Interv Neuroradiol
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Published: June 2024
Introduction: The mantra "time is brain" cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVOs) requiring transfer to an endovascular thrombectomy (EVT) capable center. We sought to evaluate the spoke hospital door in-door out (DIDO) times for patients transferred to our hub center for EVT.
Methods: Individuals who first presented with LVO to a spoke hospital and were then transferred to the hub for EVT were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 minutes based in the American Heart Association goal for DIDO ≤90 minutes for 50% of transfers. Multivariable regression analyses were performed for determinants of the 90-day ordinal modified Rankin Scale (mRS) and DIDO.
Results: We identified 194 patients transferred for EVT with available DIDO. The median age was 67 years (IQR 57-80), and 46% were female. The median National Institutes of Health Stroke Scale (NIHSS) was 16 (10-20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B-3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 minutes (97-149), with DIDO ≤90 minutes achieved in 18%. DIDO was a significant determinant of 90-day ordinal mRS ( = 0.007, 95% CI = 0.001-0.012, = 0.013), even when accounting for the last known well-to-spoke door in, spoke door out-to-hub arrival, hub arrival-to-puncture, puncture-to-first pass, age, NIHSS, intravenous thrombolysis, TICI 2B-3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity ( = 0.918, 95% CI = 0.010-1.826, = 0.048), atrial fibrillation or heart failure ( = 0.793, 95% CI = 0.257-1.329, = 0.004), and basilar LVO location ( = 2.528, 95% CI = 1.154-3.901, < 0.001).
Conclusion: Spoke DIDO was the most important period of time for long-term outcomes of LVO stroke patients treated with EVT. Targets were identified to reduce DIDO and improve patient outcomes.
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http://dx.doi.org/10.1177/15910199241261760 | DOI Listing |
Sci Rep
January 2025
Department of Pathology, School of Medical Sciences, Clinical Teaching Center, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana.
Cervical cancer continues to disproportionately burden women in sub-Saharan Africa, and is the commonest gynecological cancer in Ghana. The Cervical Cancer Prevention and Training Centre (CCPTC), Battor, Ghana spearheaded the Ghana arm of the mPharma 10,000 Women Initiative (mTTWI) between September 2021 and October 2022. The aim of this study was to examine the outcomes of nationwide concurrent screening using high-risk human papillomavirus (hr-HPV) DNA testing and visual inspection methods, as well as factors associated with the screening outcomes.
View Article and Find Full Text PDFPatient Educ Couns
January 2025
Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA. Electronic address:
Context: Effective communication between patients and oncologists is crucial, particularly around illness understanding. When this communication is asymmetric or imbalanced, it can hinder shared decision-making and lead to suboptimal clinical outcomes.
Objectives: We sought to describe physician-patient speech imbalances ("asymmetry") in illness understanding portions of discussions between oncologists and advanced cancer patients and explore potential trends related to patient characteristics.
Pediatr Emerg Care
January 2025
Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Mayo Clinic, Rochester, MN.
Objectives: ImPACTS (Improving Acute Care Through Simulation) is a collaborative simulation-based program partnering pediatric specialty centers ("hubs") with general emergency departments (GEDs) to improve pediatric acute care. Objective measurements of ImPACTS, such as evaluating Pediatric Readiness Score (PRS) and simulation-based outcome improvements, have been reported previously. Barriers to and facilitators of program involvement and the downstream effects of the program have not been previously described.
View Article and Find Full Text PDFBackground And Objectives: While workforce diversity helps mitigate health inequities, few initiatives support prospective abortion providers who are underrepresented in medicine (URiM). To address this issue, Reproductive Health Education in Family Medicine established the Resident Scholars Program for Workforce Diversity (RSPWD), a year-long program for URiM and other Black, Indigenous, People of Color (BIPOC) residents committed to sexual and reproductive health (SRH) provision. Program elements include: (a) mentorship by BIPOC family physicians; (b) virtual didactic sessions about SRH integration into primary care, advocacy, leadership, reproductive justice, and patient-centered care; (3) conference sponsorship; and (4) community-building among residents and mentors.
View Article and Find Full Text PDFInt J Mol Sci
December 2024
Istituto di Ricerca Pediatrica "Città della Speranza", 35128 Padua, Italy.
Currently, risk stratification for pediatric Hodgkin lymphoma is based on clinical factors such as stage, bulk, and systemic symptoms. Novel minimally invasive biomarkers could enhance both prognosis and treatment strategies. Therefore, the plasma extracellular vesicles' microRNA profile was characterized by small RNA sequencing in 36 classical Hodgkin lymphoma cases and these findings were confirmed in an extended cohort of 86 patients by RT-qPCR.
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