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  1. Article ; Online: Benefit of a Stroke Management Program.

    Gzesh, Dan / Murphy, Deborah A / Peiritsch, Heather / MacCracken, Timothy

    Population health management

    2020  Volume 23, Issue 6, Page(s) 482–486

    Abstract: Hospital participation in stroke bundle programs presents financial risk. There are limited comparative data on the success of such programs. The authors aimed to assess the success of a management program in reducing the number of patients admitted to a ...

    Abstract Hospital participation in stroke bundle programs presents financial risk. There are limited comparative data on the success of such programs. The authors aimed to assess the success of a management program in reducing the number of patients admitted to a skilled nursing facility (SNF), average length of stay, and the number of patients discharged to inpatient rehabilitation units. Three program metrics included reduction in number of stroke patients admitted to SNF, reduction in length of stay at SNFs, and reduced 90-day hospital readmission rates. The program was implemented during a 3-year period from October 1, 2015, through September 30, 2018, included 803 patients in the data, and demonstrated financial gain with positive patient outcomes. There was a 0.5% reduction in the number of stroke patients admitted to SNF. Sending patients home with a high-quality home care agency for rehabilitation and navigation assistance were the goals for this metric. A 1.65-day reduction in length of stay for overall SNF providers was noted. This was achieved by utilizing a preferred network of skilled facilities and community partners that the nurse navigator interfaced with weekly. The proportion of patients discharged to inpatient rehabilitee units was 2.2% less than in the baseline years. With the implementation of a stroke nurse navigator, hospital readmissions as a percentage of admissions for stroke decreased by 4%. Overall return on investment was greater than 400% after accounting for additional staffing and data/license fees.
    MeSH term(s) Hospitalization ; Humans ; Patient Discharge ; Patient Readmission ; Skilled Nursing Facilities ; Stroke/epidemiology ; Stroke/therapy ; United States
    Language English
    Publishing date 2020-01-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2454546-6
    ISSN 1942-7905 ; 1942-7891
    ISSN (online) 1942-7905
    ISSN 1942-7891
    DOI 10.1089/pop.2019.0123
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5170: Show issues Location:
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  2. Article: MRI and angiographic diagnosis of lupus cerebral vasculitis.

    Liem, M D / Gzesh, D J / Flanders, A E

    Neuroradiology

    1996  Volume 38, Issue 2, Page(s) 134–136

    Abstract: The authors present a patient with striking angiographic findings of systemic lupus erythematosus (SLE) cerebral vasculitis. Although lupus is often cited as part of the differential diagnosis for angiographically apparent cerebral vasculitis, true SLE ... ...

    Abstract The authors present a patient with striking angiographic findings of systemic lupus erythematosus (SLE) cerebral vasculitis. Although lupus is often cited as part of the differential diagnosis for angiographically apparent cerebral vasculitis, true SLE cerebral vasculitis is rare in pathological and radiological series. The clinical spectrum and pathological findings of CNS lupus with particular attention to cerebral vasculitis are briefly discussed.
    MeSH term(s) Arteritis/diagnosis ; Biopsy ; Brain/blood supply ; Capillaries/pathology ; Cerebral Angiography ; Cerebral Arterial Diseases/diagnosis ; Cerebral Arteries/pathology ; Cerebral Cortex/blood supply ; Cerebral Infarction/diagnosis ; Female ; Humans ; Lupus Erythematosus, Systemic/diagnosis ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Skin/blood supply ; Vasculitis/diagnosis
    Language English
    Publishing date 1996-02
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 123305-1
    ISSN 1432-1920 ; 0028-3940
    ISSN (online) 1432-1920
    ISSN 0028-3940
    DOI 10.1007/bf00604798
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 658: Show issues Location:
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  3. Article ; Online: Pennsylvania comprehensive stroke center collaborative: Statement on the recently updated IV rt-PA prescriber information for acute ischemic stroke.

    Daou, Badih / Deprince, Maureen / D'Ambrosio, Robin / Tjoumakaris, Stavropoula / Rosenwasser, Robert H / Ackerman, Daniel J / Bell, Rodney / Tzeng, Diana L / Ghobrial, Michelle / Fernandez, Andres / Shah, Qaisar / Gzesh, Dan J / Murphy, Deborah / Castaldo, John E / Mathiesen, Claranne / Pineda, Maria Carissa / Jabbour, Pascal

    Clinical neurology and neurosurgery

    2015  Volume 139, Page(s) 264–268

    Abstract: Objective: Recently, the FDA guidelines regarding the eligibility of patients with acute ischemic stroke to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in ... ...

    Abstract Objective: Recently, the FDA guidelines regarding the eligibility of patients with acute ischemic stroke to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in discrepancies in patient selection for intravenous thrombolysis.
    Methods: Several comprehensive stroke centers in the state of Pennsylvania have undertaken a collaborative effort to clarify and unify our own recommendations regarding how to reconcile these different guidelines.
    Results: Seizure at onset of stroke, small previous strokes that are subacute or chronic, multilobar infarct involving more than one third of the middle cerebral artery territory on CT scan, hypoglycemia, minor or rapidly improving symptoms should not be considered as contraindications for intravenous thrombolysis. It is recommended to follow the AHA/ASA guidelines regarding blood pressure management and bleeding diathesis. Patients receiving factor Xa inhibitors and direct thrombin inhibitors within the preceding 48 h should be excluded from receiving IV rt-PA. CT angiography is effective in identifying candidates for endovascular therapy. Consultation with and/or transfer to a comprehensive stroke center should be an option where indicated. Patients should receive IV rt-PA up to 4.5h after the onset of stroke.
    Conclusions: The process of identifying patients who will benefit the most from IV rt-PA is still evolving. Considering the rapidity with which patients need to be evaluated and treated, it remains imperative that systems of care adopt protocols to quickly gather the necessary data and have access to expert consultation as necessary to facilitate best practices.
    MeSH term(s) Administration, Intravenous ; Antithrombins/therapeutic use ; Brain Ischemia/complications ; Brain Ischemia/diagnosis ; Brain Ischemia/drug therapy ; Cerebral Angiography ; Cooperative Behavior ; Factor Xa Inhibitors/therapeutic use ; Fibrinolytic Agents/therapeutic use ; Humans ; Patient Selection ; Pennsylvania ; Practice Guidelines as Topic ; Stroke/diagnosis ; Stroke/drug therapy ; Stroke/etiology ; Thrombolytic Therapy/methods ; Time-to-Treatment/standards ; Tissue Plasminogen Activator/therapeutic use ; Tomography, X-Ray Computed ; United States ; United States Food and Drug Administration
    Chemical Substances Antithrombins ; Factor Xa Inhibitors ; Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
    Language English
    Publishing date 2015-12
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 193107-6
    ISSN 1872-6968 ; 0303-8467
    ISSN (online) 1872-6968
    ISSN 0303-8467
    DOI 10.1016/j.clineuro.2015.10.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: The spectrum of epilepsy in sickle cell anemia.

    Liu, J E / Gzesh, D J / Ballas, S K

    Journal of the neurological sciences

    1994  Volume 123, Issue 1-2, Page(s) 6–10

    Abstract: In a study population of 152 patients seen at Thomas Jefferson University Hospital's sickle cell center between 1981 and 1992, 21 patients with seizures were identified. Clinical charts, electroencephalograms and neuroradiological studies were reviewed ... ...

    Abstract In a study population of 152 patients seen at Thomas Jefferson University Hospital's sickle cell center between 1981 and 1992, 21 patients with seizures were identified. Clinical charts, electroencephalograms and neuroradiological studies were reviewed retrospectively. Seventeen patients with epilepsy were identified. Eleven had generalized tonic-clonic, 2 had partial, and 4 had poorly characterized seizures. CT/MRI evaluation was focally abnormal in 6 patients, 4 of whom had cortical lesions. Atrophy was noted in 3 patients, while imaging studies were normal in 6 patients. The EEGs demonstrated focal epileptiform discharges in 9 patients, generalized slowing in 5 patients, and was normal in 3 patients. Four patients had generalized seizures only with meperidine administration, all of whom had nonfocal EEG and radiological studies. We concluded that (1) epilepsy is more common in sickle cell patients than in the general population; (2) the majority of our epileptic sickle cell patients have nonfocal CT or MRI studies but demonstrate focal EEG abnormalities; and (3) meperidine administration is associated with generalized seizures in sickle cell patients.
    MeSH term(s) Adult ; Anemia, Sickle Cell/complications ; Anemia, Sickle Cell/physiopathology ; Brain/diagnostic imaging ; Brain/pathology ; Electroencephalography ; Epilepsy/complications ; Epilepsy/physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Meperidine ; Middle Aged ; Retrospective Studies ; Seizures/complications ; Seizures/physiopathology ; Tomography, X-Ray Computed
    Chemical Substances Meperidine (9E338QE28F)
    Language English
    Publishing date 1994-05
    Publishing country Netherlands
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 80160-4
    ISSN 1878-5883 ; 0022-510X ; 0374-8642
    ISSN (online) 1878-5883
    ISSN 0022-510X ; 0374-8642
    DOI 10.1016/0022-510x(94)90196-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 308: Show issues Location:
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  5. Article: Complex partial epilepsy: the role of neuroimaging in localizing a seizure focus for surgical intervention.

    Gzesh, D / Goldstein, S / Sperling, M R / Alavi, A

    Journal of nuclear medicine : official publication, Society of Nuclear Medicine

    1990  Volume 31, Issue 11, Page(s) 1839–1843

    MeSH term(s) Adult ; Deoxyglucose/analogs & derivatives ; Electroencephalography ; Epilepsy, Temporal Lobe/diagnostic imaging ; Epilepsy, Temporal Lobe/pathology ; Epilepsy, Temporal Lobe/surgery ; Female ; Fluorine Radioisotopes ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging ; Temporal Lobe/surgery ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon
    Chemical Substances Fluorine Radioisotopes ; Fluorodeoxyglucose F18 (0Z5B2CJX4D) ; Deoxyglucose (9G2MP84A8W)
    Language English
    Publishing date 1990-11
    Publishing country United States
    Document type Clinical Conference ; Journal Article
    ZDB-ID 80272-4
    ISSN 1535-5667 ; 0161-5505 ; 0097-9058 ; 0022-3123
    ISSN (online) 1535-5667
    ISSN 0161-5505 ; 0097-9058 ; 0022-3123
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.MO 328: Show issues

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  6. Article: Dialysis-induced hypoxemia: membrane dependent and membrane independent causes.

    Francos, G C / Besarab, A / Burke, J F / Peters, J / Tahamont, M V / Gee, M H / Flynn, J T / Gzesh, D

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    1985  Volume 5, Issue 3, Page(s) 191–198

    Abstract: Hypoxemia during hemodialysis may result from several differing processes. We initially studied patients undergoing standard acetate hemodialysis. At 15 minutes of dialysis, leukopenia (primarily neutropenia), a decline of platelet count, and hypoxemia ... ...

    Abstract Hypoxemia during hemodialysis may result from several differing processes. We initially studied patients undergoing standard acetate hemodialysis. At 15 minutes of dialysis, leukopenia (primarily neutropenia), a decline of platelet count, and hypoxemia occurred, but without a significant change in mean minute ventilation. Complement activation (V/A ratios of C5a greater than 1.0) persisted throughout dialysis. Leukocyte count returned to baseline by one hour. To separate the effects of solute and/or gas fluxes from those of blood-membrane interaction we studied changes in Po2, WBC, C5a, TxB2, and PGI2 during a period of blood membrane interaction without dialysis, and during subsequent acetate dialysis. Patients were studied with both polyacrylonitrile (PAN) and cuprophan membranes containing different priming solutions during membrane contact alone. Despite leukopenia and complement activation, hypoxemia failed to occur during membrane contact alone. At 15 minutes of subsequent acetate dialysis, significant hypoxemia occurred with both membranes. However, the degree of hypoxemia was twice as great with a cuprophan membrane primed with acetate (18.6 +/- 3.3 mm Hg) compared with air or bicarbonate (9.1 +/- 1.4 and 7.0 +/- 2.0 mm Hg, respectively), or compared with PAN (8 +/- 2.8 mm Hg). Changes in thromboxane B2, PGI2, and C5a did not correlate with changes in Po2. We conclude that there are two major components to dialysis related hypoxemia. One is membrane independent, and may relate to the metabolic effects of acetate or to dialyzer CO2 loss. The remaining portion is membrane dependent, occurring with cuprophan, but not with PAN, and is conditioned by an acetate dependent interaction between blood and membrane.
    MeSH term(s) Adolescent ; Adult ; Carbon Dioxide/blood ; Epoprostenol/blood ; Female ; Humans ; Hypoxia/blood ; Hypoxia/etiology ; Leukocyte Count ; Male ; Membranes, Artificial ; Middle Aged ; Oxygen/blood ; Platelet Count ; Renal Dialysis/adverse effects ; Respiration ; Thromboxane B2/blood ; Time Factors
    Chemical Substances Membranes, Artificial ; Carbon Dioxide (142M471B3J) ; Thromboxane B2 (54397-85-2) ; Epoprostenol (DCR9Z582X0) ; Oxygen (S88TT14065)
    Language English
    Publishing date 1985-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1016/s0272-6386(85)80050-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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