Kumar, Aditya

Introduction: Stroke code simulation training is effective at reducing door to needle times (DTNT) for tPA administration. We aimed to evaluate the effect on DTNT from simulation training specifically for Neurology residents. Method: Stroke code simulation was implemented at our comprehensive stroke center in July 2017, targeting PGY2 adult neurology residents and PGY3 pediatric neurology residents who were first responders at stroke codes during off-hours. Training was completed at the beginning of the residents’ respective training years. An interrupted time series analysis of DTNT for tPA before and after the implementation of simulation training from July 2016 to July 2019 was performed. Demographics, tPA metrics, and safety and hospital metrics were compared pre and post intervention among the residents. No other quality improvement projects targeting DTNT were implemented during this time. Results: Between July 2016 and July 2019, 305 patients received thrombolysis from a resident first responder - 118 (39%) of whom were treated pre-simulation and 187 (61.3%) treated during the simulation period. There was no significant difference in patient baseline characteristics between the two groups (Table 1). Median DTNT was 49.5 (IQR 40-71) min during the pre-simulation period and 48 (IQR 37-60) min during the post-simulation period (p= 0.04). Compared to pre-simulation, there were no months in which the median DTNT exceeded 60 min post-simulation. IQR for the DTNT appeared both clinically and statistically different. Pre and post simulation, there was no difference in incidence of symptomatic intracranial hemorrhage nor in 90-day outcomes. Conclusion: In our analysis of the effect of stroke code simulation training among neurology residents, improvement in DTNT after simulation training appears more driven by improvement in the variation in times rather than a clinically significant decrease in median times.

ABSTRACT Introduction : A randomized trial demonstrated benefit from thymectomy in nonthymomatous acetylcholine receptor (AChR)‐antibody positive myasthenia gravis (MG). Uncontrolled observational and histologic studies suggest thymectomy may not be efficacious in anti–muscle‐specific kinase (MuSK)‐MG. Methods : The therapeutic impact of thymectomy was evaluated from data collected for a multicenter, retrospective blinded review of rituximab in MuSK‐MG. Results : Baseline characteristics were similar between thymectomy ( n = 26) and nonthymectomy ( n = 29) groups, including treatment with rituximab (42% vs. 45%). At last visit, 35% of thymectomy subjects reached the primary endpoint, a Myasthenia Gravis Foundation of America (MGFA) post‐intervention status (PIS) score of minimal manifestations (MM) or better, compared with 55% of controls ( P = 0.17). After controlling for age at onset of MG, rituximab, prednisone, and intravenous immunoglobulin/plasma exchange treatment, thymectomy was not associated with greater likelihood of favorable clinical outcome (odds ratio = 0.43, 95% confidence interval 0.12–1.53, P = 0.19). Discussion : Thymectomy was not associated with additional clinical improvement in this multicenter cohort of MuSK‐MG patients. Muscle Nerve 59:404–410, 2019