Establishment of primary stroke centers: a survey of physician attitudes and hospital resources

OBJECTIVES

To survey US physicians involved in acute stroke care to determine the proportion of hospitals that currently meet the recommended Brain Attack Coalition (BAC) criteria for Primary Stroke Centers (PSC) and obtain opinions regarding the value of stroke centers.

METHODS

A survey regarding the BAC guidelines for the establishment of stroke centers was mailed to 3,245 US neurologists, neurosurgeons, and emergency physicians.

RESULTS

A total of 1,032 responses were received. Seventy-nine percent (range by specialty 58 to 98%) of respondents believed there was a need for stroke centers. If formal stroke center designation were established, 81% (range 72 to 90%) would like their hospital to become a PSC. Although 77% of respondents believed that their hospital currently met recommended criteria for a PSC, only 7% actually meet all recommended elements. However, 44% of hospitals already provide most acute stroke services. The BAC criteria most frequently lacking were continuing medical education for professional stroke center staff, stroke training for emergency department staff, formal establishment of a stroke unit, and designation of a stroke center director.

CONCLUSIONS

The majority of emergency medicine and neuroscience physician respondents involved in acute stroke care support the designation of primary stroke centers. Although respondents globally overestimated the extent to which their facilities currently meet BAC recommended criteria for PSC, detailed responses suggested that over 40% of hospitals possess substantial existing acute stroke care resources and are poised to function as PSC with modest additional administrative and financial commitment.

The role of IVP in blunt trauma

To investigate the role of the IVP, we studied 139 patients with blunt abdominal trauma and hematuria. Multivariate analysis of clinical parameters was utilized in attempt to predict which patients would have abnormal IVP's and which would eventually require genitourinary operation. Thirty-four patients (25%) demonstrated abnormalities on IVP; however, no combination of clinical findings (including degree of hematuria) could reliably predict which patients would have abnormal IVP's. On the other hand, in 90% of the patients, the necessity for genitourinary operation could be reliably predicted based on: presence of blood at the urethral meatus, degree of hematuria, patient age, Injury Severity Score, and number of rib fractures. We conclude that to detect IVP abnormalities, IVP's need to be performed on all blunt trauma patients with hematuria. However, patients likely to have injuries requiring operative repair can be predicted. Those patients unlikely to have genitourinary injury requiring repair, therefore, may have IVP performed on a nonurgent basis.

Pulse-modulated light source for psychometric and vision experiments

Light-emitting diodes (LED) of various colours were used to produce accurately controllable light sources. Variable light intensity was obtained by applying 800-ns current pulses to the LEDs at frequencies 1-1000 kHz using a single potentiometer. These current pulses were generated from an oscillator which was voltage-controlled from a potentiometer and an antilogarithmic amplifier. Its output was gated to produce an optional flicker of 1-100 Hz. The light intensity was indicated by a frequency meter connected to the oscillator. The reading of this was found to linearly indicate light intensity.

Making continuous quality improvement a reality: innovation skills

Creativity and innovation, according to Grudin, "lie near the heart of humanity." If CQI is to be the force that will transform healthcare organizations into more systems-conscious and customer-driven endeavors, creativity and innovation must be encouraged and practiced. Given that they have a responsibility to introduce new products and services to their organization, materiel management professionals are particularly well-suited to practice and encourage creativity and innovation.

The continuous improvement-focused quality improvement plan

The QI plan of a department or functional area is a statement of philosophy about quality improvement and a guide to doing quality improvement. In that sense, the QI plan is both a roadmap and a description of the journey. The form of the QI plan varies by organization and is a reflection of the individual style of the organization. The substance of the plan is important. QI plan developers who consider structure, process and outcome will generate a viable document that supports meaningful quality improvement.

Change and quality

In the culture of most healthcare organizations, change is described by anecdotes or represented by new structures such as buildings. Change in the systems and processes that enable work in healthcare organizations often goes unmeasured and underreported.

Anastomosis Groups of Rhizoctonia solani and Binucleate Rhizoctonia Associated with Potatoes in Idaho

A survey of the relative incidence of anastomosis groups (AGs) of Rhizoctonia spp. associated with potato disease was conducted in Idaho, the leading potato producing state in the U.S.A. In total, 169 isolates of Rhizoctonia solani and seven binucleate Rhizoctonia (BNR) isolates were recovered from diseased potato plants. The AG of each isolate was determined through real-time PCR assays for AG 3-PT and phylogenetic analysis of the internal transcribed spacer region of ribosomal DNA. AG 3-PT was the predominant AG, accounting for 85% of isolates recovered, followed by AG 2-1 (5.7%) and AG 4 HG-II (4.5%). Two different subsets of AG 2-1 isolates were recovered (subset 2 and 3). Three isolates each of AG A and AG K were recovered, as well as one isolate each of AG 5 and AG W. An experiment carried out under greenhouse conditions with representative isolates of the different AGs recovered from Idaho potatoes showed differences in aggressiveness between AGs to potato stems, with AG 3-PT being the most aggressive followed by an isolate of AG 2-1 (subset 3). The three BNR isolates representative of AG A, AG K, and AG W appeared to be less aggressive to potato stems than the R. solani isolates except for the AG 2-1 (subset 2) isolate. This is the first comprehensive study of the relative incidences of Rhizoctonia species associated with Idaho potatoes and the first study to report the presence of BNR AG W outside of China.

Creating, improving, and innovating

Technological innovations have fundamentally changed the science and practice of medicine. Increased awareness of the need to enhance processes and systems supporting delivery of safe, accessible, affordable health care has sparked an interest in creativity and innovation as essential skills in quality management. This article considers four points regarding the role of creativity and innovation in health care quality management: Creativity and innovation are essential skills in improving and enhancing health care processes and health care delivery systems; creativity is a personal characteristic that can be enhanced; innovation, the legacy of creativity, begins with values-centered design; and innovations emerge in many sizes and forms.