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  • 1
    Online Resource
    Online Resource
    Rebuttal from Eric J. Stöhr, Barry J. McDonnell, Paolo C. Colombo and Joshua Z. Willey
    Wiley ; 2019
    In:  The Journal of Physiology Vol. 597, No. 2 ( 2019-01), p. 361-362
    Details
    In: The Journal of Physiology, Wiley, Vol. 597, No. 2 ( 2019-01), p. 361-362
    Type of Medium: Online Resource
    ISSN: 0022-3751 , 1469-7793
    URL: Issue
    URL: Article
    DOI: 10.1113/tjp.2019.597.issue-2
    DOI: 10.1113/JP277243
    RVK:
    WA 15000
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1475290-6
    SSG: 12
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  • 2
    Online Resource
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    Therapies for Hemorrhagic Transformation in Acute Ischemic Stroke
    Springer Science and Business Media LLC ; 2017
    In:  Current Treatment Options in Neurology Vol. 19, No. 1 ( 2017-1)
    Details
    In: Current Treatment Options in Neurology, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2017-1)
    Type of Medium: Online Resource
    ISSN: 1092-8480 , 1534-3138
    URL: Article
    DOI: 10.1007/s11940-017-0438-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2076603-8
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  • 3
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    Abstract TP283: Association Between Spanish Language and Emergency Medical Service Use in Ischemic Stroke Patients Treated with IV-tPA
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: Use of emergency medical services (EMS) is associated with decreased door-to-needle time in acute ischemic stroke. While racial and ethnic disparities in EMS use are well documented, the role of patient language in EMS use has been understudied. We sought to characterize EMS use by patient language among IV-tPA treated patients at a single center with a large Spanish-speaking patient population. Methods: We identified all patients who received IV-tPA over five years (7/2011-6/2016) at an academic medical center in New York City. Primary language, EMS use, pre-notification, and patient demographics were recorded from the EMR. We compared baseline characteristics, EMS use, and stroke pre-notification between English and Spanish-speaking patients. Logistic regression was used to measure the association between primary patient language and EMS use, adjusting for potential confounders. Results: Over the study period, 391 patients received IV-tPA; 208 (53%) primarily spoke English and 174 (45%) primarily spoke Spanish. Nine patients (2%) spoke other languages and were excluded. Mean age (66 vs. 69, p=0.09), male sex (43% vs. 33%, p=0.05) and median NIHSS (7 vs. 6, p=0.12) did not differ between English and Spanish-speaking patients. Of the 380 (97%) patients with EMS data, EMS use was higher among Spanish-speaking patients (69% vs. 80%, p 〈 0.01). Pre-notification did not differ by language (63% vs. 61%, p=0.8). In a multivariable model adjusting for age, sex, and initial NIHSS, Spanish speakers remained more likely to use EMS (OR 1.9, 95% CI 1.1-3.2, p=0.02). Conclusion: Among patients treated with IV-tPA at an urban academic medical center, EMS usage was higher in Spanish-speakers compared to English-speakers. Although language is not an exact surrogate for ethnicity, these findings are in contrast to previously published work demonstrating low rates of EMS usage among Hispanics. Future studies should evaluate differences in EMS utilization according to primary language as well as ethnicity.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tp283
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract 3429: Implementation of Electronic Medical Record Stroke Templates Increases Compliance with Stroke Performance Measures
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background and Purpose The literature demonstrates how utilizing evidence-based, standardized stroke care can improve patient outcomes; however, the contribution of electronic medical record (EMR) systems may also impact outcomes by ensuring utilization and compliance with established stroke performance measures, facilitating and improving documentation requirements, and standardizing approach to care. In 2008, documentation in patients’ medical records was done in combination of paper and a template free EMR. Originally, the EMR was used for order entry, then transitioned to full electronic documentation in 2009. At that time we implemented our stroke templates and performance measures based on regulatory standards. We hypothesized that the stroke template implementation would help us achieve performance measure criteria above state benchmarks as set out by the New York State Department of Health (NYS DOH). Methods Implementation was phased in [over 18 months], initially using a template that only included neurological assessment and free text fields for stroke measures. By July 2010, existing templates were modified and additional stroke templates were implemented to meet new regulatory requirements and meaningful use criteria. Retrospective data review was conducted for performance comparison between 2008 -- one year prior to EMR/template implementation -- and 2010. In Quarter 1 of 2011 EMR was also implemented in the Emergency Department (ED). Data was reviewed for compliance with stroke measures. Results Documentation compliance substantially improved between 2008 and Quarter 1 2011: Compliance for these measures has been maintained ≥ 85% since November 2010, ≥ 90% Q1 2011 Conclusions The EMR implementation of stroke templates and performance measures can produce substantial improvement in performance measure compliance. Future steps will include automated documentation alerts to retrieve information and real time discovery of missing documentation for concurrent quality review and improvement
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3429
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 12 ( 2017-12)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 12 ( 2017-12)
    Abstract: Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. Methods— A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. Results— sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STR.0000000000000152
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Door-to-Needle Delays in Minor Stroke : A Causal Inference Approach
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 7 ( 2017-07), p. 1980-1982
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 7 ( 2017-07), p. 1980-1982
    Abstract: Thrombolysis rates among minor stroke (MS) patients are increasing because of increased recognition of disability in this group and guideline changes regarding treatment indications. We examined the association of delays in door-to-needle (DTN) time with stroke severity. Methods— We performed a retrospective analysis of all stroke patients who received intravenous tissue-type plasminogen activator in our emergency department between July 1, 2011, and February 29, 2016. Baseline characteristics and DTN were compared between MS (National Institutes of Health Stroke Scale score ≤5) and nonminor strokes (National Institutes of Health Stroke Scale score 〉 5). We applied causal inference methodology to estimate the magnitude and mechanisms of the causal effect of stroke severity on DTN. Results— Of 315 patients, 133 patients (42.2%) had National Institutes of Health Stroke Scale score ≤5. Median DTN was longer in MS than nonminor strokes (58 versus 53 minutes; P =0.01); fewer MS patients had DTN ≤45 minutes (19.5% versus 32.4%; P =0.01). MS patients were less likely to use emergency medical services (EMS; 62.6% versus 89.6%, P 〈 0.01) and to receive EMS prenotification (43.9% versus 72.4%; P 〈 0.01). Causal analyses estimated MS increased average DTN by 6 minutes, partly through mode of arrival. EMS prenotification decreased average DTN by 10 minutes in MS patients. Conclusions— MS had longer DTN times, an effect partly explained by patterns of EMS prenotification. Interventions to improve EMS recognition of MS may accelerate care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.017386
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke
    SAGE Publications ; 2017
    In:  The Neurohospitalist Vol. 7, No. 4 ( 2017-10), p. 159-163
    Details
    In: The Neurohospitalist, SAGE Publications, Vol. 7, No. 4 ( 2017-10), p. 159-163
    Abstract: To determine whether e-mail is a useful mechanism to provide prompt, case-specific data feedback and improve door-to-needle (DTN) time for acute ischemic stroke treated with intravenous tissue plasminogen activator (IV-tPA) in the emergency department (ED) at a high-volume academic stroke center. Methods: We instituted a quality improvement project at Columbia University Medical Center where clinical details are shared via e-mail with the entire treatment team after every case of IV-tPA administration in the ED. Door-to-needle and component times were compared between the prefeedback (January 2013 to March 2015) and postfeedback intervention (April 2015 to June 2016) periods. Results: A total of 273 cases were included in this analysis, 102 (37%) in the postintervention period. Median door-to-stroke code activation (2 vs 0 minutes, P 〈 .01), door-to-CT Scan (21 vs 18 minutes, P 〈 .01), and DTN (54 vs 49 minutes, P = .17) times were shorter in the postintervention period, although the latter did not reach statistical significance. The proportion of cases with the fastest DTN (≤45 minutes) was higher in the postintervention period (29.2% vs 42.2%, P = .03). Conclusion: E-mail is a simple and effective tool to provide rapid feedback and promote interdisciplinary communication to improve acute stroke care in the ED.
    Type of Medium: Online Resource
    ISSN: 1941-8744 , 1941-8752
    URL: Article
    DOI: 10.1177/1941874416689358
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2629083-2
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  • 8
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    Online Resource
    Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Neurology Clinical Practice Vol. 6, No. 5 ( 2016-10), p. 389-396
    Details
    In: Neurology Clinical Practice, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 5 ( 2016-10), p. 389-396
    Type of Medium: Online Resource
    ISSN: 2163-0402 , 2163-0933
    URL: Article
    DOI: 10.1212/CPJ.0000000000000287
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2645818-4
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  • 9
    Online Resource
    Online Resource
    Abstract W P268: Language Discordance Between Patient and Treating Physician Does Not Delay Time to Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Introduction: Shorter door-to-needle time (DNT) is associated with better outcomes in acute ischemic stroke. Reducing door-to-CT time is a major focus of national quality improvement initiatives designed to reduce DNT, however time from CT-to-tPA administration has received far less attention. Recent data suggests that the CT-to-tPA interval contributes to significant delays in DNT. We hypothesized that language barriers between patients and treating neurologists would lead to longer CT-to-tPA times at a single stroke center serving a large Spanish-speaking population. Methods: We retrospectively reviewed the electronic medical record (EMR) on all patients who received IV-tPA in the emergency department over 2.5 years (July 2011 to December 2013). Patient’s primary language was obtained from the EMR; language fluency of treating neurologists was self-reported via standardized questionnaire. We compared baseline characteristics and relevant time intervals between encounters where the treating neurologist and patient spoke the same language (concordant group) versus those where they spoke a different language (discordant group). Means were compared with t-tests, medians with Mann-Whitney U tests, and dichotomized variables with Fisher exact tests. Results: A total of 199 patients received IV-tPA during the study period. English was the primary language for 110, Spanish for 83, and other languages for 6; of these, 120 cases were classified as concordant and 79 as discordant. There were no significant differences in mean age (67 vs. 69, p=0.3), male sex (37.5% vs. 24.1%, p=0.06), and median NIHSS (7 vs. 6, p=0.9) between concordant and discordant groups. We found no differences between median onset-to-arrival (68 vs. 71, p=0.3), door-to-CT (25 vs. 25, p=0.8), CT-to-tPA (33 vs. 29, p=0.2) and DNT (61 vs. 60, p=0.3) in minutes. There was a trend towards a greater proportion of patients with CT-to-tPA time under 30 minutes in the discordant group (52% vs. 38%, p=0.08). Conclusion: At our institution, language discordancy did not contribute to delays in CT-to-tPA nor overall DNT. CT-to-tPA time represents a largely unexplored contributor to overall delays in DNT that warrants further investigation.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.wp268
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Online Resource
    Abstract WMP80: Stroke Mimic Treatment Rates and Physician-patient Language Discordance
    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: Intro: While thrombolysis in stroke mimics (SM) is considered safe, recent data highlights the excess cost associated with treatment of these patients. Several studies have identified common demographic features of SM, however less is known about whether language barriers between patient and physician influence SM treatment rates. We sought to evaluate the role of physician-patient language discordance on the rate of SM treatment at a single center serving a large Spanish-speaking population. Hypothesis: Stroke mimic treatment rates are higher when there are language barriers between physician and patient due to greater diagnostic uncertainty Methods: We reviewed the electronic medical record (EMR) for all patients who received tPA in the ED from 7/2011 to 7/2015. Patient’s primary language was obtained from the EMR; language fluency of treating neurologists was obtained via questionnaire; final diagnosis (SM, imaging negative, imaging confirmed) was the attending physician’s impression at discharge. We compared baseline characteristics and SM rates between encounters where the treating neurologist and patient spoke the same language (concordant group) versus those where they did not (discordant group). Means were compared via t test, medians via Mann Whitney U test and dichotomized variables via chi square test. Results: During this period 311 patients received tPA. English was the primary language for 158 (51%), Spanish for 144 (46%), and other languages for 9 (3%); 183 (59%) encounters were classified as concordant and 128 (41%) as discordant. Final diagnosis was SM for 37 (12%); among those with a final diagnosis of stroke, 65 (24%) were imaging negative. There were no significant differences in mean age (67 vs. 70, p=0.1), male sex (38% vs. 32%, p=0.3), and median NIHSS (7 vs. 7, p=0.4) between concordant and discordant groups. We found higher rates of SM in the concordant group (16% vs. 6%, p=0.01). When imaging negative strokes were included with SM, these differences were no longer significant (33% vs. 32%, p=0.9). Conclusion: At our institution, language discordancy does not contribute to higher rates of SM treatment. Careful observation of how language discordant pairs communicate is needed to understand the role of interpreters in these findings
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp80
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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