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  • Ovid Technologies (Wolters Kluwer Health)  (5)
  • 1
    Online Resource
    Online Resource
    Abstract P98: Patient Impressions and Cost-Savings Associated With Home-Based International Normalized Ratio Monitoring in a Prospective Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 4, No. suppl_1 ( 2011-11)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_1 ( 2011-11)
    Abstract: OBJECTIVE: The aim of this study was to evaluate patient impressions and cost-savings associated with home INR monitoring as compared to usual INR monitoring at a medical clinic. METHODS: This was a “before and after” study that was conducted in a local clinical research center. Patients were enrolled from twelve sites with a variety of indications for chronic oral anticoagulation. Patients began a program of INR self-testing and automated online management provided by one of the investigators (HIB). Patients completed a survey that asked for demographics, monitoring preference, miles driven, and time spent for monitoring; the Duke Anticoagulation Satisfaction Scale (DASS) was completed at baseline and follow-up. Only patients with baseline and follow-up surveys were included in the analysis. Chi-square was used to compare nominal variables. Responses from a five-item likert scale for monitoring preference, income, and amount willing-to-pay were dichotomized. Time spent, miles driven for monitoring, and DASS scores were compared using Wilcoxon signed-rank. RESULTS: Of the 44 patients who completed both surveys, most were male (24/44), married (33/44), Caucasian (36/44), and had finished at least some college (40/44). Nearly half were retired (21/43) and had an annual household income of at least $50,000 (21/44). Patients spent more time for clinic versus home monitoring (median, interquartile range): clinic 108 (60-150) min versus home 10 (7-15) min, p 〈 0.0001. Home monitoring reduced miles driven by a median of 20 (10-50) miles. Almost all patients agreed or strongly agreed with the statement that “home INR monitoring is preferable to clinic monitoring” (38/42). Most patients reported that they would pay for home monitoring to eliminate one clinic visit (28/37). Income greater than $50,000 was associated with an amount willing-to-pay greater than $25 (p=0.02). Overall satisfaction (p=0.007) and patient recommendation of anticoagulation management (p 〈 0.0001) improved at follow-up compared to baseline. Perceptions of monitoring difficulty (p=0.04), complexity (p=0.03), and inconvenience (p=0.02) all decreased. CONCLUSION: Home INR monitoring is preferred by patients and saves time and money compared to clinic monitoring.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.4.suppl_1.AP98
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2453882-6
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    Online Resource
  • 2
    Online Resource
    Online Resource
    The State of Disparities in Opportunistic Infection Prophylaxis for Blacks With HIV/AIDS
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Medical Care Vol. 50, No. 11 ( 2012-11), p. 920-927
    Details
    In: Medical Care, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 11 ( 2012-11), p. 920-927
    Type of Medium: Online Resource
    ISSN: 0025-7079
    URL: Article
    DOI: 10.1097/MLR.0b013e31826c85d1
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2045939-7
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  • 3
    Online Resource
    Online Resource
    Abstract 42: Epidemiological Surveillance of the Impact of the Covid-19 Pandemic on Stroke Care Using Artificial Intelligence
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Background: The degree to which the COVID-19 pandemic has affected systems of care, in particular those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence (AI) platform. Methods: Data were derived from the Viz Platform, an AI application designed to optimize the workflow of acute stroke patients. Neuroimaging data on suspected stroke patients across 97 hospitals in 20 US states were collected in real-time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of CTA, CTP, Large vessel occlusions (LVOs) (defined according to the automated software detection), and severe strokes on CTP (defined as those with hypoperfusion volumes 〉 70mL) normalized as number of patients per day per hospital. Data from the pre-pandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23,223 patients were included. The incidence of LVO on CTA and severe strokes on CTP were 11.2%(n=2,602) and 14.7%(n=1,229/8,328), respectively. There were significant declines in the overall number of CTAs (-22.8%;1.39 to 1.07 patients/day/hospital,p 〈 0.001) and CTPs (-26.1%;0.50 to 0.37 patients/day/hospital,p 〈 0.001) as well as in the incidence of LVO (-17.1%;0.15 to 0.13 patients/day/hospital,p 〈 0.001) and severe strokes on CTP (-16.7%;0.12 to 0.10 patients/day/hospital, p 〈 0.005). The sampled cohort showed similar declines in the rates of LVOs versus thrombectomy (18.8%vs.19.5%, p=0.9) and CSC hospitalizations (18.8%vs.11.0%, p=0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This underscores the broader application of AI neuroimaging platforms for the real-time monitoring of stroke systems of care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.42
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. 23 ( 2016-06-07), p. 2279-2286
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. 23 ( 2016-06-07), p. 2279-2286
    Abstract: The Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial used innovative imaging and aggressive target time metrics to demonstrate the benefit of endovascular treatment in patients with acute ischemic stroke. We analyze the impact of time on clinical outcome and the effect of patient, hospital, and health system characteristics on workflow within the trial. Methods and Results— Relationship between outcome (modified Rankin Scale) and interval times was modeled by using logistic regression. Association between time intervals (stroke onset to arrival in endovascular-capable hospital, to qualifying computed tomography, to groin puncture, and to reperfusion) and patient, hospital, and health system characteristics were modeled by using negative binomial regression. Every 30-minute increase in computed tomography-to-reperfusion time reduced the probability of achieving a functionally independent outcome (90-day modified Rankin Scale 0–2) by 8.3% ( P =0.006). Symptom onset-to-imaging time was not associated with outcome ( P 〉 0.05). Onset-to-endovascular hospital arrival time was 42% (34 minutes) longer among patients receiving intravenous alteplase at the referring hospital (drip and ship) versus direct transfer (mothership). Computed tomography-to-groin puncture time was 15% (8 minutes) shorter among patients presenting during work hours versus off hours, 41% (24 minutes) shorter in drip-ship patients versus mothership, and 43% (22 minutes) longer when general anesthesia was administered. The use of a balloon guide catheter during endovascular procedures shortened puncture-to-reperfusion time by 21% (8 minutes). Conclusions— Imaging-to-reperfusion time is a significant predictor of outcome in the ESCAPE trial. Inefficiencies in triaging, off-hour presentation, intravenous alteplase administration, use of general anesthesia, and endovascular techniques offer major opportunities for improvement in workflow. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01778335.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.115.019983
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
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  • 5
    Online Resource
    Online Resource
    Epidemiological Surveillance of the Impact of the COVID-19 Pandemic on Stroke Care Using Artificial Intelligence
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 5 ( 2021-05), p. 1682-1690
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 5 ( 2021-05), p. 1682-1690
    Abstract: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence platform. Methods: Data were derived from the Viz Platform, an artificial intelligence application designed to optimize the workflow of patients with acute stroke. Neuroimaging data on suspected patients with stroke across 97 hospitals in 20 US states were collected in real time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of computed tomography (CT) angiography, CT perfusion, large vessel occlusions (defined according to the automated software detection), and severe strokes on CT perfusion (defined as those with hypoperfusion volumes 〉 70 mL) normalized as number of patients per day per hospital. Data from the prepandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23 223 patients were included. The incidence of large vessel occlusion on CT angiography and severe strokes on CT perfusion were 11.2% (n=2602) and 14.7% (n=1229/8328), respectively. There were significant declines in the overall number of CT angiographies (−22.8%; 1.39–1.07 patients/day per hospital, P 〈 0.001) and CT perfusion (−26.1%; 0.50–0.37 patients/day per hospital, P 〈 0.001) as well as in the incidence of large vessel occlusion (−17.1%; 0.15–0.13 patients/day per hospital, P 〈 0.001) and severe strokes on CT perfusion (−16.7%; 0.12–0.10 patients/day per hospital, P 〈 0.005). The sampled cohort showed similar declines in the rates of large vessel occlusions versus thrombectomy (18.8% versus 19.5%, P =0.9) and comprehensive stroke center hospitalizations (18.8% versus 11.0%, P =0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This analysis underscores the broader application of artificial intelligence neuroimaging platforms for the real-time monitoring of stroke systems of care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.031960
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
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