Poster & Oral Abstracts
12 versus 24-hour Bed Rest after Acute Ischemic Stroke Reperfusion Therapy
Brian Silver, MD – Department of Neurology, University of Massachusetts Medical School, Worcester, MA
Other Authors: Tariq Hamid, MD; Muhib Khan, MD; Mario DiNapoli, MD; Reza Behrouz, DO; Gustavo Saposnik, MD; Jo-Ann Sarafin, RNP; Susan Martin, OT; Majaz Moonis, MD; Nils Henninger, MD, PhD; Richard Goddeau, MD; Adalia Jun-O’Connell, MD; Shawna M Cutting, MD, MS; Ali Saad, MD; Shadi Yaghi, MD; Wiley Hall, MD; Susanne Muehlschlegel, MD, MPH; Raphael Carandang, MD; Marcey Osgood, DO; Bradford B. Thompson, MD; Corey R Fehnel, MD; Linda C. Wendell, MD; N. Stevenson Potter, MD; James M Gilchrist, MD; Bruce Barton, PhD
24-hour bed rest following treatment with tPA and/or mechanical thrombectomy is standard practice. Shorter periods of bed rest have not been evaluated. We conducted a retrospective study before and after a change in practice to 12-hour bed rest was done. Patients who had 12-hour bed rest appeared to be as safe 24 hour bed rest, and may be associated with reduced neurological deficit at discharge, shorter length-of-stay, and reduced rates of readmission within 30 days. A randomized trial is needed to verify these findings.
CTA Collaterals vs CT Perfusion CBF Maps for Core Infarct Volume Assessment in Patient Transfer for Intra-Arterial Thrombectomy?
Shahmir Kamalian, MD – Massachusetts General Hospital; Sebastian R. McWilliams, MD – Massachusetts General Hospital; Scott B. Raymond, MD – Massachusetts General Hospital; Mohammad Mansouri, MD – Massachusetts General Hospital; Reza Hakimelahi, MD – Memorial Sloan Kettering Cancer Center; Lee H. Schwamm, MD, FAHA – Massachusetts General Hospital; Pamela W. Schaefer, MD – Massachusetts General Hospital; Thabele M. Leslie-Mazwi, MD – Massachusetts General Hospital; Ramon G. Gonzalez, MD, PhD, FACR – Massachusetts General Hospital; Michael H. Lev, MD, FAHA, FACR – Massachusetts General Hospital
CTA is becoming the new standard of care in triage of patients for intra-arterial thrombolysis (IAT). DWI is the gold standard for core assessment; however, MRI is not usually available at the referring hospitals. Therefore, CT perfusion (CTP) is sometimes employed in these centers as an expedient surrogate for DWI, although controversy exists over the accuracy of CTP. Our results showed that for making transfer decisions from referral hospitals to IAT capable centers– if MRI is unavailable – a simple and easy to implement standardized CT/CTA protocol may be sufficient, without added sensitivity or specificity provided by CTP.
Hospital and EMS Collaborative through an EMS Quality Group
Joshua Onyan, BSN, RN, SCRN- Upstate University Hospital; Jennifer Schleier BSN, RN, SCRN, CCRN Upstate University Hospital; Doug Sandbrook, EMT-P Central New York EMS; Susie Surprenant, EMT-P Upstate University Hospital
New York State requires all Emergency Medical Services (EMS) providers to notify receiving hospitals of presumptive stroke patients. As a process improvement project, Upstate University Hospital created a collaborative EMS Quality group that focused on increasing the rates of EMS pre-notification through education and continuous feedback through partnering EMS agencies. Over the course of roughly 30 months, the EMS Quality group was able to increase pre-notification rates roughly from 46% to an (2018 YTD) average of 91%.
The Impact of Extending the Acute Stroke Triage Criteria to 24 hours from Last Known Normal
Dawn K. Beland, MSN, RN, CCRN-K, ACNS-BC, CNRN, SCRN – Hartford Hospital; Amre Nouh MD, FAHA – Hartford Hospital, Hartford, CT
While the benefit of extending the therapeutic time window to 24 hours to enhance patient functional outcomes has been proven, the impact of implementing this evidence-based medicine on the triage process and care in a large urban university affiliated Level 1 and Comprehensive Stroke Center is not known. This retrospective QI project compared process of care metrics prior to and after the implementation of a 24-hour treatment window.
When to Stop: Diminishing Returns from Additional Thrombectomy Passes
Scott B. Raymond, MD PhD – Massachusetts General Hospital; Matthew J. Koch, MD – Massachusetts General Hospital; James D. Rabinov, MD – Massachusetts General Hospital; Thabele Leslie-Mazwi, MD – Massachusetts General Hospital; Christopher J. Stapleton, MD – University of Illinois, Chicago; Aman B. Patel, MD – Massachusetts General Hospital
Acute large vessel occlusion can frequently be resolved by a single aspiration or stent retriever pass. Some occlusions, however, require repeated passes of the thrombectomy device in order to achieve recanalization. In this study, we develop guidelines for when to stop recanalization attempts based on the probability of thrombectomy success after each pass and the outcomes for patients requiring many passes.
A Closer Look at Stroke Epidemiology in the State of Maine Using Hospital Discharge Data 2010 – 2014
Gillian Gordon Perue, MD – Eastern Maine Medical Center; Keerthi Padooru, MD – Morehouse School of Medicine Internal Medicine Residency; Samreen Fathima, MPH – Eastern Maine Healthcare Systems; Barbara Sorondo, MD MBA – Eastern Maine Medical Center
Maine’s stroke prevalence/mortality is highest of New England states. We describe the epidemiology of stroke in Maine and identify the local determinants for in hospital stroke mortality. These include limited access to certified stroke centers and an older population.
Assessing Knowledge of Identifying Stroke Symptoms and Risk Factors After a Women’s Community-Based Education Program
Jennifer Kusaila, RN BSN, Kandy Reilly RN, Debra Cook RN, Stacy Montague RN, & Kaitlin Boyen RN – St. Mary’s Hospital, Trinity Health of New England – Waterbury, CT
Community outreach education and women’s awareness of stroke was investigated post event to evaluate effectiveness of education and if increased knowledge was obtained.
Marie Luby PhD, NINDS, Glastonbury, CT; Kaylie Cullison BS, NINDS, Bethesda, MD, Amie W Hsia MD, NINDS, Bethesda, MD, MedStar Washington Hospital Center, Washington, DC, Lawrence L Latour PhD, NINDS, Bethesda, MD
Renormalization of ADC values is seen more frequently in patients following EVT than IVT, presumably as the result of earlier, and more successful recanalization. This suggests irreversible injury has not occurred in the core, which may contribute to the higher rate of early neurologic improvement seen following EVT.
Improving INR Door to Result Time: An Interprofessional Performance Improvement Project
Joseph P. Scarano, MSN, RN -Holy Name Medical Center; Louise Fronjian, BS, MT, – Holy Name Medical Center; Elbio M. Ipar, AS, MLT – Holy Name Medical Center; Ana Lopez, MSN, RN, CEN- Holy Name Medical Center; Maryann Mclaughlin, RN – Holy Name Medical Center; Angelica Mercado, BSN, RN, BC, CEN – Holy Name Medical Center; Jeffrey Ramirez, MSN, RN Holy Name Medical Center; Edward A. Torres, MPA – Holy Name Medical Center
PT/INR levels are critical in aiding the determination of Alteplase eligibility for stroke patients. This is particularly true within the patient population taking Coumadin (warfarin). The ability to have prompt results is key to the timely delivery of the medication. Ensuring the location and proper staff training in the use of point of care INR (POCINR) devices is critical.
Karan Topiwala, MBBS – Hartford Hospital; Karan Tarasaria, MBBS – Hartford Hospital; Dawn Beland, MSN, RN – Hartford Hospital; Erica Schuyler, MD – Hartford Hospital; Amre Nouh MD, FAHA – Hartford Hospital
Stroke alerts are a common in-hospital scenario, requiring a rapid response with significant prognostic implications of a timely-intervention. Between 7% and 15% of all strokes occur in patients who are already hospitalized with studies documenting significant delays in the evaluation of in-hospital stroke-codes compared to those that present to the emergency room. Further, it has been shown that the yield of ED-Stroke-Codes is largely driven by accurate stroke symptom recognition by providers. Thus it becomes imperative for hospital-systems to analyze their inpatient stroke alerts and identify potential quality improvement measures which can aid in improving the yield of in-house stroke alerts.
Victoria M. Nielsen, MPH – Massachusetts Department of Public Health; Glory Song, MPH – Massachusetts Department of Public Health; Claudine DeJoie-Stanton, COTA – Massachusetts Department of Public Health; Rebecca Sullivan, MEd – Massachusetts Department of Public Health; Anita Christie, RN MHA CPHQ – Massachusetts Department of Public Health; Jing Guo, PhD – Massachusetts Department of Public Health
The Stroke Systems of Care (SSoC) model aims to facilitate collaborations between emergency medical services (EMS), hospitals, and post-acute providers to improve quality of stroke care across the continuum. A primary goal of SSoC is to increase use of IV-tPA among eligible patients. The SSoC model facilitates this by increasing the proportion of patients who arrive at the emergency department by EMS. Increased arrival by EMS permits pre-notification by EMS field staff to the Emergency Department (ED), also known as stroke alert. Stroke alert includes ED notification of time last known well (LKW), a key factor in determining IV-tPA eligibility. This analysis aims to quantify the association between arrival by EMS and EMS stroke alert with receiving IV-tPA to evaluate the effectiveness of the Massachusetts Paul Coverdell SSoC in enhancing IV-tPA use.
Florence Chukwuneke, MSN, APN, CNRN; Dawn Marie DeVito, MSN, RN, CPAN; Judith Lane, MHA, BSN, SCRN; Rebecca Weber, BSN, RN, CNRN; Marlene Thompson, MHA, BSN, RN – Robert Wood Johnson University Hospital, New Brunswick, NJ
Mechanical Thrombectomy is a high risk low volume procedure that requires high quality clinical care. The project created a model to foster the PACU clinicians’ skill sets necessary for delivery of high quality clinical care. The analysis of data post implementation revealed remarkable improvement in compliance with the established metrics.
James Clemmons, BA – Summer Research Training Program Participant, Massachusetts General Hospital, MD Candidate, Howard University College of Medicine; Lee Schwamm, MD, FAHA – Executive Vice Chairman of Neurology, Director of MGH Comprehensive Stroke Center, Massachusetts General Hospital; Kori S. Zachrison, MD, MSc – Assistant Professor, Department of Emergency Medicine, Massachusetts General Hospital
As of 2018, performance of pre-hospital stroke severity testing is now mandated in Massachusetts. We performed a retrospective analysis of stroke patients discharged from the Massachusetts General Hospital between December 2016 to May 2018. We found that most patients experienced onset of stroke symptoms at home, and that among those transported by EMS, the majority did not have documented stroke severity scale performance. If these findings are confirmed in larger datasets, this highlights an area for improvement in optimization of stroke systems of care.
Jennifer Sposito MSN, RN. UConn Health John Dempsey Hospital, Elizabeth Bjorge MSN, RN, CNL, PCCN. UConn Health John Dempsey Hospital
Stroke is the 5th cause of death & #1 leading cause of adult disability, however 80% of strokes can be prevented. Educating patients about their individual stroke risk factors is important to aid in preventing future strokes. Our purpose was to increase Intermediate Stroke Unit RN’s understanding of a patient’s individual Stroke/TIA specific risk factors & in turn implement focused education; including documenting electronically.
Time Matters: Saving Brain Cells as a System
Gayle E. Walker-Cillo, MSN/Ed, RN, CEN, SCRN, FAEN – Morristown Medical Center; Dimple Gandhi, BS, BA, CPhT – Morristown Medical Center; Fiona Ahern, RN – Chilton Medical Center; Wendy J. Beatrice, MSN, RN, SCRN – Hackettstown Medical Center; Deborah Butler, MSN, RN, SCRN – Newton Medical Center; Olivia Joy Eboras, BSN, RN-BC, SCRN – Overlook Medical Center; Megan Ewing, BSN, BSHR, RN – Overlook Medical Center
Acute ischemic stroke occurs when a cerebral artery is occluded, and nutrients and oxygen cannot get to a specific part of the brain. Timely reperfusion of the blood vessel is critical to salvage the affected brain tissue and the surrounding penumbra. By decreasing our average DTN, we can provide better patient outcomes, and decrease neuronal loss.
Florence Chukwuneke, APN, MSN, CNRN – Robert Wood Johnson University Hospital; Judith Lane, MHA, BSN, SCRN – Robert Wood Johnson University Hospital; Kimberley Hollender, APN, MSN, AVNP- Robert Wood Johnson University Hospital; Evelyn Burgos – Robert Wood Johnson University Hospital – New Brunswick, NJ
The Joint Commission (TJC) requires Comprehensive Stroke Center (CSC) to perform a 7- day post discharge follow- up phone call (Call Back) for stroke patients discharged to home. Addressing the patient’s education is part of TJC Stroke Center Certification standard. At our institution we provide written stroke education materials from AHA /ASA to the patients or caregivers addressing the specific stroke diagnosis, individual risk factors for stroke, activation of EMS, secondary stroke prevention, medications and discharge follow up plan. We developed a Call Back questionnaire designed to assess the effectiveness of the stroke education provided to patients or caregivers.
Instructions for Accepted Abstracts
- Each presenter is responsible for the printing, transport, set-up and break-down of their poster display.
- Poster displays must be set up Thursday, October 25th by 8:00 am and remain on display through Friday, October 26th 11:00 am.
- The NECC is not responsible for any posters that are not collected by the end of The Summit.
- A representative must be available during the poster presentation sessions to answer any questions from the attendees. Poster Sessions will be during the breaks, networking lunch and cocktail reception.
Please Note: There will be no availability of audio visual equipment or table top displays. If you are bringing your personal laptop for multimedia related to your project, please ensure that you bring a fully charged battery and please let The NECC organizers know so that they can do their best to accommodate your presentation near a power source.
- Posters will be displayed on a cork board and push pins and clips will be available for your use.
- Large font is recommended so that text will be easily visible from a 3-4 foot distance. A combination of text and graphics (bar graphs, pie charts, line graphs, radiological images and tables) is the most visually appealing. Posters can be made easily in PowerPoint. Please use a background and font that have good contrast to increase readability (i.e., black text on white background, white text on dark background).
- Please list funding sources, acknowledgements and IRB approval at the end of the poster. The corresponding author should be identified by an asterisk. For example, Jane Smith, Jane Doe, and Lisa Brown*.
- All statistical Methods should be described, including statistical tests utilized to determine the significance of the results.
- Maximum allowable poster size is 4’ tall x 8’ wide.
- Please email a Microsoft Office or Adobe PDF version of your poster to firstname.lastname@example.org no later than October 5th, 2018. All posters will be converted to an Adobe PDF for inclusion on The NECC website following the summit.
For more information, please refer to 2018 Poster Abstract Instructions
Questions? Please email email@example.com.