Implementation of Coordinated Telestroke Program in an Urban Setting Improves Acute Stroke Care

Purpose: Telestroke has been shown to improve acute ischemic stroke (AIS) care in rural settings, but few studies have examined the impact of telestroke in an urban setting. In an urban area, there was a planned transition from an outpatient-based acute stroke provider pool to a centralized telehealth team of neurovascular and neurocritical care providers. This study assessed the impact of this change by comparing patient outcomes during three time periods: pre-initiation (PRE), transition after initiation (TRAN) and post-transition (POST). Methods: Data for AIS patients 18 and older from five urban hospitals were used. Outcomes were hospital length of stay (LOS) and percentage of patients who had a door-to-needle time (DTN) \u3c45 and \u3c60 minutes, IV-alteplase or endovascular treatment, an IV-alteplase-related complication, and a discharge other than to home or rehab. Generalized linear and Cox proportional hazard models were used to compare outcomes for patients discharged during PRE (June 2015 - June 2016), TRAN (July 2016 – December 2016) and POST (January 2017 – March 2018) time periods adjusting for arrival mode, gender, admit NIHSS, age, and arrival time. Results: Of 4,984 patients that met inclusion criteria, there were 2,075 treated in PRE, 1,052 in TRAN and 1,857 in POST. After adjustment, TRAN patients were 1.77 times more likely to be treated with IV-alteplase than PRE patients (p=.013). POST patients were 2.46 times more likely to receive endovascular treatment than PRE patients (p=.009) and 2.07 times as likely as those in the TRAN period (p=.007). Patients in the TRAN period were 1.63 times more likely to be treated with IV alteplase in \u3c60 minutes (p\u3c.001) and 2.22 times more likely in the POST period (p=.002) compared to those in PRE. There were no significant differences in the odds of being treated in \u3c45 minutes, LOS, or discharge disposition. Conclusion: A transition to a specialty stroke care through a telestroke network showed improvements in treatment rates and percentage of patients with DTN less than 60 minutes.https://digitalcommons.psjhealth.org/other_pubs/1072/thumbnail.jp

Complications from IV Alteplase in Mild Stroke Patients in a Multi-state Health System

https://digitalcommons.psjhealth.org/other_pubs/1071/thumbnail.jp

Cost Analysis of Implementing Standardized Stroke Patient Education Materials in a Large Five State Health System

https://digitalcommons.psjhealth.org/other_pubs/1052/thumbnail.jp

Large Five State Health System Standardizes Stroke Patient Education While Significantly Improving Health Literacy

https://digitalcommons.psjhealth.org/other_pubs/1053/thumbnail.jp

Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection

General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n = 569) of an international 12 site longitudinal randomized controlled trial (RCT) (n = 775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, nausea, and neuropathy. Symptom burden, engagement with the provider, and antiretroviral adherence were analyzed with regard to GSE. Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE. Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group. There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group. The low GSE group was also significantly ( p= \u3c 0.001) less engaged with their healthcare providers. Given the difference in substance use by perceived GSE, and the importance of engagement with the healthcare provider, more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted

A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)

Background Social capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS. Methods We recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis. Results Participant\u27s mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected. Conclusions This is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population

Detailed SZ study of 19 LoCuSS galaxy clusters: masses and temperatures out to the virial radius

We present 16-GHz AMI SZ observations of 19 clusters with L_X >7x10^37 W (h50=1) selected from the LoCuS survey (0.142<z<0.295) and of A1758b, in the FoV of A1758a. We detect 17 clusters with 5-23sigma peak surface brightnesses. Cluster parameters are obtained using a Bayesian cluster analysis. We fit isothermal beta-models to our data and assume the clusters are virialized (with all the kinetic energy in gas internal energy). Our gas temperature, T_AMI, is derived from AMI SZ data, not from X-ray spectroscopy. Cluster parameters internal to r500 are derived assuming HSE. We find: (i) Different gNFW parameterizations yield significantly different parameter degeneracies. (ii) For h70 = 1, we find the virial radius r200 to be typically 1.6+/-0.1 Mpc and the total mass M_T(r200) typically to be 2.0-2.5xM_T(r500).(iii) Where we have found M_T X-ray (X) and weak-lensing (WL) values in the literature, there is good agreement between WL and AMI estimates (with M_{T,AMI}/M_{T,WL} =1.2^{+0.2}_{-0.3} and =1.0+/-0.1 for r500 and r200, respectively). In comparison, most Suzaku/Chandra estimates are higher than for AMI (with M_{T,X}/M_{T,AMI}=1.7+/-0.2 within r500), particularly for the stronger mergers.(iv) Comparison of T_AMI to T_X sheds light on high X-ray masses: even at large r, T_X can substantially exceed T_AMI in mergers. The use of these higher T_X values will give higher X-ray masses. We stress that large-r T_SZ and T_X data are scarce and must be increased. (v) Despite the paucity of data, there is an indication of a relation between merger activity and SZ ellipticity. (vi) At small radius (but away from any cooling flow) the SZ signal (and T_AMI) is less sensitive to ICM disturbance than the X-ray signal (and T_X) and, even at high r, mergers affect n^2-weighted X-ray data more than n-weighted SZ, implying significant shocking or clumping or both occur even in the outer parts of mergers.Comment: 45 pages, 33 figures, 13 tables Accepted for publication in MNRA

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

Background Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. Methods We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. Results Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. Conclusions Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care