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Reinmuth N, Cho B, Luft A, Alexander JA, Geater SL, Laktionov K, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Barrett K, Lowery C, Tattersfield R, Peters S, Garon E, Mok T, Johnson M. 12MO Patterns of response in metastatic (m) NSCLC after 2 and 4 cycles of chemotherapy (CT), alone or with durvalumab (D) ± tremelimumab (T), in the phase III POSEIDON study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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2
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Eswaran H, Lau C, Murphy P, Siegel ER, Preissl H, Lowery C. Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high-risk conditions. Dev Psychobiol 2020; 63:5-15. [PMID: 32654120 DOI: 10.1002/dev.22008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 04/08/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022]
Abstract
Magnetoencephalography (MEG) has been successfully applied to record fetal auditory (auditory evoked response [AER]) and visual evoked responses (VER). In this study, we report the AER and VER development trajectory by tracking the evoked response detectability and latency from recordings starting at 27 weeks of gestation in pregnancies classified as high risk. Fetal MEG and ultrasound recordings were performed on 158 pregnant women, and the total number of fetal auditory and visual tests conducted was 321 and 237, respectively. The overall evoked response analysis showed 237 AER (73.8%) and 164 VER detections (69.2%). The mean AER latency was 290.7 (SD 125.5) ms and the mean VER latency was 293.7 (SD 114.5) ms. The rate of decrease (95% confidence limits) in average AER and VER first-peak latency between 100-350 ms was 1.97 (-1.86, +5.81) ms/week and 1.35 (-3.83, +6.53) ms/week, respectively. This trend in high-risk fetuses conforms to the general trajectory of decrease in latency with gestational age progression, even though this decrease was non-significant, as reported in the case of normal growing fetuses. Although there was a significant difference in detection rates between male and female fetuses, this was not reflected in either latency values or the sensory modality applied. Furthermore, the main factors that had the most significant effect on response detectability included the presence of intervening layers of adipose tissue between the fetal head and stimulus source and an increase in the maternal body mass index.
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Affiliation(s)
- Hari Eswaran
- Department of Obstetrics and Gynecology, SARA Fetal MEG Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chrystal Lau
- Department of Obstetrics and Gynecology, SARA Fetal MEG Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pam Murphy
- Department of Obstetrics and Gynecology, SARA Fetal MEG Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Curtis Lowery
- Department of Obstetrics and Gynecology, SARA Fetal MEG Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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3
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Nalleballe K, Brown A, Sharma R, Sheng S, Veerapaneni P, Patrice KA, Shah V, Onteddu S, Culp W, Lowery C, Benton T, Joiner R, Kapoor N. When Telestroke Programs Work, Hospital Size Really Does Not Matter. J Neurosci Rural Pract 2020; 11:403-406. [PMID: 32753804 PMCID: PMC7394625 DOI: 10.1055/s-0040-1709362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background There are still marked disparities in stroke care between rural and urban communities including difference in stroke-related mortality. We analyzed the efficiency of tissue plasminogen activator (tPA) delivery in the spoke sites in our telestroke network to assess impact of telecare in bridging these disparities. Methods We analyzed critical time targets in our telestroke network. These included door-to-needle (DTN) time, door-to-CT (D2CT) time, door-to-call center, door-to-neurocall, and total consult time. We compared these time targets between the larger and smaller spoke hospitals. Results Across all the 52 spokes sites, a total of 825 stroke consults received intravenous tPA. When compared with larger hospitals (>200 beds), the smaller hospital groups with 0 to 25 and 51 to 100 beds had significantly lower D2CT time ( p -value 0.01 and 0.005, respectively) and the ones with 26 to 50 and 151 to 200 beds had significantly lower consult time ( p -value 0.009 and 0.001, respectively). There was no significant difference in the overall DTN time when all the smaller hospital groups were compared with larger hospitals. Conclusion In our telestroke network, DTN times were not significantly affected by the hospital bed size. This shows that a protocol-driven telestroke network with frequent mock codes can ensure timely administration of tPA even in rural communities regardless of the hospital size and availability of local neurologists.
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Affiliation(s)
- Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Aliza Brown
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Rohan Sharma
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Sen Sheng
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Poornachand Veerapaneni
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Kelly-Ann Patrice
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Vishank Shah
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - William Culp
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Curtis Lowery
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Tina Benton
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Renee Joiner
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Nidhi Kapoor
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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4
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Lowery C. Telemedicine and Connected Health in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2020. [DOI: 10.1016/s0889-8545(20)30039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5
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Lowery C. Intro to Telemedicine and Connected Health in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2020; 47:xv-xvi. [PMID: 32451025 DOI: 10.1016/j.ogc.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Curtis Lowery
- University of Arkansas for Medical Sciences, Institute for Digital Health and & Innovation, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA.
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6
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Payakachat N, Rhoads S, McCoy H, Dajani N, Eswaran H, Lowery C. Using mHealth in postpartum women with pre-eclampsia: Lessons learned from a qualitative study. Int J Gynaecol Obstet 2020; 149:339-346. [PMID: 32119129 DOI: 10.1002/ijgo.13134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/03/2020] [Accepted: 02/27/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore perceptions and attitudes of postpartum women with pre-eclampsia towards remote monitoring (mHealth) and communication with the call center. METHODS A non-randomized cohort study was conducted in postpartum hypertensive women, recruited from a tertiary hospital between October 2015 and February 2016. Participants were categorized into users (using mHealth) and non-users (not using mHealth) to monitor vital signs at home over a 2-week period after discharge. Non-users were informed about functionality of mHealth. Both groups participated in a 30-minute phone interview at the end of the study. Directed content analysis of interview transcripts was conducted. RESULTS In total, 21 users and 16 non-users participated in the interview. Both groups perceived that mHealth helped manage their condition. However, non-users were concerned about the challenge of incorporating mHealth into their routine, whereas users mentioned that they liked using mHealth on a daily basis. They also stated that communication with nurses in the call center was helpful. Barriers identified by users included size of the blood pressure cuffs, size of the equipment set, wireless connection, and stress associated with mHealth monitoring. Users stated that they would have preferred using mHealth during pregnancy. CONCLUSION The findings provide useful insights to inform a successful remote monitoring program among perinatal and postpartum women.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Rhoads
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hannah McCoy
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nafisa Dajani
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis Lowery
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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7
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Brown AT, Backus M, Onteddu S, Nalleballe K, Sheng S, Haldal S, Joiner R, Kapoor N, Benton T, Lowery C. Abstract TP179: No Need to 'Card' Here; Cocaine/Opioid Use in Middle Age and Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Drug overdose from 1999 to 2017 in the US has continued to increase. Rural America has seen an increase in methamphetamine (Meth) users. Meth usage in Arkansas and its effects on stroke incidence and treatment are all largely unknown. Drug abuse can cause an immediate stroke or increase the risk of stroke either by damage to the cerebrovasculature, hypertension, or by affecting vital organs. Here we retrospectively examined strokes from 57 rural communities that self-reported positive for drug use from a large telestroke program for age, thrombolysis, alcohol and smoking use, gender, race, deficit level and symptom to door time.
Hypothesis:
Incidence of drug use is greater among younger age groups and increases the incidence of stroke in younger age categories.
Methods:
We analyzed consult prospective data from 2015 to 2018 of the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telestroke program for consults who self-reported as positive for drug use. We included all stroke assessed consults for age (ranged by decade), thrombolysis (alteplase use), alcohol and smoking use, consult gender, race, initial deficit level at presentation using the national institutes of health stroke scale (NIHSS) and symptom to door time (minutes).
Results:
In 2015 to 2018 the number of consults positive for drug use per person were 2,349, 1,747, 1,910 and 1,137 per 100,000, respectively. Sixty-two percent of drug users were in their 40’s and 50’s (p<0.0001) with hypertension (p<0.0001). Drug users were most frequently smokers (73%) and consumed alcohol (39%) at p
<
0.0001. Significantly fewer received alteplase (20%, p=0.039). There was no difference of gender in drug use (p=0.08). Almost half of the drug users were consulted for stroke but were not confirmed as stroke (46%, p=0.045). Symptom to door time average was lower in drug users, though not significant at 56.4±10 vs. 68.9±1.9 minutes, p=0.37. There was no effect of race in incidence of drug use, or deficits.
Conclusion:
While the incidence of drug use does persist in the rural communities, demographics suggest it is more common in the middle age group than younger patients.
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8
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Schwartz N, Mhajna M, Jakobs M, Levitt rosen L, Ben Aviraham K, Reches A, Eswaran H, Warsof S, Sohn C, Lowery C, Yagel S. 361: Towards a solution for remote pregnancy monitoring: a novel non-invasive method for uterine activity monitoring. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Rabie NZ, Sandlin AT, Ounpraseuth S, Nembhard WN, Lowery C, Miguel KS, Magann EP. Teleultrasound for pre-natal diagnosis: A validation study. Australas J Ultrasound Med 2019; 22:248-252. [PMID: 34760566 DOI: 10.1002/ajum.12175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction/Purpose There are no large validation trials comparing teleultrasound to on-site ultrasound. We aim to compare the sensitivity and accuracy of teleultrasound and demonstrate that teleultrasound is not inferior to on-site ultrasound in the pre-natal diagnosis of fetal anomalies. Methods All targeted ultrasounds performed between November 2010 and December 2012 were considered. We excluded studies performed at less than 17 weeks' gestation, on multiple gestations and for reasons other than an anatomical survey. Post-natal diagnoses were obtained from a state level mandatory birth defects surveillance programme. Descriptive statistics (sensitivity, specificity, positive and negative predictive values and accuracy) were calculated for both groups. A test of non-inferiority was performed, with the non-inferiority difference set at 0.15. Results The teleultrasound and on-site ultrasound groups consisted of 2368 and 3145 studies, respectively. The sensitivity of teleultrasound and on-site ultrasound was 57.46% and 76.57%, and the accuracy was 95.9% and 90.97%, respectively. The observed sensitivity difference was -0.1911. The accuracy, specificity, positive and negative predictive values of teleultrasound are similar to on-site ultrasound. Discussion Teleultrasound is inferior to on-site ultrasound in the detection of fetal anomalies; however, it has improved accuracy, as well as higher negative and positive predictive values. A negative teleultrasound is more likely to identify a non-anomalous fetus, and a positive teleultrasound is more likely to correctly identify an anomalous fetus. Conclusion Teleultrasound has an important role in pre-natal diagnosis for those patients unable or unwilling to travel for an on-site ultrasound.
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Affiliation(s)
- Nader Z Rabie
- Department of Ob-Gyn Tripler Army Medical Center 1 Jarrett White Road Honolulu Hawaii 96859 USA
| | - Adam T Sandlin
- Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences 4301 West Markham Street Little Rock Arkansas 72205 USA
| | - Song Ounpraseuth
- Department of Biostatistics University of Arkansas for Medical Sciences 4301 West Markham Street Little Rock Arkansas 72205 USA
| | - Wendy N Nembhard
- Arkansas Children's Research Institute 1 Children's Way Little Rock Arkansas 72202 USA
| | - Curtis Lowery
- Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences 4301 West Markham Street Little Rock Arkansas 72205 USA
| | - Kelly San Miguel
- Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences 4301 West Markham Street Little Rock Arkansas 72205 USA
| | - Everett Pat Magann
- Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences 4301 West Markham Street Little Rock Arkansas 72205 USA
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10
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Brown A, Wells J, Onteddu S, Bryant-Smith G, Sharma R, Joiner R, Nalleballe K, Richard-Davis G, Sheng S, Benton T, Culp W, Lowery C. Women on Hormone Therapy with Ischemic Stroke, Effects on Deficits and Recovery. J Neurol Neurosurg PsychiatryRes 2019; 1. [PMID: 31008455 PMCID: PMC6469869 DOI: 10.31531/edwiser.jnnpr.1000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Hormone replacement therapy (HT) for post-menopausal women is associated with increased incidence of ischemic stroke risk. Effects of HT on stroke related deficits and functional outcomes in acute ischemic stroke (AIS) are uncertain. We retrospectively examined female consult data for HT use and National Institutes of Health Stroke Score (NIHSS) at baseline and recovery for 2015 and 2016 in a large stroke telemedicine program. Hypothesis: The age of women who acknowledged HT use will negatively impact stroke severity and outcomes. Methods: We analyzed consult data from two consecutive years for all women and included HT use, current age, and baseline and 24 h NIHSS’s. We included all women consults regardless of IV Alteplase treatment. 24 h NIHSS and three month modified Rankin scale (mRS) were included from women given IV Alteplase. Results: Strokes were identified in 523 women and 244 women received Alteplase therapy. Women without HT use numbered 459 and 64 women listed HT use. Mean NIHSS scores regardless of HT use significantly improved 24 h NIHSS vs. baseline NIHSS (p<0.0001). Baseline NIHSS scores were significantly improved in women on HT vs. non-HT users (p=0.01) in women age 50 to 79 years. Although mean NIHSS scores at 24h was not different from HT to no HT use (4.9 ± 1.6 vs. 7.8 ± 0.6, p=0.08) a trend was present for lower NIHSS scores for women 50–79 years. The mRS scores at three months indicated significant improvements among HT users vs. non-HT use (1.46 ± 0.4 vs. 2.51 ± 0.2, p=0.05). Conclusion: While cautions persist on the use, route and dosage of HT for risks of ischemic stroke, the HT moderation of AIS deficits and outcomes in women <80 years of age warrants further investigation.
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Affiliation(s)
- Aliza Brown
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jordan Wells
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Rohan Sharma
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Renee Joiner
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gloria Richard-Davis
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sen Sheng
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tina Benton
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
| | - William Culp
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Curtis Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR
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11
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Abstract
Background:
Telestroke rural networks are comprised of micro>small>medium>large sized hospitals without specialized neurology support. Many times the micro hospitals are
<
25 beds. In an examination of spoke hospitals in the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telestroke program, we determined program efficacy correlating bed number. Efficacy was determined by the mean Door-to-ED physician (D2MD) time and door-to-needle (D2N) Alteplase time, and numbers of Alteplase administrations (#Alteplase), mock scenario sessions (#Mocks) and consults (#Consults).
Hypothesis:
All hospitals would perform equally well with the larger hospitals with slight tendencies to outperform the smaller hospital sites in the #Consults and #Alteplase.
Methods:
We retrospectively reviewed 2015-2017 spoke hospital data from AR SAVES, the largest statewide telestroke program. The #Mocks and #beds were comparatively analyzed using regression analysis for D2MD, D2N, #Consults and #Alteplase. Spoke sites were categorized by bed numbers; 0-25, 26-50, 51-100, 101-150, 151-200 and
>
200.
Results:
Data from 53 spokes encompassing 2,555 consults over three years indicated that sites
>
151 beds were significantly higher in #Alteplase (p
<
0.01) and #Consults (p
<
0.002). Although the #Mocks were not different among the smaller vs. larger hospitals (p
>
0.19), nor was the D2MD time (p=0.82). However, the hospitals
<
50 beds had significantly shorter D2N mean time (p
<
0.03). The micro (0-25 beds) vs the largest hospitals (
>
200 beds) D2N mean times, were significantly less (76.0±2.5 vs 87.5±4.0 min, p=0.01, respectively).
Conclusions:
Although the smaller hospitals receive less volume of consults and #Alteplase, with training they perform equally if not better than their larger counterparts.
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Brown AT, Onteddu S, Nalleballe K, Joiner R, Benton T, Lowery C. Abstract 169: Rural Hospitals in Telestroke: How Effective are On-Site Mock Drills and Community Education on Stroke Awareness? Stroke 2019. [DOI: 10.1161/str.50.suppl_1.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mock drills of stroke triage care is an essential training component of most telestroke programs. Another potential component for telestroke programs is community stroke awareness education. While stroke-mocks improve the timeliness and care in rural spoke emergency departments (ED), community stroke awareness education may also improve treatment. Mocks and community education information was evaluated in the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telestroke program. Correlations were made with mean Door to ED physician (D2MD) time and door-to-needle (D2N) Alteplase time and administration numbers (#Alteplase) and consult numbers (#Consults).
Hypothesis:
Total number of mocks (#Mocks) and community education events (#Community-events) will independently increase #Consults and #Alteplase, and improve the D2MD and D2N time.
Methods:
We retrospectively reviewed 2017 spoke hospital data from AR SAVES, the largest statewide telestroke program. The total number of #Mocks, #Community-Events was comparatively analyzed using regression analysis for D2MD, D2N, #Consults and #Alteplase.
Results:
Data from 51 spoke sites and 1,002 consults, indicated #Mocks were positively correlated to the D2MD time (R=0.31; p=0.03) and the #Alteplase (R=0.28; p=0.04); however, increasing the #Mock sessions did not influence the D2N time or the #Consults (p=NS). Community-Events were significantly associated with #Consults (R=0.48; p=0.0004) and #Alteplase (R=0.47; p=0.0006); however not to D2MD time or D2N time (p=NS).
Conclusions:
Mocks and Community stroke awareness education played crucial roles in the AR SAVES program improving #Consults and #Alteplase administrations. Both education components are warranted for telestroke programs.
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Nalleballe K, Sharma R, Brown A, Joiner R, Kapoor N, Morgan T, Benton T, Williamson C, Culp W, Lowery C, Onteddu S. Ideal telestroke time targets: Telestroke-based treatment times in the United States stroke belt. J Telemed Telecare 2018; 26:174-179. [PMID: 30352525 DOI: 10.1177/1357633x18805661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Studying critical time interval requirements can enhance thrombolytic treatment for stroke patients in telestroke networks. We retrospectively examined 12 concurrent months of targeted time interval information in the South Central US telemedicine programme, Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES).Hypothesis: We hypothesised that consult data analysis would highlight areas for improvement to shorten overall door to Intra venous (IV) tissue plasminogen activator (tPA) administration time. Methods We analysed critical time targets for 238 consecutive telestroke neurology consults obtained over 12 months from AR SAVES spoke sites when tPA was administered. The following time intervals were analysed: emergency department (ED) door to Computed Tomography (D-CT); ED door to call centre (D-CC) for initiation of consult; ED door to neurology call (D-NC); neurology call to camera (NC-Cam); tele consult time (Con); ED door to tissue plasminogen activator (tPA)/needle (DTN). Results The median times of D-CT (13 min, inter quartile range (IQR) 6–22 min), D-CC (34 min, IQR 20–45 min), D-NC (40 min, IQR 21–71 min), NC-Cam (4 min, IQR 2–8 min), and Con (25 min, IQR 17–37 min) all contributed to a DTN median time of 71 min (IQR 50–104 min). A total of 238 patients received tPA with a 29.4% treatment rate and a DTN time of ≤60 min was achieved in 25.2% of patients. Conclusions Focusing on reducing D-CC and Con times may help to achieve the DTN time of < 60 min for the majority of patients. Having ideal time targets for telestroke patients akin to traditional patients will help identify and improve the overall goal of a DTN time < 60 min.
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Affiliation(s)
- Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Rohan Sharma
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Aliza Brown
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Renee Joiner
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Nidhi Kapoor
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Tiffany Morgan
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Tina Benton
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Conelia Williamson
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | - William Culp
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Curtis Lowery
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
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Hollander JE, Davis TM, Doarn C, Goldwater JC, Klasko S, Lowery C, Papanagnou D, Rasmussen P, Sites FD, Stone D, Carr BG. Recommendations from the First National Academic Consortium of Telehealth. Popul Health Manag 2018; 21:271-277. [DOI: 10.1089/pop.2017.0080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Judd E. Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Charles Doarn
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Stephen Klasko
- Thomas Jefferson University and Jefferson Health, Philadelphia, Pennsylvania
| | - Curtis Lowery
- Maternal Fetal Medicine, Obstetrics and Gynecology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Frank D. Sites
- Telehealth & JeffConnect, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danica Stone
- Telehealth & JeffConnect, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brendan G. Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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15
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Onteddu S, Brown AT, Kovvuru S, Chen YT, Joiner R, Morgan T, Benton T, Culp W, Lowery C. Abstract TP233: An Analysis of Thrombolysis in a Large Telestroke Program in the Stroke Belt. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Thrombolytic treatment of stroke patients in telestroke can be enhanced by studying critical time interval requirements. We retrospectively examined 12 concurrent months of targeted time interval information from 2016 in a large 48 site telemedicine program. Telemedicine programs with new spoke sites added throughout the year must continually evaluate where improvements can be made to decrease the arrival to treatment time.
Hypothesis:
We hypothesized that referral data analysis would highlight areas for improvement to shorten time to treatment.
Methods:
We analyzed critical time targeted information during 12 months of 247 consecutive telestroke neurology referrals from AR SAVES spoke sites when tissue plasminogen activator (tPA) was given. Measured time intervals of: emergency department (ED) door to CT (ED2CT), ED door to call center (ED2CC) for initiation of consult and ED door to neurology call (ED2NeuroCall), neurology call to camera (NeuroCall2Cam), total consult (Con), ED door to tPA (ED2tPA) were studied.
Results:
Reported median times of door to CT [ED2CT, 8 min, IQR 4-15 min], door to call center [ED2CC, 37 min, IQR 26-53 min], door to neurology call time [ED2NeuroCall, 42 min, IQR 33-57 min], neurology call response time [NeuroCall2Cam, 3 min, IQR 2-5 min], and total time spent in consult [Con, 24 min, IQR 19-32 min] all contributed to a ED2tPA median time of 73 min [IQR 60-90]. Twenty-six percent of referral patients received tPA ≤ 60 min and an overall tPA treatment rate of 33.2% was reported. The largest delay in time were: arrival to neurology call time and in consult time, 27 minutes and 13 minutes respectively. Totaling 40 minutes in variation.
Conclusion:
Focus in either ED2NeuroCall or Con of these time areas, may produce the largest improvements and reduce the door to treatment time. A 20 minute reduction in time would dramatically reduce the door to treatment time and increase the percentage of tPA administration to well within the goal of 60 minutes or less.
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16
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Wells J, Brown AT, Bryant-Smith G, Onteddu S, Joiner R, Morgan T, Benton T, Culp W, Lowery C. Abstract WP149: Women on Hrt With Ischemic Stroke, a Positive Effect on Deficits and Recovery? Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Hormone replacement therapy (HRT) for post-menopausal women is associated with increased incidence of ischemic stroke risk. Effects of HRT on stroke related deficits and functional outcomes in acute ischemic stroke (AIS) are uncertain. We retrospectively examined female consult data for HRT use and National Institutes of Health Stroke Score (NIHSS) at baseline and recovery for 2015 and 2016 in a large stroke telemedicine program.
Hypothesis:
The age of women on HRT will affect stroke severity and outcomes.
Methods:
We analyzed consult data from two consecutive years for women HRT use, age, and baseline and 24 hour NIHSS’s. We included all treated with IV Activase.
Results:
In two years 235 women received Activase therapy. Women without HRT use numbered 208 and 27 women listed HRT use. All 235 consults regardless of HRT use had significantly improved 24 h NIHSS vs. baseline (7.5 +/- 0.5 vs. 11.2 +/- 0.5, p<0.0001). Women on HRT had significantly improved 24 h NIHSS vs. baseline, (4.9 +/- 1.6 vs. 8.4 +/- 1.2, p=0.0084). Composite NIHSS’s at 24 h for ‘No HRT’ was not different from ‘Yes HRT’ (7.8 +/- 0.6 vs. 4.9 +/- 1.6, p=0.084) when groups included all women regardless of age. The baseline NIHSS’s when divided into specific age ranges showed decreased values when on HRT from 50s through 70s (
figure A
) p=0.028. Women placed in decade age ranges showed that 24 h NIHSS’s (40-80 years) with HRT use were lower vs. women >80 years (
figure B
). p=0.084.
Conclusion:
While controversy persists on the use, route and dosage of HRT for risks of ischemic stroke, positive HRT benefits could include moderation of AIS deficits and improved outcomes in women <80 years of age. Further study is needed.
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Morgan T, Brown AT, Onteddu S, Joiner R, Benton T, Culp W, Lowery C. Abstract TMP60: Validation of an Education Gauge for Measuring Stroke Outreach Efforts. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tmp60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
To improve rural population access to telestroke sites for referral and treatment, hospitals are required to fulfill monthly educational outreach. Telehealth sites that provide stroke outreach through awareness educational campaigns remain unaware of the efficacy of their outreach efforts. This study sought to apply a measurable scale to their outreach efforts and determine if the values correlated to the sites referral and treatment rates.
Hypothesis:
Measurable differences of outreach efforts in rural populations positively correlate to referral and treatment rates at telestroke hospital sites.
Methods:
A large telestroke network (n=48 spoke sites) had 12 consecutive months during 2016 of community outreach efforts evaluated on an educational gauge scale. Events were categorized as active or passive depending on the type of event. All events were assigned a value based on the type of event, audience size and the crowd’s level of attention/participation. Total monthly values for all spoke sites were calculated and compared by month and category. Regression analysis was used to determine significance of correlative analysis of education vs. number of referrals and vs. number of tissue plasminogen activase (tPA) treatments.
Results:
Outreach efforts promoting stroke awareness from all 48 sites totaled 2,625 educational points. There was a temporal trend of active events occurring in the spring (April through June) and in the fall (October). In regression analysis there was a positive correlation in the number of referrals vs. educational gauge (R=0.23; P=0.0013) and in the number of tPA treatments (R=0.20; P=0.0055). One spoke site was evaluated for their community events due to their high referral rate in the first quarter of the year. Outreach efforts during these months included stroke awareness events at local high schools, a sporting race event and to apartment residents.
Conclusion:
Targeted outreach efforts can now be measured for efficacy of reaching diverse populations with direct effects on referral and treatment rates.
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Rabie NZ, Sandlin AT, Barber KA, Ounpraseuth S, Nembhard W, Magann EF, Lowery C. Teleultrasound: How Accurate Are We? J Ultrasound Med 2017; 36:2329-2335. [PMID: 28660654 DOI: 10.1002/jum.14304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/04/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound serves an important role in the prenatal diagnosis of fetal structural anomalies. Recently, there has been increased use of teleultrasound protocols. We aimed to evaluate the sensitivity and accuracy of teleultrasound. METHODS We conducted an Institutional Review Board-approved retrospective cohort study determining the sensitivity and accuracy of teleultrasound. In addition, we evaluated the number of ultrasound examinations required to complete an anatomic survey. Only ultrasound examinations performed for anatomic surveys were included. Studies were excluded if performed before 16 completed weeks' gestation, if they had multiple gestations, or for reasons other than anatomy (eg, Doppler studies and fluid assessment). Prenatal diagnoses were compared with postnatal diagnoses obtained from a robust mandatory birth defects surveillance program that records all birth defects in the entire state, from deliveries before 20 weeks' gestation through infants up to 2 years of age. RESULTS A total of 2499 studies were evaluated; 2368 were included. The teleultrasound cohort had a congenital anomaly prevalence of 5.66%. The sensitivity of teleultrasound was 57.46%; the specificity was 98.21%; and the accuracy was 95.9%. Anatomic surveys were completed after 1 visit in 82% of patients, whereas 63% and 61% of the remaining patients required 2 and 3 visits, respectively. CONCLUSIONS Teleultrasound for prenatal diagnosis has similar sensitivity and accuracy as the published literature for on-site ultrasound. Further studies are needed to compare the sensitivity and accuracy within the same population and further validate this potentially cost-saving modality.
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Affiliation(s)
- Nader Z Rabie
- Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Adam T Sandlin
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin A Barber
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Wendy Nembhard
- Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
| | - Everett F Magann
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Curtis Lowery
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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19
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Coker JL, Mease A, Lowery C. Pregnant Women, Babies and Substance Use: Prevention of Neonatal Abstinence Syndrome. J Ark Med Soc 2017; 113:264-265. [PMID: 30351738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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20
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Brown A, Onteddu S, Joiner R, Benton T, Culp W, Lowery C. Abstract 226: Strokes Worse in Women at 24 hours but Severity Reduced in Younger Women With Hormone Therapy. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Gender related differences in stroke incidence hallmark the increased observation of women experiencing strokes later in life. Complications of women longevity has accounted for their increased risk of cardiovascular and cerebrovascular diseases. However, the severity of acute ischemic stroke (AIS) outcomes in women remains problematic. Previous studies have reported that women experience more disabilities and have poorer outcomes at three month follow-ups and may be related back to age at the time of stroke. We retrospectively examined 12 months of neurology consults in the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telemedicine program.
Objective:
To investigate whether gender influenced recovery at 24 hours following therapy for AIS.
Methods:
During 12 consecutive months 809 patients received neurology acute stroke consults and 238 (29%) received tissue plasminogen activator (tPA). Outcome data at 24 hours was available on 216 tPA-consults. Patient demographics, age, and gender, were analyzed along with baseline and 24 hour outcome National Institutes of Health Stroke Scale (NIHSS), onset to tPA, smoking, alcoholism, and hormone replacement therapy (HRT). Co-morbidity information collected included previous transient ischemic attacks (TIA), atrial fib (AF), diabetes, chronic obstructive pulmonary disease (COPD), hypertension (HT), hyperglycemia and coronary artery disease (CAD).
Results:
A total of 108 men and 108 women tPA treated patients showed no significant differences in age for male vs. female (mean±se 67.5±1.3 vs. 70±1.5, p=0.79). However, the men had twice the number of women in the 70-79 age range and women had twice the number of men at >80 years of age (
χ
2
p=0.0096 for all age ranges for both sexes). While baseline NIHSS was not significant in men vs. women (10.8±0.6 and 11.8±0.7, p=0.32, respectively), the women’s 24 hour NIHSS was significantly greater (5.9±0.7 vs. 9.1±0.9, p=0.0047, respectively). The incidence of HRT use in n=11 women < 80 years of age was associated with lower NIHSS’s at 24 hours vs. women without HRT (2.3±0.8 vs. 8.7±1.4, p=0.03, respectively). Males had a higher incidence of smoking (
χ
2
p=0.007). All other co-morbidities occurred equally between sexes.
Conclusion:
Women in this study had more severe 24 hour AIS outcomes than men but this improved with HRT use in women younger than 80 years. This cannot be fully explained by age differences as there could be other underlying factors. Improving 24 hour NIHSS may correctly predict later outcomes following AIS. Further study of HRT use in AIS outcomes is justified.
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Affiliation(s)
- Aliza Brown
- Univ of Arkansas for Med Sciences, Little Rock, AR
| | | | - Renee Joiner
- Univ of Arkansas for Med Sciences, Little Rock, AR
| | - Tina Benton
- Univ of Arkansas for Med Sciences, Little Rock, AR
| | - William Culp
- Univ of Arkansas for Med Sciences, Little Rock, AR
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21
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Effertz G, Alverson DC, Dion D, Duffy V, Noon C, Langell K, Antoniotti N, Lowery C. Sustaining and Expanding Telehealth: A Survey of Business Models from Selected Prominent U.S. Telehealth Centers. Telemed J E Health 2016; 23:137-142. [PMID: 27483137 DOI: 10.1089/tmj.2016.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Telehealth centers across the country, including our own center, are addressing sustainability and best practice business models. We undertook this survey to explore the business models being used at other established telehealth centers. In the literature on telehealth and sustainability, there is a paucity of comparative studies as to how successful telehealth centers function. METHODS In this study, we compared the business models of 10 successful telehealth centers. We conducted the study by interviewing key individuals at the centers, either through teleconference or telephone. RESULTS We found that there are five general approaches to sustaining a telehealth center: grants, telehealth network membership fees, income from providing clinical services, per encounter charges, and operating as a cost center. We also found that most centers use more than one approach. CONCLUSION We concluded that, although the first four approaches can contribute to the success of a center, telehealth centers are and should remain cost centers for their respective institutions.
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Affiliation(s)
- Glen Effertz
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Dale C Alverson
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Denise Dion
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Veronica Duffy
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Charles Noon
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Kevin Langell
- 1 Center for Telehealth, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Nina Antoniotti
- 2 Telehealth and Clinical Outreach, Southern Illinois University Health Care , Springfield, Illinois
| | - Curtis Lowery
- 3 Department of Maternal-Fetal Medicine, Center for Distance Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas
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22
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Odibo IN, Mac Bird T, McKelvey SS, Sandlin A, Lowery C, Magann EF. Childhood Respiratory Morbidity after Late Preterm and Early Term Delivery: a Study of Medicaid Patients in South Carolina. Paediatr Perinat Epidemiol 2016; 30:67-75. [PMID: 26480292 PMCID: PMC5373474 DOI: 10.1111/ppe.12250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing body of research documenting an increased risk of neonatal morbidity for late preterm infants (LPI, 34(0/7) weeks to 36(6/7) weeks) and early term infants (ETI, 37(0/7) weeks to 38(6/7) weeks) compared with term infants (TI, 39(0/7) to 41(6/7) ); however, there has been little research on outcomes beyond the first year of life. In this study, we examined respiratory outcomes of LPI and ETI in early childhood. METHODS South Carolina Medicaid claims data for maternal delivery and infant birth hospitalisations were linked to vital records data for the years 2000 through 2003. Medicaid claims for all infants were then followed until their fifth birthday or until a break in their eligibility. Infants born between 34(0/7) and 41(6/7) weeks were eligible. Infants with congenital anomaly, birthweight below 500 g or above 6000 g, and multiple births were excluded. We fit Cox proportional hazard models from which adjusted hazard ratio (HR) and 95% confidence interval (CI) were derived. RESULTS A total of 3476 LPI, 12 398 ETI, and 25 975 term infants were included. Both LPI and ETI were associated with an increased risk for asthma (LPI: HR 1.24, 95% CI 1.10, 1.40; ETI: HR 1.12, 95% CI 1.06, 1.19), and bronchitis (LPI: HR 1.15, 95% CI 1.00, 1.34; ETI: HR 1.13, 95% CI 1.05, 1.2) at 3 to 5 years of age. CONCLUSIONS Late preterm infants and early term infants are at increased risk for asthma and bronchitis.
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Affiliation(s)
- Imelda N. Odibo
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - T. Mac Bird
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Samantha S. McKelvey
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Adam Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Curtis Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - E. F. Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
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Bucciarelli V, Avenatti E, Rosner SJ, Cherneva ZHCH, Li H, Surkova EA, Degiovanni A, Ortiz Garrido A, Mihaila S, Tamulenaite E, Amorouayeche FZ, Kolesnyk MY, Garcia Campos A, Savcioglu AS, Filipiak D, Kuusisto JK, Torbas O, Kupczynska K, Tountas X, Ionin VA, Cescau A, Altin C, Ferreiro Quero C, Lowery C, Najih H, Valuckiene Z, Onciul S, Yang LT, Baricevic Z, Ghulam Ali S, Bianco F, Izzicupo P, Ghinassi B, Di Baldassarre A, Gallina S, Milazzo V, Milan A, Patel A, Kuvin J, Pandian N, Orban M, Nadjiri J, Lesevic H, Hadamitzky M, Sonne C, Kuneva ZK, Vasilev DV, Yuan L, Xie MX, Jin XY, Muraru D, Grapsa J, Donal E, Lancellotti P, Habib G, Badano LP, Buffa MC, De Vecchi F, Prenna E, Boggio E, Marino P, De La Chica J, Cuenca Peiro V, Picazo Angelin B, Conejo Munoz L, Narbona I, Anderica JR, De Mora M, Zabala Arguelles JI, Velcea A, Matei L, Andronic A, Calin S, Rimbas R, Muraru D, Badano LP, Vinereanu D, Ovsianas J, Valuckiene Z, Jurkevicius R, Latreche S, Benkhedda S, Dzyak GV, Riznyk YY, Kovalyova OV, Velasco-Alonso E, Colunga-Blanco S, Martin-Fernandez M, Corros-Vicente C, Rodriguez-Suarez ML, Leon-Aguero V, De La Hera Galarza JM, Safak O, Nazli C, Akyildiz Akcay F, Yakar Tuluce S, Kahya Eren N, Ozdemir E, Kocabas U, Kasprzak JD, Lipiec P, Jarvinen VM, Sinisalo JP, Sirenko YU, Radchenko G, Rekovets O, Kushnir S, Michalski BW, Miskowiec D, Kasprzak JD, Wdowiak-Okrojek K, Wejner-Mik P, Lipiec P, Beldekos D, Protogerou A, Gournizakis A, Panopoulos S, Theodosis-Georgilas A, Fousas S, Sfikakis P, Soboleva AV, Listopad OV, Nifontov SE, Polyakova EA, Belyaeva OD, Baranova EI, Shlyachto EV, Baudet M, Cohen-Solal A, Logeart D, Sakallioglu O, Aydin E, Yilmaz M, Sade LE, Muderrisoglu H, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Frenneaux MP, Parasuraman SK, Rudd AE, Srinivasan J, Elbaghdadi D, Laarej A, Allouch M, Azzouzi L, Habbal R, Ovsianas J, Mizariene V, Ablonskyte-Dudoniene R, Jurkevicius R, Cucchini U, Miglioranza MH, Dorobantu M, Iliceto S, Badano LP, Muraru D, Tsai WC, Cikes M, Ljubas Macek J, Skoric B, Skorak I, Jurin H, Samardzic J, Gasparovic H, Milicic D, Separovic Hanzevacki J, Fusini L, Tamborini G, Gripari P, Muratori M, Celeste F, Carminati MC, Alamanni F, Pepi M. HIT Poster session 2P486The effect of short term aerobic exercise and ACE polymorphism on cardiovascular remodeling in healthy sedentary postmenopausal womenP487Are there predictors of malignant progression of aortic stenosis severity?P488Quantitative und semiquantitative parameters in the classification of aortic insufficiency: a 3D-echocardiography and magnet resonance imaging studyP489Vascular indicies surrogate markers for left ventricular dysfunctionP490Left ventricular systolic strain data does not require indexation to cavity size in mitral valve diseasesP491Impact of EACVI grant programme on career progression of grant winnersP492Early predictor of atrial fibrillation recurrence after electrical cardioversion: diastolic parameters come firstP493Echocardiographic diagnosis of arrhythmias in the fetusP4943D echocardiography is a fast-learning and a more reliable method compared with 2D echocardiography for the assessment of left ventricular volumes and ejection fraction in patients with heart failureP495Right ventricular mechanics in functional ischemic mitral regurgitation in acute inferior myocardial infarctionP496Added value of two dimentional strain in assessement of left ventricular systolic function in rheumatic mitral stenosis patients with normal ejection fractionP497Left ventricular myocardial deformation in arterial hypertension with different types of glucose metabolism disordersP498Epicardial to pericardial adipose tissue ratio: predicting myocardial ischemia in patients referred for exercise stress echocardiographyP499Echocardiographic evaluation of the patients with asd after percutaneous closureP500Screening for carotid artery stenosis with the use of pocket-size imaging device equipped with linear probeP501LAD correlates poorly with LAVIP502Predictors associated with the diastolic dysfunction formation in patients with moderate hypertensionP503Assessment of left atrial function by speckle tracking analysis in transthoracic echocardiography for predicting the presence of left atrial appendage thrombus in patients with atrial fibrillationP504can echocardiography detect subclinical myocardial damage in the layers of myocardial wall? (The first study in a large population with known inflammatory disease)P505Epicardial fat thickness and galectin 3 in patients with atrial fibrillation and metabolic syndromeP506Left ventricular reverse remodeling in heart failure: a new obesity paradox?P507Epicardial adipose tissue and carotid intima media thickness in hemodialysis patients; single center experienceP508Echocardiographic parameters of mitral valve remodeling associated with poor clinical outcome in high risk patients with functional mitral regurgitation after Mitraclip implantationP509Prevalence of valve disease in a community population over the age of 60P510Discordance between mitral valve area and mean transmitral pressure gradient in mitral stenosis: Is mean gradient marker of the severity or parameter of tolerance in severe mitral stenosis?P511Ischemic mitral regurgitation is associated with impaired radial and circumferential myocardial deformation in acute inferoposterior myocardial infarctionP512The importance of early left atrial functional changes in predicting long term left ventricular remodeling in patients surviving a ST elevation myocardial infarctionP513Remodeling of myocardial deformation after mitral valve surgeryP514Global longitudinal peak systolic strain is reduced shortly after heart transplantationP515Detailed transthoracic and transesophageal echocardiographic analysis of mitral leaflets in patient undergoing mitral valve repair. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rhoads SJ, Bush E, Haselow D, Vyas KS, Wheeler JG, Faulkner A, Lowery C. Mobilizing a Statewide Network to Provide Ebola Education and Support. Telemed J E Health 2015; 22:153-158. [PMID: 26367104 DOI: 10.1089/tmj.2015.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Healthcare providers require the latest information and procedures when a public health emergency arises. During the fall of 2014, when the Ebola virus was first identified in a patient in the United States, education about Ebola virus disease (EVD) and procedures for its identification and control needed widespread and immediate dissemination to healthcare providers. In addition, there was a need to allay fears and reassure the public and providers that a process was in place to manage Ebola should it arrive in Arkansas. The state health department engaged multiple interest groups and provided a variety of educational and management activities. The Arkansas Department of Health and the only academic medical center in the state began offering time-consuming, one-on-one education over the phone, which reached too few providers. A solution was needed to educate many providers across the state in the protocols for identification, isolation, and management of patients with EVD. In response, the Arkansas Department of Health and the University of Arkansas for Medical Sciences leveraged the interactive video and Webinar capabilities of the state's telemedicine network to educate both providers and the public of this public health emergency. MATERIALS AND METHODS Six interactive video events were staged over 5 days in October 2014. RESULTS In six events, 82 individual healthcare facilities (67 of which were hospitals) and 378 providers attended via the Webinar option, whereas 323 healthcare professionals received continuing education credits. CONCLUSIONS A statewide videoconferencing infrastructure can be successfully mobilized to provide timely public health education and communication to healthcare providers and the public in multiple disciplines and practice settings.
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Affiliation(s)
- Sarah J Rhoads
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Erin Bush
- 2 South Central Telehealth Resource Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Dirk Haselow
- 3 Arkansas Department of Health , Little Rock, Arkansas
| | - Keyur S Vyas
- 4 Division of Infectious Diseases, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - J Gary Wheeler
- 3 Arkansas Department of Health , Little Rock, Arkansas.,5 Department of Pediatrics, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Alan Faulkner
- 6 Center for Distance Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Curtis Lowery
- 1 Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
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Cikes M, Tong L, Jasaityte R, Hamilton J, Sutherland G, D'hooge J, Yurdakul S, Oner F, Avci BK, Sahin S, Direskeneli H, Aytekin S, Fang F, Chan A, Zhang Q, Sanderson J, Kwong J, Yu C, Zaidi A, Raju H, Ghani S, Gati S, Cox A, Sheikh N, Sharma R, Sharma S, Kutty S, Kottam A, Padiyath A, Gao S, Drvol L, Lof J, Li L, Rangamani S, Danford D, Kuehne T, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Schirmer H, Bijnens B, Myrmel T, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Jorge C, Silva D, Placido R, Goncalves S, Almeida A, Nunes Diogo A, Poulidakis E, Aggeli C, Sideris S, Dilaveris P, Gatzoulis K, Felekos I, Koutagiar I, Sfendouraki E, Roussakis G, Stefanadis C, Zhang Q, Sun J, Gao R, Feng Y, Liu X, Sheng W, Liu F, Yu C, Hallioglu O, Citirik D, Buyukakilli B, Ozeren M, Gurgul S, Tasdelen B, Rodriguez Lopez A, Rodriguez Lopez A, Garcia Cuenllas L, Garcia Cuenllas L, Medrano C, Medrano C, Granja S, Granja S, Marin C, Marin C, Maroto E, Maroto E, Alvarez T, Alvarez T, Ballesteros F, Ballesteros F, Camino M, Camino M, Centeno M, Centeno M, Alraies M, Aljaroudi W, Halley C, Rodriguez L, Grimm R, Thomas J, Jaber W, Knight D, Coghlan J, Muthurangu V, Grasso A, Toumpanakis C, Caplin M, Taylor A, Davar J, Mohlkert LA, Halvorsen C, Hallberg J, Sjoberg G, Norman M, Cameli M, Losito M, Lisi M, Natali B, Massoni A, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Sljivic A, Stojcevski B, Celic V, Pencic B, Majstorovic A, Cosic Z, Backovic S, Ilic-Djordjevic I, Muraru D, Gripari P, Esposito R, Tamborini G, Galderisi M, Ermacora D, Maffessanti F, Santoro C, Pepi M, Badano L, Bombardini T, Cini D, Picano E, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Banovic M, Vukcevic V, Ostojic M, Markovic Z, Mladenovic A, Trifunovic D, Stojkovic S, Bacic D, Dedovic D, Seferovic P, Huttin O, Coulibaly S, Mercy M, Schwartz J, Zinzius P, Sellal J, Popovic B, Marie P, Juilliere Y, Selton-Suty C, Gurzun MM, Ionescu A, Bahlay B, Jones G, Rimbas R, Enescu O, Mihaila S, Ciobanu A, Vinereanu D, Vlasseros I, Koumoulidis A, Tousoulis D, Veioglanis S, Avgeropoulou A, Katsi V, Stefanadis C, Kallikazaros I, Kiviniemi T, Ylitalo A, Airaksinen K, Lehtinen T, Saraste A, Pietila M, Karjalainen P, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Banovic M, Boricic M, Draganic G, Petrovic M, Stepanovic J, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Dekleva M, Stevanovic A, Kleut M, Suzic Lazic J, Markovic Nikolic N, Akhunova S, Saifullina G, Sadykov A, Loudon M, D'arcy J, Arnold L, Reynolds R, Mabbet C, Prendergast B, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Lowery C, Frenneaux M, Dawson D, Dwivedi G, Singh S, Rudd A, Mahadevan D, Srinivasan J, Jiminez D, Sahinarslan A, Vecchio F, Maccarthy P, Wendler O, Monaghan M, Harimura Y, Seo Y, Ishizu T, Noguchi Y, Aonuma K, Urdaniz MM, Palomares JFR, Rius JB, Surribas IB, Tura GT, Garcia-Moreno LG, Alujas TG, Masip AE, Mas PT, Dorado DG, Meimoun P, Germain A, Clerc J, Elmkies F, Zemir H, Luycx-Bore A, Nasr GM, Erraki A, Dulgheru R, Magne J, Capoulade R, Elhonsali Z, Pierard LA, Pibarot P, Lancellotti P, Wrideier S, Butz T, Schilling I, Gkiouras G, Sasko B, Van Bracht M, Prull M, Trappe HJ, Castillo Bernal F, Mesa Rubio M, Ruiz Ortiz M, Delgado Ortega M, Morenate Navio M, Baeza Garzon M, Del Pino ML, Toledano Delgado F, Mazuelos F, Suarez de Lezo Herreros de Tejada J, Prinz C, Schumann M, Burghardt A, Seggewiss H, Oldenburg O, Horstkotte D, Faber L, Bistola V, Banner N, Hedger M, Simon A, Rahman Haley S, Baltabaeva A, Adamyan K, Tumasyan LR, Chilingaryan A, Makavos G, Kouris N, Kostopoulos V, Stamatelatou M, Damaskos D, Kartsagoulis E, Olympios C, Sade L, Eroglu S, Bircan A, Pirat B, Sezgin A, Aydinalp A, Muderrisoglu H, Sargento L, Satendra M, Sousa C, Longo S, Lousada N, Dos Reis RP, Kuznetsov V, Krinochkin D, Gapon L, Vershinina A, Shurkevich N, Bessonova M, Yaroslavskaya E, Kolunin G, Sargento L, Satendra M, Sousa C, Lousada N, Dos Reis RP, Azevedo O, Lourenco M, Machado I, Guardado J, Medeiros R, Pereira A, Quelhas I, Lourenco A, Duman D, Sargin F, Kilicaslan B, Inan A, Ozgunes N, Goktas P, Ikonomidis I, Tzortzis S, Paraskevaidis I, Andreadou I, Katseli C, Katsimbri P, Papadakis I, Pavlidis G, Anastasiou-Nana M, Lekakis J, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs J, Dobson RA, Cuthbertson DJ, Burgess M, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Krupa M, Grudzka K, Palczewski P, Pruszczyk P, Mansencal N, Marcadet D, Montalvan B, Dubourg O, Matveeva N, Nartsissova G, Chernjavskiy A, Eicher JC, Berthier S, Lorcerie B, Philip JL, Wolf JE, Wiesen P, Ledoux D, Massion P, Piret S, Canivet JL, Cusma-Piccione M, Zito C, Imbalzano E, Saitta A, Donato D, Madaffari A, Luzza G, Pipitone V, Tripodi R, Carerj S, Bombardini T, Gherardi S, Arpesella G, Maccherini M, Serra W, Del Bene R, Sicari R, Picano E, Al-Mallah M, Ananthasubramaniam K, Alam M, Chattahi J, Zweig B, Boedeker S, Song T, Khoo J, Davies J, Ang KL, Galinanes M, Chin D, Papamichael ND, Karassavidou D, Mpougialkli M, Antoniou S, Giannitsi S, Chachalos S, Gouva C, Naka K, Katopodis K, Michalis L, Tsang W, Cui V, Ionasec R, Takeuchi M, Houle H, Weinert L, Roberson D, Lang R, Altman M, Aussoleil A, Bergerot C, Sibellas F, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Mohamed A, Omran A, Hussein M, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Squeri A, Binno S, Ferdenzi E, Reverberi C, Baldelli M, Barbieri A, Iaccarino D, Naldi M, Bosi S, Kalinowski M, Szulik M, Streb W, Stabryla J, Nowak J, Rybus-Kalinowska B, Kukulski T, Kalarus Z, Ouss A, Riezebos R, Nestaas E, Skranes J, Stoylen A, Brunvand L, Fugelseth D, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Placido R, Jorge C, Silva D, Goncalves S, Almeida A, Nunes Diogo A, Nagy A, Kovats T, Apor A, Nagy A, Vago H, Toth A, Toth M, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Da Silva SG, Marin C, Rodriguez A, Marcos C, Rodriguez-Ogando A, Maroto E, Medrano C, Del Valle DI, Lopez-Fernandez T, Gemma D, Gomez-Rubin M, De Torres F, Feliu J, Canales M, Buno A, Ramirez E, Lopez-Sendon J, Magalhaes A, Silva Marques J, Martins S, Placido R, Silva D, Jorge C, Calisto C, Goncalves S, Almeida A, Nunes Diogo A, Jorge C, Cortez-Dias N, Goncalves S, Ribeiro S, Santos L, Silva D, Barreiros C, Bernardes A, Carpinteiro L, Sousa J, Kim SH, Choi W, Chidambaram S, Arunkumar R, Venkatesan S, Gnanavelu G, Dhandapani V, Ravi M, Karthikeyan G, Meenakshi K, Muthukumar D, Swaminathan N, Vitarelli A, Barilla F, Capotosto L, Truscelli G, Dettori O, Caranci F, D-Angeli I, De Maio M, De Cicco V, Bruno P, Doesch C, Sueselbeck T, Haghi D, Streitner F, Borggrefe M, Papavassiliu T, Laser K, Schaefer F, Fischer M, Habash S, Degener F, Moysich A, Haas N, Kececioglu D, Burchert W, Koerperich H, Dwivedi G, Al-Shehri H, Dekemp R, Ali I, Alghamdi A, Klein R, Scullion A, Beanlands R, Ruddy T, Chow B, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Rotkiewicz A, Stefanczyk L, Szymczyk K, Kasprzak J, Angelov A, Yotov Y, Mircheva L, Kisheva A, Kunchev O, Ikonomidis I, Tsantes A, Triantafyllidi H, Tzortzis S, Dima K, Trivilou P, Papadopoulos C, Travlou A, Anastasiou-Nana M, Lekakis J, Bader R, Agoston-Coldea L, Lupu S, Mocan T, Loegstrup B, Hofsten D, Christophersen T, Moller J, Bjerre M, Flyvbjerg A, Botker H, Egstrup K, Park Y, Choi J, Yun K, Lee S, Han D, Kim J, Kim J, Kim J, Chun K. Poster Session Wednesday 5 December all day Display * Determinants of left ventricular performance. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shamoon H, Center D, Davis P, Tuchman M, Ginsberg H, Califf R, Stephens D, Mellman T, Verbalis J, Nadler L, Shekhar A, Ford D, Rizza R, Shaker R, Brady K, Murphy B, Cronstein B, Hochman J, Greenland P, Orwoll E, Sinoway L, Greenberg H, Jackson R, Coller B, Topol E, Guay-Woodford L, Runge M, Clark R, McClain D, Selker H, Lowery C, Dubinett S, Berglund L, Cooper D, Firestein G, Johnston SC, Solway J, Heubi J, Sokol R, Nelson D, Tobacman L, Rosenthal G, Aaronson L, Barohn R, Kern P, Sullivan J, Shanley T, Blazar B, Larson R, FitzGerald G, Reis S, Pearson T, Buchanan T, McPherson D, Brasier A, Toto R, Disis M, Drezner M, Bernard G, Clore J, Evanoff B, Imperato-McGinley J, Sherwin R, Pulley J. Preparedness of the CTSA's structural and scientific assets to support the mission of the National Center for Advancing Translational Sciences (NCATS). Clin Transl Sci 2012; 5:121-9. [PMID: 22507116 DOI: 10.1111/j.1752-8062.2012.00401.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The formation of the National Center for Advancing Translational Sciences (NCATS) brings new promise for moving basic science discoveries to clinical practice, ultimately improving the health of the nation. The Clinical and Translational Science Award (CTSA) sites, now housed with NCATS, are organized and prepared to support in this endeavor. The CTSAs provide a foundation for capitalizing on such promise through provision of a disease-agnostic infrastructure devoted to clinical and translational (C&T) science, maintenance of training programs designed for C&T investigators of the future, by incentivizing institutional reorganization and by cultivating institutional support.
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Affiliation(s)
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- Albert Einstein College of Medicine (partnering with Montefi ore Medical Center)David Center
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Prendergast PJ, Galibarov PE, Lowery C, Lennon AB. Computer simulating a clinical trial of a load-bearing implant: an example of an intramedullary prosthesis. J Mech Behav Biomed Mater 2012; 4:1880-7. [PMID: 22098887 DOI: 10.1016/j.jmbbm.2011.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/08/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
Abstract
Computational modelling is becoming ever more important for obtaining regulatory approval for new medical devices. An accepted approach is to infer performance in a population from an analysis conducted for an idealised or 'average' patient; we present here a method for predicting the performance of an orthopaedic implant when released into a population--effectively simulating a clinical trial. Specifically we hypothesise that an analysis based on a method for predicting the performance in a population will lead to different conclusions than an analysis based on an idealised or 'average' patient. To test this hypothesis we use a finite element model of an intramedullary implant in a bone whose size and remodelling activity is different for each individual in the population. We compare the performance of a low Young's modulus implant (E=20 GPa) to one with a higher Young's modulus (200 GPa). Cyclic loading is applied and failure is assumed when the migration of the implant relative to the bone exceeds a threshold magnitude. The analysis for an idealised of 'average' patient predicts that the lower modulus device survives longer whereas the analysis simulating a clinical trial predicts no statistically-significant tendency (p=0.77) for the low modulus device to perform better. It is concluded that population-based simulations of implant performance-simulating a clinical trial-present a very valuable opportunity for more realistic computational pre-clinical testing of medical devices.
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Affiliation(s)
- P J Prendergast
- Trinity Centre for Bioengineering, School of Engineering, Trinity College, Dublin 2, Ireland.
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Chang H, Horak CE, Mukhopadhyay P, Lowery C, Baselga J, Sparano JA. Effect of neoadjuvant ixabepilone (ixa) on cell cycle genes and tumor-initiating cell (TIC) signature in breast cancer (BC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nugent R, Golden WE, Hall W, Bronstein J, Grimes D, Lowery C. Locations and outcomes of premature births in Arkansas. J Ark Med Soc 2011; 107:258-259. [PMID: 21667683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Most (57.6%) of the extremely premature infants were born at a hospital without the availability of neonatal and MFM specialists, and 38.4% of the very premature were born at a hospital without a neonatologist. Increasing evidence indicates that delivery at a Level 3 facility results in better survival for these high risk infants. Health professionals, administrators and policy leaders could fashion new approaches to obstetrical care in Arkansas to improve neonatal outcomes.
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Adler J, Lowery C, Simmons S, Tracy J, Vo A. ATA Institutional Council. Telemed J E Health 2011; 16:1090. [PMID: 21186992 DOI: 10.1089/tmj.2010.9943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sparano J, Zhuang S, Londhe A, Lantz K, Lowery C. Relationship of Anthracycline-Free Interval to Outcomes in a Phase 3 Trial of Pegylated Liposomal Doxorubicin Plus Docetaxel Compared with Docetaxel Monotherapy in Patients with Advanced Breast Cancer Treated with Adjuvant Anthracycline. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: An earlier report showed that pegylated liposomal doxorubicin (PLD) + docetaxel (D) improved time to progression (TTP) vs D alone in patients (pts) with advanced breast cancer (ABC) who had relapsed at least 1 year after adjuvant or neoadjuvant anthracycline therapy. (Sparano et al., SABC 2008, #80) This analysis evaluated whether the time between completion of adjuvant anthracycline therapy until relapse impacts overall outcome. We retrospectively examined outcomes in pts with an anthracycline-free (A-F) interval of 1 to 2 years and pts with an A-F of >2 years.Methods: 751 pts were randomly assigned to receive either D 75 mg/m2 (N=373) or PLD 30 mg/m2 followed by D 60 mg/m2 (N=378) every 21 days. Treatment was continued until disease progression or the occurrence of unacceptable toxicity. The primary endpoint was TTP and secondary endpoints included overall survival (OS), progression free survival (PFS), objective response rate (ORR), and safety. Pts were categorized into groups by anthracycline-free interval of 1-2 years or >2 years. Relationship between the interval and outcomes was examined by proportional hazards model for TTP, OS (updated as of 1-Dec-2008), and PFS.Results: Approximately 60% of pts in both treatment groups had A-F intervals of >2 years. Median TTP, OS, and PFS (months) by A-F interval groups are listed in the Table. A-F interval 1-2 years A-F interval >2 years D, n=151PLD+D, n=155HR (CI)*; P**D, n=221PLD+D, n=221HR (CI)*; P**TTP5.77.80.67 (0.52, 0.87); .0027.710.60.63 (0.50, 0.79); <.001OS15.817.90.90 (0.69, 1.16); .40424.722.91.10 (0.86, 1.40); .448PFS5.57.70.67 (0.52, 0.87); .0027.710.00.65 (0.51, 0.81); <.001ORR25%34%P=.086†27%36%P=.042† A-F interval 1-2 years, N=306 A-F interval >2 years, N=442 HR (CI)***; P**TTP6.6 8.9 0.74 (0.63, 0.88); .001OS17.2 23.4 0.63 (0.52, 0.75); <.001PFS6.5 8.7 0.74 (0.62, 0.87); <.001ORR30% 31% P=.826†*Proportional hazard model for PLD+D vs D; **Log-rank test; ***Proportional hazard model for >2 years vs ≤2 years A-F; †Cochran-Mantel-Haenszel test.Overall, HFS and stomatitis occurred more often in pts treated with PLD+D. The overall incidence of CHF was 1%.Conclusions: An A-F interval of >2 years reduced the risk for TTP, OS, and PFS, regardless of treatment. However, similar to results of the overall study, treatment with the combination PLD+D resulted in statistically significant improvement of TTP and PFS, but not OS, compared with D among pts with ABC, regardless of A-F interval. The addition of PLD to a D-based regimen is an active option for pts with ABC previously treated with adjuvant anthracycline regimens.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2095.
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Affiliation(s)
- J. Sparano
- 1Albert Enstein College of Medicine, NY,
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- 3Centocor Ortho Biotech Services, LLC, PA,
| | - K. Lantz
- 3Centocor Ortho Biotech Services, LLC, PA,
| | - C. Lowery
- 3Centocor Ortho Biotech Services, LLC, PA,
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Shah JJ, Londhe A, Lantz KC, Lowery C, Orlowski RZ. Relationship of rapid M protein reduction to outcomes in a trial of pegylated liposomal doxorubicin (PLD) plus bortezomib (B) versus B alone in previously treated multiple myeloma (MM). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8591 Background: An early response in MM results in rapid improvement in symptoms and may benefit outcomes. To investigate the relationship between rapid response and outcomes, we retrospectively evaluated early reduction in M protein (MProt) in a trial of pegylated liposomal doxorubicin + bortezomib (PLD+B) vs B alone in relapsed/refractory multiple myeloma (MM). (Orlowski, JCO 2007) Methods: Patients (pts) were randomized to bolus IV B 1.3 mg/m2 on days 1, 4, 8, & 11 of each 3-week cycle (N=322) or to the same B regimen + IV PLD 30 mg/m2 on day 4 (N=324) of each cycle. % decrease from baseline of MProt was evaluated using a landmark analysis at the end of cycles 2 and 4. Pts were categorized into 4 groups by reduction in MProt at the landmark timepoints. 199 PLD+B and 205 B pts were included in the analysis at end of cycle 2. Time to progression (TTP) post-landmark was evaluated using a Cox proportional hazard model with treatment and the three ≥25% MProt reduction groups compared to the <25% group as factors. Results: Regardless of treatment, a decrease in risk of TTP was observed for greater reduction in MProt. This was significant for the 50–75% and ≥75% MProt reduction groups. Hazard ratios (95% CI) were: [0.84 (0.55, 1.30), P=.438] for 25-<50% vs 25%; [0.41 (0.26, 0.64), P=.001] for 50-<75% vs <25%; and [0.26 (0.15, 0.45), P=.001] for ≥75% vs <25%. PLD+B had a significant benefit over B alone in extending TTP [1.68 (1.19, 2.37), P=.003]. TTP was longer as MProt decreased and improved for PLD+B vs B. Similar results were observed at the end of cycle 4 landmark. Safety profiles for the 2 regimens were consistent with known toxicities of the agents. Conclusions: PLD+B had significant benefit over B alone in extending TTP in landmark analyses similar to the overall study. A >50% reduction in MProt resulted in a significant risk reduction for progression. These data suggest that early reductions in MProt may provide better outcomes. [Table: see text] [Table: see text]
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Affiliation(s)
- J. J. Shah
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Centocor Ortho Biotech Services LLC, Horsham, PA
| | - A. Londhe
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Centocor Ortho Biotech Services LLC, Horsham, PA
| | - K. C. Lantz
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Centocor Ortho Biotech Services LLC, Horsham, PA
| | - C. Lowery
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Centocor Ortho Biotech Services LLC, Horsham, PA
| | - R. Z. Orlowski
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Centocor Ortho Biotech Services LLC, Horsham, PA
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Kiefer I, Siegel E, Preissl H, Ware M, Schauf B, Lowery C, Eswaran H. Delayed maturation of auditory-evoked responses in growth-restricted fetuses revealed by magnetoencephalographic recordings. Am J Obstet Gynecol 2008; 199:503.e1-7. [PMID: 18533116 DOI: 10.1016/j.ajog.2008.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 12/20/2007] [Accepted: 04/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate fetal brain development of growth-restricted fetuses with auditory evoked responses (AER) that were recorded by the noninvasive magnetoencephalographic technique. STUDY DESIGN Serial fetal recordings that started at 27 weeks of gestation were conducted on a fetal magnetoencephalographic device that was especially designed for obstetric assessment. Fifteen normotrophic fetuses were compared with 14 hypotrophic fetuses. After birth, 10 of the hypotrophic fetuses were diagnosed with asymmetric growth restriction; 4 fetuses were classified as symmetrically small for gestational age. RESULTS Fetal AER latencies in both groups showed an average developmental decrease of 12.74 msec/wk (P = .0035). Hypotrophic fetuses had longer age-adjusted latencies compared with normotrophic fetuses, with a difference of 73.5 msec (P = .034). The subgroup of symmetrically growth-restricted fetuses showed the longest latencies for age, with a difference from the normotrophic fetuses of 120.0 msec (P = .045). CONCLUSION The results indicate that biomagnetically recorded AER can be used to monitor functional brain development in growth-restricted fetuses.
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Liu W, Zagzebski JA, Hall TJ, Madsen EL, Varghese T, Kliewer MA, Panda S, Lowery C, Barnes S. Acoustic backscatter and effective scatterer size estimates using a 2D CMUT transducer. Phys Med Biol 2008; 53:4169-83. [PMID: 18635893 DOI: 10.1088/0031-9155/53/15/011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compared to conventional piezoelectric transducers, new capacitive microfabricated ultrasonic transducer (CMUT) technology is expected to offer a broader bandwidth, higher resolution and advanced 3D/4D imaging inherent in a 2D array. For ultrasound scatterer size imaging, a broader frequency range provides more information on frequency-dependent backscatter, and therefore, generally more accurate size estimates. Elevational compounding, which can significantly reduce the large statistical fluctuations associated with parametric imaging, becomes readily available with a 2D array. In this work, we show phantom and in vivo breast tumor scatterer size image results using a prototype 2D CMUT transducer (9 MHz center frequency) attached to a clinical scanner. A uniform phantom with two 1 cm diameter spherical inclusions of slightly smaller scatterer size was submerged in oil and scanned by both the 2D CMUT and a conventional piezoelectric linear array transducer. The attenuation and scatterer sizes of the sample were estimated using a reference phantom method. RF correlation analysis was performed using the data acquired by both transducers. The 2D CMUT results indicate that at a 2 cm depth (near the transmit focus for both transducers) the correlation coefficient reduced to less than 1/e for 0.2 mm lateral or 0.25 mm elevational separation between acoustic scanlines. For the conventional array this level of decorrelation requires a 0.3 mm lateral or 0.75 mm elevational translation. Angular and/or elevational compounding is used to reduce the variance of scatterer size estimates. The 2D array transducer acquired RF signals from 140 planes over a 2.8 cm elevational direction. If no elevational compounding is used, the fractional standard deviation of the size estimates is about 12% of the mean size estimate for both the spherical inclusion and the background. Elevational compounding of 11 adjacent planes reduces it to 7% for both media. Using an experimentally estimated attenuation of 0.6 dB cm(-1) MHz(-1), scatterer size estimates for an in vivo breast tumor also demonstrate improvements using elevational compounding with data from the 2D CMUT transducer.
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Affiliation(s)
- W Liu
- Department of Medical Physics, University of Wisconsin-Madison, 1300 University Avenue, 1530 MSC, Madison, WI 53706, USA.
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Lowery C, Bronstein J, McGhee J, Ott R, Reece EA, Mays GP. ANGELS and University of Arkansas for Medical Sciences paradigm for distant obstetrical care delivery. Am J Obstet Gynecol 2007; 196:534.e1-9. [PMID: 17547884 DOI: 10.1016/j.ajog.2007.01.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/15/2006] [Accepted: 01/22/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article describes the process by which the Arkansas Medicaid Program, the University of Arkansas for Medical Sciences (the state's only academic health center), and Arkansas' practicing physicians are collaborating to improve the process of perinatal regionalization by providing access to expertise, education, and support of maternal-fetal medicine specialists. The described ANGELS model encourages replication among other programs that wish to improve perinatal regionalization attempts in their service areas. STUDY DESIGN Through this unique collaboration, ANGELS is composed of 5 distinctive elements: a statewide telemedicine and clinic network, an education and support program for obstetric providers, case management services, a 24-hour Call Center, and an evidence-based guidelines development and distribution network. RESULTS Since Arkansas has undertaken perinatal regionalization, technology has allowed the state's only group of board-certified maternal-fetal medicine specialists, located centrally in Little Rock, to provide real-time clinical support to physicians, as well as consultation or direct care to patients statewide. CONCLUSION ANGELS' continued efforts have the potential to significantly improve perinatal care in rural areas throughout the state, while the cost of maternal and fetal health care could decline. The program's design, although unique, can be replicated elsewhere to encourage perinatal regionalization.
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Affiliation(s)
- Curtis Lowery
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Draganova R, Eswaran H, Murphy P, Lowery C, Preissl H. Serial magnetoencephalographic study of fetal and newborn auditory discriminative evoked responses. Early Hum Dev 2007; 83:199-207. [PMID: 16863685 DOI: 10.1016/j.earlhumdev.2006.05.018] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 05/23/2006] [Accepted: 05/25/2006] [Indexed: 11/19/2022]
Abstract
The mismatch negativity (MMN) response elicited to auditory stimuli is an indicator for cognitive function of sound discrimination in humans. MMN was successfully recorded in previous studies in newborns and fetuses (33-40 weeks of gestation) with magnetoencephalography (MEG). The aim of our study was to perform systematic serial MMN recordings on fetuses starting at 28 weeks of gestation with a follow up recording within 2 weeks after birth. The recording of weak magnetic fields from the fetal brain were performed with the 151 channel MEG system called SARA (SQUID Array for Reproductive Assessment). Two tone bursts were presented in a sequence of a standard complex tone of 500 Hz intermixed with a deviant complex tone of 750 Hz in 12% of the stimuli, inter-stimulus interval 800+/-100 ms. Eighteen pregnant women between 28th and 39th gestational weeks participated in the study. Measurements were performed every two weeks and once after delivery. The averaged evoked responses to standard and deviant tones were obtained and subtraction between them was calculated. A successful detection of response to the frequency change was found in 66% of the fetal data and 89% of the neonatal data. Responses to the standard tone were detected in 56% of all records. In the 28-39 week gestational age group, the discriminative brain responses to tone frequency change could be detected as early as 28 weeks. Although not statistically significant, a decrease in latency was observed with increase in gestational age. The ability of the fetus to detect changes in sounds is a prerequisite to normal development for cognitive function; related to language learning and clinical aspects of auditory disorders.
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Affiliation(s)
- Rossitza Draganova
- SARA Research Center, Department of Ob/Gyn, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, Arkansas 72205-7199, United States
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Glen M, Lowery C, Bronstein J, Nugent R, Hall RW. Effects of distance-based obstetrical management on patterns of delivery for high-risk pregnancies. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mays G, Lowery C, Bronstein J, Richard N, Hall RW. Improving low birthweight infant survival through distance-based obstetrical management. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schaller C, Eswaran H, Preissl H, Wilson J, Oglesby DM, Lowery C. Habituation of fetal evoked brain responses to visual stimulation. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lowery C, Eswaran H, Preissl H, Murphy P. Assessment of fetal brain exposure to smoking. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.10.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Draganova R, Eswaran H, Murphy P, Huotilainen M, Lowery C, Preissl H. Sound frequency change detection in fetuses and newborns, a magnetoencephalographic study. Neuroimage 2005; 28:354-61. [PMID: 16023867 DOI: 10.1016/j.neuroimage.2005.06.011] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 04/06/2005] [Accepted: 06/01/2005] [Indexed: 10/25/2022] Open
Abstract
The mismatch negativity (MMN) response to auditory stimuli has been successfully recorded in newborns thus demonstrating the discriminative cognitive ability. The aim of our study was to determine whether and when such an MMN response could be detected in the human fetus. The recordings of weak magnetic fields from the fetal brain were performed with the 151 channel MEG system called SARA (SQUID Array for Reproductive Assessment). Two tone bursts were presented in a sequence of a standard complex tone of 500 Hz intermixed with a deviant complex tone of 750 Hz in 12% of the stimuli. Sound intensity delivered over the maternal abdomen was 110 dB. The interstimulus interval (ISI) varied between 500 ms and 1100 ms. Fetal response, corresponding to sound frequency change detection, was calculated from the records where responses to standard and deviant tones were observed. A successful response was found in 60% of 25 fetal recordings. The MMN response with an average latency of 321 ms was observed in 48% of the fetal data. In 12% of the fetal data, a late component, referred to as the late discriminative negativity (LDN) response, was detected with an average latency of 458 ms. The same paradigm was applied in 5 newborns after birth. The capability for sound discrimination is a prerequisite for normal speech development. The investigation of sound discrimination and related cortical activity of the fetus can help to identify and determine the nature of deficits caused by central processes in the auditory system at very early stages.
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Affiliation(s)
- Rossitza Draganova
- SARA Research Center, Ob/Gynecology Department, 4301 West Markham Street, number 518 Little Rock, AR 72205-7199, USA.
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Ramon C, Preissl H, Murphy P, Wilson JD, Lowery C, Eswaran H. Synchronization analysis of the uterine magnetic activity during contractions. Biomed Eng Online 2005; 4:55. [PMID: 16197557 PMCID: PMC1266387 DOI: 10.1186/1475-925x-4-55] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 10/01/2005] [Indexed: 11/20/2022] Open
Abstract
Background Our objective was to quantify and compare the extent of synchronization of the spatial-temporal myometrial activity over the human uterus before and during a contraction using transabdominal magnetomyographic (MMG) recordings. Synchronization can be an important indicator for the quantification of uterine contractions. Methods The spatialtermporal myometrial activity recordings were performed using a 151-channel noninvasive magnetic sensor system called SARA. This device covers the entire pregnant abdomen and records the magnetic field corresponding to the electrical activity generated in the uterine myometrium. The data was collected at 250 samples/sec and was resampled with 25 samples/sec and then filtered in the band of 0.1–0.2 Hz to study the primary magnetic activity of the uterus related to contractions. The synchronization between a channel pair was computed. It was inferred from a statistical tendency to maintain a nearly constant phase difference over a given period of time even though the analytic phase of each channel may change markedly during that time frame. The analytic phase was computed after taking Hilbert transform of the magnetic field data. The process was applied on the pairs of magnetic field traces (240 sec length) with a stepping window of 20 sec duration which is long enough to cover two cycle of the lowest frequency of interest (0.1 Hz). The analysis was repeated by stepping the window at 10 sec intervals. The spatial patterns of the synchronization indices covering the anterior transabdominal area were computed. For this, regional coil-pairs were used. For a given coil, the coil pairs were constructed with the surrounding six coils. The synchronization indices were computed for each coil pair, averaged over the 21 coil-pairs and then assigned as the synchronization index to that particular coil. This procedure was tested on six pregnant subjects at the gestational age between 29 and 40 weeks admitted to the hospital for contractions. The RMS magnetic field for each coil was also computed. Results The results show that the spatial patterns of the synchronization indices change and follow the periodic pattern of the uterine contraction cycle. Spatial patterns of synchronization indices and the RMS magnetic fields show similarities in few window frames and also show large differences in few other windows. For six subjects, the average synchronization indices were: 0.346 ± 0.068 for the quiescent baseline period and 0.545 ± 0.022 at the peak of the contraction. Discussion These results show that synchronization indices and their spatial distributions depict uterine contractions and relaxations.
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Affiliation(s)
- Ceon Ramon
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Hubert Preissl
- MEG Center, University of Tübingen. Tübingen, Germany
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pam Murphy
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James D Wilson
- Graduate Institute of Technology, University of Arkansas at Little Rock, Little Rock, Arkansas, USA
| | - Curtis Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Holst M, Eswaran H, Lowery C, Murphy P, Norton J, Preissl H. Development of auditory evoked fields in human fetuses and newborns: A longitudinal MEG study. Clin Neurophysiol 2005; 116:1949-55. [PMID: 16005681 DOI: 10.1016/j.clinph.2005.04.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Revised: 04/08/2005] [Accepted: 04/11/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the maturation of the auditory cortex by non-invasive recording of auditory evoked magnetic fields in human fetuses and newborns with the relatively novel and completely non-invasive technology of MEG. METHODS Serial recordings were performed every 2 weeks on 18 fetuses beginning from week 27 of gestational age until term with a follow-up recording on the newborn. Auditory stimulation consisted of tone bursts in an oddball design with standard tones and deviant tones. RESULTS In 52 of 63 fetal and in all of the neonatal recordings an auditory evoked magnetic field was obtained. A decrease in latency with increasing age of the subjects was observed in the combined analysis of fetuses and neonates. CONCLUSIONS With advanced study using MEG, 83% of the measurements showed auditory evoked fields in fetuses that correspond with existing literature in electrophysiology in the past. These findings indicate that MEG is a technique that can be used to investigate maturation of the auditory cortex based on auditory evoked fields in fetuses and neonates. SIGNIFICANCE Maturational changes have been examined in the past. With the use of this novel technique, applied to a serial study, it is possible to trace the development of auditory responses in utero and newborns.
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Affiliation(s)
- Manuela Holst
- Department of Obstetrics and Gynecology, SARA Research Center, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 518, Little Rock, AR 72205, USA.
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Preissl H, Norton J, Wilson J, Eswaran H, Kay H, Campbell J, Murphy P, Lowery C. Effects of auditory evoked stimuli on fetal behavior. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Campbell JQ, Preissl H, Eswaran H, Kay HH, Wilson J, Murphy P, Lowery C. Improved spatio-temporal evaluation of fetal cardiac signals. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Britt D, Butler B, Hulen A, McGhee J, Kay H, Lowery C. Low birth weight patterns: assessing telemedical access inequality in Arkansas. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lowery C, Preissl H, Wilson J, Bayrak C, Norton J, Kay H, Murphy P, Kolukisaog H, Eswaran H. Non-invasive magnetomyographic recordings of the uterus to predict labor in term pregnancies. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lowery C, Kay H, Norton J, McGhee J. Effects of prior authorization on statewide medicaid non-stress testing claims. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The development of suitable techniques for quantifying mechanical and electrophysiological aspects of uterine contractions has been an active area of research. The uterus is a physiological system consisting of a large number of interacting muscle cells. The activity of these cells evolves with time, a trait characteristic of a dynamical system. While such complex physiological systems are non-linear by their very nature, whether this non-linearity is exhibited in the external recording is far from trivial. Traditional techniques such as spectral analysis have been used in the past, but these techniques implicitly assume that the process generating the contractions is linear and hence may be biased. In this tutorial review, a systematic approach using a hierarchy of surrogate algorithms is used to determine the nature of the process generating the contractions produced during labor. The results reveal that uterine contractions are probably generated by non-linear processes. The contraction segments were obtained through simultaneous recordings of the electrical and magnetic signals corresponding to the electrophysiological activity of the uterus and then analyzed. The electrical activity was recorded by placement of non-invasive electrodes onto the maternal abdomen and magnetic activity was recorded non-invasively using a superconducting quantum interference device (SQUID).
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Affiliation(s)
- R Nagarajan
- Center on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Schauf B, Lowery C, Wilson JD, Eswaran H, Birbaumer N, Aydeniz B, Wallwiener D, Preissl H. [New perspectives in intrauterine surveillance with the fetal magnetoencephalogram]. Zentralbl Gynakol 2003; 125:218-25. [PMID: 14556120 DOI: 10.1055/s-2003-42602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite intensive research and surveillance up to now one has failed to reduce cerebral handicaps in newborn. Fetal heart rate tracing (CTG) and Doppler have reduced the number of subpartal severe asphyxia and fetal death. But, 90% of cerebral damage is a result of antepartal problems. Thus only 10% can be avoided by intensive surveillance during labor. Detection of antenatal cerebral injury is a rare case and its impact on later fetal life can only be estimated. Insight in fetal neuronal function is not possible. Factors and time pattern determining fetal cerebral injury are thus not known. This publication explains a new system with whom one might be able to get more insight in cerebral wellbeing during the fetal intrauterine life. METHODS AND RESULTS A new diagnostic approach is set up by recording fetal magnet encephalographic signals (fMEG) thus offering the opportunity to detect fetal brain function. An array which was especially designed to fit to the pregnant body consists of 151 sensors which are able to record the fMEG. Clinical testing is performed in the moment at the UAMS in Little Rock, Arkansas in Cooperation with the Institutes for Medical Psychology and the Frauenklinik in Tiibingen. First results and arising questions are published. CONCLUSION With this new system a deeper insight into the fetal neuronal development and fetal wellbeing during pregnancy might be achieved thus reforming the fetal surveillance in the 21st century.
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Affiliation(s)
- B Schauf
- Universitäts-Frauenklinik Tübingen.
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