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Alabyad D, Lemuel-Clarke M, Antwan M, Henriquez L, Belagaje S, Rangaraju S, Mosley A, Cabral J, Walczak T, Ido M, Hashima P, Bayakly R, Collins K, Sutherly-Bhadsavle L, Brasher C, Danaie E, Victor P, Westover D, Webb M, Skukalek S, Barrett AM, Esper GJ, Nahab F. Telemedicine impact on post-stroke outpatient follow-up in an academic healthcare network during the COVID-19 pandemic. J Stroke Cerebrovasc Dis 2023; 32:107213. [PMID: 37384981 PMCID: PMC10284452 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107213] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up. METHODS We retrospectively evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive and primary stroke centers in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of 90-day follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1, 2019- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across hospitals less than 1 mile, 10 miles, and 25 miles from the stroke clinic. RESULTS Of 1096 ischemic stroke patients discharged home or to a rehab facility during the study period, 342 (31%) had follow-up in the Emory Stroke Clinic (comprehensive stroke center 46%, primary stroke center 10 miles away 18%, primary stroke center 25 miles away 14%). Overall, 90-day follow-up increased from 19% to 41% after telemedicine implementation (p<0.001) with telemedicine appointments amounting for up to 28% of all follow-up visits. In multivariable analysis, factors associated with teleneurology follow-up (vs no follow-up) included discharge from the comprehensive stroke center, thrombectomy treatment, private insurance, private transport to the hospital, NIHSS 0-5 and history of dyslipidemia. CONCLUSIONS Despite telemedicine implementation at an academic healthcare network successfully increasing post-stroke discharge follow-up in a centralized subspecialty stroke clinic, the majority of patients did not complete 90-day follow-up during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Marlyn Antwan
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Laura Henriquez
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Samir Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Srikant Rangaraju
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Ashlee Mosley
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Jacqueline Cabral
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Teri Walczak
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Moges Ido
- Georgia Department of Public Health, Atlanta, GA, United States
| | | | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA, United States
| | | | | | | | | | | | | | - Mark Webb
- Emory Healthcare, Atlanta, GA, United States
| | - Susana Skukalek
- Department of Neurosurgery, Emory University, Atlanta, GA, United States
| | - A M Barrett
- Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Gregory J Esper
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States.
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Victor P, Mohamed G, Aboul Nour HOM, Miller K, Singh K, Patel S, Segovis CM, Nahab FB. Abstract WP25: Up-front Vascular Imaging At A Primary Stroke Center: Impact On Door In Door Out Time For Patients With Acute Ischemic Stroke And Large Vessel Occlusion. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp25] [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: 02/05/2023]
Abstract
Background:
AHA/ASA guidelines recommend obtaining early vessel imaging with CT angiography (CTA) or MR angiography (MRA) only in a select group of acute ischemic stroke (AIS) patients suspected to have large vessel occlusion (LVO). There is limited data on the utility of early cerebrovascular imaging in all suspected AIS patients presenting within 24 hours and its impact on door in-door out (DIDO) time.
Methods:
In January 2020, our Primary Stroke Center implemented a protocol to obtain upfront head and neck CTA simultaneously with a non contrast head CT for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 hours from last known normal time. We retrospectively reviewed patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022) to assess time metrics for patients receiving IV thrombolysis and/or transfer for thrombectomy.
Results:
A total of 86 AIS patients were evaluated during the study period. Time metrics before and after protocol implementation for thrombectomy eligible patients are shown in the figure. Compared to 2019, up-front CTA was associated with significant reductions in Door-to-CTA start (median 37 vs 14 minutes, p=0.05), Door-to-CTA interpretation (median 83 vs 52 minutes, p=0.02) and DIDO times (median 150 vs 106 minutes, p=0.02) in the final 12 months of the study period. There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 minutes, p=0.40).
Conclusion:
In conclusion, up-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 hours resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and accelerate patient transport to thrombectomy capable centers.
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Lemuel-Clarke M, Antwan M, Henriquez L, Belagaje SR, RANGARAJU S, Mosley A, Cabral J, Walczak T, Ido M, Hashima P, Bayakly R, Jaffe J, Sutherly-Bhadsavle L, Brasher C, Danaie EI, Victor P, Westover D, Webb M, Skukalek SL, Barrett AM, Esper GJ, Nahab F. Abstract NS3: Telemedicine Impact On Post-stroke Outpatient Follow-up In An Academic Healthcare Network. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.ns3] [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
Introduction:
The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up.
Methods:
With this retrospective cohort study, we evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive (CSC) and primary stroke centers (PSC) in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of successful post-hospitalization follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across network hospitals less than 1 mile (CSC) and 25 miles (PSC25) from the specialty stroke clinic.
Results:
Of the 553 ischemic stroke patients [median age 68 years (IQR 58-79), median NIHSS 4 (IQR 1-8)] discharged home or to a rehab facility during the study period, 241 (43.6%) had follow-up in the Emory Stroke Clinic (CSC=48%, PSC25=23%). Overall, 90-day follow-up increased from 31% before to 48% after telemedicine implementation. Similarly, telemedicine appointments increased from 19% to 72% of the follow-up visits. The increase in follow-up visits was modest among CSC patients, from 41% to 51% (p=0.16), relative to the increase among PSC25 patients (5.3% to 31%, p=0.002).
Conclusions:
Telemedicine implementation at an academic healthcare network successfully increased post-stroke discharge follow-up in a centralized subspecialty stroke clinic for hospitalized patients up to 25 miles from the clinic site. However, more work is required to facilitate follow up in the majority of patients.
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Kichenaradjou A, Victor P. When to explore the orbit. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.182] [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: 10/22/2022]
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D'sa SR, Victor P, Jagannati M, Sudarsan TI, Carey RAB, Peter JV. Severe methemoglobinemia due to ingestion of toxicants. Clin Toxicol (Phila) 2014; 52:897-900. [DOI: 10.3109/15563650.2014.947377] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ramos P, Victor P, Branco S. Spontaneous melanotic lesions in axillary seabream, Pagellus acarne (Risso). J Fish Dis 2013; 36:769-777. [PMID: 23383748 DOI: 10.1111/jfd.12031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/27/2012] [Revised: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 06/01/2023]
Abstract
In this article, we describe spontaneous melanotic lesions in the skin of axillary seabream, Pagellus acarne (Risso), from a defined area of the Portuguese Coast, located in Cabo da Roca and Foz do Arelho. The lesions corresponded to the black pigmentation spots on the skin of the head, fins, lips and conjunctiva and, additionally, black nodules on the skin of the head and lips. In some specimens, the nodular formations in the head changed their anatomical conformation. Histologically, there were melanophores scattered along the basement membrane or forming aggregates in the dermis, infiltrating the subcutaneous tissue but not invading the adjacent muscle tissue. The aim of this study was to characterize the macroscopic and microscopic features of the pigmented lesions. These fish show sessile hyperpigmented lesions (spots) that correspond to proliferative lesions of melanophores in the dermis and nodular lesions that correspond to neoplastic lesions, melanophoromas. The melanophores in such lesions showed high concentration of melanin in the cytoplasm, moderate pleomorphism and compact distribution throughout all of the dermis.
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Affiliation(s)
- P Ramos
- Laboratory of Pathology of Aquatic Animals, Portuguese Institute for the Sea and Atmosphere (IPMA, I.P.), Lisbon, Portugal.
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Affiliation(s)
- Patricia Victor
- Applied Math & CS, UGent, 9000 Gent, Belgium. E-mails: {Patricia.Victor, Chris.Cornelis, Martine.DeCock}@UGent.be
| | - Chris Cornelis
- Applied Math & CS, UGent, 9000 Gent, Belgium. E-mails: {Patricia.Victor, Chris.Cornelis, Martine.DeCock}@UGent.be
| | - Martine De Cock
- Applied Math & CS, UGent, 9000 Gent, Belgium. E-mails: {Patricia.Victor, Chris.Cornelis, Martine.DeCock}@UGent.be
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Suhr J, Victor P, Ci L, Sreekala S, Zhang X, Nalamasu O, Ajayan PM. Fatigue resistance of aligned carbon nanotube arrays under cyclic compression. Nat Nanotechnol 2007; 2:417-21. [PMID: 18654325 DOI: 10.1038/nnano.2007.186] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 05/30/2007] [Indexed: 05/22/2023]
Abstract
Structural components subject to cyclic stress can succumb to fatigue, causing them to fail at stress levels much lower than if they were under static mechanical loading. However, despite extensive research into the mechanical properties of carbon nanotube structures for more than a decade, data on the fatigue behaviour of such devices have never been reported. We show that under repeated high compressive strains, long, vertically aligned multiwalled nanotubes exhibit viscoelastic behaviour similar to that observed in soft-tissue membranes. Under compressive cyclic loading, the mechanical response of the nanotube arrays shows preconditioning, characteristic viscoelasticity-induced hysteresis, nonlinear elasticity and stress relaxation, and large deformations. Furthermore, no fatigue failure is observed at high strain amplitudes up to half a million cycles. This combination of soft-tissue-like behaviour and outstanding fatigue resistance suggests that properly engineered nanotube structures could mimic artificial tissues, and that their good electrical conductivity could lead to their use as compliant electrical contacts in a variety of applications.
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Affiliation(s)
- J Suhr
- Department of Mechanical Engineering, The University of Nevada, Reno, Nevada 89557, USA
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Talapatra S, Kar S, Pal SK, Vajtai R, Ci L, Victor P, Shaijumon MM, Kaur S, Nalamasu O, Ajayan PM. Direct growth of aligned carbon nanotubes on bulk metals. Nat Nanotechnol 2006; 1:112-6. [PMID: 18654161 DOI: 10.1038/nnano.2006.56] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 08/21/2006] [Accepted: 08/29/2006] [Indexed: 05/20/2023]
Abstract
There are several advantages of growing carbon nanotubes (CNTs) directly on bulk metals, for example in the formation of robust CNT-metal contacts during growth. Usually, aligned CNTs are grown either by using thin catalyst layers predeposited on substrates or through vapour-phase catalyst delivery. The latter method, although flexible, is unsuitable for growing CNTs directly on metallic substrates. Here we report on the growth of aligned multiwalled CNTs on a metallic alloy, Inconel 600 (Inconel), using vapour-phase catalyst delivery. The CNTs are well anchored to the substrate and show excellent electrical contact with it. These CNT-metal structures were then used to fabricate double-layer capacitors and field-emitter devices, which demonstrated improved performance over previously designed CNT structures. Inconel coatings can also be used to grow CNTs on other metallic substrates. This finding overcomes the substrate limitation for nanotube growth which should assist the development of future CNT-related technologies.
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Abstract
Arrays of Cr zigzag nanosprings and slanted nanorods, 15-55 nm and 40-80-nm-wide, respectively, were grown on SiO2/Si substrates by glancing angle deposition. The arrays exhibit a reversible change in resistivity upon loading and unloading, by 50% for nanosprings and 5% for nanorods, indicating their potential as pressure sensors. The resistivity drop is due to a compression of nanosprings (by a measured 19% for an applied external force of 10(-10) N per spring), which causes them to physically touch their neighbors, providing a path for electric current to flow between nanosprings. Repeated loading and unloading at large loads (> or =1 MPa) results in irreversible plastic deformation and a degradation of the pressure sensitivity.
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Affiliation(s)
- S V Kesapragada
- Department of Materials Science & Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
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Victor P. Early detection and early intervention of hearing handicapped children. ICCW News Bull 1992; 40:3-10. [PMID: 12286295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Victor P. One Hundred and Twenty-Two Round Worms Discharged by a Child in Five Days. Ind Med Gaz 1885; 20:319. [PMID: 29001254 PMCID: PMC5184518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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