to identify patients with delirium whether they were coded with a delirium diagnosis and whether the management of delirium followed best practice.Results77 inpatients across two hospices were assessed in one month in 2018. There were 37 episodes of possible delirium only five were coded as delirium none had assessment with a recognised delirium tool. Reversibility was considered for 48 episodes; it was not clear from the documentation that this was all possible reversible causes. Family were kept informed 94% of the time. A management plan was documented for five patients.ConclusionDelirium was being considered but not documented a common problem in medical notes. Documentation of a management plan was poor but when there was a plan best practice was followed with non-pharmacological management then low dose antipsychotic with stronger sedation reserved for terminal agitation. An education feedback loop formal training on delirium and design of an electronic medical record template to prompt the management of delirium is ongoing. Practice will be reassessed three months after this intervention.References. Hosie A, Davidson P, Agar M, et al. Delirium prevalence incidence and implications for screening in specialist palliative care inpatient settings: A systematic review. Palliative Medicine2013;27(6):486–498.. Lawlor P, Gagnon B, Mancini I, et al. Occurrence causes and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine2000;160(6):786–794.

scholarly journals Modeling Users’ Empowerment in E-Health Systems

2021 ◽  
Vol 13 (23) ◽  
pp. 12993
Author(s):  
Muhammad Anshari ◽  
Mohammad Nabil Almunawar ◽  
Mustafa Z. Younis ◽  
Adnan Kisa
Keyword(s):  
Health Systems ◽  
Customer Service ◽  
Best Practice ◽  
Patient Empowerment ◽  
Customer Relationships ◽  
Three Dimensions ◽  
Health Decision Making ◽  
Health Initiatives ◽  
Health Decision

In conventional e-health initiatives, customers (patients) are mostly perceived as recipients of medical care, where they play little roles in the process of health decision making. Empowerment in e-health enables individuals to access their health data and consult online with medical staff. The proposed concept is intended to improve the existing e-health theory in relation to patient empowerment. The study suggests a model that expands the role of customers (patient) in three dimensions: as an individual health actor, social health agent, and medical partner. This study is theoretically significant because it explores a comprehensive approach of patient empowerment in e-health systems to achieve best practice customer service, establish long-term customer relationships to improve customer satisfaction, and achieve better health literacy of individuals.

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