White Plains Hospital

Background: Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Mechanical thrombectomy has emerged as the gold standard for treatment in patients with large vessel occlusion, offering potential for significant neurological recovery. Timely reperfusion therapy is critical for brain tissue preservation, with shorter door-to-puncture times linked to better survival, reduced disability, and improved quality of life. Purpose: This quality improvement initiative aimed to achieve the American Heart Association’s door-to-puncture time of ≤60 minutes in ≥85% of eligible patients, regardless of arrival mode. Methods: An interdisciplinary team spearheaded this initiative, emphasizing enhanced communication and collaboration across care settings. Through a comprehensive review of existing processes, clinical practices, and data, the team pinpointed opportunities for optimization. Key interventions included strengthening prehospital EMS communication by implementing an escalation notification system based on the S-LAMS score, designating a dedicated emergency department room near the CT scanner for rapid neurological assessment of S-LAMS-positive patients, and prioritizing ongoing EMS education paired with a standardized feedback form for case-specific reviews to support triage accuracy and foster continuous quality improvement. Results: The initiative significantly improved stroke care, increasing the percentage of patients meeting the American Heart Association’s ≤60-minute door-to-puncture target by 106%. From January to May 2025, 33% of patients achieved the goal, with monthly rates rising from 0% in January and February to 40%, 50%, and 60% in March, April, and May, respectively, reflecting enhanced coordination, workflow efficiency, and sustained improvements in stroke care metrics. Conclusions: This performance improvement initiative demonstrated that interdisciplinary collaboration, targeted communication strategies, and process optimization can significantly enhance stroke care delivery. Strengthening partnerships with EMS and implementing streamlined workflows contributed to improved efficiency and alignment with national time-sensitive goals.

BackgroundGreater Trochanteric Pain Syndrome (GTPS) is a common cause of chronic lateral hip pain, often refractory to conservative medical management (CMM). Combined percutaneous ultrasound-guided tenotomy (PUT) of the gluteus medius (GMed) and iliotibial band (ITB) has shown promising one-year results, but data on long-term outcomes remain limited. This study evaluates two-year clinical outcomes in patients undergoing combined GMed and ITB PUT for recalcitrant GTPS.MethodsThis retrospective cohort study included 69 patients (79 hips) treated with combined GMed and ITB PUT between January 2022 and August 2023. Baseline and follow-up data, collected for an average of 2-year, were obtained through chart review and structured phone interviews. The primary outcome was ≥50 % reduction in Numeric Rating Scale (NRS) pain scores. Secondary outcomes included side-lying tolerance, sitting-to-standing ability, responder rate and need for additional hip interventions. Responder status required both pain reduction and complete side-lying tolerance. Statistical significance was evaluated using paired t-tests with p < 0.05.ResultsMedian baseline Numeric Rating Scale (NRS) pain score was 10 interquartile range (IQR 9–10), decreasing significantly to 2 (IQR 1–4) at 1, 6, and 12 months, then increasing to 6 (IQR 4–10) at 24 months (p < 0.001 vs. baseline). Rates of ≥50 % improvement in NRS were 88.6 % at 1 month, 89.6 % at 6 months, 83.0 % at 12 months, and 59.5 % at 24 months. Side-lying tolerance improved from 21.5 % hips at baseline to 88.9 % reporting improvement at 1 month and 55.7 % at 24 months (p < 0.001). Sitting-to-standing ability showed sustained improvement at 81.0 % at 24 months. Composite responder rate declined from 88.6 % at 1 month to 57.0 % at 24 months. Subsequent invasive interventions were required in a minority of cases (2.5 % total hip arthroplasty; 11.4 % repeat TENEX).ConclusionCombined PUT of the GMed and ITB provides durable pain relief and functional improvement in patients with refractory GTPS at two years post-procedure. Despite declining responder rates over time, this minimally invasive dual-target technique demonstrates a favorable safety profile and may delay or reduce the need for more invasive surgery. Further prospective studies are warranted to optimize patient selection and validate long-term efficacy.

Emotion regulation (ER) plays a central role in mental health, but the effect differs across cultures. Here, expanding from extant literature's focus on Western-Eastern dichotomy or individualism-collectivism, this meta-analysis synthesized evidence on the associations between the two most-studied ER strategies (cognitive reappraisal and expressive suppression) and two mental health outcomes (psychopathology and positive functioning) and investigated the moderating roles of several cultural dimensions: Hofstede's national cultures dimensions, education, industrialization, richness and democracy (EIRDness), and sample demographics. A comprehensive literature search was conducted using electronic databases (CINAHL, Scopus, Web of Science, PsycINFO and MEDLINE) to identify eligible studies reporting relationships between ER and mental health outcomes (PROSPERO: CRD42021258190, 249 articles, n = 150,474, 861 effect sizes, 37 countries/regions). For Hofstede's national cultures and EIRDness, multimodel inference revealed that greater reappraisal propensity was more adaptive in more short-term-oriented, uncertainty-tolerant and competition-driven cultures, whereas greater suppression propensity was more maladaptive in more indulgent and competition-driven cultures. For demographics, greater reappraisal propensity was more adaptive for samples with more female (B = -0.19, 95% confidence interval (CI) -0.29 to -0.09) and more racial minority participants (B = -0.32, 95% CI -0.51 to -0.13), whereas greater suppression propensity was more maladaptive in younger samples (B = -0.004, 95% CI -0.005 to -0.002). These findings elucidate how cultures are associated with the function of ER and suggests ways in which future studies can integrate cultural characteristics when examining ER and psychological adjustment.

Inclusion, diversity, equity, and accessibility (IDEA) is a set of practices that aims to create a welcoming and inclusive environment. They are organizational frameworks which seek to promote fair treatment and full participation of all people, particularly groups who have historically been underrepresented and/or unrepresented or subject to discrimination based on identity or disability. The IDEA is a relatively new way of thinking about and fully realizing the abilities and contributions of all individuals. The year 2020 was a year of focus on issues of systemic racism, inequality in our institutions, and cultural divisions. To support the Society for Vascular Ultrasound’s (SVU) goals, the Diversity, Equity, and Inclusion Advisory Council (DEI-AC) was established in July 2020 to provide ongoing and evolving assessment and recommendations integral to the success of the Society. Its purpose is to assist the SVU Board of Directors (BoD) to ensure that the voices of diverse SVU members are heard and represented within the SVU; its authority is to make recommendations to the BoD. The Council evaluated the current status of diversity, equity, and inclusion within the SVU, and what follows is a summary of those activities, goals of the DEI-AC, and recommendations for enhancing IDEA within our Society and for our members.

Background: The objective of this study was to examine the impact of the National Accreditation Program for Breast Centers (NAPBC) breast center accreditation on breast reconstruction rates at Commission on Cancer (CoC) centers with (CoC-NAPBC) and without NAPBC accreditation (CoC-noNAPBC). Methods: We conducted a retrospective observational cohort study that queried the National Cancer Data Base (NCDB) for trends in breast reconstruction from 2009 to 2017. Multivariable logistic regression was used to determine if NAPBC accreditation was an independent predictor of receipt of reconstruction at CoC-NAPBC sites. Results: Of 172,865 patients treated with mastectomy at 451 CoC-NAPBC centers, 88,436 (51.2%) had reconstruction compared to 191,295 (33.7%) at CoC-noNAPBC sites. After adjusting for confounders, CoC-NAPBC centers were 32% more likely {odds ratio (OR) 1.32 [95% confidence interval (CI): 1.30–1.34]} to perform reconstruction than CoC-noNAPBC sites. The absolute difference in the proportion of CoC-NAPBC sites that performed reconstruction before and after NAPBC accreditation went from 14.1% for centers accredited in 2010 to 2.9% for centers accredited in 2015. Comparing CoC-NAPBC to CoC-noNAPBC centers, more Black (38.5% vs. 24.8%), Hispanic (43.1% vs. 31.3%) and Asian Americans (35.5% vs. 26.7%) and Medicaid patients (35.6% vs. 22.5%) underwent reconstruction. Conclusions: NAPBC accreditation at CoC sites was associated with increased rates of reconstruction but this effect decreased by 2015. CoC-NAPBC sites have higher breast reconstruction rates than CoC-noNAPBC sites with fewer disparities by race, insurance status, and facility type.