Patient Treatment Time Research Articles

Highly Visible Wall-Timer to Reduce Endovascular Treatment Time for Stroke.

Endovascular therapy for acute ischemic stroke has revolutionized clinical care for patients with stroke and large vessel occlusion, but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the angio-suite. Here, we apply the concept of a highly visible timer in the angio-suite to quantify the impact on endovascular treatment time. This was a single-center prospective pseudorandomized study conducted over a 32-week period. Pseudorandomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome was angio-suite-to-groin time, and secondary outcomes were angio-suite-to-intubation time, groin-to-recanalization time, and 90-day modified Rankin scale. A stratified analysis was performed based on type of anesthesia (ie, endotracheal intubation versus not). During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was on and off for 38 and 59 cases, respectively. The timer resulted in faster angio-suite-to-groin time (28 versus 33 minutes; P=0.02). The 5-minute reduction in angio-suite-to-groin was maintained after adjusting for intubation status in a multivariate regression (P=0.02). There was no difference in the 90-day modified Rankin scale between groups. The timer impact was consistent across the 32-week study period. A highly visible timer in the angio-suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for patients with stroke. Given the lack of risk and low cost, it is reasonable for stroke centers to consider a highly visible timer in the angio-suite to improve treatment times.

Time Window for Acute Stroke Treatment: Current Practice in King Abdullah Medical City Specialist Hospital in Makkah, Saudi Arabia.

IntroductionStroke has become one of the most severe causes of long-term neurological impairment and disability and is considered one of the leading causes of mortality worldwide. This study aimed to determine time delays in stroke patients from symptoms onset to treatment with tissue plasminogen activator (tPA) initiation in King Abdullah Medical City Specialist Hospital, Makkah, Saudi Arabia.Patients and methodsWe reviewed 81 patients who suffered from acute stroke. The data were collected from patients’ electronic and paper files. Patients were divided into two main categories based on interval time from recognition of symptoms to tPA treatment. Patients were divided into early treatment, if the duration was less than or equal to 120 minutes, and delayed treatment, if the interval time was more than 120 minutes.ResultsNearly two-thirds (64.2%) were males, and more than half (5.6%) were in the older age group (>65 years). Patients who underwent thrombectomy were 7.4%. The mean value of the National Institutes of Health Stroke Scale (NIHSS) score was 10.7 (SD: 7.14). The mean time from symptoms onset to arrival at the hospital was 82.4 (SD: 44.1) minutes, while the total time from recognition of symptoms to tPA treatment was 154 (SD: 50.8) minutes. The prevalence of patients with delayed treatment was 72.8%, and the rest were assumed to have early treatment (27.2%). None of the socio-demographic variables were predicted to influence delayed treatment.ConclusionA significant number of patients were delayed in treatment. Patients' socio-demographic data and NIHSS scores seem to have no significant effect on delayed treatment. Further research is needed to establish the delay in time for pre-hospital and in-hospital treatment of stroke patients.

Retrospective Analysis of Treatment Workflow in Frame-Based and Frameless Gamma Knife Radiosurgery.

ObjectiveTo improve the efficiency of frame-based and frameless Gamma Knife® Icon™ (GKI) treatments by analyzing the workflows of both treatment approaches and identifying steps that lead to prolonged patient in-clinic or treatment time.MethodsThe treatment processes of 57 GKI patients, 16 frame-based and 41 frameless cases were recorded and analyzed. For frame-based treatments, time points were recorded for various steps in the process, including check-in, magnetic resonance imaging (MRI) completion, plan approval, and treatment start/end times. The time required for completing each step was calculated and investigated. For frameless treatments, the actual and planned treatment times were compared to evaluate the patient tolerance of the treatment. In addition, the time spent on room cleaning and preparation between treatments was also recorded and analyzed.ResultsFor frame-based cases, the average in-clinic time was 6.3 hours (ranging from 4 to 8.7 hours). The average time from patient check-in to plan approval was 4.2 hours (ranging from 2.8 to 5.5 hours), during which the frame was placed, stereotactic reference MRI images were taken, target volumes were contoured, and the treatment plan was developed and second-checked. For patients immobilized with a mask, treatment pauses triggered by the intra-fractional motion monitoring system resulted in a significantly longer actual treatment time than the planned time. In 50 (or 55%) of the 91 frameless treatments, the patient on-table time was longer than the planned treatment time by more than 10 minutes, and in 19 (or 21%) of the treatments the time difference was larger than 20 minutes. Major treatment interruptions, defined as pauses leading to a longer than 10-minute delay, were more commonly encountered in patients with a planned treatment time longer than 40 minutes, which accounted for 64% of the recorded major interruptions.ConclusionFor frame-based cases, the multiple pretreatment steps (from patient check-in to plan approval) in the workflow were time-consuming and resulted in prolonged patient in-clinic time. These pretreatment steps may be shortened by performing some of these steps before the treatment day, e.g., pre-planning the treatment using diagnostic MRI scans acquired a few days earlier. For frameless patients, we found that a longer planned treatment time is associated with a higher chance of treatment interruption. For patients with a long treatment time, a planned break or consideration of fractionated treatments (i.e., 3 to 5 fractionated stereotactic radiosurgery) may optimize the workflow and improve patient satisfaction.

Customized Multifunctional Peptide Hydrogel Scaffolds for CAR-T-Cell Rapid Proliferation and Solid Tumor Immunotherapy.

CAR-T-cell therapies must be expanded to obtain a large number of effector cells quickly, and the current technology cannot address this challenge. A longer operational time would lose or alter the function and phenotype of CAR-T cells in response to therapy, and it also causes a loss in the optimal treatment time for patients. At present, lower survival time and homing efficiency reduce the antitumor effect of CAR-T in vivo. But nobody has solved these two issues in one system, which has a similar microenvironment of lymphoid organs to activate/expand cell delivery for immunotherapy. Here, we generated artificial, customized immune cell matrix scaffolds based on a self-assembling peptide to preserve and augment the cell phenotype in light of the characteristics of CAR-T. The all-in-one nanoscale matrix scaffolds reduced the processing time of CAR-T to 3 days and resulted in over a 10-fold increase compared with the traditional protocol. The cells were combined to modulate mechanotransduction and chemical signals, and the mimic matrix scaffolds showed optimal stiffness and adhesive ligand density, thereby accelerating CAR-T-cell proliferation. Meanwhile, engineering CAR-T-secreted intrinsic PD-1 blocking single-chain variable fragments (scFv) further increased cell proliferation and cytotoxicity by resisting the self and tumor microenvironment in a paracrine and autocrine manner. Local delivery of CAR-T cells from the scaffolds significantly enabled long-term retention, suppressed tumor growth, and increased infiltration of effector T cells compared with traditional CAR-T treatment. The application of bioengineering and genetic engineering approaches has led to the development of rapid culture environments that can control matrix scaffold properties for CAR-T-cell and cancer immunotherapies.

Characteristics and Assessment of Frailty as Risk Factor of Therapy-Related Acute Toxicities and Delayed Overall Treatment Time in Elderly Patients Treating with External Beam Radiation Therapy at Indonesia Top Referral Hospital

BACKGROUND: Older patients are at a higher risk of being frail. Frailty implies that even a minor stressor can have major negative implications on physical, psychological domains. Geriatric-8 (G-8) screening tool shows good screening properties for identifying vulnerable elderly patients with cancer. AIM: We, therefore, decided to investigate the utility of G-8 associated with acute toxicity and prolonged overall treatment time (OTT) in elderly cancer patients treated with radiotherapy (RT). MATERIALS AND METHODS: A prospective observational cohort study is performed. Eligible subjects are patients aged ≥60 years and were referred for curative or palliative RT. We use the G-8 questionnaire for consecutive patients before starting RT. We recorded acute toxicity and OTT and identified potential predictors. RESULTS: A total of 52 consecutive geriatric patients were included with an average age of 67 years. Of all those subjects, 21% had head-and-neck cancers, 29% gynecology cancers, 23% breast cancers, and 27% other cancers. According to the G-8, 65% of the patients were potentially frail. Toxicity Grade ≥3 was observed among 32% of subjects who were potentially frail according to the G-8 and 0% of the subject who was fit (p = 0.007). Prolonged OTT was observed in 61.8% of potentially frail and 27.8% of the subjects who were fit (p = 0.020). On multivariate analysis, only chemoradiation was strongly associated with acute toxicity Grade ≥3 odds ratio 11.1 (95% confidence interval 1.4–83.6; p = 0.019). CONCLUSION: The utility of G-8 in daily practice seems to be limited. Only concurrent chemoradiation was associated with acute toxicity. Future prospective studies should investigate whether the G-8 is a good predictor for other relevant clinical outcomes and survival in our local settings.

Predicting time to treatment in follicular lymphoma on watchful waiting using baseline metabolic tumour burden

PurposeAsymptomatic patients with follicular lymphoma (FL) and a low tumour burden can be followed without initial therapy, a strategy called watchful waiting (WW). Prediction of the time to treatment (TTT) is still a challenge. We investigated the prognostic value of baseline total metabolic tumour volume (TMTV) and whole-body total lesion glycolysis (WB-TLG) to predict TTT in patients with FL on WW.MethodsWe conducted a retrospective study of 54 patients with FL (grade 1–3a) diagnosed between June 2013 and December 2019, staged with FDG PET/CT, and managed on WW. Median age was 62 years (range 34–85), stage was advanced (III–IV) in 57%, and FLIPI score was intermediate to high (≥ 2) in 52% of the patients.ResultsThe median TMTV and WB-TLG were 7.1 and 43.3, respectively. With a median follow-up of 59 months, 41% of patients started immuno-chemotherapy. The optimal cut-points to identify patients with TTT within 24 months were 14 for TMTV (AUC 0.70; 95% CI 51–88) and 64 for WB-TLG (AUC 0.71; 95% CI 52–89) (p < 0.005). The probability of not having started treatment within 24 months was 87% for TMTV < 14 and 53% for TMTV ≥ 14 (p < 0.005). TMTV was independent of the FLIPI score for TTT prediction. Patients with both FLIPI ≥ 2 and TMTV ≥ 14 had only an 18% probability of not having started treatment at 36 months, while this probability was 75% in patients with TMTV < 14.ConclusionMetabolic tumour volume parameters may add information to clinical scores to better predict TTT and better stratify patients for interventional studies.

The value of dental implant superior frontal sinus augmentation combined with orthodontic treatment

To explore the clinical value of dental implant superior frontal sinus elevation combined with orthodontic treatment. From August 2020 to August 2021, 88 patients with maxillary posterior tooth defect were enrolled. There were 44 patients in each group. The experimental group received the combined treatment of upper frontal sinus elevation and orthodontic treatment, while the control group received general prosthodontic treatment. The evaluation indexes included the total treatment time and recovery time of teeth, chewing efficiency, bite force, clinical efficacy and treatment satisfaction data. Data summary showed that the bite force of the experimental group was similar to that of the control group before treatment, and the chewing condition was consistent with the above, P &gt; 0. 05; After different treatment intervention, the bite force of the control group was worse, the chewing condition of the experimental group was better, the effective rate and total satisfaction rate of the control group were less than the experimental group, at the same time, the total repair time of the experimental group was shorter, compared with the control group, there was a significant difference in data, P &lt; 0. 05. The combined treatment of upper frontal sinus augmentation and orthodontics can effectively improve the masticatory efficiency and occlusal ability of patients, improve the clinical treatment effect, and shorten the total treatment and repair time of patients, with higher acceptance of clinical patients, which has an important reference value.

Complete revascularization of multivessel coronary artery disease in patients with ST elevation acute coronary syndrome - for whom and when? A comprehensive review.

Atherosclerosis is the most common cause of coronary steno-occlusive disease and acute myocardial infarction is the leading cause of death in industrialized countries. In patients with acute ST elevation myocardial infarction (STEMI), there is unquestionable evidence that primary percutaneous coronary intervention providing recanalization of the infarct related artery (IRA) is the preferred reperfusion strategy. Nevertheless, up to 50% of patients with STEMI have multivessel coronary artery disease defined as at least 50% stenosis exclusive of IRA. There is conflicting data regarding the optimal treatment strategy and timing in such patients. Currently, it is assumed that stable patients might benefit from complete revascularization particularly in reducing the need for future unplanned procedures but only culprit lesion should be treated during index procedure in unstable patients. In this article, we provide a comprehensive overview of this important and currently highly debated topic.

Retrospective analysis of clinical characteristics of and treatment strategies for patients with long-acting anticoagulant rodenticide poisoning.

Long-acting anticoagulant rodenticide (LAAR) poisoning remains a serious public health problem. The aim of this study was to explore the clinical characteristics of different LAARs and a method of making a decision on the VK1 treatment course and the time to stop VK1 treatment safely. This retrospective study compared the clinical characteristics of two LAARs poisoning patients and used multivariate regression method to explore the relationship between blood LAAR concentration and vitamin K1 dose/treatment time. A total of 115 patients with LAAR poisoning were included in this study after screening. Of these, 50 patients attempted to commit suicide. The median LAAR concentration of the patients at admission was 409 (157-1174)ng/mL, and the VK1 treatment duration was 14 (8-34)days. The total VK1 treatment time in patients with LAAR poisoning was positively correlated with admission LAAR concentration. During the maintenance treatment period, the VK1 dosage was positively correlated with blood LAAR concentration. Low dose of VK1 during the maintenance period is indicative of the blood LAAR concentration being relatively low. This provides a basis for judging the LAAR content in the body during the maintenance treatment period.

Timing and outcome of bystanders treatment in patients with subarachnoid hemorrhage associated with multiple aneurysms

In case of subarachnoid hemorrhage (SAH) associated with multiple intracranial aneurysms (MIAs), the main goal of acute treatment is securing the source of bleeding (index aneurysm). Indications and timing of bystanders treatment are instead still debated as the risk of new SAHs in patients harboring MIAs is not yet established. However, even if technically feasible, a simultaneous management of all aneurysms remains questionable, especially for safety issues. We retrospectively reviewed our last 5-year experience with SAH patients harboring MIAs entered in a clinic-radiological monitoring for bystanders follow-up in order to evaluate the occurrence of morphological changes, bleeding events, and safety and efficacy of a delayed treatment. We included 39 patients with mean age of 59.5 ± 12.2 years who survived a SAH. Among them, 14 underwent treatment, whereas 25 continued follow-up. The mean time between index and bystanders treatment was 14.3 ± 19.2 months. Patients undergoing bystanders treatment were mainly female and in general younger than patients undergoing observation. No cases of growth or bleeding were observed among bystanders within the two groups during the follow-up, which was longer than 1 year for the intervention group, and almost 40 months for the observation group. No major complications and mRS modifications were observed after bystanders treatment. Our data seem to suggest that within the short follow-up, intervention and observation seem to be likewise safe for bystander aneurysms, showing at the same time that a delayed management presents a similar risk profile of treating unruptured aneurysms in patients with no previous history of SAH.

Accurate screening of early‐stage lung cancer based on improved ResNeXt model combined with serum Raman spectroscopy

AbstractScreening and diagnosis of early‐stage lung cancer is low worldwide, and when lung cancer progresses to late stage, it will greatly affect the treatment and survival time of patients. Therefore, the development of an affordable and accurate diagnostic technique is critical for lung cancer patients. In this study, we analyzed and verified the changes of substance composition in the serum of early‐stage lung cancer patients and proposed an improved ResNeXt model to achieve accurate classification of serum Raman spectra of lung cancer. The robustness of the model is improved by adding different decibels of Gaussian white noise and spectral offset to augment the data, trying to process the augmented data with various pre‐processing methods, and inputting the pre‐processed data into the improved ResNeXt model, the improved ResNeXt model still shows the optimal performance after sufficient comparison experiments with three other more advanced deep learning models. The experimental results show that the improved ResNeXt model is very suitable for the classification of early‐stage lung cancer serum Raman spectra and may provide a reference for future early screening studies of other cancers.

Trends in treatment of non-small cell lung cancer in Finland 2014–2019

Introduction Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality in the Western world. However, emerging treatment options and more patients directed to active treatments might improve the outcomes. Here, we retrospectively studied the patient characteristics and treatment practices for NSCLC in Finland 2014–2019 with a special focus on changes in trends over time. Material and methods The cohort consisted of patients diagnosed with NSCLC in Finland 2014–2018. Cancer treatments for the patients were followed until the end of 2019. The data, both structured and unstructured, were collected from electronic medical records of four university hospitals in Finland Results Of the study population (n = 4047), 65% had adenocarcinoma and 29% squamous cell carcinoma. The share of patients who had not received any active treatment (except palliative radiotherapy) decreased from 32% to 18% between 2014–18. The percentage of patients receiving surgery increased slightly from 22.7% to 24% and for patients receiving chemotherapy or immuno-oncological (IO) treatments from 29% to 41.2% and from 0.8% to 8%, respectively between, 2014–18. However, the time of treatment for patients receiving systemic cancer treatments did not change during the same time period. Discussion The current study suggests a trend in NSCLC towards more active treatment approaches in 2014–18.

Application Effect of Emergency Nursing Process in Elderly Patients with Acute Cerebral Infarction

Objective — To explore the application effect of emergency nursing process in elderly patients with acute cerebral infarction. Methods — 206 elderly patients with acute cerebral infarction who received routine care in our hospital from January to December 2020 were selected as the control group, and 297 patients who received emergency nursing procedures from January to December 2021 were selected as the observation group. The treatment time, neurological function score, and living ability were compared between the two groups. Results — The triage time, referral time, and comprehensive treatment time of the observation group were shorter than those of the control group (P&lt;0.05); the neurological function scores and daily living ability scores of the observation group were higher than those of the control group (P&lt;0.05). Conclusion — The emergency nursing process can seize the best treatment time for elderly patients with acute cerebral infarction, improve the treatment effect and living ability, and is worthy of popularization and application.

It's Not About the Money: Continued Treatment and Survival Outcome Disparities in Minority Rectal Cancer Patients After Controlling for Socioeconomic Factors.

While the disparities for minority patients with cancer have been well established, few studies have illustrated disparities in cancer outcomes while controlling for potential confounding factors. The current study was designed to address these confounding variables and how they influence the treatment and survival time for patients with rectal cancer. Using the Surveillance, Epidemiology, and End Results database, black and Hispanic patients were compared with white patients with rectal cancer for the rates of chemotherapy, radiation, and surgery in addition to survival time after diagnosis. Following this analysis, confounding variables were controlled for and analysis was repeated with groups of comparable demographic variables. Before controlling for confounding variables, there were significant differences in treatment and survival for both Hispanic and black patients compared with white. Following matching, black patients continued to have lower rates of treatment and shorter survival times. These differences in treatment methods and survival outcomes for minorities, particularly black patients, highlight the need for more advocacy and focus on these underrepresented populations with rectal cancer.

Development and Validation of a Prediction Model for the Treatment Time of Deformational Head Shapes Using a Cranial Remolding Orthosis

The cranial remolding orthosis (CRO) has been shown in previous studies to be an effective method of treatment for deformational head shapes. Many studies have shown younger infants achieve greater correction than older infants and generally have a shorter treatment duration. The goal of this study is to develop and validate a prediction equation for the maximum treatment time for deformational head shapes when utilizing a CRO. This retrospective study included subjects with deformational plagiocephaly (DP), deformational brachycephaly (DB), or deformational asymmetrical brachycephaly (DAB) who began CRO treatment between 3 and 18 months of gestational age. Prediction models were derived from 1250 subjects with DP, DB, and DAB and the validation used data from 210 different subjects. Actual treatment time was less than or equal to predicted treatment time in 85.19% (DP), 56.67% (DB), and 75.40% (DAB) of the cases when rounding the prediction up to the nearest month. The prediction equation has moderate accuracy for predicting the likely maximum amount of CRO treatment time for patients with DP, DB, and DAB and may be used clinically to give caregivers an estimated treatment duration for a patient who is indicated for a CRO, if treatment was initiated immediately.

Bladder volume variation in hypofractionated prostate radiotherapy.

234 Background: A full bladder for prostate radiotherapy treatment limits overall dose to the bladder and displaces bowel from high dose regions. There is currently no clear consensus on optimum bladder volume for prostate radiotherapy. Inconsistent bladder volumes can cause dosimetric uncertainty, distress, treatment delay and negative toxicity outcomes for patients. To identify potential ways to improve bladder filling consistency we retrospectively analysed bladder volume variation over the course of patients’ treatment and its relationship to various patient and treatment factors. Methods: We included all patients treated with 60gy in 20 fractions to the prostate only over a 1-year period. Standard fractionation, palliative, post-operative, and whole pelvis treatment regimens were excluded from our study. Patient, tumour, and treatment characteristics were collected retrospectively. We recorded patient reported IPSS scores that were completed pre and post treatment. Daily bladder volumes were recorded from cone beam CT (CBCT) retrospectively for a subset of 34 patients and included in correlative analyses with various treatment and patient factors. Results: 69 men were included in this study with a mean planning CT bladder volume of 272ml (79-574). Patients were divided into large ( &gt; 180ml) and small subgroups (N = 46 vs 23). Smaller bladders resulted in a greater post treatment IPSS score (10.2 vs 7.7 (p = 0.2)) and greater change in IPSS (+3.3 vs +1.4 (p = 0.23). The variation of daily bladder volumes as measured by the standard deviation was positively associated with planning CT volume (p &lt; 0.05), variation in daily treatment time (p &lt; 0.05) and urinary symptoms (p = 0.29). Greater discordances between planning CT time and mean radiotherapy time resulted in a greater average difference between CBCT bladder volume and planning CT volume (p = 0.16). There were no appreciable seasonal or diurnal associations for all recorded bladder volumes. Conclusions: Smaller bladder volumes at planning CT are associated with increased urinary symptoms whereas larger volumes undergo more daily variation. This data suggests an optimal planning bladder volume of 200-400ml to minimise on treatment variation. This is the first study to demonstrate a relationship between variation in daily treatment times and daily bladder variation. Synchronisation of planning CT time with patient treatment time preference will enable patients to better replicate planning CT bladder volumes. This, along with several other areas for improvement highlighted by this study have formed the basis for a prospective single centre pilot study.

Dosimetric Comparison and TCP-NTCP Modeling for Lung, Heart, Left Anterior Descending, and Right Coronary Artery in Left-sided Breast Cancer Conventional and Hypofractionated Radiotherapy

Background: The aim of this study was to evaluate the dose distribution, as well as tumor control probability (TCP) and normal tissue complications probability (NTCP) models for females with left-sided breast cancer for 3D-CRT, 6, and 9 fields intensity modulated radiotherapy (IMRT) and hypofractionated tangential plans. Methods: Eighty females with left-sided breast cancer (N1T1 – N3T3) were included in this study. The patients were divided into breast conserving surgery (BCS) (n= 50) and mastectomy (n=30) patients. CT simulation images of the patients were imported on the treatment planning software (TiGRT, LinaTech, China) and the tangential treatment plans of the mentioned methods were done, using TPS. Dose assessments were performed, employing the TPS, and TCP-NTCP models of stated modalities were done, using Poisson linear-quadatric (PLQ) and Lyman-Kutcher-Burman (LKB) models on MATLAB and R software. Results: For the BCS and post-mastectomy patients, 6FIMRT imposed lower doses to ipsilateral lung, heart, LAD, RCA, and contralateral breast compared to 9FIMRT, hypofractionated RT, and 3D-CRT (P &lt; 0.005). Also, the NTCPs of the mentioned normal tissues for 6FIMRT were lower than other methods for both BCS and post-mastectomy groups. Moreover, it was found that the V20Gy for Ipsilateral lung and the V25Gy for heart, LAD, and RCA of 6FIMRT, 9FIMRT, and hypofractionated RT was significantly lower compared to 3D-CRT (P &lt; 0.005) for both BCS and mastectomy groups, while there were no significant differences among them for the 6FIMRT and 9FIMRT with hypofractionated RT (P &gt; 0.005). The TCP values of 9FIMRT, 6FIMRT, and hypofractionated RT were not considerably different; however, the TCP values of 3D-CRT were lower compared to other stated methods. Conclusions: 6FIMRT is a suitable choice for RT of patients with left-sided breast cancer compared to other mentioned modalities, as a result of providing adequate PTV dose coverage and TCPs. Also, it may impose lower doses and NTCPs for OARs. Hypofractionated RT is a good alternative to reduce treatment time for patients with breast cancer.

Abstract WP53: Highly Visible Wall-timer To Reduce Endovascular Treatment Time For Stroke

Background and Purpose: Endovascular therapy for acute ischemic stroke has revolutionized clinical care for stroke patients with large vessel occlusion (LVO), but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the neuro-interventional radiology (NIR) suite. Here we apply the concept of a highly visible timer in the NIR suite to quantify the impact on endovascular treatment time in stroke patients with LVO. Methods: This was a single-center prospective pseudo-randomized study conducted over a 32-week period (September 14, 2020 through April 25, 2021). Pseudo-randomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome and secondary outcomes were reduction in IR to groin time and 90-day mRS, respectively. We also performed a stratified analysis based on anesthesia status for the procedure along with a multivariate regression to evaluate the effect of the intervention on treatment time while accounting for endotracheal intubation. Results: During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was ON and OFF for 38 and 59 cases, respectively. The timer resulted in a reduction in IR-to-groin time (27.7 mins vs 32.6 mins; p=0.02). Endotracheal intubation (80% of overall cohort) was associated with a longer NIR-to-groin time (33 mins vs 23 mins; p&lt;0.05). Among patients that underwent intubation, the timer resulted in a reduction in IR-to-intubation time (29.5 mins vs 34.4 mins; p=0.03). After adjusting for intubation status in a multivariate regression, the timer was associated with a 5-minute reduction in IR-to-Groin time (p=0.02). There was no difference in the 90-day mRS between both groups. Conclusions: A highly visible timer in the NIR suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for stroke patients with LVO. A larger study would be necessary to measure a potential impact on long-term functional outcome, and a multi-center study may be necessary to confirm generalizability. However, based on these results, the lack of risk, and low cost, it is reasonable for stroke centers to consider using a highly visible timer in the NIR suite to improve stroke treatment times.

Abstract WMP26: Performance Improvement During A Pandemic: Implementing Weekly Case Review To Decrease Door-to-CT And Door-to-Needle Times For Code Stroke Patients

Background and Purpose: When reviewing Code Stroke workflow data early in the COVID pandemic, a delay in obtaining CT brain imaging for stroke patients was identified. This study was aimed at improving Door-to-CT and Door-to-IVtPA bolus times by developing an Emergency Department (ED) led process improvement (PI) team to identify and track root causes for delays, provide feedback after fallouts, and recognize care teams after successful cases. Our primary goal was to demonstrate improved trends for performance metrics utilizing a novel method of process improvement, data collection, analysis, and dissemination. Methods: All ED patients activated as a Code Stroke were included in a weekly workflow review conducted by the PI team. Patients with a Door-to-CT of &gt; 20 minutes were analyzed by the team via an in-depth chart review to identify the root cause of the delay. Specific metrics analyzed included Door-to-CT times and Door-to-IVtPA bolus times, along with the percentage of cases that met process metric time goals. Implementation of the weekly review began September 31, 2020, with the pre-implementation period corresponding to the prior nine months and the post-implementation period being the ensuing nine months. Metrics were analyzed using a control chart based on monthly metric averages, standard deviations (SD), and both an upper and lower control limit defined as 1 sigma level of variability from the average. Results: The average Door-to-CT time pre-implementation was 30.6 minutes versus 22.8 minutes post-implementation, with a percentage goal within 20 minutes pre- and post-implementation of 47% and 66%.The average Door-to-IVtPA Bolus time pre-implementation was 40.1 minutes versus 31.5 minutes post-implementation, with a percentage goal &lt;30 minutes pre and post-implementation of 42% and 56%.The SD for Door-to-CT average improved from 4.81 to 3.76, while the Door-to-IVtPA Bolus average SD decreased from 9.26 to 8.53. Conclusion: Reviewing identification, activation, and treatment times for all ED Code Stroke patients during the COVID pandemic was associated with significantly reduced imaging and treatment times.

Effect of acetylcysteine solution combined with fiberoptic bronchoscopy alveolar lavage in elderly patients with severe ventilator-associated pneumonia

&#x0D; &#x0D; &#x0D; &#x0D; Purpose: To explore the effect of acetylcysteine solution combined with fiberoptic bronchoscopy alveolar lavage in elderly patients with severe ventilator-associated pneumonia (VAP).&#x0D; Methods: A total of 120 elderly patients with severe VAP admitted to Department of Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University in the past two years were selected for this study. They were randomized into groups A and B. Group B underwent fiberoptic bronchoscopy alveolar lavage for 7 days, group A received acetylcysteine solution plus. Clinical pulmonary infection score (CPIS), respiratory mechanics changes, blood gas levels, inflammatory factor levels, antibiotic use time and mechanical ventilation time were compared.&#x0D; Results: Compared to group B, group A witnessed a lower CPIS, an evidently superior dynamic lung compliance (Cdyn), and worse for other respiratory mechanics indices (p &lt; 0.001). After treatment, the partial pressure of blood oxygen (PaO2) and oxygenation index (PaO2/FiO2) saw a surge; the partial pressure of carbon dioxide (PaCO2) tapered off, and the levels of inflammatory factors witnessed a slump in group A than compared with those for group B (p &lt; 0.001). A shorter antibiotic use time and mechanical ventilation time was observed in group A compared with group B (p &lt; 0.001).&#x0D; Conclusion: Acetylcysteine solution combined with fiberoptic bronchoscopy alveolar lavage yields a promising outcome in notably ameliorating CPIS, respiratory mechanics indicators and blood gas levels, driving down the level of inflammatory factors and diminishing treatment time in elderly patients with severe VAP.&#x0D; &#x0D; &#x0D; &#x0D;