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Search Results: 1 - 10 of 139528 matches for " Amelia K. Boehme "
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Circle of Willis Variants: Fetal PCA
Amir Shaban,Karen C. Albright,Amelia K. Boehme,Sheryl Martin-Schild
Stroke Research and Treatment , 2013, DOI: 10.1155/2013/105937
A comprehensive stroke center patient registry: advantages, limitations, and lessons learned
James E Siegler,Amelia K. Boehme,Adrianne M. Dorsey,Dominique J. Monlezun
Medical Student Research Journal , 2013,
Abstract: Introduction: The use of medical data registry allows insitutions to effectively manage information for many different investigations related to the registry, as well as evaluate patient's trends over time, with the ultimate goal of recognizing trends that may improve outcomes in a particular patient population.Methods: The purpose of this article is to illustrate our experience with a stroke patient registry at a comprehensive stroke center and highlight advantages, disadvantages, and lessons learned in the process of designing, implementing, and maintaining a stroke registry. We detail the process of stroke registry methodology, common data element (CDE) definitions, the generation of manuscripts from a registry, and the limitations.Advantages: The largest advantage of a registry is the ability to prospectively add patients, while allowing investigators to go back and collect information retrospectively if needed. The continuous addition of new patients increases the sample size of studies from year to year, and it also allows reflection on clinical practices from previous years and the ability to investigate trends in patient management over time.Limitations: The greatest limitation in this registry pertains to our single-entry technique where multiple sites of data entry and transfer may generate errors within the registry.Lessons Learned: To reduce the potential for errors and maximize the accuracy and efficiency of the registry, we invest significant time in training competent registry users and project leaders. With effective training and transition of leadership positions, which are continuous and evolving processes, we have attempted to optimize our clinical research registry for knowledge gain and quality improvement at our center.
Circle of Willis Variants: Fetal PCA
Amir Shaban,Karen C. Albright,Amelia K. Boehme,Sheryl Martin-Schild
Stroke Research and Treatment , 2013, DOI: 10.1155/2013/105937
Abstract: We sought to determine the prevalence of fetal posterior cerebral artery (fPCA) and if fPCA was associated with specific stroke etiology and vessel territory affected. This paper is a retrospective review of prospectively identified patients with acute ischemic stroke from July 2008 to December 2010. We defined complete fPCA as absence of a P1 segment linking the basilar with the PCA and partial fPCA as small segment linking the basilar with the PCA. Patients without intracranial vascular imaging were excluded. We compared patients with complete fPCA, partial fPCA, and without fPCA in terms of demographics, stroke severity, distribution, and etiology and factored in whether the stroke was ipsilateral to the fPCA. Of the 536 included patients, 9.5% ( ) had complete fPCA and 15.1% ( ) had partial fPCA. Patients with complete fPCA were older and more often female than partial fPCA and no fPCA patients, and significant variation in TOAST classification was detected across groups ( ). Patients with complete fPCA had less small vessel and more large vessel strokes than patients with no fPCA and partial fPCA. Fetal PCA may predispose to stroke mechanism, but is not associated with vascular distribution, stroke severity, or early outcome. 1. Introduction Fetal PCA (fPCA) is a common variant of cerebral circulation. Two definitions of fPCA exist in the literature: complete fetal PCA and partial fetal PCA. Complete fetal PCA (cfPCA) is defined as posterior cerebral artery that completely originates from the internal carotid artery ICA with no connection with the basilar artery. Partial fetal PCA (pfPCA) is defined as posterior cerebral artery originating from ICA with a small, or atretic, connection with the basilar. Available studies have largely used the pfPCA definition. Variable prevalence of fPCA has been demonstrated in healthy subjects (15–32%) and those with cerebral infarction (5–36%) using autopsy or magnetic resonance angiography (MRA). Unilateral pfPCA is more frequent (11–29%) than bilateral pfPCA (1–9%). Unilateral cfPCA was detected in 4–26% of cases with only 2–4% having bilateral cfPCA. Prevalence was lower with MRA than autopsy [1]. Study population (healthy subjects versus cerebral infarction) did not influence the fPCA prevalence [1]. cfPCA can impact the anatomy of the cerebral circulation. More area is perfused by the anterior circulation as PCA is completely supplied by ICA. In addition, leptomeningeal collaterals fail to develop between the ICA and the vertebrobasilar system since both the MCA and the PCA are connected to the internal
The Impact of Left Ventricular Hypertrophy and Diastolic Dysfunction on Outcome in Intracerebral Hemorrhage Patients
Karen C. Albright,Joshua M. Burak,Tiffany R. Chang,Aimee Aysenne,James E. Siegler,Laurie Schluter,Sharyl R. Martini,Amelia K. Boehme,Sheryl Martin-Schild
ISRN Stroke , 2013, DOI: 10.1155/2013/898163
Abstract: Background. The objective of this study was to determine the prevalence of LVH and DD in patients presenting with supratentorial deep ICH and to determine if the presence of LVH or DD was an independent predictor of initial ICH volume, hematoma expansion, or poor outcome. Methods. A cross-sectional study was performed on ICH patients who presented from 7/2008 to 12/2010. Cases were excluded if ICH was traumatic, lobar, infratentorial, secondary to elevated international normalized ratio, suspicious for underlying structural malformation, or where surgical evacuation was performed. Logistic and linear regressions were used to assess the ability of LVH to predict ICH imaging characteristics and patient outcomes. Results. After adjusting for use of hemostatic agents, LVH was not a significant independent predictor of initial ICH volume or 33% volume expansion . After adjusting for age, infectious complications, and use of hemostatic agents, LVH was not a significant independent predictor of poor functional outcome . Similar results were seen for DD. Conclusion. In our sample, patients with deep ICH and LVH were more likely to develop IVH, but LVH was not a significant independent predictor of initial ICH volume, hematoma expansion, or poor short-term outcome. 1. Introduction Intracerebral hemorrhage (ICH) accounts for 10% to 15% of strokes [1, 2]. With an estimated 30-day mortality rate greater than 40% and fewer than 1 in 5 survivors functionally independent at 6 months, ICH is more likely to result in death and disability than ischemic stroke [3–6]. Epidemiologic evidence suggests that the pathophysiology of spontaneous ICH differs for lobar and deep ICH [7]. Lobar ICH, frequently seen in the elderly, is often presumed to be the result of amyloid angiopathy, whereas deep ICH, such as this seen in the basal ganglia, is attributed to a modifiable risk factor—hypertension (HTN). The majority of hypertensive intracerebral hemorrhages are located in deep supratentorial regions [8–13]. In addition to being the single largest risk factor for ICH, hypertension is the primary risk factor for cardiac disease [14]. Hypertensive end organ damage in the heart (i.e., hypertensive heart disease) is prevalent with reported rates of left ventricular hypertrophy (LVH) in hypertensive patients of 36%–41% [15]. In patients with resistant hypertension, these rates range from 55% to 75% [16]. While LVH has been shown to be a significant independent predictor of myocardial infarction, stroke, and cardiovascular death in the general population [17, 18], patients with coronary
Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay
Alexander J. George,Amelia K. Boehme,James E. Siegler,Dominique Monlezun,Bethena D. Fowler,Amir Shaban,Karen C. Albright,T. Mark Beasley,Sheryl Martin-Schild
ISRN Stroke , 2013, DOI: 10.1155/2013/312348
Abstract: Introduction. Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis. Methods. Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours. Results. Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, ). A larger proportion of patients with pLOS developed an infection ( ), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, ). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, ). Conclusions. The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay. 1. Introduction Typical management of acute stroke has a variable duration, lasting from 5 to 14 days on average [1, 2]. Longer stays are more common in older patients [2–4] and those with more severe strokes [1], anterior circulation infarcts [2, 4], atrial fibrillation [1, 4], and hemorrhagic-type strokes [1, 2]. Longer stays also correlate with worse functional outcome and unfavorable discharge disposition in patients with acute ischemic stroke (AIS) [4, 5]. Koton et al. demonstrated a valid scoring tool to identify patients with stroke at risk for a hospitalization of ≥7 days at triage [1, 6]. Unfortunately, this tool was designed to predict prolonged hospitalization using common data elements collected at triage, failing to take into account complications that may occur during the inpatient stay. Second, studies that have described in-hospital associations with pLOS defined length of stay by an absolute threshold, with some using a threshold of about 30 days [4, 7]. These studies do not compare differences between patients with and without pLOS. More importantly, they do not include patients with pLOS with a hospital course of <30 days—which represents the majority of stroke patients at U.S. centers [8]. In this study, we define pLOS without a threshold to better demonstrate its associations. We aim to
24-Hour ICH Score Is a Better Predictor of Outcome than Admission ICH Score
Aimee M. Aysenne,Karen C. Albright,Tiffany Mathias,Tiffany R. Chang,Amelia K. Boehme,T. Mark Beasley,Sheryl Martin-Schild
ISRN Stroke , 2013, DOI: 10.1155/2013/605286
Abstract: Background. The ICH score is a validated tool for predicting 30-day morbidity and mortality in patients with intracerebral hemorrhage. Aims and/or Hypothesis. The aim of this study is to determine if the ICH score calculated 24 hours after admission is a better predictor of mortality than the ICH score calculated on admission. Methods. Patients presenting to our center with ICH from 7/08–12/10 were retrospectively identified from our prospective stroke registry. ICH scores were calculated based on initial Glasgow coma scale (GCS) and emergent head computed tomography (CT) on initial presentation and were recalculated after 24 hours. Results. A total of 91 patients out of 121 had complete data for admission and 24-hour ICH score. The ICH score changed in 38% from baseline to 24 hours. After adjusting for age, NIHSS on admission, and glucose, ICH score at 24 hours was a significant, independent predictor of mortality (OR = 2.71, 95% CI 1–19–6.20, and ), but ICH score on admission was not (OR = 2.14, 95% CI 0.88–5.24, and ). Conclusion. Early determination of the ICH score may incorrectly estimate the severity and expected outcome after ICH. Calculations of the ICH score 24 hours after admission will better predict early outcomes. 1. Introduction The intracerebral hemorrhage (ICH) score was developed as a predictive tool for mortality at thirty days after hemorrhagic stroke [1]. The ICH score is a 6-point calculation based on five clinical indicators: age > 80 years, Glasgow coma scale (GCS), volume of hematoma on baseline CT scan, location (infratentorial or supratentorial), and the presence of intraventricular extension. The ICH score has also been validated for 30-day and one-year functional outcome in additional studies [2, 3]. In these studies the GCS was measured at the time of admission to the intensive care unit (ICU) or to the operating room regardless of the time of onset of symptoms. Almost 40% of patients with brain imaging obtained in the first 3 hours after onset of symptoms of ICH experience hematoma expansion and this is highly associated with neurological deterioration [4]. Recent studies show a strong association between contrast extravasation on computed tomography angiography (CTA) and hematoma expansion and worse outcome [5]. 2. Aims and/or Hypothesis We hypothesize that, due to the dynamic nature of early ICH, with high risk of hematoma expansion, new IVH, and decreasing level of consciousness, a delayed measure of the ICH score would be more useful in predicting outcomes. In our center, the ICH score is calculated once all five
Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt
James E. Siegler,Muhammad Alvi,Amelia K. Boehme,Michael J. Lyerly,Karen C. Albright,Reza Bavarsad Shahripour,Pawan V. Rawal,Niren Kapoor,April Sisson,J. Thomas Houston,Anne W. Alexandrov,Sheryl Martin-Schild,Andrei V. Alexandrov
ISRN Stroke , 2013, DOI: 10.1155/2013/681673
Abstract: Background. Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states. Methods and Results. We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008–2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07–34.1, ) when patients were dichotomized by score. Conclusions. In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region. 1. Background Despite multiple acute stroke treatment trials, thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) remains the only FDA-approved acute treatment for ischemic stroke with proven long-term benefit [4, 5]. This treatment, while highly effective when administered in the appropriate setting, is not without risk. As many as 6% of patients treated with IV tPA for ischemic stroke were found to clinically deteriorate in the earliest randomized trial [5]; however current rates of symptomatic intracranial hemorrhage (sICH) are lower [6] and hemorrhagic transformation (HT) rates are around 9% [7]. These differences may be explained by differences in criteria used to define sICH [8]. Due to provider concern for sICH, early efforts at minimizing these adverse events focused on identifying sICH risk factors. Elevated serum glucose [9–11] or ferritin [12] on admission, history of diabetes mellitus [13], older age [10], greater baseline stroke severity [10, 14–16], and current tobacco use [14, 17] have all been identified as potential risk factors for sICH. In an effort to more accurately predict which patients are at the greatest risk of postthrombolytic hemorrhagic transformation (HT) [1, 18, 19] and/or sICH [2, 18–20],
New Thrombotic Events in Ischemic Stroke Patients with Elevated Factor VIII
Brittany M. Gouse,Amelia K. Boehme,Dominique J. Monlezun,James E. Siegler,Alex J. George,Katherine Brag,Karen C. Albright,T. Mark Beasley,Cindy Leissinger,Ramy El Khoury,Sheryl Martin-Schild
Thrombosis , 2014, DOI: 10.1155/2014/302861
Abstract: Background. Heightened levels of Factor VIII (FVIII) have been associated with both arterial and venous thrombosis. While elevated FVIII is common during acute ischemic stroke (AIS), whether elevated FVIII confers an increased risk for recurrent thrombotic events (RTEs) following AIS has not been previously explored. Methods. Consecutive AIS patients who presented to our center between July 2008 and September 2013 and had FVIII measured during admission were identified from our stroke registry. Baseline characteristics and the occurrence of RTE (recurrent or progressive ischemic stroke, DVT/PE, and MI) were compared in patients with and without elevated FVIII levels. Results. Of the 298 patients included, 203 (68.1%) had elevated FVIII levels. Patients with elevated FVIII had higher rates of any in-hospital RTE (18.7% versus 8.4%, ). This association remained after adjustment for baseline stroke severity and etiology (OR 1.01, 95% CI 1.00–1.01, ). Rates of major disability were also higher in patients who experienced a RTE (17.8% versus 3.2%, ). Conclusion. A significantly higher frequency of in-hospital RTEs occurred in AIS patients with elevated FVIII. The occurrence of such events was associated with higher morbidity. Further study is indicated to evaluate whether FVIII is a candidate biomarker for increased risk of RTEs following AIS. 1. Introduction The procoagulant Factor VIII (FVIII) plays an important role in the activation of thrombin and ultimately in the formation of a fibrin-rich thrombus. Elevated plasma levels of FVIII have been previously associated with an increased risk of both venous [1–3] and arterial thrombotic events [4–7]. Elevated plasma levels of FVIII have been found to be common in patients with acute ischemic stroke (AIS) [6, 7], one of the leading causes of death and significant long-term disability worldwide [8]. Previous prospective work has found plasma FVIII levels to be one of the strongest hemostatic predictors of ischemic stroke occurrence [6]. More recent research has demonstrated elevated levels of plasma FVIII to be present in approximately 70% of patients with AIS during hospital admission, suggesting further that elevated FVIII levels are common during the acute phase of ischemic stroke [7]. FVIII has also been shown to be associated with other thromboembolic conditions known to complicate the course of AIS, such as deep vein thrombosis (DVT) [2], pulmonary embolism (PE) [3], and myocardial infarction [4, 5] in several different patient populations. Despite evidence suggesting an association between elevated FVIII
Experiencia clínica con el antipsicótico clozapina en ni os y adolescentes menores de 18 a os en Chile Clinical experience in Chile with clozapine in child and adolescents under 18 years
Virginia Boehme K,Eduardo Durán L
Revista Chilena de Neuro-Psiquiatría , 2012,
Abstract: Introducción: El aumento de psicopatología severa en la clínica infanto-juvenily la resistencia a los tratamientos habituales, lleva a los clínicos buscar nuevas alternativas farmacológicas. Surge entonces la clozapina como una alternativa útil, avalada por la literatura para tratamiento de estas patologías. Objetivos: Describir una muestra de 47pacientes ni os y adolescentes entre 10 y 18 a os tratados con clozapina entre los a os 1985 y 2010. Se indican: variables demográficas, diagnósticos, hospitalizaciones, dosis y efectos adversos, especialmente los hematológicos. Material y Método: Estudio descriptivo, retrospectivo consistente en revisión de fichas clínicas, protocolo de investigación y análisis estadístico con plantilla Excel. Resultados: Muestra de 47 pacientes; 40% hombres, 60% mujeres, el menor de 10 a os y el mayor de 17 a os y 11 meses; la edad más frecuente fue de 15 a os. El 80% presentó al menos una hospitalización. Diagnósticos agrupados: Trastornos a predominio afectivo el 64%, Trastornos esquizomorfo el 23% y Trastornos a predominio del descontrol de los impulsos y agresión 9%. Un 57% recibió TEC. Causa de indicación:psicosis irreductible 36%, suicidalidad alta 33%, conducta heteroagrsiva 25%, efectos laterales con otros fármacos 23%. La dosis promedio de mantención fue de 200 mg. Los efectos adversos más frecuentes fueron: sedación 76%, salivación 68%, alza peso 66%. Baja inespecífica de neutrófilos: 17%, alarma 1:15%, alarma II: 2%, alarma III: 2%. Discusión: Clozapina aparece como fármaco útil, con efectos adversos frecuentes, pero en nuestra muestra fueron graves no y transitorios. Hubo un caso con alarma III que requirió de suspensión, pero se reinstaló 3 meses después; sin reincidir, ni presentar otros efectos adversos de gravedad. Se requieren estudios controlados, a largo plazo. Objective: Increase in severe psychopathology in adolescents who are resistant to common treatment creates a need to search new alternatives in pharmacological treatment. Background: To describe a sample 47 child and adolescent patients treated with clozapine between 1985 and 2010, indicating: age, gender, diagnoses, hospitalization, electroconvulsive therapy, dosing, adverse effects specially hematological ones. Methods: 47patients between the ages of 10 and 18 were treated with clozapine. Review of clinical charts, protocol investigation and Excel statistic analysis. Results: The sample consisted in: male: 40%, female: 60%, the youngest was 10 and the oldest 17years and 11 month old; the most frequent age was 15 years. The mean number of hospitaliza
An atomic resolution, single-spin magnetic resonance detection concept based on tunneling force microscopy
A. Payne,K. Ambal,C. Boehme,C. C. Williams
Physics , 2015, DOI: 10.1103/PhysRevB.91.195433
Abstract: A comprehensive study of a force detected single-spin magnetic resonance measurement concept with atomic spatial resolution is presented. The method is based upon electrostatic force detection of spin-selection rule controlled single-electron tunneling between two electrically isolated paramagnetic states. Single spin magnetic resonance detection is possible by measuring the force detected tunneling charge noise on and off spin resonance. Simulation results of this charge noise, based upon physical models of the tunneling and spin physics, are directly compared to measured AFM system noise. The results show that the approach could provide single spin measurement of electrically isolated qubit states with atomic spatial resolution at room temperature.
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