Abstract 105: Impact of the Extended Window Mechanical Thrombectomy on Tele Stroke Call Volume in the Post-DAWN and DEFUSE -3 Era

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Line Abdul Rahman ◽  
Michael Nahhas ◽  
Jillian Harvey ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Clinical Characteristics ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
The United States ◽  
Controlled Trials ◽  
Stroke Mimics ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Before And After

Introduction: Recently, two randomized controlled trials proved the safety and efficacy of mechanical thrombectomy in patients presenting up to 24 hours from symptom onset. While the number of patients receiving mechanical thrombectomy has increased following the publication of the extended time window trials, the literature on acute stroke calls over telestroke is relatively scant. In this study we evaluate the volume of telestroke calls, rate of transfers to the thrombectomy center and MT receipt before and after the extended window MT trials publication. Methods: We interrogated the prospectively collected data from a major telestroke network in Southeast the United States to include patients who received a telestroke consult between January 2015 and July 2019. We compared the demographical and clinical characteristics and the outcomes between patients who presented before and after the publication of the extended window mechanical thrombectomy trials. Results: Total of 7,438 patients were evaluated during the study period. Of those, 3392 were after February 2018. There was no difference in age, race, or sex between the two groups (table 1). Patients in the post extended window group had lower National Institute of Health stroke scale (NIHSS) on presentation (3 vs. 4, P<0.001), had longer symptom-onset to door time (123 vs. 85 min, P<0.001), and were more likely to present with stroke mimics (41% vs. 35.3%, P<0.001).Despite this increase in the number of consults per month (190 vs. 103, P<0.001) in the post-DAWN era, there was similar rates of patients eventually receiving MT (3.9% vs. 3.8%, p=0.849) Conclusion: The number of telestroke consults almost doubled since the publication of the extended thrombectomy trials without increase in the rate of MT receipt. These findings have important operational implications for hospitals implementing telestroke call coverage.

Abstract W P240: The Effect of Telestroke Network on Tissue Plasminogen Activator Utilization and Door to Needle Time on Rural Hospitals.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Karina Castellon Larios ◽  
Katherine Rybka ◽  
Diana Greene-Chandos ◽  
Sergio Bergese ◽  
Michel Torbey
Keyword(s):  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Symptom Onset ◽  
Time Window ◽  
The United States ◽  
Rural Setting ◽  
Nihss Score ◽  
Number Of Patients ◽  
Tissue Plasminogen

Introduction: Stroke is the 4 th leading cause of death in the United States. Only 2-3% of ischemic stroke patients are receiving Tissue plasminogen activator (t-PA) despite an increase in time window to 4.5 hours. With less than 85% of the US population living within 30 minutes of primary stroke centers, it is important to review the effectiveness of telestroke network in delivering t-PA. The Ohio State University Wexner Medical Center (OSUWMC) Telestroke network was established in May 2011. Currently the network expands across 24 spokes located in rural central Ohio. Most of these centers have not given t-PA prior to joining the network. Objective: Evaluate the effectiveness of the OSUWMC telestroke in delivering t-PA for acute ischemic stroke in a rural setting and compare the stroke quality metrics to Ohio Coverdell registered Hospitals. Methods: We conducted a retrospective data review from the OSUWMC Telestroke Network database from May 22, 2011 to November 30, 2012. This included demographics, diagnostic impression, NIHSS score, average symptom onset to ED arrival, average door to CT time, average consult duration. t-PA administration and transfer status to OSUMWC were also collected. Summary statistics were generated using Microsoft Excel (version 2010, Microsoft Corporation) and SAS (version 9.3, SAS Institute). Results: In this study, a total of 422 Telestroke consultations were completed. 180 patients were diagnosed with ischemic stroke (57.5%). Average NIHSS score was 5 ±6, average symptom onset to ED arrival time was 4 hours 26 minutes (n=378), and the average door to CT time was 26 minutes (n=204). Forty-four percent (n=80) were approved to receive IV t-PA; 60% within one hour of ED arrival. From this number of patients thirty percent received t-PA within one hour compared to 38% in Ohio Coverdell hospitals. Conclusion: The implementation of telestroke network can deliver care that is equivalent to primary stroke centers. This approach may be an effective tool for rapid evaluation of patients in remote hospitals that require neurologic specialists.

The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review

2014 ◽  
Vol 29 (8) ◽  
pp. 741-751 ◽  
Author(s):  
Andresa R Marinho-Buzelli ◽  
Alison M Bonnyman ◽  
Mary C Verrier
Keyword(s):  
Randomized Controlled Trials ◽  
Gait Speed ◽  
Neurological Diseases ◽  
Dynamic Balance ◽  
Experimental Studies ◽  
Controlled Trials ◽  
Aquatic Therapy ◽  
Randomized Controlled ◽  
Randomized Studies ◽  
Before And After

Objective:To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases.Data sources:MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE and OT Seeker were searched from inception to 15 September 2014. Hand-searching of reference lists was performed in the selected studies.Review methods:The search included randomized controlled trials and quasi-experimental studies that investigated the use of aquatic therapy and its effect on mobility of adults with neurological diseases. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction and quality assessment. A narrative synthesis of data was applied to summarize information from included studies. The Downs and Black Scale was used to assess methodological quality.Results:A total of 116 articles were obtained for full text eligibility. Twenty studies met the specified inclusion criteria: four Randomized Controlled Trials (RCTs), four non-randomized studies and 12 before-and-after tests. Two RCTs (30 patients with stroke in the aquatic therapy groups), three non-randomized studies and three before-and-after studies showed “fair” evidence that aquatic therapy increases dynamic balance in participants with some neurological disorders. One RCT (seven patients with stroke in the aquatic therapy group) and two before-and-after tests (20 patients with multiple sclerosis) demonstrated “fair” evidence on improvement of gait speed after aquatic therapy.Conclusion:Our synthesis showed “fair” evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.

Basilar Artery Occlusion Chinese Endovascular Trial: Protocol for a prospective randomized controlled study

2021 ◽  
pp. 174749302110409
Author(s):  
Chuanhui Li ◽  
Chuanjie Wu ◽  
Longfei Wu ◽  
Wenbo Zhao ◽  
Jian Chen ◽  
...  
Keyword(s):  
Sample Size ◽  
Basilar Artery ◽  
Symptom Onset ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Controlled Study ◽  
Randomized Controlled

Rationale There are no randomized trials examining the best treatment for acute basilar artery occlusion in the 6–24-hour time window. Aims To assess the safety and efficacy of thrombectomy for stroke due to basilar artery occlusion in patients randomized within 6–24 h from symptom onset or time last seen well. Sample size For an estimated difference of 20% in proportions of the primary outcome between the two groups, 318 patients will be included for 5% significance and 90% power with a planned interim analysis after two-thirds of the sample size (212 patients) have achieved the 90 days follow-up. Methods and design A prospective, multi-center, randomized, controlled, open-label and blinded-endpoint trial. The randomization employs a 1:1 ratio of mechanical thrombectomy with the detachable Solitaire thrombectomy device and best medical therapy (BMT) vs. BMT alone. Study outcomes The primary outcome will be the proportion of patients achieving modified Rankin Scale (mRS) 0–3 at 90 days. Key secondary outcomes are: dramatic early favorable response, dichotomized mRS score (0–2 vs. 3–6 and 0–4 vs. 5–6) at 90 days, ordinal (shift) mRS analysis at 90 days, infarct volume at 24 h, vessel recanalization at 24 h in both treatment arms, and successful recanalization in the thrombectomy arm according to the modified thrombolysis in cerebral infarction (mTICI) classification defined as mTICI 2 b or 3. Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage rates at 24 h, and procedure-related complications. Discussion Results from this trial will indicate whether mechanical thrombectomy is superior to medical management alone in achieving favorable outcomes in subjects with acute stroke caused by basilar artery occlusion presenting within 6–24 h from symptom onset. Trial registration: URL: http://www.clinicaltrials.gov . ClinicalTrials.gov Identifier: NCT02737189.

scholarly journals The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis

2020 ◽  
pp. 1357633X2091786
Author(s):  
Miia M Jansson ◽  
Arja Rantala ◽  
Jouko Miettunen ◽  
Ari-Pekka Puhto ◽  
Minna Pikkarainen
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Randomized Controlled Trials ◽  
Physical Functioning ◽  
Joint Replacement ◽  
Lower Limb ◽  
Controlled Trials ◽  
Narrative Synthesis ◽  
Randomized Controlled ◽  
Number Of Patients

Introduction As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. Methods A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. Results Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. Discussion Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.

scholarly journals Designing and Evaluating Culturally Specific Smoking Cessation Interventions for American Indian Communities

2013 ◽  
Vol 16 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Steven S. Fu ◽  
Kristine L. Rhodes ◽  
Christina Robert ◽  
Rachel Widome ◽  
Jean L. Forster ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
American Indian ◽  
Randomized Controlled Trials ◽  
American Indians ◽  
The United States ◽  
Controlled Trials ◽  
Culturally Specific ◽  
Indian Community ◽  
Randomized Controlled ◽  
American Indian Community

Abstract Introduction: American Indians have the highest smoking rates in the United States, yet few randomized controlled trials of culturally specific interventions exist. This study assessed American Indians’ opinions about evidence-based treatment and attitudes toward participating in clinical trials. Methods: Six focus groups were conducted based on smoking status (current/former smoker), sex, and elder status (55 years and older or younger). Meetings were held at local American Indian community organizations. This project was accomplished in partnership with the American Indian Community Tobacco Projects, a community–academic research partnership at the University of Minnesota. Thematic qualitative data analyses were conducted. Results: Participants desired the following: (a) programs led by trained American Indian community members, (b) the opportunity to connect with other American Indian smokers interested in quitting, and (c) programs promoting healthy lifestyles. Strategies desired for treatment included (a) free pharmacotherapy, including nicotine replacement therapy (NRT); (b) nominal incentives, e.g., gift cards for groceries; and (c) culturally specific program components such as American Indian images, education on traditional tobacco use, and quit-smoking messages that target the value of family and include narratives or story telling in recruitment and program materials. Biochemical verification of smoking abstinence, such as salivary cotinine or carbon monoxide breathalyzers, is likely acceptable. Standard treatment or delayed treatment control groups were viewed as potentially acceptable for randomized study designs. Conclusions: Rigorously conducted randomized controlled trials of culturally specific smoking cessation interventions are sorely needed but will only be accomplished with the commitment of funders, researchers, and collaborative trusting relationships with the community.

Evaluating the reporting of adverse events in controlled clinical trials conducted in 2010–2015 on migraine drug treatments

Cephalalgia ◽  
2018 ◽  
Vol 38 (12) ◽  
pp. 1885-1895
Author(s):  
Peer Tfelt-Hansen ◽  
Janus Kaufmann Lindqvist ◽  
Thien Phu Do
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
International Headache Society ◽  
Controlled Trial ◽  
Migraine Treatment ◽  
Controlled Trials ◽  
Acute Administration ◽  
Drug Trials ◽  
Randomized Controlled ◽  
Number Of Patients

Background In 2008, the International Headache Society published guidelines on the “evaluation and registration of adverse events in clinical drug trials on migraine”. They listed seven recommendations for reporting adverse events in randomized controlled trials on migraine. The present study aimed to evaluate adherence to these recommendations, and based on the results, to recommend improvements. Methods We searched the PubMed/MEDLINE database to identify controlled trials on migraine drugs published from 2010 to 2015. For each trial, we noted whether five of the recommended parameters were presented. In addition, we noted whether adverse events were reported in abstracts. Results We identified 73 trials; 51 studied acutely administered drugs and 22 studied prophylactic drugs for migraine. The number of patients with any adverse events were reported in 74% of acute-administration and 86% of prophylactic drug trials. Only 30 (41%) of the 73 studies reported adverse events with data in the abstracts, and 27 (37%) abstracts did not mention adverse events. Conclusion Adverse events, both frequency and symptoms, should be reported to allow a fair judgement of benefit/tolerability ratio when randomized controlled trials in migraine treatment are published. Clinically significant adverse events should be included in the abstract of every randomized controlled trial in migraine treatment.

Can we reduce the need for coercive interventions?

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Complex Interventions ◽  
Psychiatric Hospitals ◽  
The United States ◽  
Treatment Preferences ◽  
Controlled Trials ◽  
Treatment Team ◽  
Crisis Plans ◽  
Coercive Measures ◽  
Randomized Controlled ◽  
Inpatient Units

Sadly, little research has been devoted to developing interventions aimed at reducing the use of coercive measures. A large study in the United States showed that patient perceptions of coercion at admission to psychiatric hospitals are less if they believe their ‘voice’ has been heard, and they have been treated with respect, concern, and in good faith—termed ‘procedural justice’. However, trials of whether training staff in accord with these observations will reduce coercion have yet to be done. The most promising interventions to reduce involuntary admissions have been ‘joint crisis plans’. These offer opportunities for patients to state their treatment preferences in case of future crises, and plans are negotiated in joint meetings with the treatment team. Though randomized controlled trials are lacking, ‘before versus after’ comparisons have suggested a range of complex interventions that may reduce the use of coercive measures, such as restraint and seclusion, on inpatient units.

scholarly journals Oral Corticosteroid Regimens in the Management of Chronic Rhinosinusitis

2020 ◽  
pp. 014556131987690
Author(s):  
Ahmed Mansi ◽  
Roger Bui ◽  
Mohamad R. Chaaban
Keyword(s):  
Side Effects ◽  
Chronic Rhinosinusitis ◽  
Medical Management ◽  
Oral Corticosteroid ◽  
Surgical Intervention ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Before And After ◽  
Oral Corticosteroids

Background: Oral corticosteroids are often used in the medical management of chronic rhinosinusitis (CRS) with and without polyps. The purpose of our study is to review the literature for studies reporting the dosage of oral corticosteroids as part of the appropriate medical management prior to, immediately before, and after surgical intervention. Methods: We reviewed the literature for oral corticosteroid regimens given to patients with CRS from March 2012 to September 2018. Studies that did not disclose the exact doses of the regimen were excluded from our analysis. Results: Our search resulted in 7 articles with 4 studies of Level of Evidence (LOE) 1b, 2 studies with LOE III, and 1 study with LOE IV. The daily doses varied from 15 mg to 1 mg/kg, and with total doses ranging from 150 to 352 mg. In addition, several studies gave the same regimen to both subtypes of CRS. There was no mention of side effects in most of the studies. Conclusion: There is a wide variation in the steroid doses given to patients with CRS and prospective or randomized controlled trials are needed to provide better improved evidence.

scholarly journals Correlation without a cause: an epidemiological odyssey

2020 ◽  
Vol 49 (1) ◽  
pp. 4-14 ◽  
Author(s):  
George Davey Smith ◽  
Andrew N Phillips
Keyword(s):  
Mendelian Randomization ◽  
Density Lipoprotein ◽  
Controlled Trials ◽  
Epidemiological Investigation ◽  
Causal Understanding ◽  
High Profile ◽  
Randomized Controlled ◽  
Chd Risk ◽  
Before And After ◽  
High Degree

Background In the 1980s debate intensified over whether there was a protective effect of high-density lipoprotein cholesterol (HDL-C) or an adverse effect of triglycerides on coronary heart disease (CHD) risk. In a 1991 paper reprinted in the IJE we suggested that the high degree of correlation between the two, together with plausible levels of measurement error, made it unlikely that conventional epidemiological approaches could contribute to causal understanding. The consensus that HDL-C was protective, popularly reified in the notion of ‘good cholesterol’, strengthened over subsequent years. Reviewing the biostatistical and epidemiological literature from before and after 1991 we suggest that within the observational epidemiology pantheon only Mendelian randomization studies—that began to appear at the same time as the initial negative randomized controlled trials—made a meaningful contribution. It is sobering to realize that many issues that appear suitable targets for epidemiological investigation are simply refractory to conventional approaches. The discipline should surely revisit this and other high-profile cases of consequential epidemiological failure—such as that with respect to vitamin E supplementation and CHD risk—rather than pass them over in silence.

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