Abstract TP265: Far-Forward Stroke Care: Parallel Processing in the Prehospital Environment May Achieve Door-to-Needle Times of Less Than 15 Minutes on a Mobile Stroke Treatment Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Zammit ◽  
Sarah Gallagher ◽  
Jason Burgett ◽  
Christopher Grassman ◽  
Joshua L'Esperance ◽  
...  
Keyword(s):  
Medical Center ◽  
Stroke Care ◽  
Patient Centered ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
Forward Stroke ◽  
Imaging Results ◽  
Iphone Application ◽  
The University ◽  
The City

Introduction: The time from 911 activation (i.e. alarm) to administration of intravenous (IV) alteplase in acute ischemic stroke is associated with functional, patient centered-outcomes. Mobile stroke treatment units (MSTUs) have emerged as a stroke system tool that may hasten treatment times. Optimal workflows on MSTUs remain to fully elucidated. Methods: Retrospective review of a QA database of patients treated on a MSTU with door-to-needle-times (DTN) of </= 15 minutes to describe workflows and team dynamics that were associated with expeditious treatment. Results: In October of 2018 the University of Rochester Medical Center launched a MSTU, initially operating on Monday through Friday in the city of Rochester from 8am until 4 pm. Over the initial 3 months, there were 96 MSTU responses leading to 54 transported patients, 3 of which were treated with IV alteplase. One patient with an initial NIHSS of 17 was treated with IV alteplase within 9 minutes of reaching the MSTU door. Workflow elements felt to hasten treatment included registration of the patient in the electronic health record (EHR) prior to the patient reaching the MSTU and enabling the telestroke provider to listen to the initial history and physical being performed by the MSTU RN at the scene. The later is accomplished by using a telestroke iPhone application that allows for a “3-way-call” between the MSTU RN, the MSTU, and the telestroke provider. The MSTU RN wears a Bluetooth earpiece that captures the conversation with the patient, witnesses on scene, and initial EMS responders and enables the MSTU RN to summarizes key history and exam findings, vitals, and blood glucose results while keeping their hands available for patient care. Simultaneously, the telestroke provider reviews the patient’s chart in the EHR for alteplase contraindications, prior imaging results, and pertinent medical history. Conclusion: Registering the patient in the EHR and integrating the telestroke provider into the initial patient assessment at the scene in the prehospital setting may allow for consistent door to needle times of < 15 minutes on MSTUs, which may further improve patient outcomes.

scholarly journals Carelign: A Novel Handoff System for Medical and Surgical Consultants

2020 ◽  
Vol 12 (01) ◽  
pp. e63-e66
Author(s):  
Brian Michael Shafer ◽  
Thomasine Gorry ◽  
Paul Tapino ◽  
Subha Airan-Javia
Keyword(s):  
Medical Center ◽  
University Of Pennsylvania ◽  
Inpatient Setting ◽  
Patient Centered ◽  
System A ◽  
Item Questionnaire ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
The University ◽  
Work Management

Abstract Background Patient handoffs are ubiquitous in hospital settings. Historically, formal handoffs of patient information have been conducted in the inpatient setting mainly by primary teams, as opposed to medical and surgical consultants. Carelign is a software developed by the University of Pennsylvania Health System to function as an interdisciplinary, patient-centered handoff. While mainly utilized by primary teams for work management and transitions, it has been enhanced to include specialty consultant handoff functionality. Objective The aim of this study is to determine whether using Carelign for consultant handoffs improves clinical handoffs in comparison to the prior handoff system (a custom-built handoff report within the electronic health record) used by the Department of Ophthalmology at Penn Presbyterian Medical Center. Methods A 7-item questionnaire assessing the effectiveness, efficiency, accessibility, reliability, communication, and security of the handoff using a 1 to 5 scale was distributed to residents prior to and 6 months subsequent to the implementation of Carelign. Results Users reported a statistically significant increase in Health Insurance Portability and Accountability Act (HIPPA)-compliance (44 vs. 100%, p < 0.0001) and ability to communicate with primary teams (38 vs. 70%, p = 0.019) after implementation of Carelign. There was a trend toward significance with ease of accessing information after switching to Carelign (67 vs. 85%, p = 0.185). There was no statistically significant difference in effectiveness, efficiency, accessibility from home, or reliability of information on handoff after converting to the new system. Conclusion Carelign is perceived to be an effective tool that can be used by consulting providers to ensure HIPPA-compliance and the ability to communicate with primary teams without sacrificing effectiveness, efficiency, accessibility, or reliability.

scholarly journals Supporting COVID-19 Vaccine Rollout before Charter Class Arrives: The University of California, Irvine Experience

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 164
Author(s):  
Alexandre Chan ◽  
Melanie D. Joe ◽  
Jan D. Hirsch
Keyword(s):  
Interprofessional Education ◽  
Large Scale ◽  
Medical Center ◽  
The United States ◽  
University Of California ◽  
Pharmaceutical Sciences ◽  
Patient Centered ◽  
Raising Awareness ◽  
Centered Care ◽  
The University

Despite numerous challenges in relation to being a recently established school, the University of California, Irvine (UCI) School of Pharmacy and Pharmaceutical Sciences (SPPS), similar to many schools of pharmacy in the United States, was highly committed to supporting the rollout of COVID-19 vaccines. UCI SPPS and our affiliated UCI Medical Center (UCIMC) Pharmacy Department partnered to spearhead the pharmacy element of a large-scale COVID-19 vaccination clinic on campus for both employees and the community. Three key initiatives were established in order to overcome the obstacles we faced in the large-scale roll out of COVID-19 vaccines: (1) forging new collaborations within the pharmacy team, (2) leveraging interprofessional education and practice, and (3) raising awareness of the pharmacists’ role. Our response to the COVID-19 vaccines at UCI was a tangible, visible model that demonstrated that, while we continue to embrace our role in team-based, patient-centered care, it is also important for us to step up and lead the profession. Additionally, this vaccine rollout experience is a teachable moment for our communities and our health professional partners as we continue to march forward as one voice to serve the American public.

Abstract MP24: Pitfalls of Mobile Stroke Treatment Unit - A Single Center Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mangala Gopal ◽  
Ciaran Powers ◽  
Shahid M Nimjee ◽  
Sharon Heaton ◽  
Vivien Lee
Keyword(s):  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Acute Stroke Care ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
The Mean ◽  
Suspected Stroke ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Although Mobile Stroke Treatment Units (MSTU) can reduce time to intravenous thrombolysis (IVtPA), limitations in MSTU care have not been well described. Methods: We retrospectively reviewed consecutive patients transported by MSTU to our academic comprehensive stroke center (CSC) from May 2019 to August 2020 for suspected stroke to assess for potential limitations of care. The Columbus MSTU is owned by a separate health system, but represents a collaborative venture with 3 CSCs and the Columbus Division of Fire, operating daily from 7am-7pm. Data was abstracted on demographics, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, and IVtPA administration. Results: Among 93 patients transported to our CSC by MSTU, the mean age was 65 years (range, 21-93) and 61 (66%) were female. The mean initial NIHSS was 7.1 (range, 0 to 33) and 52 (55.9%) had a final diagnosis of stroke (4 hemorrhagic, 48 ischemic). IVtPA was administered in 15 (16.1%) with a mean LKN to IVtPA time of 120 minutes (range, 41 to 243). Among 15 patients treated with IVtPA, 10 received IVtPA in MSTU and 5 in CSC ED. In 7 patients who underwent thrombectomy, mean door to groin time was 57 minutes (range, 28 to 88). Among the overall group, 9 (9.7%) cases were identified with limitations in MSTU care, including 2 patients who received IVtPA by MSTU that were more than 10% off from ideal dosing (underdosed by 9mg and overdosed by 21mg), 1 warfarin-associated hemorrhage requiring intubation who did not receive reversal in MSTU but did upon arrival to CSC ED, and 5 patients who received IVtPA after arrival to CSC ED. The reasons for withholding IVtPA included inability to confirm LKN, patient declination, lack of translator, incorrect LKN, and seizure requiring intubation. The LKN to IVtPA time was significantly longer in the ED compared to MSTU (197 vs 82 minutes, p <0.0001). Conclusion: In our series of suspected stroke patients evaluated by MSTU, gaps identified within MSTU acute stroke care were related to limitations of resources and included errors in weight-based IVtPA dosing, inability to administer IVtPA, or reversal for anti-coagulation related hemorrhage. Clinicians need to be aware of potential pitfalls of MSTU evaluation.

Abstract P310: Impact of COVID-19 Pandemic on Stroke Care at the University of Rochester Medical Center

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Benjamin P George ◽  
Christine Boerman ◽  
Peter J Papadakos ◽  
Curtis Benesch ◽  
Robert G Holloway ◽  
...  
Keyword(s):  
Medical Center ◽  
Control Period ◽  
Stroke Care ◽  
Admission Rates ◽  
Period 2 ◽  
Rochester Medical ◽  
Pandemic Response ◽  
Incident Rate ◽  
The University ◽  
The Impact

Introduction: The impact of the COVID-19 pandemic response on medical care for stroke is unknown. Methods: We used local “Get With The Guidelines” stroke data for patients with ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage/subarachnoid hemorrhage (ICH/SAH) from March 20–April 14, 2020 (study period) and January 1–March 19, 2020 (control period #1) and March 20–April 14, 2019 (control period #2). We examined daily admission rates, transfers, tPA administration, thrombectomy, and time from last well to hospital arrival. Results: There were 349 patients (n=40 study period, n=225 control period #1, n=84 control period #2); 263 with IS, 37 with TIA, and 49 with ICH/SAH. Overall, 46% were female, 82% white, with median age 70 years (IQR 58-82 years). Daily admission rates were 1.4 IS/day for the study period compared to 2.1 IS/day (Incident rate ratio [IRR] 1.49 95% CI 1.05-2.13, p=0.027) and 2.2 IS/day (IRR 1.57 1.04-2.37, p=0.033) for control periods #1 and #2 ( Table ), respectively. There was only one admission for TIA in the study period compared to approximately one every 4 days in control period #1 (IRR 7.2 95% CI 1.0-53.7, p=0.053) and one every 2 days in control period #2 (IRR 14.0 95% CI 1.8-106.5, p=0.011). ICH/SAH admissions were fewer in the study period. Transfers were less common with approximately one transfer every four days in the study period compared to one each day of the control periods. Rates of tPA, thrombectomy, and time from last well to first hospital contact did not differ across the epochs. Conclusions: Our data suggest the COVID-19 pandemic response has led to reduced admission volumes for all stroke types in the University of Rochester Medical Center catchment area, partly due to decreases in hospital transfers. These data raise the question whether fewer patients sought care for stroke symptoms at the height of the COVID-19 pandemic.

Humanist Engagements

2017 ◽  
Author(s):  
Howell A. Lloyd
Keyword(s):  
Educational Provision ◽  
The Third ◽  
Social Composition ◽  
Cultural Life ◽  
Law Faculty ◽  
Editorial Work ◽  
Governmental Institutions ◽  
The University ◽  
The City

Bodin arrived in Toulouse c.1550, a brief account of the economy, social composition, and governmental institutions of which opens the chapter. There follow comments on its cultural life and identification of its leading citizenry, with remarks on the treatment of alleged religious dissidents by the city itself, and especially on discordant intellectual influences at work in the University, most notably the Law Faculty and the modes of teaching there. The chapter’s second part reviews Bodin’s translation and edition of the Greek poem Cynegetica by Oppian ‘of Cilicia’, assessing the quality of his editorial work, the extent to which allegations of plagiarism levelled against him were valid, and the nature and merits of his translation. The third section recounts contemporary wrangling over educational provision in Toulouse and examines the Oratio in which Bodin argued the case for humanist-style educational provision by means of a reconstituted college there.

scholarly journals Liquid materials for biomedical research: a highly IT-integrated and automated biobanking solution

2019 ◽  
Vol 43 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Daniela Popp ◽  
Romanus Diekmann ◽  
Lutz Binder ◽  
Abdul R. Asif ◽  
Sara Y. Nussbeck
Keyword(s):  
Life Cycle ◽  
Medical Center ◽  
Research Results ◽  
Long Term Storage ◽  
Medical Centers ◽  
It Systems ◽  
Complete Life Cycle ◽  
The University ◽  
Term Storage

Abstract Various information technology (IT) infrastructures for biobanking, networks of biobanks and biomaterial management are described in the literature. As pre-analytical variables play a major role in the downstream interpretation of clinical as well as research results, their documentation is essential. A description for mainly automated documentation of the complete life-cycle of each biospecimen is lacking so far. Here, the example taken is from the University Medical Center Göttingen (UMG), where the workflow of liquid biomaterials is standardized between the central laboratory and the central biobank. The workflow of liquid biomaterials from sample withdrawal to long-term storage in a biobank was analyzed. Essential data such as time and temperature for processing and freezing can be automatically collected. The proposed solution involves only one major interface between the main IT systems of the laboratory and the biobank. It is key to talk to all the involved stakeholders to ensure a functional and accepted solution. Although IT components differ widely between clinics, the proposed way of documenting the complete life-cycle of each biospecimen can be transferred to other university medical centers. The complete documentation of the life-cycle of each biospecimen ensures a good interpretability of downstream routine as well as research results.

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