bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP36: The Role of Intravenous Thrombolysis in Patients With Acute Ischemic Stroke Treated With Mechanical Thrombectomy
Authors: Coutinho Jonathan M , Liebeskind David S , Slater Lee-Anne , Nogueira Raul G , Baxter Blaise , Davalos Antoni , Bonafé Alain , Jahan Reza , Goyal Mayank , Levy Elad I , Zaidat Osama , Gralla Jan , Saver Jeffrey L , Pereira Vitor M
Published: March 2022

Introduction:
Mechanical thrombectomy (MT) improves clinical outcome of patients with acute ischemic stroke (AIS) and a large vessel occlusion. Approximately 90% of patients in the recent MT trials received intravenous thrombolysis (IVT) prior to MT.

Aim:
To determine if IVT in combination with MT is superior to MT alone in patients with AIS and a large vessel occlusion.

Methods:
A patient-level pooled analysis of the STAR and SWIFT studies, two large multicenter prospective studies on MT for AIS was utilized. Using multivariate logistic regression analysis, we compared mRS at follow-up, reperfusion rates, and complication rates (intracerebral hemorrhage and emboli to uninvolved territories) between patients who underwent MT following IVT, to those who underwent only MT. An independent core laboratory scored all radiological outcomes.

Results:
Of 291 included patients, 160 (55%) underwent MT following IVT, and 131 (45%) underwent only MT. Of the patients treated with IVT, 116 were IVT failures (full tpa dose) and 44 received bridging therapy (mean tpa dose 0.62 mg/kg). Patients who received IVT less often had atrial fibrillation (33 vs. 47 %, p=0.016) and diabetes (14 vs. 24%, p=0.023), and had a lower mean ASPECTS (8.1 vs. 8.5, p=0.031) compared to thos who underwent only MT. There was no difference in baseline NIHSS (both median 17) or location of the occlusion between groups. We did not find a statistically significant association between use of IVT in addition to MT vs. MT alone for any of the outcomes. There were trends towards a lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.12, 95% CI 0.01-1.13), a higher risk of vasospasm (adjusted OR 1.81, 95% CI 0.86-3.80), and a higher chance of mRS 0-2 (adjusted OR 1.60, 95% CI 0.86-3.80) in patients who received MT following IVT, compared to MT alone.

Conclusions:
We observed no statistically significant benefit or harm for the use of IVT in addition to MT in patients with AIS and a large vessel occlusion.
Abstract WP361: Patients From the Tranexamic Acid for Hyperacute Intracerebral Haemorrhage (TICH-2) Trial Suffering From Hyperglycaemia at Baseline; Their Characteristics and Day 90 Outcomes
Authors: Sprigg Nikola , Robson Katie , Bath Philip M
Published: March 2022

Introduction:
Hyperglycaemia (HG) at presentation has been associated with poor outcome in intracerebral haemorrhage. Relationship with haematoma location (HL) has not been studied.

Methods:
In the ongoing TICH-2 study, history of diabetes and blood glucose level is recorded at baseline. Baseline characteristics and day 90 outcomes were compared for those with HG (glucose>6.5 mmol/L) and people with a history of diabetes. Day 90 outcomes include; modified Rankin Scale (mRS), Barthel index (BI) and Euroqol-5D (EQ-5D).

Results:
As of 21st July 2015, of 1065 participants, 477 (44.8%) of these had HG. Patients with HG had more lobar and infra-tentorial, than deep locations (chi-square: p<0.0001) and their baseline NIHSS scores were worse (multiple linear regression (MLR): p<0.0001). Day 90 mRS was worse for the HG patients (ordinal logistic regression, OR (95% CI): 1.87 (1.47, 2.38), p<0.0001). MLR was performed on other day 90 outcomes; BI (p=0.0103), EQ-5D (p<0.0001) and Zung (p=0.0447) were all worse for the HG group. The total number of patients with a SAE was found to differ significantly (chi-square: p<0.0001). Deaths were analysed and found to be non-significant. Patients with a history of diabetes were found to have significantly higher baseline glucose levels than those without (9.8 vs. 6.7, MLR: p<0.0001). BI was the only significant outcome for patients with diabetes (p=0.0473).

Conclusion:
Participants with HG had different haematoma locations and a worse NIHSS score at baseline. They also had significantly worse outcomes at day 90. History of diabetes was related to glucose level and BI at day 90 but not HL or other outcomes.
Abstract WP366: A Novel Risk Score to Predict In-hospital Deterioration After Spontaneous Intracerebral Hemorrhage: ICH Progression Score
Authors: Ji Ruijun , Zhang Runhua , Zhao Xingquan , Wang Yongjun
Published: March 2022

Background:
To develop a risk model (ICH Progression Score) to predict in-hospital deterioration after ICH using routinely collected variables at presentation.

Methods:
The ICH Progression Score was developed based on the China National Stroke Registry, in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Variables routinely collected at presentation were used for predicting in-hospital deterioration after ICH. For testing the added value of hematoma volume measure, we separately developed two models with (ICH Progression Score-A) and without (ICH Progression Score-B) hematoma volume included. In-hospital deterioration after ICH was defined as the episode in which a patient experienced a persistent increase in NIHSS score of 4 or more or death during hospitalization. Multivariable logistic regression was performed to identify independent predictors. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test was used to assess model discrimination and calibration, respectively.

Results:
In-hospital deterioration was 13.2% and 11.6% in the derivation (n=2870) and validation (n=1921) cohorts, respectively. A 23-point ICH Progression Score-A was developed based on a set of predictors and showed good discrimination in the derivation (AUROC=0.82; 95%CI=0.80-0.84) and validation (AUROC=0.79; 95%CI=0.76-0.82) cohorts. The ICH Progression Score-A was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.62) and validation (P=0.36) cohorts. Similarly, a 25-point ICH Progression Score-B was established. The ICH Progression Score-A and -B were not significantly different in discrimination for in-hospital deterioration after ICH.

Conclusion:
the ICH Progression Score are valid clinical grading scales for predicting in-hospital deterioration after ICH at presentation.
Abstract WP37: Whole Brain CT Perfusion Identifies Ischemic Events in Patients With Mild Neurological Symptoms
Authors: Frank Robert , Chakraborty Santanu , Mungham Alexander , Ross James , Dowlatshahi Dariush , Hogan Matthew J , Stotts Grant
Published: March 2022

Introduction:
More than half of ischemic stroke patients present as minor strokes (NIHSS<6). A lack of thrombolysis guidelines for this population leads to untreated strokes and erroneously treated stroke mimics, producing adverse outcomes. Data suggest that whole brain CT perfusion (WB-CTP) improves detection of ischemia, offering a potential method of ameliorating diagnostic uncertainty in these patients.

Hypothesis:
WB-CTP can guide clinical decisions by identifying patients with ischemic episodes that would benefit from thrombolysis or early intervention.

Methods:
This retrospective chart review enrolled 524 consecutive patients receiving WB-CTP with a Toshiba 320 detector scanner between 08/2008 and 06/2015, for acute stroke less than 6 hours from onset and NIHSS<6, and who showed no evidence of intracranial hemorrhage. Patients were excluded for non-diagnostic (n=25) or unreported (n=8) scans and non-ischemic findings (7). For diagnostic accuracy calculations, the reference standard was the final clinical impression suggesting ischemic events, as only 52% had follow-up imaging. Subgroup analyses were performed in patients receiving follow-up imaging.

Results:
A total of 484 patients (age 17-101, 54% men, mean NIHSS 2.47) were included. Follow-up imaging was performed in 251 patients; 150 underwent MRI with diffusion-weighted imaging (DWI). A summary of diagnostic accuracy values is shown in table below. WB-CTP is highly specific with a high positive predictive value in all groups and has moderate to high negative predictive value. Positive and negative likelihood ratios were 21.24 and 0.5 in the whole group analysis.

Conclusions:
Positive WB-CTP findings may warrant early intervention, including thrombolysis, while negative findings alone are not a sufficient basis upon which to confidently withhold interventions.
Abstract WP370: Differential Alternative Splicing of Leukocyte mRNAs After Intracerebral Hemorrhage and Ischemic Stroke of Different Etiologies
Authors: Dykstra-Aiello Cheryl J , Jickling Glen C , Ander Bradley P , Zhan Xinhua , Liu DaZhi , Hull Heather , Orantia Miles A , Ho Carolyn , Sharp Frank R , Stamova Boryana S
Published: March 2022

Transcriptome studies have used 3’-biased microarrays to study regulated genes and pathways in the blood of ischemic stroke (IS) patients, missing a majority of transcript isoforms due to alternative splicing (AS). AS is implicated in many diseases but is unexplored with respect to IS and intracerebral hemorrhage (ICH). Thus, we hypothesized AS differs between 1) IS, ICH and vascular risk factor control (VRFC) subjects; 2) three main causes of IS (Cardioembolic, Large Vessel and Lacunar), ICH and VRFC.

For Aim1, differential alternative splicing (DAS) in whole blood of IS vs ICH vs VRFC males was studied on Affymetrix exon junction HTA 2.0 arrays (n=36, 12 per group). For Aim 2, we investigated DAS between Cardioembolic, Large Vessel and Lacunar IS etiologies, and ICH and VRFC using paired-end RNA-Seq (Illumina Solexa, 200M 2X100bp reads per sample) on 20 whole blood RNA samples (n=4 males per group). DAS was assessed with 1-way-ANOVA (FDR p<0.05). Significant differential exon-usage was calculated between each group (p<0.0005; fold change> |1.2|). Differential usage of 90 exons separated the IS, ICH and VRFC groups. Affected genes included HGF (hepatic growth factor), involved in thrombosis and angiogenesis, and NOS1 (nitric oxide synthase 1), implicated in stroke risk. DAS among ICH, three main causes of IS, and VRFC was displayed by 412 genes. Differential expression of 308 exons separated these 5 groups. Several genes with DAS belonged to NF-kB and PPAR signaling pathways, SRA1, steroid receptor RNA activator 1, and Akt1, all of which have been implicated in experimental ICH pathogenesis. ICH activates NF-kB transcription factor which perpetuates inflammation. PPAR-gamma, via inhibition of NF-kB and induction of antioxidative pathways, reduces inflammation and oxidative stress and stimulates phagocytosis-mediated hematoma cleanup. In conclusion, our results provide first evidence for DAS in whole blood in ICH vs IS, and vs different IS etiologies. These data indicate disease specific immune response and could yield biomarkers for ICH and various IS causes. Future studies in a larger cohort are needed to validate results.
Abstract WP372: Preeclampsia and Intracerebral Hemorrhage Risk in Later Life
Authors: Koch Sebastian , Kittner Steven , Sekar Padmini , Moomaw Charles J , Osborne Jennifer , Langefeld Carl , Woo Daniel
Published: March 2022

Background:
Preeclampsia is an under recognized risk factor for vascular disease. Women with preeclampsia are at higher risk for ischemic cardiovascular and cerebrovascular events later in life. It is currently unknown if this risk also applies to hemorrhagic stroke. We here investigate the risk of non-pregnancy related intracerebral hemorrhage (ICH) in women with a history of preeclampsia. Our hypothesis was that a history of preeclampsia confers an increased risk of ICH in later life.

Method:
ERICH is a multi-center, prospective, case-control study of a racial-ethnically mixed population with ICH. Controls were identified through random digit dialing to match cases by age (+/- 5 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic) and geographic area. An obstetric history was obtained in all women with ICH and their controls. Pre-eclampsia was defined as: 1) Having been told to have had toxemia, pre-eclampsia or eclampsia or 2) having had high blood pressure and protein in the urine during any pregnancy. Odds ratios (OR) for preeclampsia were calculated in cases and controls. We also compared baseline demographics and ICH characteristics of women with and without a history of preeclampsia.

Results:
A total of 685 cases were matched to controls. Mean age was 65 years and hypertension was more prevalent in cases (76% vs. 47%, p <.0001). A history of preeclampsia was noted in 6% of controls and 7% of cases with an OR of 1.20 (0.77-1.88, p=0.425). In a case-case comparison, women with ICH and a history or preeclampsia were more likely to be younger (55±14 vs. 66±14 years, p<.0001) and hypertensive (93% vs. 83%, p=.0387). After adjusting for other baseline differences women with ICH and preeclampsia history remained significantly younger than those with no history of preeclampsia.

Conclusion:
Despite associations of pre-eclampsia with ischemic cardiovascular and cerebrovascular events later in life, we found no association of an increased risk of spontaneous ICH. Women with ICH and a history of pre-eclampsia, however, were more likely to have an ICH at a younger age, by nearly a decade, after controlling for all other variables. Women with preeclampsia may be a suitable target for interventions to prevent early life ICH.
Abstract WP373: Hyperacute Blood Pressure Variability in Intracerebral Hemorrhage Clinical Outcome
Authors: Cherkassky Georgy , Khorchid Yasser , Tsivgoulis Georgios , Alexandrov Andrei V , Chang Jason J
Published: March 2022

Background and Purpose:
Recently published trials--INTERACT 2, SAMURAI--have shown that early aggressive systolic blood pressure (SBP) management in patients presenting with intracerebral hemorrhage (ICH) may improve functional outcome and prevent early neurological deterioration, respectively. Additionally, post-hoc analyses and growing literature have demonstrated the importance of SBP variability toward clinical outcome. We sought to evaluate the role of blood pressure variability within the hyperacute phase (defined as the first 24 hours) after hospitalization for ICH and its role in short-term clinical outcome.

Material and Methods:
We retrospectively analyzed consecutive patients presenting with ICH at a tertiary level stroke center. Study inclusion criteria included adult age, ICH etiology as either hypertensive or amyloid angiopathy, and image confirmation of ICH. All patients with ICH were initially admitted to the intensive care unit; hourly blood pressure measurements within the first twelve hours were recorded. Blood pressure variability was calculated by taking the standard deviation of these initial hourly measurements.

Results:
90 patients fulfilled study inclusion criteria. Independent samples T-test showed the following: (1) maximum systolic blood pressure (maxSBP) were higher in those with poor outcome (197 ±29 mmHg) and good outcome (183 ±28 mmHg) (p=0.024) and (2) systolic blood pressure variation (SBPsd) was greater in those with poor outcome (24 ±9 mmHg) than good outcome (20 ±8 mmHg) (p=0.021). Multivariable regression analysis, adjusted for age, vascular risk factors (hypertension, diabetes, coronary artery disease, congestive heart failure, alcohol abuse, smoking), and clinical condition at admission (admission NIH stroke scale score and ICH score) showed that SBPsd remained an independent predictor of poor clinical outcome (p=0.043) and showed that for every 1 mmHg increase in SBP variability, the likelihood of poor clinical outcome was independently increased by 18% [95%CI (0.01-0.39)].

Conclusions:
Systolic blood pressure variability in the hyperacute phase could independently account for poor clinical outcomes in patients with intracerebral hemorrhage.
Abstract WP377: Gender Differences of Modifiable Risk Factors of Stroke and Psychological Factors Among Community-residing Adults With Prehypertension
Authors: Song Hee-Young , Nam Kyoung A
Published: March 2022

Introduction:
People with prehypertension that is systolic blood pressure (BP) over 120 mmHg or diastolic BP over 80 mmHg are known to be at increased risk for stroke compared to normotensive people. In addition to well-delineated impact of traditional risk factors such as hypercholesterolemia, diabetes, and obesity on the development of hypertension and stroke, recent research also suggests a need to examine further the relationship between psychological health factors such as stress and depression, and BP, and differences of these factors by gender in this population.

Objectives:
This study was undertaken to investigate modifiable risk factors of stroke and psychological factors including stress and depression; to explore differences of these variables and their relationships by gender among community-residing adults with prehypertension.

Methods:
A total of 103 participants aged 45.8 years old were recruited by a convenient sampling in two urban areas in South Korea. Along with BP and anthropometric measurement, trained interviewers interviewed participants with a structured questionnaire including demographic characteristics, lifestyle risk factors of stroke, stress measured by Korean version of Brief Encounter of Psychosocial Instrument, and depression measured by Korean version of Beck Depression Inventory. Data were analyzed using SPSS statistics 20.0

Results:
Mean systolic BP of participants was 131.0 mmHg and mean diastolic BP, 80.3 mmHg. Sixty four percent of participants were men and they showed significantly higher diastolic BP, and higher prevalence of stroke risk factors including physical inactivity, high fat diet, currently smoking, and immoderate drinking, whereas stress and depression showed no significant gender differences in this population. Among men, depression showed significant negative correlation with both systolic and diastolic BP, predicting 10% of systolic BP and 6 % of diastolic BP. No significant relationship between these variables was found among women.

Conclusions:
These results suggest the need to address gender differences of prevalence of stroke risk factors and relationships between psychological factor and BP for BP management among community-residing prehypertensive adults.
Abstract WP381: DTN Too Slow? Who You Gonna Call? Clot Busters - and the Stroke Coordinator!
Authors: Richardson Alicia , Morrison Kathy
Published: March 2022

Background:
Tissue plasminogen activator (tPA) remains the only FDA approved drug treatment for acute ischemic stroke, and research continues to provide evidence that the earlier treatment brings better outcomes. In 2013, the stroke team at this Comprehensive Stroke Center was treating 24% of patients with tPA in less than 60 minutes and 8% in less than 45 minutes. In order to meet the increasingly challenging DTN benchmarks, the program leadership recognized the need to re-invigorate the acute stroke process and to address reasons for delay: staff disengagement, lack of knowledge of stroke core measures, and little incentive to meet the benchmark.

Hypothesis:
Consistent presence by a stroke coordinator during acute stroke events results in improved outcomes through identification of barriers, focused recognition of nurses and providers, competitive use of data, and facilitation of relevant team education.

Methods:
A report card was developed for providers, identifying their average DTN, and personal best and worst times. A stacked bar graph showed the critical time frames for each case. Staff involved with good DTN times were promptly recognized publicly, via same-day group email and received ID badge holders that read “Bustin’ clots faster than you can say tPA”. The stroke coordinator and a provider “champion” developed mock brain attack scenarios utilizing simulation technology which are now available to EMS, ED and ICU nurses and providers, CT staff, and neuroscience residents. The education focused on a standardized process for the first 5 minutes.

Results:
In 2014, tPA was administered 66% of the time under 60 minutes- a 57% improvement. In 2015, 94% under 60 minutes and 69% under 45 minutes. In addition, 5/16 (31%) were under 20 minutes, the fastest being 9 minutes. All patients who received tPA in 20 minutes or less were back to baseline by discharge.

Conclusion:
Stroke coordinator’s consistent presence during acute strokes promotes: 1) healthy competition as staff become aware of the data and benchmark goals, 2)timely feedback, and 3) relevant hands-on education to appropriate team members with the ultimate outcome being significantly reduced DTN times which leads to better patient outcomes.
Abstract WP387: Outcomes of a Wake-up Stroke Protocol
Authors: Barrilleaux Wendy , Fredericks Ruth , McPherson Scott , Hatten Karl , Allen Elizabeth , Slawson Tracey , Turnbow Brian , Nesenson Amber , Smith Ashley
Published: March 2022

Background:
Patients who present with stroke symptoms upon awakening, often referred to as wake-up stroke (WUS), account for approximately 25% of acute ischemic strokes. In this group, onset time is unknown. Due to the unknown time of onset, patients with WUS are often excluded from consideration of aggressive stroke treatment and are generally treated with routine medical management only. However, through the use of advanced imaging and rapid interpretation of findings, we have found that selected WUS patients may benefit from endovascular stroke therapies. We identified the need for a standardized protocol to ensure that all WUS patients are urgently assessed as candidates for aggressive management.

Purpose:
The purpose of this project was to establish a standardized protocol, including a one-call alert system and pre-set orders for advanced diagnostic imaging, to be used in the quick determination of a treatment plan for patients presenting with WUS.

Methods:
A protocol was created by the stroke team. The stroke team responds to the one-call alert system, advanced diagnostics are rapidly performed, and a decision regarding endovascular treatment is made by the Interventional Radiologist. Education was provided to all major stakeholders including all Neurologists, Emergency Department Physicians and staff, Radiologists, Stroke Nurse Practitioners, Emergency Medical Providers, Diagnostic Imaging and Special Procedures staff. Wake-Up Stroke alert activations, procedures, and outcomes are monitored by the Stroke Coordinator.

Results:
Wake Up Stroke Protocol was published for use in February 2015. Within the 90-day period immediately following, 16 Stroke Alert activations were called for WUS patients. Eight of the 16 were deemed to be candidates for endovascular stroke therapy. Of the eight patients treated, the average improvement in NIHSS score is 5.5 points (range 0-14).

Conclusion:
In conclusion, the WUS Protocol is effective in the rapid identification of patients who could benefit from endovascular stroke therapies.
Abstract WP391: Time out Process Prior to Administration of Tissue Plasminogen Activator for Acute Ischemic Stroke Treatment
Authors: Spahr Catherine , Linde Ruth , McKniff Sueanne , Deel Julie , Mingle John
Published: March 2022

The goal to administer tissue plasminogen activator within 60 minutes of patient arrival to the Emergency Department is attainable through rigorous attention to a standardized process and interdisciplinary collaboration.

This pilot sought to enhance safety and improve reliability of administration for tissue plasminogen activator with implementation of a time out prior to administration.

An interdisciplinary team designed an improvement strategy related to the process reliability of tissue plasminogen activator administration. Four errors occurred in 12 months, a failure rate of 10¯
1
(failure of 1 in 10 administrations). Primary goal: design a process with a failure rate of <10¯
3
(failure of 1 in 1000 administrations). Secondary goal: ensure alignment with current work flow associated with bar code medication administration. The concept of a safety time out was adopted with 7 confirmatory elements: time last known well, blood glucose, anticoagulation status, blood pressure, contraindications, team consensus, and assurance of a patent intravenous catheter. The Informatics team designed a tool within the electronic health record. A standardized communication process was written. Participants in the time out included a physician and nurse at the patient’s bedside. All stakeholders received training. Prior to redesign, there was a failure rate of 10¯
1
with confirmation of all safety elements in 88% of tissue plasminogen activator recipients. The time out procedure was trialed in 5 patients with 100% compliance and an extrapolated failure rate of 10¯
3
. The average door to needle time was 60 minutes versus 69 minutes prior to the pilot. The time out process took less than 1 minute in all cases. In this group, the time-out successfully identified a missing element - a blood glucose result - the process was stopped until the result was available.

The redesigned process is safe. There was no negative impact to achieving the standard of care. The primary goal of 10¯
3
performance was achieved. Secondary goal: alignment with current medication administration process achieved. Unanticipated results: decrease door to needle time and greater satisfaction with a collaborative approach to medication administration.
Abstract WP398: Can a Shorter, Colorful Education Book Improve Stroke Patient Satisfaction Scores?
Authors: Fussner Julie M , Supan Erin , Makii Jason , Montgomery Kelly , Sundararajan Sophia , Sila Cathy
Published: March 2022

Stroke patients need written information on how to recognize and prevent a secondary stroke. Limited health literacy is associated with medication errors and a lack of knowledge for chronic health conditions. Written communication needs to be inviting and understood by the largest population possible. At University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC) the education book, “HOPE, A Stroke Recovery Guide” from the National Stroke Association has been given to patients for many years. It is 66 pages long, black and white print with very few pictures. Patients in the acute hospital setting describe it as overwhelming. The purpose of this project is to assess any impact on stroke patient satisfaction scores at UHCSCC using a new education book. Using the principles of health literacy, a group of physicians, nurses, and a pharmacist collaborated to develop a hospital branded stroke education book. Health Literacy Advisor software was used to assess readability and suggest plain language alternatives. The format was presented in chunks of information using bullet points on 21 pages and many colored pictures. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, the national, standardized publicly reported survey of patients’ perspective on hospital care, was used to evaluate any impact of the new education material. Four questions on the HCAHPS survey were used: “How often did nurses explain things in a way you understand?” “How often did doctors explain things in a way you understand?” “Did you understand the purpose of taking your medicines? “Before giving you any new medicine, how often did the hospital staff tell you what the medicine was for?” Reviewing responses over a 12 month period, the top box percentages for all four questions increased after the introduction of the new book. Nurses’ explanations score increased 5.5%. Doctors’ explanations score increased 5.3%. Understanding purpose of medications score increased 15.2% and Explanations for a new medication score increased 2.7%. Publicly reporting of HCAHPS results creates incentives for the hospitals to improve quality of care. At UHCSCC stroke patient satisfaction scores improved with introduction of new shorter, colorful education book.
Abstract WP400: Decreasing Readmissions With Improved Stroke Education
Authors: White Teresa S , Leach Barbara
Published: March 2022

Background and Purpose:
Education for stroke survivors and their caregivers is an essential part of the plan of care. Often times, only written materials are provided to this population which can be difficult due to varying levels of cognitive function and aphasia after a stroke. Our project sought to find a tool that would help to give education in a different format to help decrease our readmission rates.

Process:
A group of nurses and the stroke committee at SwedishAmerican evaluated several types of education that exists for stroke survivors and their caregivers. It was decided that the educational video “You’ve Had a Stroke, Now What?” contained the information the group that would be most beneficial to this population. Nurses provided a copy of the educational DVD to stroke survivors prior to discharge to take home with them. They also conducted a survey during their follow-up discharge phone calls to ensure that they had the DVD and if they did not a copy was sent to their home.

Results:
Pre-data showed that our 7 day readmission rates for stroke ranged from 3.13-7.69%. After implementation of providing the stroke education DVD to patients and their families the 7 day readmission rates dropped to 0%.

Conclusions:
Health disparities, such as stroke, can cause tremendous anxiety and are taxing on not only the stroke survivor, but the caregivers as well. Using the “You’ve Had a Stroke, Now What?” has proven to be a beneficial educational tool that can help to overcome some of the initial anxiety and stress that is often encountered as this population is learning to adapt upon discharge to home from the hospital setting and help to prevent unnecessary readmissions.
Abstract WP402: Performance Measurement of Blood Pressure Management in the Acute Phase of Intracerebral Hemorrhage
Authors: Glendening Christine , Moser Hope , Cai Chunyan , Pandurengan Renganayaki , Diaz Carolina , Marcotte Abigail , Denzler Jacqueline , Cao Jennifer , Gonzales Nicole
Published: March 2022

Background:
Patients with intracerebral hemorrhage (ICH) frequently present with elevated blood pressure (BP) requiring treatment. We conducted an exploratory analysis to examine BP management during the acute phase of ICH. We hypothesized that BP management and time to achieve goal BP would be variable. Our aim was to identify areas for improvement in BP management.

Methods:
We performed a retrospective chart review on consecutive patients with spontaneous ICH admitted to our neurosurgical intensive care unit (NSICU) from February-March 2015. Exclusions included secondary causes of ICH or comfort care orders placed within 72 hours of arrival. Demographic and clinical characteristics were collected as well as times for BP treatment order placement, IV treatment initiation and discontinuation. We recorded hourly BPs for the first 72 hours of hospitalization. Primary outcome measure was the time to achieve institutional guideline recommended BP control defined as SBP <150 mmHg, maintained for >6 hours. Secondary outcome included the proportion of patients who achieved SBP target >85% of the time.

Results:
We screened 37 patients and 29 met criteria. Baseline information is summarized in Table 1. Documented BP goals for 25 of 29 patients targeted a SBP goal <150 mmHg. Documentation of BP goals, orders for treatment and initiation of IV medication for BP treatment all happened concurrently about 1 hour after admission (Figure 1). SBP control was achieved at a median of 9.3 hours after admission. Only 46.4% of patients achieved target SBP >85% of the time.

Conclusions:
In our population, there is variability in the time it takes to achieve and maintain goal SBP with less than half of patients maintaining BP control. We identified targeted areas for improvement. Our data is limited by its retrospective nature and small size. Since aggressive BP management limits hematoma growth and may improve outcomes, we propose development of benchmarks to guide BP management in ICH patients.
Abstract WP403: Empowering Certified Nursing Assistants through Stroke-Specific Education
Authors: Steiner Nili E , Moore Pamela , Robertson Betty , Paletz Laurie
Published: March 2022

Background and Purpose:
Cedars-Sinai Medical Center (CSMC) requires Certified Nursing Assistants (CNAs) to possess exceptional clinical skills and in-depth knowledge and a desire to positively influence the lives of others. The CNAs at CSMC play a significant role in a patient's day-to-day experience. They are often the first to notice subtle changes in the patient’s condition. Recognizing stroke symptoms quickly is key to providing patients with the best possible outcomes. Educating CNAs with stroke-specific knowledge is crucial to our patients’ safety. Identifying these patients and expeditiously calling the experts offers patients the best possible outcomes. Armed with this knowledge, CNAs may be able to recognize stroke symptoms immediately and any change in their patients’ neurologic status. In addition, a literature search through CINAHL, Medline and Google Scholar revealed no stroke-specific education has been provided to CNAs.

Methods:
We completed a needs assessment on the CNAs’ knowledge regarding acute stroke symptoms and comfort level with activating the stroke team for acute stroke symptoms, determining there was a need for greater knowledge. We created and taught several classes using a PowerPoint/interactive lecture format, with summative assessments at the end of class (post-test and class/instructor evaluation). We performed a review of the summative assessments for all of the classes held from 2013 to 2014. A thorough literature search was also performed for any stroke-specific education provided to CNAs. We then coordinated stroke-specific classes targeted at CNAs during their Patient Assessment Classes, held throughout the year either for new CNA orientation classes or continuing education.

Results/Conclusions:
Although this education is not quantitatively measurable, it is measureable in perception. The summative assessments indicate they absorbed the information and felt the stroke-specific information provided helped them decide to initiate the stroke team for acute stroke symptoms or notify a nurse if they felt their patient was demonstrating symptoms of stroke or a change in neurologic status. The CNA stroke-specific classes are ongoing and are now a permanent part of their new and continuing education curriculum.
Abstract WP407: Assessing Quality of Patient Care in Pediatric Stroke Hospitalizations: An Analysis of the Nationwide Inpatient Sample
Authors: Rumalla Kavelin , Reddy Adithi , Tumalapenta Sirisha , Mittal Manoj
Published: March 2022

Introduction:
The Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) and the Agency for Healthcare Research and Quality patient safety indicators (PSIs) are quality metrics linked to reimbursement. An assessment of these events in the pediatric stroke population has not previously been reported.

Methods:
The Nationwide Inpatient Sample (2002-2011) was queried using primary ICD-9-CM codes to identify hospitalizations for pediatric ischemic stroke (IS), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH). We evaluated the effect of patient and hospital factors on occurrence of PSIs and HACs and the impact of these occurrences on length of stay (LOS), total costs, and in-hospital mortality.

Results:
Of a total of 6,265 IS, 3,096 SAH, and 3,103 ICH admissions, the percentage of patients with 1 or more PSI or HAC, respectively, was 15.6% and 2.0% in IS, 44.7% and 2.7% in SAH, and 38.2% and 2.0% in ICH. The most frequently reported PSIs (incidence 56,000/100,000) were respiratory failure (50.7%), deep vein thrombosis (1.65%), and sepsis (1.32%), whereas falls/trauma (1.78%) and poor glycemic control (0.22%) were the most frequently reported HACs (incidence, 2,351/100,000). Multivariate adjusted risk factors for PSI included SAH (OR: 5.02), ICH (OR: 3.79), black and Hispanic race (OR: 1.35, 1.37), urban hospital (OR: 7.00), and 3+ comorbidities (OR: 7.06) (all p<0.0001). In adjusted analyses, Hispanic race (OR: 2.04), Medicaid insurance (OR: 1.51), 3+ comorbidities (OR: 2.18), weekend admission (OR: 1.78), rural hospitals (OR: 3.03), and nonteaching hospitals (OR: 1.64) increased odds of HAC occurrence (all p<0.01). PSI occurrence increased LOS by 11 days and total costs by $47,573 per admission, while HAC occurrence increased LOS by 12 days and total costs by $12,373 per admission (all p<0.0001). In adjusted analyses, children enduring a PSI were 5 times more likely to acquire disability and 21 times more likely to suffer mortality (all p<0.0001).

Conclusion:
We established benchmark rates for PSIs and HACs in pediatric stroke. Race, insurance status, hospital characteristics, and pre-existing comorbidity significantly impact PSI and HAC occurrence, which further impacts LOS, costs, disability, and mortality.
Abstract WP417: Oxygen Extraction Fraction Measured With MRI is Reduced After Blood Transfusion in Adults With Sickle Cell Anemia
Authors: Jordan Lori C , Gindville Melissa , Scott Allison , Strother Megan K , Kassim Adetola , Chen Sheau-Chiann , Pruthi Sumit , Shyr Yu , Donahue Manus J
Published: March 2022

Introduction:
Blood transfusion for primary stroke prevention is well established in children but not adults with sickle cell anemia (SCA). Secondary stroke prevention in young adults with SCA is generally accepted. However blood transfusion therapy does not prevent all infarcts and recurrent assessment of cerebral physiology is likely necessary to portend stroke risk.

Hypothesis:
Oxygen extraction fraction (OEF), which reflects the balance of oxygen consumed to oxygen delivered, can be evaluated routinely noninvasively
in vivo
using MRI and reduces following blood transfusion; if confirmed, routine MRI-based OEF screening could be applied to evaluate impact of blood transfusion and other therapies on tissue-level impairment.

Methods:
The noninvasive T
2
-relaxation-under-spin-tagging (TRUST)-MRI method (duration=1min12s) was applied in adults with SCA (n=5) and age and race-matched control (n=11) volunteers. SCA volunteers were scanned pre- and post-transfusion and controls at two time points to assess healthy OEF reproducibility and hypothesized changes after transfusion, respectively. OEF changes were contrasted with symptoms, vasculopathy, and perfusion. A Kruskal-Wallis test with two-sided p<0.05 was used to evaluate significant differences.

Results:
In adults with SCA, mean age 33±3 years (y) OEF was significantly elevated (p<0.01, OEF=0.53±0.09) relative to controls (mean age 27±5y, OEF=0.32±0.06). OEF was not significantly different at follow-up for controls (OEF=0.33±0.05), but was reduced (OEF=0.44±0.05; p=0.021) following transfusion in SCA volunteers (Figure). Reduction in OEF is inversely correlated with increase in hematocrit post-transfusion.

Conclusion:
Noninvasive MRI can quickly detect expected reductions in OEF after blood transfusion. Ongoing work is focused on understanding relationships between OEF, changes in symptomatology and stroke risk in SCA. OEF has been predictive of stroke risk in other patient groups.
Abstract WP421: A Targeted Self-management Approach for Reducing Stroke Risk Factors in Young African-American Men who have Experienced Stroke or Transient Ischemic Attack
Authors: Sajatovic Martha , Tatsuoka Curtis , Welter Elisabeth , Colon-Zimmerman Kari , Blixen Carol , Perzynski Adam T , Cage Jamie , Sams Johnny , Moore Shirley M , Pundik Svetlana , Sundararajan Sophia , Modlin Charles , Sila Cathy
Published: March 2022

Aims:
Although overall U.S. stroke mortality rates have declined significantly since the 1950s, stroke rates remain high for African-Americans (AA). Disparities are most evident in those ≤65, and AA/white mortality ratio among men aged 45-54 years is 3.7. Care approaches targeting young AA men could improve disparities. This National Institute of Health (NIH)-funded study compared a novel behavioral TargetEd MAnageMent Intervention (TEAM) vs. treatment as usual (TAU) in 38 young (< age 65) AA men with stroke or TIA.

Methods:
A community- engaged process was used to refine an existing behavioral intervention. Participants were then randomly assigned to TEAM (N=19) or TAU (N=19). TEAM was assessed for feasibility, acceptability, and fidelity, and efficacy in comparison to TAU on medication adherence, stroke risk factors (blood pressure, diabetes control/HbA1c, lipids) and health behaviors. Qualitative assessment evaluated the perspectives of intervention participants.

Results:
Sample mean age was 52.1 (SD 7.4). Half had TIA and half had stroke. Mean body mass index was 31.4 (SD 7.4). Baseline systolic blood pressure mean was 129 (SD 16.6) and diastolic mean was 84 (SD 11.1). Baseline non-adherence (missed medication) was only 5.9% (SD 14.4). There were 14/38 (36.8%) with diabetes, with mean HbA1c of 8.0, SD 1.8. Baseline serum lipids were all within desirable targets. At 12 weeks, TEAM participants had a significantly lower rate of hypertension. This difference was maintained at 24 weeks, but was no longer statistically significant. Mean systolic pressure was significantly lower in TEAM at 24 weeks (p =.03), and diastolic pressure was lower in TEAM at 12 weeks compared to TAU (p <.05). HDL cholesterol was better in TEAM at 24 weeks (p=.03). Other biomarker and health behaviors were similar between groups. While mean HbA1c was not assessed in TAU due to small sample size, HbA1c improved in TEAM. There was minimal improvement in adherence. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

Conclusions:
TEAM can engage AA men, and has potential to improve stroke risk-factors. Qualitative findings suggest that effects might be enhanced with a slighter longer duration and including older AA and women.
Abstract WP424: Prevalence and Determinants of Non-adherence to Secondary Preventive Medication in Stroke Patients
Authors: Kim Soo-Kyoung , Jeong Da-hye , Choi Nack-Cheon , Kim Rokbum , Park Ki-Soo , Son Seungnam
Published: March 2022

Introduction:
Nonadherence to secondary preventive medication is associated with adverse outcomes and higher costs of care in stroke patients. The purpose of this study is to investigate the prevalence and major determinants of nonadherence to secondary preventive medication in stroke survivors.

Hypothesis:
We assessed the hypothesis that the determinants of nonadherence to secondary preventive medication in stroke patients may be different in both intentional and nonintentional, or/and in various classes of medication.

Methods:
We enrolled the 252 patients taking medicines > 1 year after stroke onset. Adherence was measured by a self-reported questionnaire, and nonadherence was classified to be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage, three items) or unintentional (e.g., forgetting to take medication, four items). The devices to assess the determining factors of adherence included Belief about Medication Questionnaire, Morisky Medication Adherence Scales, Lubben Social Network Scale-6, and Geriatiric Depression Scale. We also conducted a survey to assess healthy adherence effects and satisfaction level of education program about medication and healthy behaviors.

Results:
About 60% of patients were non-adherent (n=150, 59.5%). Among them, 56 (37.3%) patients were unintentionally and 94 (62.7%) patients were intentionally nonadherent to their stroke preventive medication. The determinants of nonadherence were age [Exp(B)=1.041, p=0.045], necessity [Exp(B)=1.106, p=0.057], social network [Exp(B)=1.021, p=0.044] and familial support [Exp(B)=1.032, p=0.044]. Classic oral anticoagulation therapy showed better adherence compared with antiplatelet therapy (83.6% vs. 69.7%,
p
=0.002). The behavioral education was a determinant for adherence to the classic oral anticoagulation therapy.

Conclusion:
In conclusion, nonadherence to medication in stroke surviviors was generally high. Necessity was an important determinant of both intentional and unintentional nonadherence. Older age was predictive of unintentional nonadherence, and building social networks and familial support were important for the intentionally nonadherent patients.
Abstract WP425: Blood Brain Barrier Disruption and Vascular Cognitive Impairment in Early Stages of Heart Failure Development in Tgαq*44 Mice
Authors: Adamski Mateusz G , Sternak Magdalena , Wieronska Joanna M , Czaban Iwona , Malinowska Monika , Wilczynski Grzegorz M , Pilc Andrzej , Chlopicki Stefan
Published: March 2022

Introduction:
Advanced heart failure (HF) with subsequent hypoperfusion is a well-recognized clinical risk factor for the development of Vascular Cognitive Impairment (VCI), with early mechanisms yet to be identified. Tgαq*44 mice are a transgenic model of slowly developing HF and peripheral endothelial dysfunction due to cardiomyocyte-specific overexpression of G protein αq*44 where VCI has not been assessed.

Hypothesis:
We hypothesized that Tgαq*44 mice develop VCI at early/compensated stages of HF, due to dysfunction of brain endothelium - essential for the blood brain barrier (BBB) function.

Methods:
Tgαq*44 and control FVB mice at the age of 6, 10 and 14 months (m) were studied. Novel Object Recognition (NOR) test (n=8/gr.; 6,10,14 m) was used to assess cognition. BBB permeability was assessed (n=3/gr.; 6,10 m) based on concentration of intravenously injected, fluorescently labeled molecules of increasing sizes (0.6 - 40000kD), in dissected and perfused brain homogenates. Expression of inflammatory activation markers for glia (IBA-1) and astrocytes (GFAP) in brain sections (n=2/gr.; 6,10 m) was assessed with confocal microscopy.

Results:
NOR test showed that Tgαq*44 mice compared to age matched controls are cognitively impaired based on decrease in recognition index (p=0.0002 at 6m and p=0.05 at 10m). Figure A illustrates progress in cognitive impairment in mice from 6th to 14th m (p=0.001). BBB permeability test revealed increased BBB damage in whole brain (p=0.001 at 6m) and in cortex and pons (respectively p=0.01 and 0.001 at 10m). Figure B illustrates activation of astrocytes (GFAP- red) and glia (IBA-1 -green) in 6m Tgαq*44 vs. FVB mice.

Conclusions:
We conclude that at early stages, HF induces VCI via mechanisms related to the impairment of BBB permeability and suggests that VCI precedes the development of clinical stage of HF. We also identify Tgαq*44 mice as a new model of naturally developing VCI with isolated HF and subsequent impairment of BBB permeability.