A5040202023- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Traumatic Brain Injury and Neurovascular Disturbances
- Intracerebral and Subarachnoid Hemorrhage Research
- Venous Thromboembolism Diagnosis and Management
- Diabetic Foot Ulcer Assessment and Management
- Sexual function and dysfunction studies
- Trauma and Emergency Care Studies
- Menopause: Health Impacts and Treatments
- Telemedicine and Telehealth Implementation
- Neurosurgical Procedures and Complications
- LGBTQ Health, Identity, and Policy
- Clinical practice guidelines implementation
- Cerebrovascular and Carotid Artery Diseases
- Healthcare Systems and Public Health
- Cardiovascular Health and Risk Factors
- Emergency and Acute Care Studies
- Cardiac Health and Mental Health
- Older Adults Driving Studies
- Neurological Disorders and Treatments
- Radiology practices and education
- Dementia and Cognitive Impairment Research
- Medical Imaging and Analysis
- Cardiac Arrest and Resuscitation
- Sexuality, Behavior, and Technology
Banner - University Medical Center Phoenix
2025
University of Arizona
2025
University of Tennessee Health Science Center
2017-2025
The Gurdon Institute
2019
Dillon Consulting
2019
Wichita State University
2017-2018
Central DuPage Hospital
2018
Hackensack Meridian Health
2018
Ascension Via Christi
2015-2016
Background: Primary stroke centers (PSC) lacking vascular neurologists are often challenged with evidence-compliant inpatient care. We determined impact of fellowship educated nurse practitioners (NP) for PSC Methods: Stroke patients arriving at 3 PSCs were emergently evaluated by CSC via telestroke; uncomplicated ischemic strokes admitted/triaged local hospitalists to either general neurologist (GN) or NP telestroke management. Demographics, medical management, complications, and core...
Background and Purpose- The impact of a mobile stroke unit (MSU) on access to intraarterial thrombectomy (IAT) is prespecified BEST-MSU substudy (Benefits Stroke Treatment Delivered Using Mobile Unit Compared Standard Management by Emergency Medical Services). On the MSU, IAT decision-making steps, such as computed tomography, neurological exam, tPA (tissue-type plasminogen activator) treatment are completed before emergency department arrival. We hypothesized that pre-ED assessment...
Background We sought to determine if the National Institutes of Health Stroke Scale (NIHSS) has a greater discriminative power than Glasgow coma scale (GCS) identify patients at risk poor early functional outcomes and large hematoma volumes. Methods prospectively collected clinical assessments, imaging, outcome data in consecutive with intracerebral hemorrhage, determined ability GCS NIHSS predict (modified Rankin 3–6) volume >30 cm 3 using receiver operating characteristics analysis,...
Background Mobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) the aortic arch/neck/circle Willis has not been previously reported. Methods We performed a prospective observational study first-of-its kind MSU equipped high resolution, 16-slice multiphasic CTA. Field CT/CTA was on all suspected patients regardless symptom severity or resolution. Performance dependability, efficiency over 365 days...
Alteplase is a tissue plasminogen activator approved for treating acute ischemic stroke (AIS), myocardial infarction (AMI), and massive pulmonary embolism. Two additional activators, tenecteplase reteplase, are also AMI treatment. However, neither nor reteplase AIS The U.S. Food Drug Administration has received reports of accidental administration or instead alteplase in patients with AIS, which can lead to potential overdose. Primary factors contributing medication errors include use the...
Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile units (MSU) have demonstrated ultrafast compared standard emergency care. Geospatial analysis the distribution MSU cases service delivery has not been reported.We aggregated all first-year dispatch occurrences and classified by clinical teams as true zip code calculated incidence rates. We mapped symbolized rates deviation. confirmed visual impressions clusters from map inspection local Moran's I, boxplot...
Variance from guideline-directed care for glucose and temperature control remains unknown in the United States at a time when priorities have shifted to ensure rapid diagnosis treatment of acute stroke patients. However, protocol-driven nursing surveillance hyperglycemia hyperthermia has been shown improve patient outcomes.We conducted an observational pilot study assess compliance with American guidelines association discharge outcomes consecutive patients admitted 5 US comprehensive...
Background Transfer times from primary stroke centers and acute stroke–ready hospitals to higher levels of care are often excessive, prompting some suggest ambulance bypass regulations. Since barriers rapid transfer have never been fully explored, we sought understand coordinators’ experiences with patients hyperacute lower centers. Methods We conducted a national focus group study center coordinators who had recent experience overseeing patient higher‐level center. Interviews were using...
The aim of the study was to analyze factors affecting sexual activity in individuals with and without stroke, ages 40-59 years, a national, cross-sectional, population-based sample derived from National Health Nutrition Examination Survey (NHANES).Descriptive, cross-sectional survey.Data were obtained NHANES (2011-2012) data set (N = 3,649) completing items related cardiovascular risk factors, drugs, activity. Data analyzed using chi-square, t tests, logistic regression.Overall, number...
Background: Both Glasgow Coma Scale (GCS) and NIH Stroke (NIHSS) are commonly used as serial assessment tools in ICH, however, the NIHSS lacks formal validation this population. Methods: We prospectively collected ICH assessments, imaging, outcome data. Direct comparisons of discrimination were made using GCS on prediction 24-hour poor functional (mRS-3-6) hematoma volume >30cm 3 ROC analysis; c statistics calculated compared with DeLong test. Results: 672 patients (mean age 62±14 years;...
Background: In the Australian QASC Trial (Lancet 2013), better glucose and fever control improved 90 day outcomes when nurses adhered to strict monitoring/treatment protocols. We examined variance from guideline specific care for in an American sample. Methods: An observational study was conducted assess compliance with AHA/ASA stroke guidelines consecutive acute patients 5 different U.S. Stroke Centers. The first 5-days of glucose/temperature data were analyzed along demographics outcome...
Background: Understanding geospatial regional stroke burden and emergency medical services (EMS) response locations may benefit attainment distribution of prehospital resources, enabling rapid diagnosis treatment. We sought to understand the spatial all Mobile Stroke Unit (MSU) dispatches diagnosed strokes during first year operation. Methods: All MSU dispatched cases from July 2016 2017 were assembled aggregated into groups based on status. The raw count incidents was by zip code,...
Background: MSU’s are capable of ultra-early treatment acute stroke patients in the field. We tested field use a high-resolution CT and CT-angiography on our MSU. Methods: designed implemented first its kind MSU equipped with 16 slice scanner (24-row adaptive detector array, fixed 70 cm gantry, auto-injection system, Somatom Scope, Siemens), led by fellowship trained MDs or ANVP-board certified nurse practitioners without telemedicine support. Head/neck CTA was performed all suspected...
Background: Emergent response to stroke requires internal hospital resources and manpower ensure delivery of rapid protocolized care. We compared the safety, effectiveness, efficiency an innovative Acute Stroke Response Team (I-ASRT) consisting nurse practitioners, physician assistants, critical care physicians, a traditional neurologist (T)-ASRT model. Methods: A retrospective descriptive study was conducted examine effect I-ASRT on IV-tPA treatment rates, door-to-needle (DTN) times, T-ASRT...
Prior to the conduct of Head Position in Stroke Trial (HeadPoST), an international survey (n = 128) revealed equipoise for selection head position acute ischemic stroke.We aimed determine whether exists spontaneous hyperacute intracerebral hemorrhage (ICH) patients following HeadPoST.This is international, web-distributed focused on positioning ICH patients.A was constructed examine clinicians' beliefs and practices associated with patients. Survey items were developed content experts,...