bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P791: A Lesion-Based Toolbox to Study Ischemic Stroke in Primates
Authors: Khateeb Karam , Bloch Julien , Rahimi Mona , Griggs Devon , Song Shaozhen , Liu Teng , Le Min Nhan , Wang Ruikang , Yazdan-shahmorad Azadeh
Published: March 2021

The primate cortex is a highly complex structure responsible for a variety of sophisticated tasks and behaviors including long-term memory storage, sensation, movement, and vision. However, little is understood with respect to the underlying cortical physiology and dynamics following injury. It is essential that these phenomena are studied in a model which shares a high degree of complexity and evolutionary history with human cortex: the non-human primate (NHP) cortex. Such studies would allow for the development of improved tools and strategies for treating neurological disorders such as stroke. However, current methods of inducing cortical lesions in NHP pre-clinical studies often require surgical skill, produce variable results, and lack controllability of lesion size and location.

Methods:
To address these challenges for the development of effective therapies, we developed a versatile lesion-based toolbox for studying NHP cortical physiology.First, we demonstrated the photothrombotic technique, wherein intravenous infusion of a photosensitive dye followed by targeted cortical illumination leads to the formation of localized thrombi in the vasculature. With this method, we induced ischemic lesions extending through all layers of sensorimotor cortex in 5 adult macaques. To validate the disruption of blood flow in cortical microvasculature
in vivo
, we employed optical coherence tomography angiography (OCTA) imaging. Additionally, we implanted a semi-transparent electrocorticography array to record neural activity before, during, and after the induction of lesions. The transparency of the array enabled us to illuminate through the array to induce lesions and acquire OCTA images to register electrodes to ischemic areas
in vivo
. Thus, we observed the dynamics of the underlying network neural activity as lesions were developing. Histological staining validated neuronal cell death and was used to estimate lesion volumes. Finally, we developed a computational model to predict lesion sizes based on illumination parameters. In combination with behavioral findings, this toolbox can drive the development of future rehabilitative therapies for stroke at clinically relevant time scales in pre-clinical studies.
Abstract P80: Control of Vascular Risk Factors and Response to Stroke Symptoms During the Most Restrictive Period of the Covid-19 Quarantine. A Survey of Population Behavior in Argentina
Authors: RODRIGUEZ PEREZ MARIA SOLEDAD , rosales julieta s , Dossi Daiana D , Ameriso Sebastian F
Published: March 2021

Background and objectives:
In preparation for the influx of Covid-19 patients and as a contagion prevention strategy, healthcare systems reduced or discontinued provision of ‘‘non-urgent’’ care. This policy could potentially influence stroke prevention and management. We conducted a large population survey to assess the impact of mandatory social isolation on emergency consultations, routine health controls and the behavior of the population during the pandemic.

Methods:
We distributed multiple-choice anonymous questionnaires through the institutional email database and through the email database of clients of a beverage distribution company. Most respondents resided in the Metropolitan Area of Buenos Aires. This is the area where the infection rates were higher and restriction measures were stricter. The survey assessed demographic characteristics and actual and potential behaviors of people regarding medical checkups, risk factors control, medication provision and response to onset of symptoms consistent with stroke or TIA.

Results:
A total of 10,303 questionnaires were completed. Thirty-seven percent of the respondents were older than 60 years, 74% were women and 16% lived alone. One or more vascular risk factors were present in 39% of respondents. Seventy-six percent of participants did not continue to attend to their regular medical checkups during the mandatory social preventive isolation, 21% had difficulty obtaining medical prescriptions and only 38% considered hospitals were implementing appropriate measures to avoid Covid-19 infections. When asked about response in case of onset of stroke symptoms, 9% would not consult given the context of the pandemic. Six percent reported having had symptoms consistent with stroke or TIA and only 35% of those consulted in an Emergency Room. Most of the respondents (85%) reported they were waiting for the end of the quarantine to resume their usual medical care.

Conclusions:
The implementation of a strict quarantine may have some serious adverse effects on the proper prevention and treatment of stroke. Careful communication and better education strategies are needed to keep the population safe during the pandemic while avoiding increases in the risk of occurrence of other devastating diseases as stroke.
Abstract P801: Impact of Oxidized Phospholipids on Outcomes From Cerebral Ischemia and Reperfusion Injury
Authors: Yu Jin , Zhu Hong , Yeang Calvin , Witztum Joseph L , Tsimikas Sotirios , Kindy Mark S
Published: March 2021

The mechanisms leading to oxidative stress and cellular dysfunction during stroke are not well understood. To test the hypothesis that transient cerebral artery occlusion (MCAo) in mice results in the generation of oxidized phospholipids (oxPLs) that contribute to neuronal cell death and glial activation. Both
in vitro
and
in vivo
cerebral ischemia and reperfusion injury (IRI) resulted in the elevation of specific oxPLs. Neuronal cell death was determined in the presence of oxPLs and the natural oxPL E06 antibody protected the cells from the toxic effects. IRI in mice gave rise to increased immunoreactivity of oxPLs in the brain. E06 reduced inflammatory markers in the brain following IRI, including iba-1, GFAP and inflammatory cytokines. In addition, oxPLs gave rise to M1 and Mox microglial phenotypes which was reversed in the presence of E06 and elicited a more M2 phenotype. Nrf2 deficient mice show increased infarct volumes and microglia from Nrf2
-/-
mice show a reduction in Mox gene expression, and E06 protects both mice and cells from the Nrf2 deficit. Cerebral IRI generates oxPLs which triggers neuronal cell loss and inflammation and inactivation of oxPLs in vivo reduces infarct volume and improves outcomes.
Abstract P805: Inhibition of α5β1 Integrin as a Novel Therapeutic Approach in Experimental Vascular Dementia in Middle-Aged and Diabetic Mice
Authors: Biose Ifechukwude Joachim , Narayanappa Amruta , Bix Gregory J
Published: March 2021

Bilateral carotid artery stenosis (BCAS), a model of vascular dementia (VaD), causes cognitive impairment due to white matter injury and blood-brain barrier (BBB) disruption. Although risk factors for VaD such as Type-2 diabetes and aging are clinically relevant for therapeutic discovery, they are rarely studied. Recently, we determined that inhibition of brain α5β1 integrin with the peptide ATN-161 improves BBB stability and functional outcome after cerebral ischemia in mice. Also, after 14 days BCAS in mice, we showed increased brain α5β1 integrin expression which correlates with BBB disruption. We hypothesize that middle age and / or diabetes will intensify post-BCAS brain α5β1 integrin expression, contributing to worsened cerebrovascular pathology and cognitive decline, and that inhibition of α5β1 integrin with ATN-161 would reduce brain α5β1 integrin level, stabilize the BBB, attenuate brain-vascular pathology, and protect against VaD.

Methods:
BCAS was induced with titanium micro-coils (ID: 0.18 mm) in young and middle-aged C57B6/J (13-15 weeks old; n=57 and 57-63 weeks old; n=57, respectively) as well as in young 13-weeks old diabetic (B6.BKS(D)-Leprdb
/-
J, n=27; 35-56 g) and genotype control (B6.BKS(D)-Leprdb
/+
J, n=27; 28-36 g) mice for 14, 32 and 60 days. After BCAS or sham surgery, mice were randomly assigned to ATN-161 (1 mg/kg, i.p., 3x /week) or saline groups. Functional outcome measures: Y-maze spontaneous alternation, novel object recognition and nesting tests were performed at baseline, post-BCAS days 14, 30, 48 & 60. Brain samples were assessed by immunofluorescence and western blot, for the expression of α5β1 integrin, tight junction proteins, as well as markers for white matter integrity, astrocyte and microglia activation. While the analysis of functional tests, brain histology and western blots are underway, we have thus-far determined that ATN-161 treatment reduces (p<0.01) BCAS-elevated brain α5β1 integrin to sham control levels and improves (p<0.001, compared to saline controls) Y-maze spontaneous alternation in young B6 mice after 14 days. We expect to demonstrate that inhibition of α5β1 with ATN-161 will improve cerebrovascular pathology and cognitive outcome following BCAS in middle-aged B6 and type-2 diabetic mice.
Abstract P809: A Comprehensive P75 Neurotrophin Receptor Gene Network and Pathway Analyses Identifying New Target Genes for Stroke Recovery
Authors: Sajanti Antti , Lyne Séan , Girard Romuald , Frantzen Janek , Rantamaki Tomi , Heino Iiro , Cao Ying , Diniz Cassiano , Li Yan , Takala Riikka , Posti Jussi , Roine Susanna , Koskimaki Fredrika , Rahi Melissa , Rinne Jaakko , Castren Eero , Koskimaki Janne
Published: March 2021

Introduction:
Therapeutic interest into the neurotrophins resides in their ability to regulate the process of neuronal and synaptic regeneration following acute brain injuries such as intracerebral hemorrhage, subarachnoid hemorrhage and ischemic stroke. P75 neurotrophic receptor (p75NTR) is an important receptor for the role of neurotrophins in modulating brain plasticity and apoptosis. The current understanding of the role of p75NTR in cellular adaptation following pathological insults remains blurred.

Methods:
We identified
p75NTR
and related genes through extensive data mining of a PubMed literature search including published works related to p75NTR from the past 20 years. Bioinformatic network and pathway analyses of identified genes (n=235) were performed using ReactomeFIViz in Cytoscape based on the highly reliable Reactome functional interaction network algorithm. This approach merges interactions extracted from human curated pathways with predicted interactions from machine learning.

Results:
Genome-wide pathway analysis showed total of 16 enriched hierarchical clusters. A total of 278 enriched single pathways were also identified (p<0.05, FDR corrected). Gene network analyses showed multiple known and new targets in the
p75NTR
gene network. This study provides a comprehensive analysis and investigation into the current knowledge of p75NTR signaling networks and pathways.

Discussion:
This study provides the largest comprehensive gene and functional network library of
p75NTR
and incorporates current knowledge using a large dataset approach that increases the overall understanding of complex
p75NTR
networks. These results suggest both new possible target genes for further investigation in p75NTR research, while also validating previously conducted research. These results can be used to generate novel hypotheses to gain a greater understanding of p75NTR in stroke.

Future directions:
We are currently sequencing miRNA libraries from ischemic and hemorrhagic stroke patients’ plasma with longitudinal plasma samples and clinical data. This data together with presented results will be used to test identified novel targets in
p75NTR
engineered models in order seek novel therapeutic strategies to increase recovery after stroke.
Abstract P81: SARS-CoV-2 and Stroke Characteristics a Report From the Multinational COVID-19 Stroke Study Group
Authors: Shahjouei Shima , Tsivgoulis Georgios K , Farahmand Ghasem , Koza Eric , Mowla Ashkan , Mondello Stefania , Cernigliaro Achille , Ranta Anna , Punter Martin , Naderi Soheil , Chaudhary Durgesh , Avula Venkatesh , Li Jiang , abedi vida , Zand Ramin ,   The Multinational COVID-19 Stroke Study Group
Published: March 2021

Objective and Design:
We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients.

Main Outcome Measures:
We investigated the association of demographics, clinical data, geographical regions, and countries’ health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients.

Results:
Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities.

Conclusions and Relevance:
We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. The stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.
Abstract P818: Increased Eligibility for Endovascular Therapy Following Intensive Door-To-Transfer Improvement Project
Authors: Creighton Leigh A , Kaiser Brian L
Published: March 2021

Background and Purpose:
Early EVT for large vessel acute ischemic stroke is associated with reduced disability and mortality. Longer transfer times from the sending facility contribute to poorer EVT outcomes, and in some circumstances, patient ineligibility for EVT due to a completed stroke on arrival to the endovascular site. Reducing avoidable delays will result in overall improved EVT outcomes and reduce the frequency of completed stroke upon arrival.

Methods:
A multidisciplinary group utilized the Lean A3 process and PDCA improvement cycle to reduce transfer times. Avoidable delays and resources to expedite the transfers were identified. A standardized plan with defined roles and responsibilities, communication pathways, early transport team activation, and robust staff education were implemented. The PI team met weekly for 3 months to review each individual transfer, determine what went well and what did not, and to identify additional improvement opportunities. A weekly summary with feedback was provided to front line staff and managers. Staff involved in patient transfers that had a DIDO of 90 min or less were recognized with a “Brain Pin” and staff recognition certificate.

Results:
Since its implementation, 23 patients were transferred for potential EVT. Compared with 12 months prior to implementation, the DIDO median time was reduced from 119 minutes to 80.5 minutes, transfers were achieved in 90 min or less 61% (n=15) of the time vs. 27.2%, and percentage of EVT eligible patients increased from 58.3 to 78.3%.

Conclusion:
In conclusion, rapid reduction of DIDO times and increased patient eligibility for thrombectomy is attainable through an intensive multidisciplinary process improvement project. Implementing a standardized workflow that includes rapid identification of potential EVT transfers, early activation of the transport team, development of clear pathways of communication, defined roles and responsibilities within the team, and regular staff feedback are essential.
Abstract P827: W.I.N.G.S. to Acute Stroke Treatment
Authors: Vanderhye Vanesa K , Landis Cindy , Cheetham Katelyn , Weaver Rhyan , Perry Ember , Savo James , Sands Kara A
Published: March 2021

Background:
Nearly 2 million neurons die each minute during an acute ischemic stroke (AIS). Research demonstrates patients receiving timely treatment for AIS can have more favorable outcomes. In 4
th
quarter (Q) 2018, a Stroke Center’s average door-to-needle (DTN) time was 54 minutes, acceptable for American Stroke Association’s (AHA/ASA) Get with the Guidelines (GWTG) quality requirement of DTN in 60 minutes or less. Nevertheless, time is brain and decreased DTN times can potentially improve patient outcomes. With this in mind, the emergency department (ED) implemented a quality improvement project (QIP) focused on DTN time reduction.

Purpose:
Improve the ED workflow by developing standardized roles and task prioritization to reduce DTN times by 20% from 54 minutes to 42 minutes by 4
th
Q 2019.

Methods:
Guidelines and goals were established using AHA/ASA GWTG-Stroke criteria. Included were AIS patients with symptoms occurring prior to ED arrival, met eligibility criteria, and received intravenous tissue plasminogen activator (IV t-PA). Patients with symptoms occurring after ED arrival or during the hospital stay were excluded. An interdisciplinary workgroup collaborated to formulate an evidence-based solution for workflow opportunities identified by simulations, observations, and subjective feedback. Standardized roles, similar to cardiac life support, were created. An innovative acronym, W.I.N.G.S. (weight, IV access, NIHSS, glucose, scan), was developed to strategize adoption and implementation. Education, chart reviews, and timely feedback were given to stakeholders for every stroke intervention to promote engagement.

Results:
In 4
th
Q 2019, average DTN time decreased to 35 minutes (n=16, 35.2% reduction). The average DTN time for 1
st
Q 2020 is 31 minutes (n=14, 42.6% reduction). Since QIP implementation, the current DTN record is 12 minutes.

Conclusions:
W.I.N.G.S. is now a commonly term used in the ED. The multidisciplinary approach was instrumental in implementing a feasible QIP based on evidence and did not compromise patient safety. Sustainability is dependent on continued commitment and engagement of the team to celebrate achievements and reflect, reevaluate, and revise any insufficiencies.
Abstract P830: Using a Nurse Tasklist in an Electronic Medical Record to Achieve Compliance With Documentation of Post Procedure Assessments
Authors: Allen Leigh , Scott Katie , Votti Lisa , Vella Nicole , Robinson Tracy , Greer Lacie E , Frisby Melisa , Barbour Cyndi
Published: March 2021

Background:
For stroke centers performing endovascular procedures, ensuring documentation of post procedure assessments - site and pulse - is not only important for patient safety but also for program certification. Not being able to demonstrate the appropriate documentation during certification site visits can lead to survey findings and action plans that must be created and managed. Use of tools in an EMR can assist the nurse with documentation compliance for these important assessments.

Methods:
The electronic medical record (EMR) build was mirrored after an already established process for post IV thrombolytic monitoring. When the thrombolytic order set is initiated and the IV thrombolytic medication is documented on the medication administration record, tasks “fire” to the nurse tasklist related to post thrombolytic monitoring for the 24 hour post IV monitoring period. The nurse can select the task on the tasklist and it takes the nurse to the appropriate place to document as well as at the appropriate time to document. Use of this process helped to drive compliance with post IV thrombolytic monitoring documentation. In order to achieve compliance for post procedure assessments documentation, this same process was requested by nursing. To achieve this, the EMR was designed to “fire” tasks to the nurse tasklist when the post thrombectomy order set is initiated and the time hemostasis is achieved is documented; these tasks cover the post thrombectomy monitoring for the required 24 hours. Part of these tasks include post procedure assessments.

Results:
From May 2019 to October 2019 the average monthly compliance for post procedure assessments was 77.6%. In November 2019, the appropriate tasking function was implemented in the EMR and education related to the new process was provided. From December 2019 to May 2020 average monthly compliance has been 91.1% with a monthly compliance rate greater than 90% since February 2020.

Conclusions:
Use of the nurse tasklist in an electronic medical can assist the nurse with documentation of post procedure assessments and achieve documentation compliance.
Abstract P831: Use of the Neuro-QoL Measures for Assessment of Contributors to Long-Term Quality of Life, Post-Aneurysmal Subarachnoid Hemorrhage
Authors: Wynja Kayla , Prescott Drew , Baughman Brandon , Alexandrov Anne W , Cao Xueyuan , Stanfill Ansley
Published: March 2021

Background:
Aneurysmal subarachnoid hemorrhage (aSAH) survivors are at high risk for poor quality of life (QoL). Standard outpatient neurologic assessment may not capture some affective and cognitive factors important for long-term QoL, and reintegration into normal social roles. The purpose of this study is to determine the utility of the Quality of Life in Neurological Disorders (Neuro-QoL) measures for assessment of such factors in nursing practice.

Methods:
Standard demographic and clinical characteristics were collected on patients >1 year post-aSAH, along with self-report information on seven Neuro-QoL measures (Ability to Participate in Social Roles and Activities [ABL]; Satisfaction with Social Roles and Activities [SATIS]; Cognitive Function [COG]; Depression [DEP]; Anxiety [ANX]; Lower Extremity Function - Mobility [LE] & Upper Extremity Function - Fine Motor [UE]). Scores are T-scores with mean 50(±10). Associations were determined using Spearman correlations or paired t-tests as appropriate.

Results:
Participants (N=35) were 48.6(±12.5) years, 4.7(±3.6) years post aSAH, 80% female, 65.7% African American, and mean Hunt Hess Grade 2.3(±0.8). Age, race, and gender were not associated with Neuro-QoL outcomes. Our average sample T-scores were: ABL=45.3; SATIS=47.6; COG=44.3; DEP=49.3; ANX=51.3; LE=46.5; UE=46.7. COG was associated with ABL and SATIS (
p
<0.02). ANX was associated with ABL (
p
=0.02). UE and LE were associated with ABL (r=0.5,
p
=0.001; r=0.8,
p
<0.0001, respectively) and SATIS (r=0.5,
p
=0.005; r=0.8,
p
<0.0001).

Conclusions:
The Neuro-QoL measures provide an effective tool for nursing assessment of QoL in post-aSAH. Although physical disability impairs social integration, we also found that cognitive and anxiety symptoms uniquely influenced the ability to integrate into social roles and may reduce overall QoL.
Abstract P834: Inconsistency in the Application of National Institutes of Health Stroke Scale Scores (NIHSS) Between Neurologist and Emergency Room Nurses During Acute Ischemic Stroke
Authors: Glidden Michele , Templeton Evan , Bartlett Stephanie , DCruz Lynn , McNew Abbie , Nemati Donya , Smith Danika , Zabel Samantha , Comer Amber R
Published: March 2021

Background:
The National Institutes of Health Stroke Scale (NIHSS) score is the gold standard for assessing stroke severity. One 2006 study demonstrated research nurses had better interrater reliability in clinical trials than neurologists, but little is known about NIHSS score consistency between neurologists and registered nurses in clinical practice. Consistent baseline NIHSS scoring by neurologists and nurses is crucial to determine stroke acuity, deliver evidence-based treatment, and optimize patient outcomes. The purpose of this study was to determine whether a difference existed between healthcare providers’ NIHSS scores and determine factors affecting inconsistencies in scores.

Methods:
A retrospective chart review of patients treated at a single Comprehensive Stroke Center safety net hospital compared the initial NIHSS scores given to the same patient by neurologists and emergency department nurses from January 2018 to December 2019. Of the 588 charts reviewed, 438 met inclusion criteria. Patients were divided into two cohorts based on score differences between neurologists and nurses: clinically meaningful score difference ≥2 (n= 152, 34.70%) and non-meaningful score difference <2 (n= 286, 65.30%,).

Results:
Only two variables were significantly associated with greater score inconsistencies: higher NIHSS score (p = <.01) and patients presenting with aphasia (p =<.01). Clinically meaningful score inconsistencies were 44% more likely to occur in aphasic stroke patients.

Conclusions:
Although overall NIHSS scores are similar between physicians and nurses, patients with aphasia and more severe strokes were more likely to be scored inconsistently. Neurologists and nurses have different training and certification requirements with nurses required to certify annually while neurologists are not. Implementing a policy that requires all providers to undergo the same training in specific areas of the NIHSS may eliminate disparity and ensure patients are given the interventions needed for best outcomes.
Abstract P835: Long Noncoding RNA FosDT is Developmentally Dispensable but Critical for Shaping the Therapeutic Post-Stroke Functional Outcome
Authors: Mehta Suresh L , Morris-Blanco Kahlilia , Chokkalla Anil Kiran , Bathula Saivenkateshkomal , Kim Taehee , Chelluboina Bharath , Holmes Aleah , Banerjee Anik , Chauhan Anjali , Lee Juneyoung , Venna Venugopal Reddy , McCullough Louise D , Vemuganti Raghu
Published: March 2021

Stroke induces the expression of several long noncoding RNAs (lncRNAs) in the brain. However, their functional significance in post-stroke outcome is poorly understood. We recently observed that a brain-specific lncRNA called Fos downstream transcript (FosDT) is induced rapidly in rodent brain following focal ischemia. We here show that FosDT expression is developmentally regulated with adults specifically display higher expression in the cerebral cortex than neonates. To understand its significance in ischemic brain damage, we developed FosDT knockout rats using CRISPR-Cas9 genome editing. We found that FosDT knockout rats did not show any anomalies in growth and development, fertility, brain cytoarchitecture and cerebral vasculature. However, when subjected to transient focal ischemia, FosDT knockout rats of both sexes showed enhanced sensorimotor recovery and reduced brain damage. To further understand the mechanistic implications of FosDT in the ischemic brain, we conducted RNA-seq analysis. The result showed that improved post-stroke functional outcome in FosDT knockout rats is partially associated with curtailed post-ischemic induction of inflammatory genes. When rats subjected to transient focal ischemia were treated with FosDT siRNA, there was significant neuroprotection and better functional outcome irrespective of sex and age. FosDT siRNA was efficacious when administered peripherally and also in a delayed manner. Thus, preventing FosDT activation is beneficial for the post-stroke outcome.
Abstract P839: ‘Stroke Home Care’- A Mobile Application: Home Based Innovative Nursing Care Intervention Developed by Stroke Nurse: A Need of the Time in Covid-19 Pandemic Like Situation
Authors: Kumar Ashok , Khurana Dheeraj , Pattanaik Smita , Kumar Mukesh , Modi Manish , Kaur Sukhpal , Ghai Sandhya , Nagi Manisha , Gairolla Jitender , Chellappa Rajan , CK Narayanan
Published: March 2021

Introduction:
Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home.

Purpose:
To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors.

Methods:
Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings ‘Stroke home care’ a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle’s tube feeding, Foley’s catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients.

Results:
Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers’ burden.

Conclusion:
‘Stroke Home Care’ is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.
Abstract P847: Exploring the Perspective of Patient Recipients of a Provider and Systems-Level Intervention - A Mixed Methods Analysis From the Care Transitions and Hypertension Management (catch) Program for Ischemic Stroke Study
Authors: Sico Jason J , Burrone Laura , Fenton Brenda , Phadke Manali , Ragunton Jan-Michael , Hurd Paul
Published: March 2021

Introduction:
The CAre Transitions and Hypertension management (CATcH) program was developed using Lean Six Sigma methodology and is a bundled, multi-faceted, provider- and healthcare systems-level pilot-intervention designed to enhance care coordination. Components of the intervention included: education delivered during the hospitalization, increased utilization of clinical pharmacy and home telehealth for blood pressure (BP) monitoring, and a patient care navigator.

Hypothesis:
Recipients of CATcH will find the program valuable though engaging with additional care providers may be deemed onerous.

Methods:
Twenty-eight semi-structured qualitative interviews were conducted between June 2018 and June 2019 among CATcH recipients. Interviews were audio-recorded, transcribed, and entered into an ATLAS.ti. project file. Thematic Content Analysis was used to analyze coded data, generate, and validate findings. Themes related to the overall impression of CATcH and its individual components were investigated across all patients and stratified by age, race, sex, and when they were discharged in relation to beginning of CATcH implementation.

Results:
A total of 108 Veterans were the recipients of CATcH. All patients received education, patient care navigator services, and offered both clinical pharmacy and telehealth services, with 52/108 (48.1%) attending clinical pharmacy appointments and 37/108 (34.3%) utilizing telehealth services within 6-months post-discharge. Subjects interviewed were on average 68.6±8.2 years of age, predominantly male (26/28; 92.9%) and equally distributed among black and non-black races. Themes were largely positive with patients expressing they were unaware that they were the recipients of an enhanced care program, and that CATcH. Patients who received CATcH in the second half of the program reported better care collaboration and more useful educational materials that those enrolled earlier in the project.

Conclusions:
Patients found the CATcH program and its component parts useful in the ongoing management of post-stroke BP control. Continuous self-evaluation and refinement of the program throughout the intervention period likely contributed to improvements in care collaboration and education.
Abstract P851: Embracing Virtual Connection: An Innovative Systemwide Approach to Support Groups
Authors: Rossi Carly J , Westensee Nicole , Elizabeth Dienst , Hagedorn Danielle , Schafer Julie , Graves Alex M
Published: March 2021

Background:
Following a statewide stay-at-home order, Centura Stroke Support Group meetings were postponed indefinitely due to our high-risk patient population. Throughout the organization, stroke coordinators and support group leaders recognized the importance of community and continued support for the stroke population. The objective was to develop a creative survivor & caregiver support offering following social distancing guidelines given the Covid-19 restrictions, while collaborating & expanding opportunities for stroke support across the Centura system.

Purpose:
We hypothesized that we could successfully support stroke survivors & caregivers through a virtual platform during the pandemic & improve accessibility regardless of participant location or transportation.

Methods:
Group leaders assessed stroke survivors & caregivers ongoing needs through weekly outreach identifying the importance of the support group and a need for continued group access during the Covid-19 pandemic. Attendee’s indicated an interest in virtual support & a willingness to learn the required virtual platform. Leaders collaborated across the system to organize efforts in reaching survivors & caregivers at each hospital while sharing group curriculum & education systemwide; thus, allowing groups to meet at different times and increasing overall accessibility. Facilitators worked with individuals to problem solve potential issues navigating a virtual format.

Results:
The virtual format successfully provided support from the comfort & safety of home. Attendance increased in comparison to an in-person format. When asked about preference for an in-person setting only vs. a combination of in-person & virtual format, 80% selected a combination format. Working together across the system, stroke coordinators & group facilitators benefitted from a broader range of resources and connected the greater stroke community across Colorado.

Conclusion:
Regardless of future restrictions, hospitals should consider virtual support groups to increase accessibility for survivors & caregivers. There are benefits of the virtual platform which expand access to support by reducing barriers such as community availability and transportation.
Abstract P853: Covid-19: A Catalyst for Change in the Code Brain Pathway
Authors: Steiner Nili E , Izzo Rachel , Paletz Laurie B , Robertson Betty , Wolber Nicole , Guerra Sonia , Song Shlee S
Published: March 2021

Background:
Acute stroke care is constantly evolving and often necessitates rapid change. When COVID-19 struck our community, our team determined that we needed to change our approach to emergent stroke cases without sacrificing efficiency and safety. Our goals with the changes in our hyperacute stroke response pathway (called Code Brain) in our ED was to minimize COVID-19 exposure to our team, reduce PPE usage, and maintain an environment of safety and readiness, all while providing the same high-quality stroke care.

Purpose:
The purpose of this study was to determine if the changes we made to our Code Brain pathway in the ED effected our door-to-needle time for tissue plasminogen activator (t-PA) administration our door-to-groin puncture (DTG) times, or our CT scan turn-around times (CT TAT) under 45 minutes percentage. Implementation: It was decided that the stroke team RNs would respond to the bedside and a neurology resident or fellow would respond via telemedicine robot at bedside. The stroke team nurse is the safety monitor who ensures proper PPE use. The patient is moved through the Code Brain pathway with the telemedicine robot in tow, assuring constant contact with the patient by the stroke physician and stroke nurse. We implemented our revised Code Brain pathway on March 17, 2020. We retrospectively collected data from November 2019 to July 2020 and extracted our DTN, DTG and CT TAT times for a 4 ½ month comparison.

Results:
From November 2019 through March 17, 2020, our DTN median time was 39 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 97%. From March 18, 2020 to July 2020, our DTN median time was 54 minutes, DTG median time was 101 minutes, and CT TAT under 45 minutes was 95%. Variables to consider are the length of time it takes to apply the appropriate PPE for the stroke nurse, obtaining the telemedicine robot from our ED storage area and connectivity issues.

Conclusion:
Although we radically changed the way we approach our Code Brain patients, our response and treatment times changed only slightly. We will continue to streamline this process for optimal outcomes.
Abstract P86: The Temporal Relationship of the First Reported Covid Case and Statewide Executive Orders to Regional Code Stroke Activation Trends During North Carolina’s First Covid Surge
Authors: Macko Lauren , Prasad Tanushree , Karamchandani Rahul R , Singh Sam , Asimos Andrew W
Published: March 2021

Introduction:
A decline in suspected acute stroke (“code stroke”) presentations in the United States (US) during the first COVID surge has been previously reported. While state emergency declarations may have contributed to the decline and rebound of weekly code stroke activations in our region, the exact temporal relationship of those declarations relative to weekly code stroke volumes is unclear.

Methods:
We conducted an interrupted time series analysis (ITSA) to identify the impact of the first reported COVID case in North Carolina (NC) and subsequent statewide executive orders (SEOs) on weekly code stroke activation trends across our regional stroke network’s 20 facilities during a 33-week period (December 8, 2019 to July 25, 2020). We included the following time epochs: the first reported COVID case in NC, the NC SEO prohibiting mass gatherings and closing public schools, the stay-at-home NC SEO, and the NC phase 1 and phase 2 reentry orders, which eased restrictions.

Results:
Utilizing our integrated healthcare network’s code stroke registry, we evaluated 3740 code stroke activations over a 33-week period. We performed two ITSA considering different starting points for the first intervention—one defined as the first COVID case and the other the first SEO. For both models the end of the first-time interval ended with the second SEO. Most of the downward trend in code stroke activation volume was temporally after the first COVID case (p=0.0029), not after the first SEO. After the second SEO, which increased social restrictions, there was a significant increased trend in code stroke activation volume (p=0.0047), while the phase 1 and 2 reopening SEOs were not associated with a significant increase in weekly code stroke activations.

Conclusion:
Our data indicate that in our region, the decreased trend in code stroke activations preceded the first SEO and started temporally after the first reported COVID case in NC. The overall decrease in code stroke volume was not significantly associated with increasing statewide restrictions and lessening of those restrictions was not significantly associated with a rebounding trend. Restrictive and reentry SEOs do not explain changes in weekly code stroke activation trends our region experienced during its first COVID surge.
Abstract P867: Stroke Facilitators Provide Support to the Intensive Care Unit Nurse
Authors: Dambrosio Robin , Avis Elizabeth
Published: March 2021

Purpose:
The Stroke Program manager (SPM) collaborated with the Rapid Response Team Nurses (RRTRN) to develop a facilitator process for patients in the intensive care units (ICU) presenting with stroke symptoms. The SPM developed a process to include activation of the Rapid Response Team (RRT) which included dedicated RRTRNs for all non-ICU stroke alerts (SA). This new SA improved care coordination, patient outcomes and improved the nurse work environment. The SPM identified the need for a similar SA process in the ICUs. Jointly, the SPM and RRTRNs developed a process to expand the RRTRN role to facilitate SAs in all ICUs.

Methods:
The SPM proposed involvement of the RRTRNs in the SA for ICU patients to the RRT Subcommittee with the support of nursing leadership. This new process would involve the RRTRN responding to all SA activations in the ICU. Care coordination shifted to a leadership couplet: the RRTRN and the ICURN. Implementation included specialized education orientation and scripted materials. The ICU RNs were educated on this unique process. This cutting edge process was incorporated into the RRT matrix to accommodate simultaneous RRT and SA alert activations. The RRTRNs provided efficient care coordination, dependable documentation, enhanced patient outcomes and support to the ICU RN.

Evaluation:
Utilizing RRTRNs as stroke facilitators bolstered the stroke alert process in the ICUS. When a patient exhibits sudden stroke like symptoms, the RRTRNs bring their expertise to the bedside, specifically by achieving the stroke metrics. ICU patients already have complex needs and the addition of a stroke complication is not a common occurrence. Creating this small group of “stroke experts” outside the ICU transferred easily into the ICU setting. Since its implementation, the facilitated 60 ICU SA focusing on the aspects of stroke care while the ICU nurse continues to maintain the critically ill patient.

Implications for Practice:
ICU are often very specialized in the care they deliver, but a stroke can traverse all of those specialties. Developing a small group of experts in stroke, provided consistency, support, and overall better care and outcomes for a patient when every moment counts. Utilizing the existing group of RRTRNs was fiscally sound as well as practical.
Abstract P870: Disparities in Timelines of Hospital Presentation in Patients With Ischemic Stroke: Florida Stroke Registry
Authors: Simpkins Alexis N , Wang Kefeng , Gutierrez Carolina M , Marulanda-londono Erika T , Gardener Hannah , Dong Chuanhui , Foster Dianne , Rundek Tatjana , Romano Jose G , Sacco Ralph L , Asdaghi Negar ,   Florida Stroke Registry
Published: March 2021

Introduction:
Characterizing the population of ischemic stroke (IS) patients presenting in the delayed reperfusion window is important to ensure equitable implementation of recently updated acute IS treatment guidelines.

Methods:
Florida Stroke Registry (FSR) data from Jan 2010 - Jan 2020, provided a complete dataset of 98,372 IS cases presenting within 24 hrs of symptom onset. Generalized linear regression analysis was used to identify differences between delayed IS cases (>4.5 hours) versus those presenting within the early time window (≤ 4.5 hr).

Results:
A total of 60,311 presented with 4.5 hr (median age 74 (interquartile range (IQR) 62-83), 49% women, 67% white, 15% Black, 18% Hispanic), and 38,061 presented in the delayed window (median age 72 (IQR 61- 82), 49% women, 63% white, 18% Black, 19% Hispanic). As compared to early presenters, delayed window patients were younger (OR 1.23, 95% confidence interval (CI) 1.17-1.29); more Black vs. White (OR 1.12, 95% CI 1.06-1.18), have higher NIHSS (OR 1.05, 95% 1.01-1.10), insured (OR 1.18, 95% 1.11-1.25), presenting to an academic hospital (OR 1.24, 95% CI 1.09-1.40) in South Florida (OR 1.23, 95% CI (1.08, 1.41)); less likely to arrive by EMS (OR 0.59, 95% CI 0.56-0.62) and less likely to receive reperfusion therapies (OR 0.86, 95% CI 0.79-0.94). In multivariable analysis adjusting for age, race, NIHSS, EMS, reperfusion therapies, hospital academic status and region, delayed window presentation was negatively associated with discharge home (OR 0.82, 95% CI 0.76-0.89), and ambulatory status at discharge (OR 0.89, 95% CI 0.84-0.93).

Conclusion:
We found significant race, ethnic, socioeconomic and geographical disparities amongst those presenting in the delayed vs early reperfusion time windows with consequential effects on patient outcomes. Stroke education to younger minorities and adaptation of regional stroke systems of care are urgently needed.
Abstract P871: Community and Academic Partner Creation of a Community-Informed, Behavior Theory-Based Music Video to Encourage Stroke Preparedness During the Covid-19 Pandemic
Authors: Robles Maria Cielito , Corches Casey , Bradford Morgan , Rice Tia , Sukul Devraj , Springer Mellanie , Bailey Sarah , Oliver Alina , Skolarus Lesli E
Published: March 2021

Background:
Black Americans comprise 14% of Michigan’s population, but 30% of the COVID-19 cases and 40% of deaths. The accumulating national quantitative data on decreased presentation and increased pre-hospital delay during the pandemic confirmed our Flint, MI community partners’ impression of a decline in stroke presentations. Thus, we set out to understand the community’s perception of seeking acute stroke care during the pandemic which will inform the development and dissemination of public health messaging in a predominantly Black American community.

Method:
To honor social distancing orders, we conducted semi-structured interviews based on the Theory of Planned Behavior via HIPAA-approved teleconferencing with community members. Due to the clinical and public health implications of the pandemic, we employed a rapid assessment approach to streamline qualitative data analysis. Results were used to inform the creation of a music video. Lyrics were written by the academic team, set to a soundtrack and sung by a community partner. The music video theme was conceptualized by the academic team and performed by both academic and community partners.

Results:
We reached thematic saturation after completing 15 semi-structured interviews with Flint, MI community members. Mean duration of interviews was 40 minutes. Eighty percent of participants were Black; median age was 50; 74% were women and 47% reported some college or above. There was an unfavorable attitude towards seeking emergent stroke care via ambulance and at the hospital, due to concerns for viral transmission at the hospital, hospital capacity and ability to triage, and quality of care. Community and academic partners co-created a music video with verses addressing the community-identified barriers: “
stroke is an emergency all the time, even with COVID-19 / get to the hospital as soon as symptoms start, it’s so important to do your part, be Stroke Ready”
(https://youtu.be/lKefAiUM2W0) The video reached over 1,200 users on our community-academic partner Stroke Ready Facebook page.

Conclusion:
We found that community members’ attitudes and perceived behavioral control to seek emergent stroke care were impacted during the COVID-19 pandemic. We addressed these barriers in an academic-community partner created music video. Academic and community partnerships facilitated a timely, innovative response to seeking acute stroke care in the setting of the COVID-19 pandemic.