A Smartphone Client-Server Teleradiology System for Primary Diagnosis of Acute Stroke

J Ross Mitchell; Pranshu Sharma; Jayesh Modi; Mark Simpson; Monroe Thomas; Michael D Hill; Mayank Goyal

doi:10.2196/jmir.1732

Abstract 164: Treatment Differences in Acute Stroke By Mode of Transport

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a164 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Prasanthi Govindarajan ◽

Anisha Chandra ◽

David Ghilarducci ◽

Steve Shiboski ◽

Barbara Grimes ◽

...

Keyword(s):

Acute Stroke ◽

Demographic Data ◽

Patient Discharge ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Cross Sectional ◽

Discharge Data ◽

Patient Demographic Data ◽

Mode Of Transport ◽

Time Of Admission

Background: EMS (Emergency Medical Services) is an important component of the stroke chain of survival. While in hospital stroke time targets have shown to be better when prehospital providers provide advance notification, population-wide studies on thrombolysis rates (IV t-PA) for those who arrive by EMS is sparse. Objective: To examine differences in treatment rates for acute stroke by mode of transport. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and patient location, hospital demographics, physician diagnosis and treatment rates were obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Results: Of 10,456 patients who had a hospital based discharge diagnosis of stroke, 3787 (36%) were transported by EMS. Mean age at the time of admission was 75 years (+/- 14); 55% (2093) were females, 65% (2471) were whites and 86% (3247) were Hispanics. Most of the patients had Medicare (72%, 2737) and 92% (3471) were transported from home. Majority of the patients were treated at stroke centers [n=3014, (80%)]) and at community hospitals [n=3664, (97%)]. Of 3757 patients with a primary diagnosis of stroke, 4% (150) were treated with IV t-PA. After controlling for covariates, patients transported by EMS had higher odds of treatment with IV t-PA (OR 2.6, 95 CI 1.9-3.3). Treatment at stroke centers (OR 1.5, 95 CI 1-2.2) and academic centers were independently associated with treatment rates (OR 2.4, 95 CI 1.6-3.6). Conclusions: Arrival by EMS to emergency department is associated with higher treatment rates with thrombolytics for acute stroke patients and efforts should be targeted to improve use of EMS for stroke.

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Abstract P273: Hospitalization Costs for United States Stroke Patients Receiving Tracheostomy

Stroke ◽

10.1161/str.52.suppl_1.p273 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

George P Albert ◽

David Y Hwang ◽

Benjamin P George

Keyword(s):

Acute Stroke ◽

Consumer Price Index ◽

Primary Diagnosis ◽

Stroke Patients ◽

Early Tracheostomy ◽

Stroke Population ◽

Hospitalization Costs ◽

The Us ◽

The Mean ◽

Procedure Codes

Introduction: Stroke patients who receive tracheostomy often undergo prolonged ventilation and have long, complicated ICU stays. Little is known about the hospitalization costs for these patients. Methods: We used the National Inpatient Sample from 2008-2017 to identify patients with a primary diagnosis of acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. We identified individuals who received tracheostomy based on procedure codes. We used cost-to-charge ratios to calculate hospitalization costs for each patient and adjusted costs to 2017 US dollars using the Medical Consumer Price Index. We examined differences in hospitalization costs based on age, sex, race, Elixhauser score, length of stay, and early tracheostomy placement (≤7 days). We calculated overall average annual hospitalization costs for all patients with stroke and tracheostomy in the US and compared to the total US acute stroke population inpatient costs. Results: We identified an estimated 61,322 acute stroke patients in the US receiving tracheostomy from 2008 to 2017, representing 1.1% of all US acute stroke patients. Stroke patients with tracheostomy had a mean age of 61 years (SD=13.8); 46% were female, 29% black, 12% Hispanic, and 13% rural. Among tracheostomy patients, the mean Elixhauser score was 4.7 (SD=2). The mean hospitalization cost for tracheostomy patients was $117,492 (median $97,063; IQR $64,887-$145,419). Costs were greater for younger patients, females, and those from urban locations. There was no difference in costs for white compared to minority patients. Each additional hospital day accounted for $2,023 in hospitalization costs, and those with early tracheostomy (22% of tracheostomy patients) had lower hospitalization costs (mean $89,811 vs. $125,318; p<0.001). Total US hospitalization costs for acute stroke patients receiving tracheostomy are estimated at $720.4 million per year, which represents 8.1% of total acute stroke hospitalization costs in the US. Conclusion: Acute stroke patients who receive tracheostomy account for 1% of all stroke patients, but 8% of all hospitalization costs for stroke in the US.

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Reflux Esophagitis is Associated with Higher Risks of Acute Stroke and Transient Ischemic Attacks in Patients Hospitalized with Atrial Fibrillation: A Nationwide Inpatient Sample Analysis

10.1101/2020.08.07.20169482 ◽

2020 ◽

Author(s):

Yi Jiang ◽

Konstantinos Damiris ◽

Giselle Alexandra Suero Abreu ◽

Sushil Ahlawat

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Stroke ◽

Acute Heart Failure ◽

Reflux Esophagitis ◽

Multivariate Regression Analysis ◽

Primary Diagnosis ◽

Hospital Charges ◽

Potential Association ◽

Ischemic Attack

Abstract Objectives: Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study. Methods: The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used. Results: 667,520 patients were admitted for primary diagnosis of AF out of which 5,396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (p <0.01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (p<0.05), longer LOS (p<0.001), and higher hospital charges (p<0.05) with no difference in acute heart failure (p=0.08), hospital mortality (p=0.12), or CHA2DS2-VAS score (p=0.67). Conclusion: In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIA, longer LOS, and greater hospital charges.

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Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100139780 ◽

1995 ◽

Vol 53 ◽

pp. 682-683

Author(s):

A. Hakam ◽

J.T. Gau ◽

M.L. Grove ◽

B.A. Evans ◽

M. Shuman ◽

...

Keyword(s):

United States ◽

Cell Biology ◽

Tissue Bank ◽

The United States ◽

Prostate Adenocarcinoma ◽

Correlative Microscopy ◽

Client Server ◽

Critical Elements ◽

Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

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The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽

10.1024/1012-5302.12.1.21 ◽

1999 ◽

Vol 12 (1) ◽

pp. 21-27

Author(s):

Marit Kirkevold

Keyword(s):

Acute Stroke ◽

Theoretical Perspective ◽

Stroke Patients ◽

Role Of Nursing ◽

Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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