Compliance with joint commission measures in state-designated stroke centers.

BACKGROUND: Comparison of state-designated primary and comprehensive stroke centers (PSCs and CSCs) with regard to adherence to nationally accepted performance standards are scarce. The objective of this study was to examine if a significant association exists between level of designation and fulfillment of Joint Commission (JC) stroke core measures. METHODS: A retrospective comparative data analysis of the New Jersey acute stroke registry for the calendar years 2010 and 2011 was performed. JC core measures were compared by hospital level (PSCs vs CSCs). Adjusted odds ratios (aOR) were estimated for association between hospital levels and fulfillment of JC core measures. Median door-to-thrombolytic time was also compared. RESULTS: There were 36,892 acute stroke admissions. PSCs had 60% of the patients, whereas CSCs had 40%. Hemorrhagic stroke admissions were about 2 times more frequent at CSCs than PSCs (13.3% and 7.1%, respectively). CSCs adhered better to 6 of the 8 JC measures than PSCs. Of eligible patients, 19.5% received thrombolytic therapy at CSCs compared to 9.6% at PSCs, with a 44% difference in provision of thrombolytic therapy (aOR = 0.28, 95% confidence interval: 0.24-0.34). Median door-to-thrombolytic drug times was 65 minutes at CSCs compared to 74.0 minutes at PSCs (P < 0.0001). CONCLUSIONS: New Jersey state-designated CSCs are better at adhering to the JC core stroke measures and have shorter door-to-thrombolytic drug times.

Review of Susac syndrome.

PURPOSE OF REVIEW: The quest to better understand Susac syndrome has led to advancements in different aspects of the disease. The present article reviews the current literature on the clinical presentation, diagnostic modalities and trends in the management of Susac syndrome. RECENT FINDINGS: The pathogenesis of Susac syndrome still remains unclear. Fluorescein angiography demonstrates arterial wall hyperfluorescence of the arterioles at various locations along the course of the vessels suggesting a primary endotheliopathy. Multifocal electroretinogram (mfERG) provides evidence of focal retinal dysfunction related to branch retinal artery occlusion (BRAO). Diffusion tensor imaging demonstrates widespread disruption in the normal appearing white matter with damage to the genu of the corpus callosum considered relatively specific for Susac syndrome. Single photon emission computerized tomography imaging failed to identify perfusion abnormalities with 99mTc-ethyl cysteinate dimer in a patient with Susac syndrome. SUMMARY: Susac syndrome is a multisystemic microvascular occlusive endotheliopathy with suspected immune-mediated pathogenesis. The incidence may be more common than previously thought. Diagnosing Susac syndrome can be challenging, especially in patients presenting without all features of the clinical triad of encephalopathy, BRAO and hearing loss. Awareness of the condition, a high index of suspicion in any patient with unexplained encephalopathy, a dilated fundus examination, audiogram and typical MRI findings aid in the prompt diagnosis of the condition. Successful treatment has been documented with various immunosuppressive treatment regimens.

Evaluation of a new tear osmometer for repeatability and accuracy, using 0.5-microL (500-Nanoliter) samples.

PURPOSE: To evaluate the repeatability and accuracy of a new tear osmometer that measures the osmolality of 0.5-microL (500-nanoliter) samples. METHODS: Four standardized solutions were tested with 0.5-microL (500-nanoliter) samples for repeatability of measurements and comparability to standardized technique. Two known standard salt solutions (290 mOsm/kg H2O, 304 mOsm/kg H2O), a normal artificial tear matrix sample (306 mOsm/kg H2O), and an abnormal artificial tear matrix sample (336 mOsm/kg H2O) were repeatedly tested (n = 20 each) for osmolality with use of the Advanced Instruments Model 3100 Tear Osmometer (0.5-microL [500-nanoliter] sample size) and the FDA-approved Advanced Instruments Model 3D2 Clinical Osmometer (250-microL sample size). RESULTS: Four standard solutions were used, with osmolality values of 290, 304, 306, and 336 mOsm/kg H2O. The respective precision data, including the mean and standard deviation, were: 291.8 +/- 4.4, 305.6 +/- 2.4, 305.1 +/- 2.3, and 336.4 +/- 2.2 mOsm/kg H2O. The percent recoveries for the 290 mOsm/kg H2O standard solution, the 304 mOsm/kg H2O reference solution, the normal value-assigned 306 mOsm/kg H2O sample, and the abnormal value-assigned 336 mOsm/kg H2O sample were 100.3, 100.2, 99.8, and 100.3 mOsm/kg H2O, respectively. CONCLUSIONS: The repeatability data are in accordance with data obtained on clinical osmometers with use of larger sample sizes. All 4 samples tested on the tear osmometer have osmolality values that correlate well to the clinical instrument method. The tear osmometer is a suitable instrument for testing the osmolality of microliter-sized samples, such as tears, and therefore may be useful in diagnosing, monitoring, and classifying tear abnormalities such as the severity of dry eye disease.