Timothy J. Shephard

University of Virginia

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i-10 index

Research Trends

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Document Type

Co-Authors

Richard D. Zorowitz

MedStar Georgetown University Hospital

Ellen Magnis

VA Connecticut Healthcare System

Sarah T. Tonn

VA Maryland Health Care System

Mark J. Alberts

Hartford Hospital

S. Claiborne Johnston

University of California, San Francisco

Peter Moyer

Fair Haven Community Health Center

Lee H. Schwamm

Yale University

Arthur Pancioli

University of Cincinnati Medical Center

Mark Gorman

Massachusetts General Hospital

Joe E. Acker

Sichuan University

Cooperative Institutions

University of Virginia

Northwestern University

Massachusetts General Hospital

American Heart Association

Neurological Surgery

University of Virginia Health System

Centers for Disease Control and Prevention

University of Pittsburgh

University Hospitals of Cleveland

National Institutes of Health

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Papers

Citation

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The Stroke Practice Improvement Network: A Quasiexperimental Trial of a Multifaceted Intervention to Improve Quality

Journal of Stroke and Cerebrovascular Diseases (2010)

Judith A. Hinchey Timothy J. Shephard Sarah T. Tonn Robin Ruthazer Richard C. Hermann

Stroke

10.1016/j.jstrokecerebrovasdis.2009.03.016

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Citations (17)

Excellence in stroke care: improving care in community hospitals.

PubMed (2012)

Wende Fedder Mark K. Borsody Alissa R. Gorelick David Ghilarducci Marilyn M. Rymer

Excellence

Stroke

Source

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Citations (0)

Precipitous Decrease in Blood Pressure in Acute Ischemic Stroke Patients During Transesophageal Echocardiography: A Case Study From the Adult Brain Attack Database

Journal of Neuroscience Nursing (1998)

Timothy J. Shephard Heather Shehelski

Section Editor Questions or comments about this article may be directed to: Timothy J Shephard, RN, MSN, CNRN, CCRN, CNS. Medical College of Virginia Hospital, Virginia Commonwealth University. 1300 E. Marshall Street, PO Box 985961, Richmond, Virginia 23298. He is the Neurovascular Case Manager in the Neuroscience Center. Heather Shebelski, RN, is the Research Coordinator in the Neuroscience Center at the Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia

Commonwealth

Neurovascular bundle

West virginia

Acute stroke

10.1097/01376517-199808000-00008

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Citations (3)

Assessment and Management of Hypertension in the Acute Ischemic Stroke Patient

Journal of Neuroscience Nursing (1996)

Timothy J. Shephard Sherry Fox

The assessment and treatment of bypertension in the patient with acute ischemic stroke is a controversial issue in the overall management of such patients. The primary physiologic and pathologic concepts at the core of the issue are autoregulatory failure and shift, cytotoxic and vasogenic edema. vascular pathology and hemorrhage, Chues about the interrelationsbips of these factors to bypertension in the acute stroke patient are available to the nurse, By integrating pathophysiologic concepts with knowledge gained during assessment of stroke onset, patient history and clinical presentation, the nurse is better prepared to monitor and provide care for the acute stroke patient.

Stroke

Patient assessment

Presentation (obstetrics)

Acute stroke

Pathophysiology

10.1097/01376517-199602000-00003

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Citations (7)

Improving Telestroke Performance in Rural Systems of Care - The EQUITe Initiative (P6.084)

Neurology (2016)

Nina J. Solenski Andrew M. Southerland Timothy J. Shephard Diane G. Hillman Timothy L. McMurry

Background : Telestroke is well-established; however, there is sparse large-scale data on effectiveness of telestroke to improve acute treatment within rural systems-of-care. Specialist-On-Call© is the largest national provider of tele-emergency consults (23,000/yr). We evaluated the effectiveness of telestroke to improve access/timeliness of treatment for rural patients within the UVA-Telestroke program and the SOC tele-network. [HRSA#G01RH27869] Methods: PhaseI: De-identified patient data were pooled from 46 hospitals [2012-15,n=4,462]. 73[percnt] encounters were acute ischemic strokes; 19[percnt] were tPA treated. Demographics, NIHSS, [percnt] treated with tPA Results: 53[percnt] of AIS patients were >65yo. NIHSS = 0-8 in 79[percnt], 9-15 in 11[percnt], and >16 points in 10[percnt]. For tPA patients, NIHSS was 0-8 in 53[percnt], 9-15 in 23[percnt], >16 in 25[percnt]. 73[percnt] of tPA patients were treated <180min from LSN. 17[percnt] of AIS patients received tPA within 4.5hrs of LSN. The median Door-To-Needle time was 83min; 22[percnt] received tPA ≤ 60min DTN. AIS patient arrival to call initiated was 44min. Median call time to videoconsultation was 20min for AIS/tPA patients. PhaseII (on-going): Stroke ED educational STAT-PAKs were successfully piloted to rural EDs; on line telepresenter training has been launched. Conclusions : This is the largest outcomes study to date of acute telestroke encounters in rural US hospitals. The number of AIS consults treated with tPA was high indicating increased access to acute tele-neurological expertise. Teleconsultation physician response time was rapid, while patient arrival time to consult call was much longer. More work is needed to ensure better adherence to DTN guidelines. In PhaseII, we are determining the impact of an innovative telestroke education program on timeliness/outcome of treatment. Disclosure: Dr. Solenski has nothing to disclose. Dr. Southerland has received personal compensation in an editorial capacity for Neurology podcast. Dr. Shephard has nothing to disclose. Dr. Hillman has nothing to disclose. Dr. McMurry has nothing to disclose. Mr. Lawrence has received personal compensation for activities with a commercial entity. Dr. Schweickert has nothing to disclose. Dr. Wibberly has nothing to disclose.

10.1212/wnl.86.16_supplement.p6.084

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Citations (1)

Recommendations for Comprehensive Stroke Centers

Stroke (2005)

Mark J. Alberts Richard E. Latchaw Warren R. Selman Timothy J. Shephard Mark N. Hadley

To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease.A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors.There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center.

Modalities

Stroke

Evidence-Based Medicine

10.1161/01.str.0000170622.07210.b4

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Citations (582)

Establishing Data Elements for the Paul Coverdell National Acute Stroke Registry

Stroke (2003)

Wendy A. Wattigney Janet B. Croft George A. Mensah Mark J. Alberts Timothy J. Shephard

Stroke is the third-leading cause of death and a leading cause of disability in adults in the United States. In recent years, leaders in the stroke care community identified a national registry as a critical tool to monitor the practice of evidence-based medicine for acute stroke patients and to target areas for continuous quality of care improvements. An expert panel was convened by the Centers for Disease Control and Prevention to recommend a standard list of data elements to be considered during development of prototypes of the Paul Coverdell National Acute Stroke Registry.A multidisciplinary panel of representatives of the Brain Attack Coalition, professional associations, nonprofit stroke organizations, and federal health agencies convened in February 2001 to recommend key data elements. Agreement was reached among all participants before an element was added to the list.The recommended elements included patient-level data to track the process of delivering stroke care from symptom onset through transport to the hospital, emergency department diagnostic evaluation, use of thrombolytic therapy when indicated, other aspects of acute care, referral to rehabilitation services, and 90-day follow-up. Hospital-level measures pertaining to stroke center guidelines were also recommended to augment patient-level data.Routine monitoring of the suggested parameters could promote community awareness campaigns, support quality improvement interventions for stroke care and stroke prevention in each state, and guide professional education in hospital and emergency system settings. Such efforts would reduce disability and death among stroke patients.

Stroke

Acute stroke

Acute care

10.1161/01.str.0000048160.41821.b5

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Citations (76)

Recommendations for the Establishment of Stroke Systems of Care Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Task Force Members

Lee H. Schwamm Arthur Pancioli Joe E. Acker Larry B. Goldstein Richard D. Zorowitz

Task force

Stroke

Association (psychology)

Source

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Citations (7)

Advances in the genetics of cerebrovascular disease and stroke

Neurology (2001)

George J. Hádemenos Mark J. Alberts Issam A. Awad Marc R. Mayberg Timothy J. Shephard

Article abstract— MEDLINE searches identified epidemiologic, experimental, and clinical studies on the genetics of cerebrovascular disease and stroke, including the following topics: genetic epidemiology of stroke; genetics of systemic disorders that cause ischemic stroke, including coagulation disorders, connective tissue disorders, vasculopathies, metabolic disorders, and disorders of unknown etiology; and genetics of systemic disorders that cause hemorrhagic stroke. Recent discoveries in stroke genetics involve the genetic basis of monogenic disorders such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and sickle cell disease. Reproducing similar advances in other forms of cerebrovascular disease and stroke will be more difficult because their inheritance is complex, multigenic, and heterogeneous. However, the future is promising with the application of molecular genetic approaches such as linkage analysis, allele-sharing methods, association studies, and polygenic analysis of experimental crosses as well as the transmission/disequilibrium test—a statistical method for detection of linkage between a marker and a disease-susceptibility locus.

Stroke

Medical genetics

Linkage Disequilibrium

CADASIL

Multifactorial Inheritance

Genetic Association

Genome-wide Association Study

Human genetics

10.1212/wnl.56.8.997

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Citations (76)

Formal Dysphagia Screening Protocols Prevent Pneumonia

Stroke (2005)

Judith A. Hinchey Timothy J. Shephard Karen L. Furie Don B. Smith David Wang

Pneumonia is an important complication of ischemic stroke and increases mortality 3-fold. Five guidelines recommend a dysphagia screen before oral intake. What constitutes an adequate dysphagia screen and which patients should receive it remain unclear.Fifteen acute care institutions prospectively collected data on all admitted patients with acute ischemic stroke. Sites were required to collect data on demographics and 4 quality indicators. Optional data included stroke severity and complications. We measured adherence to a screen for dysphagia, the type of screen, and development of in-hospital pneumonia.Between December 2001 and January 2003, 2532 cases were collected. In-hospital complications were recorded on 2329 (92%) of cases. Stroke severity was captured on 1361 (54%). Adherence to a dysphagia screen was 61%. Six sites had a formal dysphagia screen, and their adherence rate was 78% compared with 57% at sites with no formal screen. The pneumonia rate at sites with a formal dysphagia screen was 2.4% versus 5.4% (P=0.0016) at sites with no formal screen. There was no difference in median stroke severity (5 versus 4; P=0.84) between the sites with and without a formal screen. A formal dysphagia screen prevented pneumonia even after adjusting for stroke severity.A formal dysphagia screen is associated with a higher adherence rate to dysphagia screens and a significantly decreased risk of pneumonia. A formal screening protocol should be offered to all stroke patients, regardless of stroke severity.

Stroke

10.1161/01.str.0000177529.86868.8d

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Citations (517)