Browsing by Author "Stahl, Stephanie M."

Now showing 1 - 10 of 18
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    Constructive Worry Patient Handout
    (2020-05-01) Stahl, Stephanie M.
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    Delayed Sleep-Wake Phase Disorder Management Plan
    (2020-04-20) Stahl, Stephanie M.
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    Evaluating the feasibility of implementing a Telesleep pilot program using two-tiered external facilitation
    (BMC, 2020) Rattray, Nicholas A.; Khaw, Andrew; McGrath, Mackenzie; Damush, Teresa M.; Miech, Edward J.; Lenet, Adam; Stahl, Stephanie M.; Ferguson, Jared; Myers, Jennifer; Guenther, David; Homoya, Barbara J.; Bravata, Dawn M.; Anthropology, School of Liberal Arts
    Background: Obstructive sleep apnea (OSA) can negatively impact patients' health status and outcomes. Positive airway pressure (PAP) reverses airway obstruction and may reduce the risk of adverse outcomes. Remote monitoring of PAP (as opposed to in-person visits) may improve access to sleep medicine services. This study aimed to evaluate the feasibility of implementing a clinical program that delivers treatment for OSA through PAP remote monitoring using external facilitation as an implementation strategy. Methods: Participants included patients with OSA at a Veteran Affairs Medical Center (VAMC). PAP adherence and clinical disease severity on treatment (measured by the apnea hypopnea index [AHI]) were the preliminary effectiveness outcomes across two delivery models: usual care (in-person) and Telehealth nurse-delivered remote monitoring. We also assessed visit duration and travel distance. A prospective, mixed-methods evaluation examined the two-tiered external facilitation implementation strategy. Results: The pilot project included N = 52 usual care patients and N = 38 Telehealth nurse-delivered remote monitoring patients. PAP adherence and disease severity were similar across the delivery modalities. However, remote monitoring visits were 50% shorter than in-person visits and saved a mean of 72 miles of travel (median = 45.6, SD = 59.0, mode = 17.8, range 5.4-220). A total of 62 interviews were conducted during implementation with a purposive sample of 12 clinical staff involved in program implementation. Weekly external facilitation delivered to both front-line staff and supervisory physicians was necessary to ensure patient enrollment and treatment. Synchronized, "two-tiered" facilitation at the executive and coordinator levels proved crucial to developing the clinical and administrative infrastructure to support a PAP remote monitoring program and to overcome implementation barriers. Conclusions: Remote PAP monitoring had similar efficacy to in-person PAP services in this Veteran population. Although external facilitation is a widely-recognized implementation strategy in quality improvement projects, less is known about how multiple facilitators work together to help implement complex programs. Two-tiered facilitation offers a model well-suited to programs where innovations span disciplines, disrupt professional hierarchies (such as those between service chiefs, clinicians, and technicians) and bring together providers who do not know each other, yet must collaborate to improve access to care.
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    Hypoglossal Nerve Stimulation (Inspire) - Activation Handout
    (2021-03-22) Stahl, Stephanie M.
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    Infarct Location and Sleep Apnea: Evaluating the Potential Association in Acute Ischemic Stroke.
    (Elsevier, 2015-10) Stahl, Stephanie M.; Yaggi, H. Klar; Taylor, Stanley; Qin, Li; Ivan, Cristina S.; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Tobias, Lauren; Sico, Jason; Vaz Fragoso, Carlos A.; Williams, Linda S.; Lampert, Rachel; Miech, Edward J.; Matthias, Marianne S.; Kapoor, John; Bravata, Dawn M.; Department of Neurology, IU School of Medicine
    Background: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Methods: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Results: Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. Conclusions: These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients.
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    Insomnia and Upper Airway Stimulation Therapy Benefit and Adherence: A Case Series
    (Springer, 2023-03) Stahl, Stephanie M.; Manchanda, Shalini; Parker, Noah; Chernyak, Yelena; Neurology, School of Medicine
    Obstructive sleep apnea (OSA) and insomnia are common sleep disorders that often occur concurrently. The presence of one of these disorders often negatively impacts the other, including affecting treatment benefit and adherence. While insomnia has been shown to adversely affect positive airway pressure therapy adherence, minimal data are currently available on the effects of insomnia on upper airway stimulation (UAS) therapy for the treatment of OSA. We present two cases that highlight the negative impact of insomnia on UAS therapy usage and OSA management as well as the benefits of insomnia treatment on overall outcomes. Screening for and treatment of insomnia prior to UAS implantation are recommended.
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    Journal Club: surveillance neuroimaging and neurologic examinations affect care for intracerebral hemorrhage
    (American Academy of Neurology, 2014-04-01) Stahl, Stephanie M.; Mackey, Jason; Department of Neurology, IU School of Medicine
    The article “Surveillance neuroimaging and neurologic examinations affect care for intracerebral hemorrhage”1 is reviewed. This review focuses on the methods, results, and limitations and merits of the original article.
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    Media Review: Sleep in Art: How Artists Portrayed Sleep and Dreams in the Last 7000 Years
    (American Academy of Sleep Medicine, 2021-12-01) Johal, Arminder; Stahl, Stephanie M.; Medicine, School of Medicine
    Dr. Meir Kryger’s Sleep in Art: How Artists Portrayed Sleep and Dreams in the Last 7000 Years, published in 2019, is a book likely to captivate the interests of those in sleep medicine. This book features hundreds of paintings, sculptures, and drawings by various artists. Artwork by Raphael, Henri Rousseau, Pablo Picasso, Vincent van Gogh, and Norman Rockwell are among the many found in this book. The intersection between the worlds of science, religion, and art are all explored as each artist expertly depicts the human enthrallment with sleep throughout time.
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    Moving toward standardization: physician reporting of sleep studies
    (American Academy of Sleep Medicine, 2023) Lastra, Alejandra C.; Ingram, David; Park, John; James, Elisabeth; Matthews, Camilla; Canapari, Craig; Mansukhani, Meghna; Stahl, Stephanie M.; Medicine, School of Medicine
    Detailed primary data collected from sleep studies should lead to specific and clear reports with evidence-based clinical recommendations that, when introduced by sleep medicine specialists, create a window of opportunity to support our non-sleep medicine referring teams and to engage patients and caregivers in their care as recipients of the reports. This is how sleep study reporting differs from other test reports; currently, there is wide variation in how the data collected are presented and summarized. The goal of this document is to offer recommendations for structured reporting of sleep studies. We offer a practical, complete, and relevant document and a structure that can be implemented across sleep centers nationwide and does not burden the interpreter. We anticipate some readers will opine that some of the content is beyond the scope of what the interpreter physician needs to include, while others will propose missing data that they feel should have been included. We feel that the flexibility of the proposal accommodates for this and allows for a "first step" toward standardization of physician reporting of sleep studies. High-quality structured reporting of sleep studies is becoming ever more important for patient care, benefiting patients, caregivers, clinicians, durable medical equipment companies, and payers.