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Penn Medicine Analysis Shows that One-Third of Americans Do Not Have Access to Stroke Center Within One Hour

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Newswise PHILADELPHIA Stroke is one of the leading causes of death and disability in the United States, but access to rapid EMS care and appropriate stroke care centers with the ability to deliver acute stroke therapies can drastically mitigate the debilitating effects of a stroke. A population-based approach to health planning would prevent disparities in access to specialized stroke care, says new Penn Medicine research. Their evaluation of access to stroke centers in the U.S. found that even under the most optimal conditions, a large proportion of the United States population would be unable to access a comprehensive stroke center within 60 minutes. The study is published in the current issue of Neurology.

In 2003, a system of designation of stroke care centers was initiated by The Joint Commission. The tiered approach designated acute stroke-ready hospitals, primary stroke centers (PSC) and comprehensive stroke centers (CSC) in order of increasing resources and capabilities. While certification of PSCs began in 2003, certification of CSCs did not commence until 2012, and were not yet in place at the time of this research.

We sought to demonstrate how mathematical modeling can inform the strategic development of the U.S. network of stroke centers by stimulating the conversion of PSCs into CSCs, says Michael Mullen, MD, assistant professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania and director of Penns Comprehensive Stroke Center.

Mullen and his team obtained population counts and geographic data from the 2010 Neilson-Claritas Census Estimations. Access to hospitals was calculated by ground and air transportation with the hospital that would contribute the maximal population access selected as the first CSC. Using the teams proprietary algorithm, CSCs were added in an iterative matter that would offer the greatest ground and air access for the surrounding population to a maximum of 20 CSCs.

As of December 31, 2010, there were 811 PSC-designated hospitals to which 66 percent of the U.S. population had 60 minute ground access. The teams analysis found that after the addition of up to 20 CSCs per state, 63.1% of the U.S. population would have 60 minute ground access to a CSC. And, averaging across states, the median population with 60-minute ground access to a CSC was 55.7%, but there was significant variability across states. Incorporating air ambulance transport into the model showed that median population with 60-minute ground or air access to a CSC was 85.3%, but variability across states persisted.

Their analysis also found that median ground access in the stroke belt states, including Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee, was worse, with a median of 32 percent of the population with 60-minute ground access versus 59 percent in non-stroke belt states.

Even with the most optimally located CSCs throughout the country, the team found that roughly one-third (37 percent) of the US population, 114 million people, would be unable to access a CSC by ground transportation within 60 minutes. Allowing for air transportation improved access, researchers report, but in one-quarter of the U.S., less than 60 percent of the population had ground OR air access to a CSC.

Our results highlight the need for population-based planning for developing systems of care, says Mullen. Given finite resources, it is critically important to locate CSCs in a way that maximizes population access.

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Penn Medicine Analysis Shows that One-Third of Americans Do Not Have Access to Stroke Center Within One Hour

Gaylord Physical Therapy, Orthopedics & Sports Medicine: Aquatic Therapy – Video

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Gaylord Physical Therapy, Orthopedics Sports Medicine: Aquatic Therapy
Gaylord Physical Therapy, Orthopedics Sports Medicine offers outpatient physical therapy at its North Haven, Connecticut, facility. Physical Therapist, Jacob Hunter provides an overview of...

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Health-Fit Chiropractic & Sports Medicine Boca Raton Excellent 5 Star Review by Diane S. – Video

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Health-Fit Chiropractic Sports Medicine Boca Raton Excellent 5 Star Review by Diane S.
Health-Fit Chiropractic Sports Medicine http://www.healthfitchiro.com 561-997-8898 Boca Raton Reviews Fantastic Review By Diane S. When I was training for my first full Ironman-distance...

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Health-Fit Chiropractic & Sports Medicine Boca Raton Excellent 5 Star Review by Diane S. - Video

New Ubisoft Game is Actual Medicine for Your Eyes! – The Know – Video

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New Ubisoft Game is Actual Medicine for Your Eyes! - The Know
Check out the full blog post here: http://blog.ubi.com/dig-rush-announced/ Written By: Meg Turney Hosted By: Meg Turney Music By: @EvGres at EpicWins.com Follow The Know on Twitter: http://twitte...

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Successful Cognitive Behavioral Therapy in Youth Leads to Decreased Thinking about Suicide

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Newswise PHILADELPHIA Penn Medicine researchers found that patients who did not respond to cognitive behavioral therapy (CBT) for anxiety in childhood had more chronic and enduring patterns of suicidal ideation at 7 to 19 years after treatment. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits. The complete study is available in the Journal of the American Academy of Child & Adolescent Psychiatry.

This study underscores the importance of the identification and evidence-based treatment of youth anxiety, says lead author, Courtney Benjamin Wolk, PhD, a postdoctoral researcher at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania.

The relationship between anxiety disorders in children and adolescents and the emergence of later depressive disorders is well established. But, few studies have established evidence for an independent relationship between anxiety and the range of suicidal behaviors, including suicidal ideation, plans, attempts and completed suicides or the impact of CBT treatment for anxiety in childhood and adolescent years on later suicidality. CBT is a form of psychotherapy that has been scientifically tested and is the gold standard in the treatment of anxiety and related disorders.

Wolk and colleagues looked at 66 patients who were treated for anxiety, particularly separation, social or generalized anxiety, as children, who agreed to be followed for years after treatment. These individuals had previously participated in two of the seminal randomized controlled trials of the Coping Cat program, a manualized CBT intervention for child anxiety, developed by coauthor Philip C. Kendall, PhD, of Temple University. Forty patients were classified as responding successfully to CBT treatment in childhood and adolescent years while 26 were treatment non-responders, with successful treatment defined as those patients whose primary anxiety disorder was no longer clinically significant after 16 weeks of treatment.

At seven to 19 years after treatment, treatment response was found to significantly predict lifetime suicidal ideation, such that treatment nonresponders were more likely to have experienced suicidal ideation. In fact, every patient who reported thinking about suicide in the past 12 months or past two weeks was among those who had not responded to CBT. Eighteen of these reported experiencing suicidal ideation, nine reported having made one or more suicide plans and six described making one or more suicide attempts in their lifetime.

In those patients who reported suicidal ideation, onset occurred at a mean age of about 16 years and was last reported by most patients at about 20 years of age. Mean ages of onset and recency for suicide plans were 18 and 19 years, respectively. Finally, among those who reported making suicide attempts, ideation began at a mean of 17 years and occurred most commonly/recently at the age of 21. All instances of suicidal plans and attempts reported occurred after the age of initial treatment.

This is the longest known study looking at suicidal ideation following CBT treatment in youth. This study suggests the importance of ongoing monitoring of anxious youth who are not successfully treated for later suicidal ideation, says senior author, Rinad Beidas, PhD, assistant professor at the Center for Mental Health Policy and Services Research at the Perelman School of Medicine at the University of Pennsylvania. It is the first study to demonstrate the protective function of successful evidence-based treatment for childhood anxiety disorders on suicidal ideation in late adolescence and adulthood. # # # Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year. The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.

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Successful Cognitive Behavioral Therapy in Youth Leads to Decreased Thinking about Suicide


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