Abstract P589: Pediatric Thrombectomy: Design And Workflow Lessons From Two Experienced Centers

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
David C Lauzier ◽  
Maria M Galardi ◽  
Kristin Guilliams ◽  
Manu S Goyal ◽  
Catherine Amlie-Lefond ◽  
...  
Keyword(s):  
Case Reports ◽  
Quality Care ◽  
Stroke Care ◽  
Outcome Data ◽  
Hospital Environment ◽  
Pediatric Stroke ◽  
Endovascular Thrombectomy ◽  
Stroke Imaging ◽  
Workflow Integration ◽  
Low Incidence

Introduction: While clinical trials have demonstrated the remarkable efficacy of endovascular thrombectomy (EVT) for treating adult patients suffering from acute ischemic stroke (AIS), benefits reaped from advances in adult stroke care have unfortunately not occurred in parallel with pediatric stroke care. Randomized trials of EVT in childhood stroke are unlikely given the low incidence of stroke in children compared to adults, and despite promising outcomes in small case reports and series, EVT in children remains an off-label procedure lacking established consensus guidelines. Along with a clear need to collect prospective pediatric EVT outcome data, there is a need to enhance pediatric stroke care infrastructure to provide high-quality care to children experiencing stroke. Methods: In this work, we review two successful pediatric thrombectomy programs, examining key workflow design features that are likely to be important for other programs that aspire to implement pediatric EVT capability. Discussion: While pediatric EVT workflows will vary between centers, we identify several key elements of programmatic success shared between the two reviewed stroke programs that may serve as foundational design considerations for centers aiming to develop their own pediatric EVT programs. These elements include a formalized protocol and workflow, integration with an adult EVT workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke. Conclusion: EVT shows promise in reducing stroke-associated morbidity in children. To maximize the efficacy of this intervention, workflow optimizations discussed here should be implemented by centers seeking to develop local pediatric EVT capability.

scholarly journals Pediatric Thrombectomy

Stroke ◽  
2021 ◽  
Author(s):  
David C. Lauzier ◽  
Maria M. Galardi ◽  
Kristin P. Guilliams ◽  
Manu S. Goyal ◽  
Catherine Amlie-Lefond ◽  
...  
Keyword(s):  
Stroke Care ◽  
Hospital Environment ◽  
Pediatric Stroke ◽  
Design Features ◽  
Endovascular Thrombectomy ◽  
Similar Role ◽  
Stroke Imaging ◽  
Workflow Integration

Endovascular thrombectomy has played a major role in advancing adult stroke care and may serve a similar role in pediatric stroke care. However, there is a need to develop better evidence and infrastructure for pediatric stroke care. In this work, we review 2 experienced pediatric endovascular thrombectomy programs and examine key design features in both care environments, including a formalized protocol and workflow, integration with an adult endovascular thrombectomy workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke.

scholarly journals An unusual case of aggressive malignant spread of epithelioid hemangioendothelioma

Rare Tumors ◽  
2021 ◽  
Vol 13 ◽  
pp. 203636132110108
Author(s):  
Ashley D Hickman ◽  
Evandro D Bezerra ◽  
Anja C Roden ◽  
Matthew T Houdek ◽  
Jonathan D Barlow ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Soft Tissue ◽  
Multimodal Treatment ◽  
Unusual Case ◽  
Case Reports ◽  
Case Series ◽  
Epithelioid Hemangioendothelioma ◽  
Vascular Neoplasm ◽  
Pulmonary Imaging ◽  
Low Incidence

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm which typically originates from liver, lung, or bone. Due to the low incidence of disease, the most effective treatment is not easily studied and much of the information known about EHE has been learned through case reports and case series. In this case, we will present an uncommon form of primary soft tissue EHE with local recurrence, bone metastasis, and lymphangitic spread to the lungs leading to respiratory failure. Imaging of the chest was atypical for EHE with intraseptal thickening and hilar lymphadenopathy. Respiratory failure was progressive despite aggressive multimodal treatment. This case highlights an unusually aggressive recurrence and metastasis of primary soft tissue EHE with atypical pulmonary imaging findings.

scholarly journals Case-management for nursing care of patient with stroke: a cross-cultural critical reflective analysis

2016 ◽  
Vol 2 (3) ◽  
pp. 178
Author(s):  
Dimitrios Theofanidis
Keyword(s):  
Health Care ◽  
Case Management ◽  
Health Care Professionals ◽  
Health Care Systems ◽  
Financial Burden ◽  
Quality Care ◽  
Stroke Care ◽  
Discussion Paper ◽  
Health Care Reforms ◽  
The Usa

Introduction: Stroke remains a heavy financial burden on health care systems around the world. Yet, health care reforms have called for sophisticated management systems in order to provide high-quality care on equal terms for the entire population within a cost-conscious environment. Aim: The main aim of this discussion paper is to define and reflect cross-culturally on the merits of the Case-Management (CM) approach for contemporary stroke care delivery.Methods: Critical reflective analysis was used for this paper’s needs, whereby readers are gradually introduced to skills of critical and reflective thinking. This can then be applied into a clinical context which may assist nurses to achieve a better understanding of their professional role within the complexities of contemporary health care delivery.Discussion: An overview for stroke care differences between Greece and USA is provided using the following critical analysis components: Situation, Experience evaluated, Personal Reflections and Opportunities for Change.Conclusions: CM in the USA aims to meet the urgent challenges of stroke care. CMs are health care professionals whose role is to serve as client advocates and to coordinate services whilst assuring financial and gate keeping functions as required. As these services are currently unavailable in Greece, despite adverse financial circumstances, efforts should be made to introduce a culturally adopted CM initiative for stroke care.

scholarly journals Case Report: Efficacy of Pyrotinib in ERBB2 Amplification Pulmonary Adenoid Cystic Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhongben Tang ◽  
Feng Lin ◽  
Jiarong Xiao ◽  
Xiaojun Du ◽  
Jian Zhang ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Adenoid Cystic Carcinoma ◽  
Large Scale ◽  
Case Reports ◽  
Growth Factor Receptor ◽  
Low Grade ◽  
Adenoid Cystic ◽  
Epidermal Growth ◽  
Low Incidence ◽  
Current Report

Primary pulmonary adenoid cystic carcinomas are salivary tumors that are low-grade malignant and prone to recurrence and metastasis. Surgery is currently the main treatment, but there is no standard with regard to postoperative adjuvant therapy. Adenoid cystic carcinoma is more sensitive to radiotherapy and patients benefit less from chemotherapy, but few studies have focused on targeted therapy, and their conclusions are inconsistent. With respect to primary pulmonary adenoid cystic carcinoma, large-scale studies cannot be conducted due to its low incidence, and studies on the targeted therapy of it are very scarce. A few case reports indicate that targeted therapy can be effective however, suggesting that it may be a good option. The current report is the first on the occurrence of human epidermal growth factor receptor 2 amplification in pulmonary adenoid cystic carcinoma. The patient was treated with pyrotinib for 6 months and achieved stable disease.

scholarly journals Stroke Care During the First and the Second Waves of the COVID-19 Pandemic in a Community Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Piotr Sobolewski ◽  
Wiktor Szczuchniak ◽  
Danuta Grzesiak-Witek ◽  
Jacek Wilczyński ◽  
Karol Paciura ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stroke Unit ◽  
Community Hospital ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Staff Members ◽  
Second Wave

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area.Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”), and between September 15 and November 30, 2020 (“second wave”). We compared demographic and clinical data, treatments, and outcomes of patients between the first and the second waves of the pandemic and between subjects with and without COVID-19.Results: During the “first wave,” 1.4% of 71 patients were hospitalized due to stroke/TIA, and 41.8% of 91 during the “second wave” were infected with SARS-CoV-2 (p < 0.001). During the “second wave,” more SU staff members were infected with COVID-19 than during the “first wave” (45.6 vs. 8.7%, p < 0.001). Nevertheless, more patients underwent intravenous thrombolysis (26.4 vs. 9.9%, p < 0.008) and endovascular thrombectomy (5.3 vs. 0.0%, p < 0.001) during the second than the first wave. Large vessel occlusion (LVO) (OR 8.74; 95% CI 1.60–47.82; p = 0.012) and higher 30-day mortality (OR 6.01; 95% CI 1.04–34.78; p = 0.045) were associated with patients infected with COVID-19. No differences regarding proportions between ischemic and hemorrhagic strokes and TIAs between both waves or subgroups with and without COVID-19 existed.Conclusion: Despite the greater COVID-19 infection rate among both SU patients and staff during the “second wave” of the pandemic, a higher percentage of reperfusion procedures has been performed then. COVID-19 infection was associated with a higher rate of the LVO and 30-day mortality.

Abstract WP394: Impact of MRI/A versus CTA/P versus Direct Angiosuite Triage Protocols in Stroke Care Performance and Outcome of Transferred Patients for Endovascular Thrombectomy

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Santiago Ortega-Gutierrez ◽  
Andrea Holcombe ◽  
Gloria Lopez-Cardenas ◽  
Helin Hernandez ◽  
Binbin Zheng-Lin ◽  
...  
Keyword(s):  
Stroke Care ◽  
Endovascular Thrombectomy ◽  
Transferred Patients ◽  
Care Performance

scholarly journals Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies

2017 ◽  
Vol 7 (4) ◽  
pp. 141-157 ◽  
Author(s):  
Rafael G. dos Santos ◽  
José Carlos Bouso ◽  
Jaime E. C. Hallak
Keyword(s):  
Systematic Review ◽  
Family History ◽  
Adverse Reactions ◽  
Population Studies ◽  
Case Reports ◽  
Case Series ◽  
Lysergic Acid ◽  
Psychotic Illness ◽  
History Of ◽  
Low Incidence

Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT2A agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.

Neuroleptic malignant syndrome in patients with cancer: a systematic review

2020 ◽  
Vol 10 (3) ◽  
pp. 265-270
Author(s):  
Izumi Sato ◽  
Hideki Onishi ◽  
Chiaki Kawanishi ◽  
Shuhei Yamada ◽  
Mayumi Ishida ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neuroleptic Malignant Syndrome ◽  
High Mortality ◽  
Case Reports ◽  
Healthcare Providers ◽  
D2 Receptor ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Patients With Cancer ◽  
Low Incidence

BackgroundAntipsychotics potentially cause a low incidence of the side effect called neuroleptic malignant syndrome (NMS), which has a high mortality rate. However, few studies on NMS among patients with cancer exist.AimsWe aimed to examine the characteristics of antipsychotic-induced NMS among patients with cancer.MethodsWe conducted a systematic review of published reports on NMS described during the treatment of patients with any type of cancer. Articles were identified by a comprehensive search of PubMed, Web of Science, the Cochrane Library and reference lists from relevant articles published until 25 December 2019. Original articles or case reports on humans published in English were included. This review summarises the symptoms, characteristics, treatment course and prognosis of patients with cancer with NMS.ResultsEleven patients with various cancer types from ten case reports published from 1988 to 2013 met the eligibility criteria. Mean age of the 11 patients was 52.5 (range, 32–83) years. NMS developed mostly during the postoperative period, and haloperidol and D2 receptor antagonists were determined as the common causative drugs. Ten patients survived following treatment that mostly involved discontinuing the causative drugs and administering dantrolene, if necessary.ConclusionAlthough NMS intrinsically has a low incidence and high mortality, only few reports were available, with most patients surviving after early detection and appropriate treatment. Healthcare providers should consider NMS development while prescribing antipsychotics to ensure prompt recognition of the condition and rapid treatment for preventing unnecessary deaths.

scholarly journals Why are olfactory ensheathing cell tumors so rare?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mariyam Murtaza ◽  
Anu Chacko ◽  
Ali Delbaz ◽  
Ronak Reshamwala ◽  
Andrew Rayfield ◽  
...  
Keyword(s):  
Nervous System ◽  
Case Reports ◽  
Innate Immune ◽  
Dynamic Nature ◽  
Olfactory Ensheathing Cell ◽  
Promising Therapeutic Approach ◽  
The Central Nervous System ◽  
Low Incidence ◽  
Tumor Types ◽  
New Strategies

Abstract The glial cells of the primary olfactory nervous system, olfactory ensheathing cells (OECs), are unusual in that they rarely form tumors. Only 11 cases, all of which were benign, have been reported to date. In fact, the existence of OEC tumors has been debated as the tumors closely resemble schwannomas (Schwann cell tumors), and there is no definite method for distinguishing the two tumor types. OEC transplantation is a promising therapeutic approach for nervous system injuries, and the fact that OECs are not prone to tumorigenesis is therefore vital. However, why OECs are so resistant to neoplastic transformation remains unknown. The primary olfactory nervous system is a highly dynamic region which continuously undergoes regeneration and neurogenesis throughout life. OECs have key roles in this process, providing structural and neurotrophic support as well as phagocytosing the axonal debris resulting from turnover of neurons. The olfactory mucosa and underlying tissue is also frequently exposed to infectious agents, and OECs have key innate immune roles preventing microbes from invading the central nervous system. It is possible that the unique biological functions of OECs, as well as the dynamic nature of the primary olfactory nervous system, relate to the low incidence of OEC tumors. Here, we summarize the known case reports of OEC tumors, discuss the difficulties of correctly diagnosing them, and examine the possible reasons for their rare incidence. Understanding why OECs rarely form tumors may open avenues for new strategies to combat tumorigenesis in other regions of the nervous system.

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