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  • 1
    Online Resource
    Online Resource
    Attending to the Alliance in the Application of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study
    SAGE Publications ; 2019
    In:  Clinical Case Studies Vol. 18, No. 4 ( 2019-08), p. 282-299
    Details
    In: Clinical Case Studies, SAGE Publications, Vol. 18, No. 4 ( 2019-08), p. 282-299
    Abstract: As conceptualizations of mood and anxiety disorders shift toward a dimensional approach, transdiagnostic treatments have gained recognition and support. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based cognitive behavioral therapy that targets the core processes that underlie common and comorbid mental disorders. It is designed to help clients learn how to confront, experience, and respond to their emotions in adaptive ways through the modification of their emotion regulation strategies. The current case study describes the flexible application of the UP with a treatment-naïve 25-year-old female who presented to outpatient therapy with symptoms of anxiety and depression. Additions to the UP were made to address issues related to the therapeutic alliance and information discovered over the course of treatment. Outcome measures administered to the client reflect significant symptom improvement and add to a growing body of literature that supports the usefulness of transdiagnostic approaches to treating a range of disorders. Moreover, quantitative and qualitative data point to the necessity for clinicians to attend to the therapeutic alliance and consider cultural factors when delivering manualized treatment approaches to individuals from diverse backgrounds.
    Type of Medium: Online Resource
    ISSN: 1534-6501 , 1552-3802
    URL: Article
    DOI: 10.1177/1534650119845503
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2078528-8
    SSG: 5,2
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  • 2
    Online Resource
    Online Resource
    Severe hemiparesis as a prehospital tool to triage stroke severity: a pilot study to assess diagnostic accuracy and treatment times
    BMJ ; 2016
    In:  Journal of NeuroInterventional Surgery Vol. 8, No. 8 ( 2016-08), p. 775-777
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 8, No. 8 ( 2016-08), p. 775-777
    Abstract: With the publication of the recent trials showing the tremendous benefits of mechanical thrombectomy, opportunities exist to refine prehospital processes to identify patients with larger stroke syndromes. Materials and methods We retrospectively reviewed consecutive patients who were brought via scene flight from rural parts of the region to our institution, from December 1, 2014 to June 5, 2015, with severe hemiparesis or hemiplegia. We assessed the accuracy of the diagnosis of stroke and the number of patients requiring endovascular therapy. Moreover, we reviewed the times along the pathway of patients who were treated with endovascular therapy. Results 45 patients were brought via helicopter from the field to our institution. 27 (60%) patients were diagnosed with an ischemic stroke. Of these, 12 (26.7%) were treated with mechanical thrombectomy and 6 (13.3%) with intravenous tissue plasminogen activator alone. An additional three patients required embolization procedures for either a dural arteriovenous fistula or cerebral aneurysm. Thus a total of 15 (33%) patients received an endovascular procedure and 21/45 (46.7%) received an acute treatment. For patients treated with thrombectomy, the median time from first medical contact to groin puncture was 101 min, with 8 of the 12 patients (66.7%) being discharged to home. Conclusions We have presented a pilot study showing that severe hemiparesis or hemiplegia may be a reasonable prehospital tool in recognizing patients requiring endovascular treatment. Patients being identified earlier may be treated faster and potentially improve outcomes. Further prospective controlled studies are required to assess the impact on outcomes and cost effectiveness using this methodology.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2015-011940
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2506028-4
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  • 3
    Online Resource
    Online Resource
    CODE FAST: a quality improvement initiative to reduce door-to-needle times
    BMJ ; 2016
    In:  Journal of NeuroInterventional Surgery Vol. 8, No. 7 ( 2016-07), p. 661-664
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 8, No. 7 ( 2016-07), p. 661-664
    Abstract: Rapid delivery of IV tissue plasminogen activator (tPA) in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door-to-needle (DTN) times from 60 to 45 min in the hopes of continued process improvements across institutions. Objective To start a quality improvement project called CODE FAST in order to reduce DTN times at our institution. Materials and methods We retrospectively reviewed data from our internally maintained database of patients treated with intravenous tPA before and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of tPA in patients from February 2014 to February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times before and after implementation of the protocol. Results A total of 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV tPA during the study period. Patients were equally matched between the two groups except that in the pre-CODE FAST era patients receiving tPA were younger and more likely to be men. There was a substantial reduction in door-to-imaging time from a median of 16 to 8 min (p 〈 0.0001) and DTN time with a reduction in the median from 62 to 25 min (p 〈 0.0001). In logistic regression modeling, there was a trend towards more discharges to home in patients treated during the CODE FAST era. Conclusions We present a quality improvement project that has been overwhelmingly successful in reducing DTN time to 〈 30 min. The template we present may be helpful to other institutions looking to reduce their DTN times and may also reduce costs as we note a trend towards more discharges to home.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2015-011806
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2506028-4
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  • 4
    Online Resource
    Online Resource
    Abstract WP401: Code Fast: a Quality Improvement Initiated to Reduce Door to Needle Times
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Rapid delivery of intravenous t-PA in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door to needle (DTN) times from 60 to 45 minutes in the hopes of continued process improvements across institutions. We thus started a quality improvement project called CODE FAST in order to reduce DTN times at our institution. These results were recently reported and published. Materials and Methods: We retrospectively reviewed data from our internally maintained database of patients treated with intravenous t-PA prior to and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of t-PA in patients from February 2014- February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times prior to and after implementation of the protocol. We will present the latest data from February 2014- January 2016. Results: We previously reported 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV t-PA during the study period. We showed a substantial reduction in door to imaging time from a median of 16 to 8 minutes (p 〈 0.0001) and DTN time with a reduction in the median from 62 to 25 minutes (p 〈 0.0001). In logistic regression modelling, there was a trend towards more discharges to home in patients treated during the CODE FAST era. From March 2015-July 2015 an additional 57 patients have received t-PA under the CODE FAST protocol. The median door DTN remains 27 minutes. We will report further analysis comparing day and night time analysis and further strategies to further reduce DTN times. Conclusions: We present a quality improvement project that continues to be an overwhelmingly success in reducing DTN to less than 30 minutes. Further opportunies exist to reduce time further and improve discharge outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp401
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Abstract TMP79: Delays in Recognition of Perioperative Strokes Following Cardiac Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Previous studies have suggested that perioperative stroke (PS) following cardiac surgery has a bimodal distribution of timing with more than half of cases identified beyond postoperative day one (POD1). The objective of our multicenter study was to determine preoperative and intraoperative factors that are associated with PS following cardiac surgery and to identify factors that may contribute to PS that is identified after POD1. Methods: Patients undergoing coronary artery bypass surgery (CABG) or isolated valve surgery from January 2, 2015 to April 28, 2017 at three Southeastern US centers were identified from the Society of Thoracic Surgeons (STS) Registry. Multivariable logistic regression analysis was employed to identify preoperative (patient-related) and intraoperative (procedure-related) variables from the registry to identify factors associated with PS, defined by STS as any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain that did not resolve within 24 hours and occurring within 30 days of surgery. Neurologists performed retrospective chart review on PS patients to determine last seen well time and mechanism of stroke. Results: During the study period, 2795 patients underwent cardiac surgery (mean age 64 ± 11 years, 71% male, 71% Caucasian, 9% history of stroke) of which 43 (1.5%) had a PS; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, PS was independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after POD1 in 32 (74%) patients, 26 (81%) of which had a preoperative last seen well time. Conclusion: Given the high frequency of pre operative last seen well times in PS patients who are identified after POD1, delayed stroke recognition may contribute to the bimodal distribution in timing of PS; frequent neurological monitoring within 24 hours of surgery should be considered for patients who are elderly, have a history of stroke or thoracic aorta disease to improve early stroke recognition.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TMP79
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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