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Singh H, Fakembe SP, Brown RK, Cameron JI, Nelson MLA, Kokorelias KM, Nekolaichuk E, Salbach NM, Munce S, Tang T, Gray CS, Haghayegh AT, Colquhoun H. Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01725-z. [PMID: 37523144 DOI: 10.1007/s40615-023-01725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care. METHODS A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses. RESULTS Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences. CONCLUSIONS This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Semtetam Patience Fakembe
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Racquel K Brown
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle L A Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina M Kokorelias
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Geriatrics Division, Sinai Health System, University Health Network, Toronto, ON, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Björnsson HM, Bjørnsen LP, Skjærbæk CB, Hruska K, Palomäki A. Current postgraduate training in emergency medicine in the Nordic countries. BMC MEDICAL EDUCATION 2023; 23:469. [PMID: 37349721 DOI: 10.1186/s12909-023-04430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Emergency Medicine (EM) is an independent specialty in all five Nordic countries. This study aims to evaluate the structure of post-graduate EM training in the area. METHODS A leading hospital or hospitals in EM training in each country were identified. An e-survey was sent to each hospital to gather data on patient volume and physician staffing, curriculum, trainee supervision, and monitoring of progression in training. RESULTS Data were collected from one center in Iceland and Norway, two in Finland and Sweden, and four centers in Denmark. The data from each country in Denmark, Finland, and Sweden, were pooled to represent that country. The percentage of consultants with EM specialist recognition ranged from 49-100% of all consultants working in the participating departments. The number of patients seen annually per each full time EM consultant was almost three times higher in Finland than in Sweden. In Iceland, Denmark, and Sweden a consultant was present 24/7 in the ED but not in all centers in the other countries. The level of trainee autonomy in clinical practice varied between countries. Requirements for completing standardized courses, completing final exams, scientific and quality improvement projects, and evaluation of trainee progression, varied between the countries. CONCLUSIONS All Nordic countries have established EM training programs. Despite cultural similarities, there are significant differences in how the EM training is structured between the countries. Writing and implementing a standardized training curriculum and assessment system for EM training in the Nordic countries should be considered.
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Affiliation(s)
- Hjalti Már Björnsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Department of Emergency Medicine, Landspitali-The National University Hospital of Iceland, Fossvogur, 108, Reykjavík, Iceland.
| | - Lars Petter Bjørnsen
- St. Olav's University Hospital, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Ari Palomäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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Greenberg K, Veznedaroglu E, Liebman K, Hakma Z, Kurtz T, Binning M. Stroke thrombolysis given by emergency physicians: The time is here. Am J Emerg Med 2023; 68:98-101. [PMID: 36963177 DOI: 10.1016/j.ajem.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Emergency Medicine core clinical privileges include administration of thrombolytic therapy for myocardial infarction and stroke. However, emergency medicine providers have created their own paradigm to rely on neurology specialty consultation to treat acute stroke patients. A 2013 study supported by the American Academy of Neurology showed an 11% shortage of neurologists at that time and projected a 19% shortage by 2025. The lack of neurologists is a worldwide problem. To help ease the shortage, teleneurology and telestroke care has been implemented by neurologists, most notably for acute ischemic stroke (AIS) patients. We present a model in which an Emergency Medicine (EM) Stroke Champion (SC); an EM physician within our Neurologic Emergency Department, directs care for acute stroke patients at our comprehensive hub and primary stroke center spoke hospitals. The SCs independently treat patients with fibrinolytic therapy and provide teleneurology to fellow emergency physicians caring for acute stroke patients at spoke hospitals. Over nineteen months the SCs received 457 phone calls for patients meeting stroke alert criteria. Sixteen patients were deemed eligible for IV alteplase with one hemorrhagic conversion (6.25%). Sixty-four patients required transfer, and this was facilitated by the SCs. The concept of emergency physician SCs providing teleneurology consultation to other fellow emergency physicians was found to be feasible and safe. This model has the potential to be generalized not to just stroke champions, but to all emergency physicians to feel both confident and comfortable treating acute stroke patients.
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Affiliation(s)
- Karen Greenberg
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America.
| | - Erol Veznedaroglu
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America
| | - Kenneth Liebman
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America
| | - Zakaria Hakma
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America
| | - Thomas Kurtz
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America
| | - Mandy Binning
- Drexel Neurosciences Institute, Drexel University College of Medicine, Department of Neurosurgery, Global Neurosciences Institute, 10 NJ-31 North, Pennington, NJ 08534, United States of America
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Botelho A, Rios J, Fidalgo AP, Ferreira E, Nzwalo H. Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316357. [PMID: 36498429 PMCID: PMC9735885 DOI: 10.3390/ijerph192316357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. METHODOLOGY Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. RESULTS A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. CONCLUSIONS Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.
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Affiliation(s)
- Ana Botelho
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Jonathan Rios
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Ana Paula Fidalgo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Eugénia Ferreira
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
| | - Hipólito Nzwalo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Research Institute, 8005-139 Faro, Portugal
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Sapra H. "No Time to Die" - Saving the Neurons. Indian J Crit Care Med 2022; 26:539-540. [PMID: 35719449 PMCID: PMC9160637 DOI: 10.5005/jp-journals-10071-24221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
How to cite this article: Sapra H. "No Time to Die" - Saving the Neurons. Indian J Crit Care Med 2022;26(5):539-540.
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Affiliation(s)
- Harsh Sapra
- Department of Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India,Harsh Sapra, Department of Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India, Phone: +91 9650898677, e-mail:
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Verma A, Sarda S, Jaiswal S, Batra A, Haldar M, Sheikh WR, Vishen A, Khanna P, Ahuja R, Khatai AA. Rapid Thrombolysis Protocol: Results from a Before-and-after Study. Indian J Crit Care Med 2022; 26:549-554. [PMID: 35719454 PMCID: PMC9160610 DOI: 10.5005/jp-journals-10071-24217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective Intravenous thrombolysis within 4.5 hours from time of onset has proven benefit in stroke. Universal standard for the door-to-needle (DTN) time is within 60 minutes from the time of arrival of patients to the emergency department. Our rapid thrombolysis protocol (RTPr) was developed with an aim to reduce the DTN time to a minimum by modifying our stroke post-intervention processes. Materials and methods This before-and-after study was conducted at a single center on patients who received intravenous thrombolysis in the emergency department. Consecutive patients who were thrombolysed using our RTPr (post-intervention group) were compared to the pre-intervention group who were thrombolysed before the implementation of the protocol. The primary outcomes were DTN time, time to recovery, and modified ranking score (mRS) on discharge. Secondary outcomes were mortality, symptomatic intracerebral hemorrhage, and hospital and intensive care unit length of stay. Results Seventy-four patients were enrolled in each group. Mean DTN time in pre- and post-intervention group was 56.15 minutes (95% CI 49.98–62.31) and 34.91 minutes (95% CI 29.64–40.17) (p <0.001), respectively. In pre-intervention and post-intervention groups, 43.24% (95% CI 32.57–54.59) and 41.89% (95% CI 31.32–53.26) patients, respectively, showed neurological recovery in 24 hours. About 36.49% (95% CI 26.44–47.87) in pre-intervention group and 54.05% (95% CI 42.78–64.93) in post-intervention group had discharge mRS 0–2. Conclusion The RTPr can be adapted by clinicians and hospitals to bring down the DTN times and improve outcomes for stroke patients. How to cite this article Verma A, Sarda S, Jaiswal S, Batra A, Haldar M, Sheikh WR, et al. Rapid Thrombolysis Protocol: Results from a Before-and-after Study. Indian J Crit Care Med 2022;26(5):549–554.
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Affiliation(s)
- Ankur Verma
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
- Ankur Verma, Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India, Phone: +91 9971779998, e-mail:
| | - Shivani Sarda
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Sanjay Jaiswal
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Amit Batra
- Department of Neurosciences, Max Super Speciality Hospital, New Delhi, India
| | - Meghna Haldar
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Wasil R Sheikh
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Amit Vishen
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Palak Khanna
- Department of Statistics, Amity Institute of Applied Sciences, Amity University, Noida, Uttar Pradesh, India
| | - Rinkey Ahuja
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Abbas A Khatai
- Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India
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Espiritu AI, San Jose MCZ. A Call for a Stroke Referral Network Between Primary Care and Stroke-Ready Hospitals in the Philippines: A Narrative Review. Neurologist 2021; 26:253-260. [PMID: 34734903 DOI: 10.1097/nrl.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The increasing stroke burden, inequity in the distribution of local neurologists, and the recent signing of the Universal Health Care Law in the Philippines provide compelling reasons for policy-makers to devise strategies to establish networks between primary care and stroke-ready hospitals. In this review, we explored the current literature and evidence that emphasized the roles of primary care providers (PCPs) and specialists, care transition, and telemedicine/teleneurology in various stages of stroke management. REVIEW SUMMARY Clear delegation of stroke care responsibilities among PCPs and specialists is needed. Due to the limited number of specialists/neurologists, PCPs may contribute to addressing the insufficiency of community knowledge of acute stroke symptoms/risk factors, coordination with specialists and stroke-ready hospitals during acute stroke, and continuity of care during the poststroke stage. At present, the Philippines has only 49 stroke-ready hospitals; thus, an efficient and functional referral system for the care transition between the PCPs and specialists must be organized in our country. To provide remote access to expert stroke care for underserved areas and to increase thrombolysis utilization, the establishment of an effective telestroke system is indispensable. The empowerment of PCPs in teleneurology may assist in strengthening communication and networking with specialists with the ultimate goal of improving patient outcomes. CONCLUSIONS In the era of Universal Health Care in the Philippines, the roles of PCP and specialists must be delineated. Increased access to stroke care through the establishment of networks among PCPs and stroke-ready hospitals (ie, via effective transition of care/teleneurology) must be prioritized especially in resource-constrained settings.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, Philippine General Hospital and College of Medicine
- the Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Maria Cristina Z San Jose
- Department of Neurosciences, Philippine General Hospital and College of Medicine
- the Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
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Bhatt NR, Backster A, Ido MS, Nogueira RG, Bayakly R, Wright DW, Frankel MR. Impact of Intravenous Alteplase Door-to-Needle Times on 2-Year Mortality in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:747185. [PMID: 34721274 PMCID: PMC8548610 DOI: 10.3389/fneur.2021.747185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We sought to determine whether administration of Intravenous Thrombolysis (IVT) to patients with Acute Ischemic Stroke (AIS) within 60 min from hospital arrival is associated with lower 2-year mortality. Methods: This retrospective study was conducted among patients receiving IVT in hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) from January 1, 2008 through June 30, 2018. Two-year mortality data was obtained by linking the 2008–2018 Georgia Discharge Data System data and the 2008–2020 Georgia death records. We analyzed the study population in two groups based on the time from hospital arrival to initiation of IVT expressed as Door to Needle time (DTN) in a dichotomized (DTN ≤ 60 vs. > 60 min) fashion. Results: The median age of patients was 68 years, 49.4% were females, and the median NIHSS was 9. DTN ≤60 min was associated with lower 30-day [odds ratio (OR), 0.62; 95% CI, 0.52–0.73; P < 0.0001], 1-year (OR, 0.71; 95% CI, 0.61–0.83; P < 0.0001) and 2-year (OR, 0.76; 95% CI, 0.65–0.88; P = 0.001) mortality as well as lower rates of sICH at 36 h (OR, 0.57; 95% CI, 0.43–0.75; P = 0.0001), higher rates of ambulation at discharge (OR, 1.38; 95% CI, 1.25–1.53; P < 0.0001) and discharge to home (OR, 1.36; 95% CI, 1.23–1.52; P < 0.0001). Conclusion: Faster DTN in patients with AIS was associated with lower 2-year mortality across all age, gender and race subgroups. These findings reinforce the need for intensifying quality improvement measures to reduce DTN in AIS patients.
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Affiliation(s)
- Nirav R Bhatt
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Anika Backster
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Moges S Ido
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, United States.,Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Rana Bayakly
- Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - David W Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael R Frankel
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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Grönroos M, Palomäki A. Young adult with Gorham's disease presenting in an emergency department: a case report. J Med Case Rep 2021; 15:427. [PMID: 34399846 PMCID: PMC8369709 DOI: 10.1186/s13256-021-02993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/01/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Gorham’s disease is a very rare musculoskeletal disorder characterized by progressive resorption of one or more skeletal bones. Most of the 200 cases reported earlier are diagnosed before the age of 40 years. Due to rarity, the diagnosis of Gorham’s disease in the Emergency Department may be very difficult. Case presentation We report a case of Gorham’s disease. A 23-year old Caucasian man presented to the Emergency Department with a significant loss of power and sensation of the lower limbs and lower torso. Clinical examination, computed tomography, and magnetic resonance imaging revealed resorption of the ribs and vertebrae, severe kyphosis, and spinal stenosis in the thoracic area. The patient underwent several surgical procedures, including spondylodesis and decompression, and made a good initial recovery. Biopsy confirmed the diagnosis of Gorham’s disease. Conclusion We present a young man with Gorham’s disease visiting the Emergency Department. After the proper diagnosis and treatment, our patient had good outcome, although the etiology of this rare disease is uncertain.
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Affiliation(s)
- Markku Grönroos
- Department of Emergency Medicine, Central Hospital of Kanta-Häme, Ahvenistontie 20, 13530, Hämeenlinna, Finland.
| | - Ari Palomäki
- Department of Emergency Medicine, Central Hospital of Kanta-Häme, Ahvenistontie 20, 13530, Hämeenlinna, Finland.,Faculty of Medicine and Health Technology, Tampere University, University of Tampere, 33014, Tampere, Finland
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Status of physician education in emergency medicine in four European countries: no primary specialty yet. Eur J Emerg Med 2021; 28:257-259. [PMID: 34187990 DOI: 10.1097/mej.0000000000000837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ojakäär A, Purdy M, Kechagias A, Järvelin U, Palomäki A. Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study. BMC Emerg Med 2020; 20:45. [PMID: 32471363 PMCID: PMC7257164 DOI: 10.1186/s12873-020-00339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess, whether this reorganisation was feasible and safe, i.e. did it affect the length of in-hospital stay (LOS) and the 30-day complication rate. METHODS This is a retrospective pre- and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-h observation unit of the ED instead of surgical ward. Patients operated during the first 3 months after the reorganisation were compared to those operated during the 3 months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age < 18 years and perforated disease. RESULTS Appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 h for all patients after the reorganisation compared to 24.4 h before the reorganisation (standard error 6.2 h, 95% confidence interval 2.3-15.2 h, p < 0.01). There were no more complications in the group treated postoperatively in the ED. CONCLUSIONS Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED - instead of the surgical ward - occurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.
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Affiliation(s)
- Artur Ojakäär
- Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.
| | - Martin Purdy
- Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.,Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland
| | - Aristotelis Kechagias
- Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.,Department of Surgery, Rea Hospital, Siggrou Avenue 383, 175 64 P. Faliro, Athens, Greece
| | - Ulla Järvelin
- Department of Emergency Medicine Acuta, Tampere University Hospital, Teiskontie 35, FI-33520, Tampere, Finland
| | - Ari Palomäki
- Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530, Hämeenlinna, Finland.,Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, FI-33520, Tampere, Finland
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Zwank MD. Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians. Ann Emerg Med 2019; 74:313-314. [DOI: 10.1016/j.annemergmed.2019.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 10/26/2022]
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Iiro H, Markus H, Hanna K, Ari P. In Reply:. Ann Emerg Med 2019; 74:314. [DOI: 10.1016/j.annemergmed.2019.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 11/26/2022]
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Jauch EC, Holmstedt CA. Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians: What Took So Long? Ann Emerg Med 2018; 73:113-115. [PMID: 30420233 DOI: 10.1016/j.annemergmed.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Edward C Jauch
- Mission Research Institute/Mission Health System, Asheville, NC.
| | - Christine A Holmstedt
- Departments of Neurology and Emergency Medicine, MUSC Health Comprehensive Stroke Program, and MUSC Health Teleneuroscience Program, Medical University of South Carolina, Charleston, SC
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