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Tan B, Suarez J. Biomarkers in neurocritical care. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2016. [DOI: 10.4103/2348-0548.174726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Suarez J. Accuracy of Malnutrition Documentation in the Hospitalized Adult: A Retrospective Analysis of Four Adult Patient Populations at the University of Virginia Health System. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Semien G, Suarez J, Patel P. Abstract PR331. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492726.04346.4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Braun U, Suarez J, Gasparini S, Warislohner S, Dennler M. Magnetic resonance imaging in a lamb with compression of the thoracic spinal cord by an abscess. SCHWEIZ ARCH TIERH 2016; 158:573-7. [PMID: 27518732 DOI: 10.17236/sat00079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This report describes a two-month-old Ouessant ram lamb with hind limb ataxia, knuckling and falling attributable to an abscess in the thoracic vertebral region. A swelling palpated adjacent to the spinous processes of the 9th to 12th thoracic vertebrae was identified via ultrasonography as an abscess located on the transverse processes of these vertebrae. Magnetic resonance imaging of the lamb postmortem revealed that the abscess had invaded the vertebral canal through a channel at the level of the 9th thoracic vertebra causing extradural spinal cord compression. Postmortem examination confirmed these findings, and histological examination showed acute spinal cord degeneration.
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Alen F, Marban Castro T, Ballesta-Garcia A, Anton Valades M, Ramirez-Lopez M, Vazquez M, Blanco N, Ouco D, Jaimez-Alameda M, Gomez de Heras R, Serrano A, Gorriti M, Suarez J, Rodriguez de Fonseca F. Acute administration of reboxetine reduces alcohol self-administration but, after a subchronic treatment with this drug, alcohol self-administration is enhanced. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionComorbidity between alcoholism and depression has long been acknowledged, and the possibility that similar brain mechanisms, involving both serotonergic (5-HT) and noradrenergic systems (NE), underlie both pathologies has been suggested. Thus, inhibitors of NE and 5HT uptake have been proposed for the treatment of alcoholism, as they have shown to reduce alcohol intake in various animal models. However, most of the studies mentioned were carried out acutely and there is a lack of knowledge of the possible long-term effects. Clinical studies report an overall low efficacy of antidepressant treatment on alcohol consumption, or even a worsened prognosis. In addition, several cases of alcohol dependence following antidepressant treatment have been reported in the literature.ObjectivesWe aimed at comparing the acute and chronic effects of the treatment with the antidepressant drug reboxetine on alcohol consumption.MethodsWe used a rat model of alcohol self-administration, and two different schedules of reboxetine administration (acute and chronic).ResultsOur results confirm the acute suppressant effects of reboxetine on alcohol consumption but indicate that, when this drug is administered chronically in a period of abstinence from alcohol, it can significantly increase the rate of alcohol self-administration.ConclusionsThese results are important for the understanding of the clinical reports describing cases of increased alcohol consumption after antidepressant treatment, and suggest that much more research is needed to fully understand the long term effects of antidepressants, which remain the most widely prescribed class of drugs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gavito AL, Cabello R, Suarez J, Serrano A, Pavón FJ, Vida M, Romero M, Pardo V, Bautista D, Arrabal S, Decara J, Cuesta AL, Valverde AM, Rodríguez de Fonseca F, Baixeras E. Single administration of recombinant IL-6 restores the gene expression of lipogenic enzymes in liver of fasting IL-6-deficient mice. Br J Pharmacol 2016; 173:1070-84. [PMID: 26750868 DOI: 10.1111/bph.13423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 12/18/2015] [Accepted: 01/06/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Lipogenesis is intimately controlled by hormones and cytokines as well as nutritional conditions. IL-6 participates in the regulation of fatty acid metabolism in the liver. We investigated the role of IL-6 in mediating fasting/re-feeding changes in the expression of hepatic lipogenic enzymes. EXPERIMENTAL APPROACH Gene and protein expression of lipogenic enzymes were examined in livers of wild-type (WT) and IL-6-deficient (IL-6(-/-) ) mice during fasting and re-feeding conditions. Effects of exogenous IL-6 administration on gene expression of these enzymes were evaluated in vivo. The involvement of STAT3 in mediating these IL-6 responses was investigated by using siRNA in human HepG2 cells. KEY RESULTS During feeding, the up-regulation in the hepatic expression of lipogenic genes presented similar time kinetics in WT and IL-6(-/-) mice. During fasting, expression of lipogenic genes decreased gradually over time in both strains, although the initial drop was more marked in IL-6(-/-) mice. Protein levels of hepatic lipogenic enzymes were lower in IL-6(-/-) than in WT mice at the end of the fasting period. In WT, circulating IL-6 levels paralleled gene expression of hepatic lipogenic enzymes. IL-6 administration in vivo and in vitro showed that IL-6-mediated signalling was associated with the up-regulation of hepatic lipogenic enzyme genes. Moreover, silencing STAT3 in HepG2 cells attenuated IL-6 mediated up-regulation of lipogenic gene transcription levels. CONCLUSIONS AND IMPLICATIONS IL-6 sustains levels of hepatic lipogenic enzymes during fasting through activation of STAT3. Our findings indicate that clinical use of STAT3-associated signalling cytokines, particularly against steatosis, should be undertaken with caution.
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Yaqub Y, Jenkins LA, Suarez J, Sutthiwan P, Phy M, Nugent KM, Kumar A. Emotional Stress and Tako-Tsubo Cardiomyopathy. J Investig Med 2015; 58:298-302. [DOI: 10.2310/jim.0b013e3181c9b2b8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Suarez J, Maldonado N, Cornejo F. High altitude neurophysiology applied knowledge: the Hanak project in Ecuador. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Omar S, Ali E, Mazek H, Mahmoud T, Soontrapa S, Suarez J. Takotsubo cardiomyopathy associated with hyperthyroidism treated with thyroidectomy. Proc AMIA Symp 2015; 28:194-5. [PMID: 25829652 DOI: 10.1080/08998280.2015.11929227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Takotsubo cardiomyopathy is an uncommon clinical entity, also called apical ballooning syndrome, characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle. We report a case that highlights takotsubo syndrome in the setting of thyrotoxicosis that required thyroidectomy. The association of takotsubo syndrome and hyperthyroidism has been reported before. We found 13 previously reported cases of thyrotoxicosis-induced cardiomyopathy, most associated with Grave's disease and none treated with thyroidectomy. Awareness of this possible association is important in establishing the diagnosis and instituting proper management.
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Vazquez R, Vazquez-Guillamet M, Suarez J, Mooney J, Montoya J, Dhillon G. Invasive mold infections in lung and heart-lung transplant recipients: Stanford University experience. Transpl Infect Dis 2015; 17:259-66. [DOI: 10.1111/tid.12362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/20/2014] [Accepted: 01/19/2015] [Indexed: 01/01/2023]
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Shah S, Murthy S, Karanth S, Bershad EM, Venkatasubba Rao CP, Suarez J. Abstract W P61: Treatment of Ischemic Stroke With recombinant Tissue Plasminogen-Activator in Pregnancy: A Population Study. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.wp61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Stroke during pregnancy is a rare but potentially devastating event. Reported experience with thrombolysis in pregnant patients is limited. Our aim is to study outcomes of thrombolysis in stroke associated with pregnancy by using Nationwide Inpatient Sample (NIS).
Methods:
Pregnant patients with Acute Ischemic Stroke (AIS) were identified from the 2005-2010 NIS using International Classification of Diseases, Ninth Revision (ICD-9) codes. Pregnant patients who received thrombolysis were compared with those who did not receive thrombolysis based on demographics, comorbidities, hospital characteristics, and outcomes. The main outcomes were in-hospital mortality, home-discharge and intracerebral hemorrhage (ICH).
Results:
We identified 2603 pregnant patients admitted with a diagnosis of AIS, of whom 56 (2.15%) of received thrombolysis. Pregnant patients with AIS were more likely to be treated with thrombolysis at teaching hospitals compared to non-teaching hospitals (2.78% vs 1.06%, p<0.05). Pregnant patients with AIS also had more severe Elixhauser comorbidity scores (p<0.001). Thrombolysis in pregnant patients was associated with higher in-hospital moratlity rate (26.8% vs 4.6%, p<0.001) and lower home discharge rate (44.6% vs 60.1% , p<0.05) but similar rate of ICH. In the regression model on pregnant patients with AIS, the main independent predictors of in-hospital mortality were thrombolysis (OR: 5.97, CI: 3.01-11.84, p<0.001) and ICH (OR: 2.34, CI: 1.34-4.07, p<0.001).
Conclusions:
Stroke outcomes following thrombolysis appears to be less favorable in pregnant patients. Prospective confirmation of these findings is warranted.
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Mazabob JM, Styron S, Brown G, Jones-Brown M, Suarez J, Bershad E, Venkatasubba Rao C. Abstract T P252: Improving Quality of Care and Outcomes in the Community Through the Inclusive Collaboration Between a Certified Comprehensive Stroke Center and Regional Hospitals. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tp252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
and Issues As a certified Comprehensive Stroke Center (CSC) it is our obligation to the community and regional hospitals to improve the quality of care and stroke patient outcomes. The spokes are interdependent components of our CSC program; they seek a shared value in improving the delivery of stroke care in their community. Many areas utilize telemedicine without an inclusive operational model to deliver care. Our approach to advance stroke care was to cultivate relationships between staff, physicians, Emergency Medical System (EMS) personnel and hospital administrators.
Purpose:
Construct a stroke care model, utilizing an inclusive collaborative team that consists of EMS, spoke hospitals, and regional communities.
Methods:
W. Edwards Deming’s and John A Woods’s work served as the framework for our stroke and telemedicine programs. Leaders must function with an attitude of inclusiveness, resulting in no subordinates or superiors within the multidisciplinary team. Breaking down barriers and building a shared vision in the delivery of stroke care and recognizing that each department serves the other results in shared objectives. Utilizing tele-health cloud software enhances clinical collaborations. Elimination of fear creates an environment of no-blame, permitting everyone to work at their highest potential through approachable leadership. Analyzing each step and the resultant effect involves an in-depth evaluation of processes with implementable solutions and training and education.
Results:
Results of this inclusive collaboration included: an 85% increase in administration of tissue plasminogen activator at the spoke hospitals; EMS education of over 2000 personnel; physician-driven quarterly spoke hospital case study reviews; implementation of standardized stroke order sets and algorithms; and four spoke hospitals awarded primary stroke certification and state designation.
Conclusions:
Through an inclusive quality culture and a passionate stroke team, improving regional stroke care is achievable and sustainable. A reliable cloud-based network plays a role, but leadership in collaboration with the regional entities is the strength of the program.
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Murthy S, Karanth S, Shah S, Shastri A, Rao C, Bershad E, Suarez J. Abstract W P51: Clinical Outcomes following Thrombolysis for Acute Ischemic Stroke in Patients with Systemic Malignancy: A Nationwide Case-Control Study. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.wp51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes following thrombolysis in stroke patients with cancer.
Methods:
Acute ischemic stroke (AIS) patients who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample using ICD-9 codes. Patients with cancer associated strokes (CS) and non-cancer strokes (NCS) were compared based on demographics, comorbidities, and outcomes.
Results:
There were 1,135,574 AIS in 2009-2010. Thrombolysis was administered to 807 patients out of 50,437 CS (1.6%), and 31,769 patients out of 1,085,137 non-cancer strokes (2.9%). The prevalence of stroke risk factors such as hypertension (p<0.001) and hyperlipidemia (<0.001) were significantly higher in non-cancer strokes (NCS). CS had a significantly higher percentage of patients in the third and fourth Elixhauser quartiles (p<0.001). Hospitals with > 450 beds were more likely to treat cancer patients with thrombolysis for acute stroke (p=0.011), while the hospital teaching status did not play a significant role. In the univariate analysis, CS was associated with a lower proportion of home discharge in the overall thrombolytic treatment group (OR: 0.57, CI: 0.48-0.68, p<0.001) but mortality was not significant. ICH rates were also comparable in the two groups (6.3% vs 6.4%, p= 0.927). In the regression model, there was no difference in mortality or ICH rates between CS and NCS following thrombolysis. Subgroup analysis of IV thrombolysis only and endovascular treatment also showed no difference in outcomes. Another subgroup analysis showed that compared to liquid cancers, patients with solid had worse home discharge (OR: 0.178, CI: 0.109-0.290, p<0.001), and higher in-hospital mortality (OR: 3.018, CI: 1.37-6.646, p=0.006) following thrombolysis. Metastatic cancers had poorest outcomes.
Conclusions:
Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of ICH or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolytic therapy. Prospective confirmation and attention to long-term outcomes is warranted.
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Sutamtewagul G, Dumrongmoncolgul N, Kijsirichareanchai K, Gadwala S, Arvandi A, Suarez J, Meyerrose G. Effect of Alcohol Intake in Patients with Hypertension Currently on Medication Treatment. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2013.833785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ferrer F, Guedea F, Pardo Y, Ferrer M, Suarez J, Hervás A, Mariño A, Herruzo I, Ortiz M, Sancho G. Quality of Life Impact of Treatments for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Puig L, de la Cueva P, Linares M, Suarez J, Velasco M, Vidal D, Zulaica A, García-Calvo C. Expert report on psoriasis: Spanish dermatologists' opinions on the use of biologic agents to manage moderate to severe psoriasis in adults. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:400-8. [PMID: 23669590 DOI: 10.1016/j.adengl.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/31/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. OBJECTIVE The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. MATERIALS AND METHODS An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. RESULTS The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. CONCLUSIONS This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain.
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Alegre R, Moscoso J, Martinez-Laso J, Martin-Villa M, Suarez J, AlmudenaMoreno, Serrano-Vela JI, Vargas-Alarcon G, Pacheco R, Arnaiz-Villena A. Corrigendum to “HLA genes in Cubans and the detection of Amerindian alleles” [Mol. Immunol. 44 (March (7)) (2007) 2426–2435]. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2012.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Murthy SB, Shah S, Hannawi Y, Georgiadis A, Smirnakis S, Bershad E, Suarez J, Venkatasubba Rao C. Abstract TP427: Comparison of Clinical Characteristics of Neurogenic Stunned Myocardium in Patients with Subarachnoid Hemorrhage and Acute Ischemic Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim:
Neurogenic stunned myocardium (NSM) after subarachnoid hemorrhage (SAH) is well known, but there is paucity of data regarding its occurrence following acute ischemic stroke. The aim of this study is to contrast the characteristics of NSM in SAH and acute stroke.
Methods:
An electronic literature search was performed with Medline and Google Scholar, for English-language articles using the terms “subarachnoid hemorrhage” along with “stunned myocardium” or “Takotsubo cardiomyopathy”. The search revealed 35 articles, from which 10 studies were selected based on the following criteria: prospective studies, non-traumatic SAH, N >25 patients and documentation of regional wall motion abnormalities (RWMA). For studies from the same institutional database, the one with most comprehensive documentation of cardiac parameters was selected. Another search was conducted using the terms “acute ischemic stroke” along with “stunned myocardium” or “Takotsubo cardiomyopathy” resulted in only 7 case reports/series.
Results:
In this descriptive study, 98 out of 504 SAH patients had NSM, evidenced by RWMA (23%). The mean age was 54.8 years and 68% of patients were females, mean Hunt Hess grade was 2.5 and mean LVEF was 55.8%. The mean troponin level was 1.24. The most commonly involved segments were mid-ventricular, basal and apical, in that order. A significant improvement in LVEF occurred in 70.4% of patients. Among stroke patients, the mean age for NSM was 72.5 years and 77% were females. Insular cortex was involved in 46% of cases. Mean troponin elevation was 0.64 and mean LVEF was 34.4%. Regarding outcomes, 84.6% of patients had significant improvement in LVEF, with full recovery in 53.8%.
Conclusion:
NSM was more common in females, with favorable prognosis. Mid-ventricular segment was most commonly involved in SAH. The mean troponin was twice higher in SAH, raising the possibility that sympathetic overdrive is stronger in these patients. Only half the patients with NSM following stroke had insular involvement, implying other structures may be involved in the neuro-cardiac axis. Lack of prospective studies in stroke patients, and reports only describing Takotsubo cardiomyopathy, which selectively involves apical segments, are limiting factors.
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Blanco A, Trujillo H, Hernández D, García D, Lobaina Y, Freyre F, Merino N, Suarez J. The Adoptive Transfer of HBsAG-specific Splenocytes from Balb/c Congenic Donors into HBsAg Transgenic Mice is not associated to Histographological Damage. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Suarez J, Huarte-Larrañaga F. Hydrogen confined in single-wall carbon nanotubes: Anisotropy effects on ro-vibrational quantum levels. J Chem Phys 2012; 137:064320. [DOI: 10.1063/1.4742129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Chmayssani M, Murthy S, Ghosh S, Bershad E, Suarez J. Stroke Associated with Severe Cerebral Vasospasm after Petroclival Meningioma Resection (P05.263). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fong A, Bershad E, Morsi H, Shaltoni H, Mawad M, Georgiadis A, Suarez J, Venkatasubba Rao C. Hyperacute Stenting for Acute Ischemic Stroke Is Associated with a High Rate of Symptomatic Intracranial Hemorrhage (P02.200). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hannawi Y, Bershad E, Suarez J, Shaltoni H, Yoshor D, Venkatasubba Rao C. Post Surgical Cerebral Venous Sinus Thrombosis: A Rare Surgical Complication and Challenging Management Case (P06.260). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mazabob JM, Brown G, Livesay S, Suarez J, Bershad E, Nguyen T. Abstract 159: Acute Ischemic Stroke Quality Indicators: Implementation of Evidence-Based Practice to Improve Compliance. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Stroke is the leading cause of adult disability in the United States. Compliance with the stroke quality indicators reinforces that a stroke center is adhering to the evidence based standards of care in acute stroke patients. Hardwiring a process in the delivery of care during hospitalization will ensure improved compliance of these quality indicators.
Methods:
A core multidisciplinary team was formed that included neurointensivists, neurologist, neurointerventional radiologist, pharmacist, emergency room and neuro intensive care staff along with neuroscience administration staff. Directors of the various services impacted by the stroke patients were invited on an ad hoc basis. Retrospective chart reviews were performed to collect data on a monthly basis for the following quality indicators: DVT prophylaxis Discharged on antithrombotics Patients with a-fib receiving anticoagulation Thrombolytic therapy administration Antithrombotic by end of day 2 Discharged on cholesterol meds Dysphagia screening Stroke education Smoking cessation education Assessed for Rehab Overall compliance with these indicators was on target but areas for improvement were noted in the following areas: stroke education, discharged on statin, thrombolytic therapy administration and patients with a-fib receiving anticoagulation. Aggressive action plans for each of these areas were developed and implemented. Initiatives included standardized electronic order sets, electronic admission, consult, history and physical templates with the quality indicators listed. Presentation of compliance results with a review of outliers were part of monthly section meetings. In order to understand process deviations further discussions with section chiefs resulted in investigation and resolution of issues that led to the variances. Hiring of a research registered nurse and a stroke coordinator were added to the existing stroke service team.
Results:
Dramatic improvement was achieved with no indicator falling below <85.2% (85.2 out 100) for an entire year. Gold Plus achievement level with the American Stroke Association was achieved within a three year period. Target Stroke Honor Role was also achieved during this time period.
Conclusions:
A cohesive project team was able to identify barriers, recommend process changes and ensure the implementation of change within the institution. Data collection and process revision is ongoing
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