Providence Holy Cross Medical Center

ABSTRACTObjectivesSeizures are both a common mimic and a potential complication of acute stroke. Although EEG can be helpful to evaluate this differential diagnosis, conventional EEG infrastructure is resource- intensive and unable to provide timely monitoring to match the emergent context of a stroke code. We aimed to evaluate the real-world use and utility of a point-of-care EEG device as an adjunct to acute stroke evaluation.Materials and MethodsWe performed a retrospective observational cohort study at a tertiary care community teaching hospital by identifying patients who underwent point-of-care EEG monitoring using Rapid Response EEG system (Ceribell Inc., Sunnyvale, CA) during stroke code evaluation of acute neurological deficits during the study period from January 1, 2020 to December 31, 2020. We assessed the frequency of seizures and highly epileptiform patterns among patients with either confirmed strokes or stroke mimics.ResultsPoint-of-care EEG monitoring was used in the wake of a stroke code in 70 patients. Of these, neuroimaging and clinical information resulted in a diagnosis of stroke in 38 patients (28 ischemic, 6 hemorrhagic, 4 transient ischemic attack; median NIHSS score of 6.5 [IQR 2.0-12.0]) and absence of any stroke in 32 patients. Point-of-care EEG detected seizures and highly epileptiform patterns in 6 (15.8%) stroke patients and 11 (34.4%) stroke-mimic patients, including 2 patients with persistent expressive aphasia due to repeated focal seizures.ConclusionsPoint-of-care EEG has utility for detecting nonconvulsive seizures in patients undergoing acute stroke evaluations.

Hospital-based chaplains receive specialized training to provide spiritual support to patients and healthcare staff during difficult health transitions. However, the impact of perceived chaplain importance on healthcare staff's emotional and professional well-being is unclear. Healthcare staff (n = 1471) caring for patients in an acute care setting within a large health system answered demographic and emotional health questions in Research Electronic Data Capture (REDCap). Findings suggest that as perceived levels of chaplain importance increase, burnout may decrease and compassion satisfaction may improve. Chaplain presence in the hospital setting may support healthcare staff emotional and professional well-being following occupational stressors including COVID-19-related surges.

Introduction: The American Stroke Association Guidelines on acute ischemic stroke (AIS) thrombolytic treatment endorse the use of tenecteplase (TNK) weakly (IIb) based on moderate quality (B-R) evidence. The use of alteplase for AIS is strongly recommended (I) with high quality (A) of evidence. Despite this, many healthcare systems have transitioned to the use of TNK based on limited clinical trial data. Our study presents real world outcome data comparing AIS patients treated with TNK vs alteplase. Methods: Data were retrospectively abstracted from AIS patients treated with IV thrombolytic (IVT) or IVT and endovascular therapy (EVT) discharged between 1/1/2019-6/30/2022 . Patients were grouped into alteplase w/wo thrombectomy and TNK w/wo thrombectomy. Primary outcomes were discharge disposition, complications (sICH, serious systemic hemorrhage), door to needle and door to device times, treatment complications and post-EVT TICI score. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported for likelihood to receive IVT within 45 minutes and 30 minutes of arrival for the IVT group, adjusting for sex, race, admit NIHSS, and previous stroke. Results: 3733 patients were included in the IVT group: 90.7% received alteplase, 9.3% received TNK. 814 patients received IVT and EVT: 90% received alteplase and 10% received TNK. In the IVT group, the median [Q1, Q3] DTN for alteplase was 48 [35, 66] minutes TNK was 45.5 [34.75, 63.25] (p=0.067). There was no significant difference in the likelihood of receiving IVT within 45 minutes and 30 minutes between the two drugs. Patients with higher admit NIHSS were more likely to receive IVT within 45 minutes (AOR 1.031 95% 1.021, 1.041 p<0.0001) and within 30 minutes (AOR 1.025 95% 1.013, 1.037 p<0.0001). There were no significant differences found in median DTN, DTD or TICI score for patients receiving both IVT and EVT. There were no significant differences in complications for any group. Conclusion: In our study there were no differences in benefit, risk, or treatment logistics between alteplase and tenecteplase when used in treating acute ischemic stroke. Recanalization of large vessel occlusion prior to endovascular thrombectomy was not analyzed but will be the subject of study in this cohort.

Continuing education, knowledge acquisition, and competence is required of all professional Registered Nurses. Remaining current in care delivery trends based on evidence practice is the responsibility of nurses supported by professional development specialists and educators. This project was conducted as a quality improvement project, using the evidence-based teaching modality of storytelling to educate practitioners in caring for older adults. This project addresses the question: For leaders of professional development and education focused on acute care and ambulatory practice, who have not had specialty geriatric training, how does using case-based/story-telling education for the care of patients 65 years and older affect confidence levels of the 4 M’s (mentation, mobility, what matters and medication) of elder care? A convenience sample of 12 Directors of Professional Development participated, and a validated comparison of responses to the Gerontological Nursing Competence Questionnaire (GNCQ) and the Facts on Aging (2015 version) (FAQ) were used for collecting data of pre intervention and post intervention. An eight-minute video was the educational intervention. GNCQ responses for confidence in knowledge and confidence in teaching were statistically significant. Although an increase in the mean score for interest in additional training, it was not statistically significant. The FAQ showed no statistical significance for the pre and post results. Findings indicate that storytelling is a viable teaching modality for increasing nurse’s knowledge of caring for older adults based on the concepts of the 4 Ms of age-friendly care. Keywords: storytelling, case studies, nurse education, professional development, narratives, and adult learning.

Abstract BackgroundThe SARS-CoV2 virus continues to have devastating consequences worldwide. Though vaccinations have helped to reduce the impact of the virus, new strains still pose a threat to unvaccinated, and to a lesser extent vaccinated, individuals. Therefore, it is imperative to identify treatments that can prevent the development of severe COVID-19. Recently, acute use of SSRI antidepressants in COVID+ patients has been shown to reduce the severity of symptoms compared to placebo. Since SSRIs are a widely used anti-depressant, the aim of this study was to determine if COVID+ patients already on SSRI treatment upon admission to the hospital had reduced mortality compared to COVID+ patients not on chronic SSRI treatment.MethodsA retrospective observational study design was used. Electronic medical records of 9,043 patients with a laboratory-confirmed diagnosis of Covid-19 from 03/2020 to 03/2021from six hospitals were queried for demographic and clinical information. Using R, a logistic regression model was run with mortality as the outcome and SSRI status as the exposure. An adjusted logistic regression model was run to account for age category, gender, and race. All tests were considered significant at p of 0.05 or less.ResultsIn this sample, no patients admitted on SSRIs had them discontinued. This is consistent with current recommendations. There was no significant difference in the odds of dying between COVID+ patients on chronic SSRIs vs COVID+ patients not taking SSRIs, after controlling for age category, gender, and race. The odds of COVID+ patients on SSRIs dying was 0.98 (95%CI: 0.81, 1.18) compared to COVID+ patients not on SSRIs (p=0.83).ConclusionIn times of pandemics due to novel infectious agents it is difficult, but critical to evaluate safety and efficacy of drugs that might be repurposed for treatment. This large sample size of 9,043 patients suggests that there will be no significant benefit to use of SSRIs to decrease mortality rates for hospitalized patients with Covid-19 who are not currently on SSRI medications. This study shows the utility of large clinical databases in addressing the urgent issue of determining what commonly prescribed drugs might be useful in treating COVID-19.

While the use of histamine-2 receptor blockers (H2RBs) and proton pump inhibitors (PPIs) have been useful for the prophylaxis of peptic ulcer disease (PUD), there has been little information regarding which medication should be used initially. In the hospital setting, PPIs are often prescribed for PUD prophylaxis, even when patients have no history of gastroesophageal reflux disease. While PPIs have been demonstrated to be stronger than H2RBs, their long-term use can be detrimental to health-care outcomes. Owing to this overuse of PPIs, the use of H2RBs should be re-examined. In the first part of this two-part series on H2RBs vs PPIs, Ronnell Regidor will review several studies that assess the clinical scenarios in which H2RBs and PPIs should be used. Ultimately, this article proposes that, for patients without any gastrointestinal medical history, H2RBs should be the initial medication for PUD prophylaxis.