Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Tuesday, July 31, 2012

SMART Arm investment helps stroke survivors recover faster

Yeah for Australians. You'll have to go to the link to see a non-understandable picture of what it looks like. Have your therapist report back to you on its feasibility.
SMART Arm Pty Ltd, the latest start-up enterprise from leading Australian university commercialisation company UniQuest, has secured investment from Townsville Mackay Medicare Local (TMML) to launch an innovative device for improving recovery outcomes for people who have experienced stroke and/or brain injury.

The Sensory-Motor Active Rehabilitation Training (SMART) Arm is a portable, non-robotic technology that enables stroke survivors with upper limb weakness to drive their own rehabilitation.

With feedback on performance via an interactive computer program and incremental increases in load and reaching range, the SMART Arm reduces the degrees of freedom to be controlled and provides a goal for movement. For stroke survivors with very severe weakness, it can also be used with outcome-triggered electrical stimulation to augment full-range reaching.

UniQuest Managing Director, David Henderson, said SMART Arm Pty Ltd was formed to further develop, manufacture and market the technology, which originated from multi-disciplinary research at two Queensland universities.

“SMART Arm the company is the culmination of more than eight years of stroke rehabilitation research, design and testing at James Cook University (JCU) and The University of Queensland (UQ),” Mr Henderson explained.

“The SMART Arm technology was developed by researchers across a number of disciplines, including physiotherapy, neuroscience and engineering. We now have TMML on board, bringing to the venture its commercial and community health acumen and access to rehabilitation clinic and networks worldwide.

“This partnership demonstrates how collaborations between universities, research disciplines, and industry can translate into real and practical benefits for the wider community,” Mr Henderson said.

While details of the agreement between SMART Arm Pty Ltd shareholders and TMML remain commercial-in-confidence, the transaction is expected to accelerate the device’s manufacture so units could be available for distribution within 12 months.

Led by Dr Ruth Barker, an Adjunct Senior Lecturer from JCU’s School of Public Health, Tropical Medicine and Rehabilitation Sciences, the team which developed the SMART Arm included UQ researchers Professor Richard Carson (Human Movement Studies), Associate Professor Sandy Brauer (Physiotherapy), Dr David Lloyd (Human Movement Studies) and Kate Hayward (Physiotherapy PhD student).

The research team has demonstrated that a program of SMART Arm training improved arm function, arm muscle activation and neural plasticity in people with chronic stroke, with the last finding published in the July 2012 issue of Experimental Brain Research.

“We are thrilled to have a Queensland company like TMML back our innovation,” said Dr Barker.

“Stroke is the leading cause of severe long term disability in the Western world. Every year, over three million stroke survivors try to regain use of their upper limbs. SMART Arm is one of the few interventions shown to result in positive changes in neural plasticity in people with chronic stroke, so we’re very keen to see the device become available to as many as possible, as soon as possible,” Dr Barker said.

TMML chairman, Dr Kevin Arlett, said TMML recognised the potential for SMART Arm to address a major unmet need in the allied health care industry.

“We’re proud to be partnering with Dr Barker and her team to launch this technology commercially,” Dr Arlett said.

“The SMART Arm will make a huge difference to stroke survivor outcomes because it’s interactive and it allows patients to practise independently and direct their own rehabilitation. And, because it’s small enough to be used for clinical inpatient and outpatient settings as well as in rehabilitation services, nursing homes and local area health services, more people will benefit.”

Dr Barker recently demonstrated the SMART Arm device at a workshop on driving neural plasticity that was associated with this year’s International Society for Electrophysiology and Kinesiology Congress (ISEK2012).

Predicting recovery after stroke

And I would argue that they are doing it wrong, looking at disabilities rather than the dead area location and the penumbra location.  You don't look at secondary problems you go straight to the primary cause. White matter vs. gray matter. 12 weeks is a ridiculous time to consider checking on recovery.
In work that may revolutionise rehabilitation for stroke patients, researchers from The University of Auckland and the Auckland District Health Board have shown it is possible to predict an individual's potential for recovery of hand and arm function after a stroke.
The new approach can be used to personalise rehabilitation so that patients and therapists set realistic goals for recovery.(100% recovery is the only goal needed, nothing less,figure out how to get there) It may also improve outcomes of trials that evaluate new therapies, by identifying patients who are most likely to respond to specific treatments.
"One in six people worldwide will have a stroke in their lifetime," says principal investigator Professor Winston Byblow. "After stroke, impairment of the arm and hand is very common and has a major impact on independence and quality of life.
"Until now it has only been possible to group patients together according to their broad similarity to others who have already gone through upper limb rehabilitation, but this information cannot inform an individual patient's rehabilitation plan. We have developed the first clinical algorithm to actually predict the individual patient's potential for recovery based on information gathered before rehabilitation begins."
The lead author of the study, Dr Cathy Stinear explains: "The algorithm begins with a bedside test within three days of stroke. The test takes only a few minutes and requires no special equipment. This is sufficient to provide a prediction for many patients, but for others an additional test is required to measure the integrity of neural pathways from the brain to the arm. If this test gives no definitive result, an MRI assessment can be performed to better determine whether the pathways in the stroke-damaged side of the brain remain viable."
The research team have trialled the process in patients and followed their recovery. "When the tests are combined in our stepwise algorithm they accurately predict each patient's recovery at 12 weeks, which is around the time that therapy normally ends," says Dr Stinear.
Neurologist Professor Alan Barber, a member of the research team and Head of the Auckland Hospital Stroke Service, says that the findings are very significant. "This is the first study to predict an individual's potential for motor recovery using measures obtained from that patient in the initial days after stroke. This information can be used to tailor rehabilitation before it begins."
The team is now involved in a three-year trial of the algorithm within the hospital. The results will show whether the algorithm leads to improved outcomes for patients and increases the efficiency of rehabilitation services.
The team's work was published in the journal "Brain" this week. It was funded by the Health Research Council of New Zealand.

Monday, July 30, 2012

Full list: Is there a primary stroke center near you?

From USA Today so the list is copied here;
Before you take the Joint Commissions rating call up the hospital and ask what percentage of strokes get tPA within the prescribed time.  Then ask what percentage of that percentage get full recovery. If your hospital doesn't know the answer ask them how many patients they lose track of. I don't trust anything the Joint Commission does, they don't tell what the criteria is to get certified. You can email them and try to find out what they are hiding but you won't succeed.  So we can't even tell how up-to-date the hospitals are with the latest research.

Health care organization City State
Scripps Memorial Hospital - Encinitas Encinitas CA
Emory Eastside Medical Center Snellville GA
Lehigh Valley Hospital Allentown PA
Memorial Hospital West Pembroke Pines FL
CHW Dominican Hospital Santa Cruz CA
Regional Medical Center Bayonet Point Hudson FL
Oak Hill Hospital Brooksville FL
Memorial Hermann Southwest Hospital Houston TX
Firelands Regional Medical Center Sandusky OH
Kaiser Foundation Hospital - South Sacramento Sacramento CA
Albert Einstein Medical Center Philadelphia PA
Holy Redeemer Health System Meadowbrook PA
The Chester County Hospital West Chester PA
The Reading Hospital and Medical Center Reading PA
The Williamsport Hospital and Medical Center Williamsport PA
York Hospital York PA
Anne Arundel Medical Center Annapolis MD
Franklin Square Hospital Center Baltimore MD
Greater Baltimore Medical Center Baltimore MD
Good Samaritan Hospital of Maryland, Inc. Baltimore MD
The Johns Hopkins Hospital Baltimore MD
Mercy Medical Center, Inc. Baltimore MD
St. Agnes Hospital Baltimore MD
St. Joseph Medical Center Towson MD
Sinai Hospital of Baltimore Baltimore MD
Harbor Hospital Baltimore MD
The Union Memorial Hospital Baltimore MD
University of Maryland Medical Center Baltimore MD
Suburban Hospital Bethesda MD
St. Mary Medical Center Langhorne PA
MedStar Georgetown University Medical Center Washington DC
The George Washington University Hospital Washington DC
Inova Alexandria Hospital Alexandria VA
Lancaster General Hospital Lancaster PA
Inova Fairfax Hospital Falls Church VA
Penn State Milton S. Hershey Medical Center Hershey PA
Saint Vincent Health Center Erie PA
Hamot Medical Center Erie PA
Bon Secours-St. Mary's Hospital Richmond VA
Ephrata Community Hospital Ephrata PA
Delaware County Memorial Hospital Drexel Hill PA
Winchester Medical Center, Inc. Winchester VA
Geisinger Medical Center Danville PA
Butler Healthcare Providers Butler PA
St. Luke's Hospital and Health Network Bethlehem PA
Altoona Regional Health System Altoona PA
Mission Hospitals, Inc. Asheville NC
Lehigh Valley Hospital - Muhlenberg Bethlehem PA
Carolinas Medical Center Charlotte NC
Novant Health, Inc/Southern Piedmont Region/Presbyterian Hea Charlotte NC
Abington Memorial Hospital Abington PA
St. Francis Medical Center Trenton NJ
High Point Regional Health System High Point NC
Community Medical Center Toms River NJ
Holy Name Hospital Teaneck NJ
Overlook Hospital Summit NJ
Somerset Medical Center Somerville NJ
Forsyth Medical Center and its Affiliates Winston Salem NC
North Carolina Baptist Hospital Winston Salem NC
Shore Memorial Hospital Somers Point NJ
Medical University of South Carolina Medical Center Charleston SC
Roper Hospital Charleston SC
Valley Health System Ridgewood NJ
Riverview Medical Center Red Bank NJ
Forrest S. Chilton III Memorial Hospital, Inc. Pompton Plains NJ
Robert Wood Johnson University Hospital New Brunswick NJ
Blake Medical Center Bradenton FL
Manatee Memorial Hospital Bradenton FL
Brandon Regional Hospital Brandon FL
Saint Barnabas Medical Center Livingston NJ
Seven Rivers Regional Medical Center Crystal River FL
Halifax Health Daytona Beach FL
Jersey Shore University Medical Center Neptune NJ
Broward General Medical Center Fort Lauderdale FL
Holy Cross Hospital Ministries Fort Lauderdale FL
Lee Memorial Health System Fort Myers FL
Lawnwood Regional Medical Center & Heart Institute Fort Pierce FL
Fort Walton Beach Medical Center, Inc Fort Walton Beach FL
Memorial Regional Hospital Hollywood FL
Morristown Memorial Hospital Morristown NJ
Monmouth Medical Center Long Branch NJ
Memorial Hospital Jacksonville Jacksonville FL
Lakeland Regional Medical Center Lakeland FL
JFK Medical Center Limited Partnership Atlantis FL
Largo Medical Center Largo FL
Florida Medical Center, Ltd. Fort Lauderdale FL
Munroe Regional Medical Center Ocala FL
Morton Plant North Bay Hospital New Port Richey FL
Hackensack University Medical Center Hackensack NJ
Englewood Hospital and Medical Center Englewood NJ
JFK Medical Center Edison NJ
West Florida Regional Medical Center, Inc. Pensacola FL
St. Lucie Medical Center Port Saint Lucie FL
Charlotte Regional Medical Center Punta Gorda FL
North Broward Medical Center Deerfield Beach FL
Wuesthoff Medical Center - Rockledge Rockledge FL
Flagler Hospital, Inc. Saint Augustine FL
Edward White Hospital Saint Petersburg FL
Bayfront Medical Center Saint Petersburg FL
Northside Hospital Saint Petersburg FL
Palms of Pasadena Hospital South Pasadena FL
St. Anthony's Health Care Saint Petersburg FL
St. Petersburg General Hospital Saint Petersburg FL
Central Florida Regional Hospital Sanford FL
Doctors Hospital of Sarasota Sarasota FL
Sarasota Memorial Hospital Sarasota FL
Martin Memorial Medical Center, Inc. Stuart FL
Capital Regional Medical Center, Inc. Tallahassee FL
St. Joseph's Hospital, Inc. Tampa FL
AtlantiCare Regional Medical Center Atlantic City NJ
Tampa General Hospital Tampa FL
Parrish Medical Center (North Brevard County Hospital Dst) Titusville FL
Indian River Memorial Hospital, Inc. Vero Beach FL
Columbia Hospital West Palm Beach FL
Good Samaritan Hospital Suffern NY
Akron General Medical Center Akron OH
Strong Memorial Hospital Rochester NY
St. Charles Hospital Port Jefferson NY
CSAHS/UHHS-Canton, Inc Canton OH
The University Hospital Cincinnati OH
The Mount Sinai Medical Center New York NY
Lutheran Medical Center Brooklyn NY
Grant Medical Center Columbus OH
Maimonides Medical Center Brooklyn NY
Riverside Methodist Hospital Columbus OH
Good Samaritan Hospital Dayton OH
Miami Valley Hospital Dayton OH
Albany Medical Center Albany NY
Kettering Medical Center Kettering OH
Norwalk Hospital Norwalk CT
The University of Toledo Toledo OH
Lawrence and Memorial Hospital New London CT
HMHP - St. Elizabeth Health Center Youngstown OH
Yale - New Haven Hospital New Haven CT
Bluffton Regional Medical Center Bluffton IN
Middlesex Hospital Middletown CT
Deaconess Hospital Evansville IN
Lutheran Hospital of Indiana Fort Wayne IN
Parkview Hospital Fort Wayne IN
Saint Francis Hospital and Medical Center Hartford CT
Greenwich Hospital Greenwich CT
St. Joseph Hospital & Health Center, INC. Kokomo IN
The Danbury Hospital Danbury CT
MacNeal Hospital Berwyn IL
OSF St. Joseph Medical Center Bloomington IL
University of Illinois Medical Center at Chicago Chicago IL
Loyola University Medical Center Maywood IL
Mercy Hospital and Medical Center Chicago IL
Rush University Medical Center Chicago IL
St. Vincent's Medical Center Bridgeport CT
Bridgeport Hospital Bridgeport CT
The Miriam Hospital Providence RI
Alexian Brothers Medical Center Elk Grove Village IL
Evanston Northwestern Healthcare Evanston IL
Caritas St. Elizabeth's Medical Center of Boston, Inc. Boston MA
Penobscot Bay Medical Center Rockport ME
Advocate Christ Medical Center Oak Lawn IL
Maine Medical Center Portland ME
The Methodist Medical Center of Illinois Peoria IL
OSF Saint Francis Medical Center Peoria IL
Bixby Medical Center Adrian MI
St. Joseph Mercy Hospital Ann Arbor MI
The University of Michigan Hospitals and Health Centers Ann Arbor MI
North Fulton Regional Medical Center, Inc Roswell GA
Henry Ford Health System Detroit MI
Detroit Receiving Hospital / University Health Center Detroit MI
Cypress Fairbanks Medical Center Hospital Houston TX
Saint Joseph Mercy Livingston Hospital Howell MI
Bronson Methodist Hospital Kalamazoo MI
Sparrow Health System Lansing MI
Delray Medical Center, Inc. Delray Beach FL
Northern Michigan Regional Hospital Petoskey MI
St. Joseph Mercy Oakland Pontiac MI
St. John West Shore Hospital Westlake OH
St. Mary's of Michigan Medical Center Saginaw MI
Lakeland Regional Health System Saint Joseph MI
Herrick Medical Center Tecumseh MI
Stony Brook University Hospital Medical Center Stony Brook NY
Sacred Heart Hospital Eau Claire WI
St. Alexius Medical Center Hoffman Estates IL
Lee's Summit Medical Center Lees Summit MO
Community Memorial Hospital of Menomonee Falls, Inc. Menomonee Falls WI
Columbia St. Mary's Hospital Milwaukee, Inc Milwaukee WI
California Pacific Medical Center San Francisco CA
St. Mary's Hospital Ozaukee, Inc. Mequon WI
Froedtert Memorial Lutheran Hospital Milwaukee WI
Mercy San Juan Medical Center Carmichael CA
Aurora Sinai Medical Center Milwaukee WI
Fawcett Memorial Hospital Port Charlotte FL
Jewish Hospital & St. Mary's HealthCare, Inc. Louisville KY
Baptist Hospital East Louisville KY
University Medical Center, Inc. Louisville KY
Westside Regional Medical Center Plantation FL
Erlanger Health System Chattanooga TN
Santa Clara Valley Medical Center San Jose CA
Leesburg Regional Medical Center, Inc. Leesburg FL
St. Mary's Health System Knoxville TN
The University of Tennessee Memorial Hospital Knoxville TN
Oakbend Medical Center Richmond TX
Baptist Hospital Nashville TN
Skyline Medical Center Nashville TN
Saint Thomas Hospital / Saint Thomas Health Services Nashville TN
La Porte Regional Health System, Inc. La Porte IN
Winter Haven Hospital, Inc. Winter Haven FL
Atlanta Medical Center Atlanta GA
Huntsville Hospital Huntsville AL
Northwest Community Hospital Arlington Heights IL
Decatur Memorial Hospital Decatur IL
Providence Saint Joseph Medical Center Burbank CA
Park Nicollet Health Services Minneapolis MN
Fairview Southdale Hospital Edina MN
North Memorial Health Care Robbinsdale MN
Saint Marys Hospital Rochester MN
Regions Hospital Saint Paul MN
United Hospital Saint Paul MN
BroMenn Healthcare Hospitals Bloomington IL
St. Luke's Methodist Hospital Cedar Rapids IA
Fisher-Titus Medical Center Norwalk OH
Southeast Missouri Hospital Association Cape Girardeau MO
Mercy Medical Center Cedar Rapids IA
The Hospital Authority of Habersham County Demorest GA
Menorah Medical Center Overland Park KS
Research Medical Center Kansas City MO
Saint Luke's Hospital Kansas City MO
Piedmont Hospital, Inc. Atlanta GA
St. Anthony Hospitals Denver CO
St. John's Regional Health Center Springfield MO
Tallahassee Memorial HealthCare, Inc. Tallahassee FL
Sanford USD Medical Center Sioux Falls SD
Johns Hopkins Bayview Medical Center Baltimore MD
Aurora Medical Center of Manitowoc County, Inc. Two Rivers WI
Via Christi Regional Medical Center Wichita KS
Geneva General Hospital Geneva NY
The MetroHealth System Cleveland OH
Great River Medical Center West Burlington IA
Benefis Healthcare System Great Falls MT
Grady Health System Atlanta GA
San Jacinto Methodist Hospital Baytown TX
Ellis Hospital Schenectady NY
Morton Plant Hospital Association Clearwater FL
St. Joseph's Hospital and Medical Center Paterson NJ
Hartford Hospital Hartford CT
Sierra Medical Center El Paso TX
Providence Memorial Hospital El Paso TX
Robert Wood Johnson University Hospital at Hamilton Hamilton NJ
Harris Methodist Fort Worth Hospital Fort Worth TX
Plaza Medical Center of Fort Worth Fort Worth TX
Lakewood Hospital Association Lakewood OH
Rochester General Hospital Rochester NY
The Methodist Hospital Houston TX
St. Mary's Health Care System, Inc. Athens GA
North Shore University Hospital Manhasset NY
Alta Bates Summit Medical Center Berkeley CA
The Medical Center, Inc. Columbus GA
UPMC Presbyterian Shadyside Pittsburgh PA
UPMC Mercy Pittsburgh PA
East Texas Medical Center Tyler Tyler TX
Trinity Mother Frances Health System Tyler TX
DeTar Healthcare System Victoria TX
St. Vincent Healthcare Billings MT
Allegheny General Hospital Pittsburgh PA
Swedish Medical Center Englewood CO
Nazareth Hospital Philadelphia PA
Thomas Jefferson University Hospitals, Inc. Philadelphia PA
Jeanes Hospital Philadelphia PA
Hospital of the University of Pennsylvania Philadelphia PA
Grand View Hospital Sellersville PA
Montgomery General Hospital Olney MD
University Health Care/Hospitals and Clinics Salt Lake City UT
Peninsula Regional Medical Center Salisbury MD
Valley Hospital Medical Center Las Vegas NV
Renown Regional Medical Center Reno NV
Holy Cross Hospital of Silver Spring, Inc. Silver Spring MD
Washington Hospital Center Washington DC
University of Virginia Health System Charlottesville VA
Providence St. Peter Hospital Olympia WA
Harborview Medical Center Seattle WA
Sentara Hospitals Norfolk Norfolk VA
Virginia Mason Medical Center Seattle WA
Sacred Heart Medical Center Spokane WA
Southwest Washington Medical Center Vancouver WA
Henrico Doctors' Hospital Richmond VA
Sentara Virginia Beach General Hospital Virginia Beach VA
Charleston Area Medical Center, Inc. Charleston WV
St. Mary's Medical Center Huntington WV
West Virginia University Hospitals, Inc. Morgantown WV
John Muir Medical Center Concord Campus Concord CA
Glendale Adventist Medical Center Glendale CA
Stanly Regional Medical Center Albemarle NC
University of North Carolina Hospitals Chapel Hill NC
Duke University Hospital Durham NC
El Camino Hospital Mountain View CA
Los Alamitos Medical Center,Inc. Los Alamitos CA
Moses Cone Health System Greensboro NC
Pitt County Memorial Hospital Greenville NC
Frye Regional Medical Center, Inc. Hickory NC
WakeMed Health and Hospitals Raleigh NC
Rowan Regional Medical Center Salisbury NC
University of California Irvine Medical Center Orange CA
Thomasville Medical Center Thomasville NC
AnMed Health Anderson SC
Sequoia Health Services Redwood City CA
Kaiser Foundation Hospital - Sacramento/Roseville Sacramento CA
Mercy General Hospital Sacramento CA
Spartanburg Regional Healthcare System Spartanburg SC
MCG Health, Inc. Augusta GA
Doctors Hospital of Augusta Augusta GA
Seton Medical Center Daly City CA
Saint Francis Memorial Hospital San Francisco CA
San Francisco General Hospital Medical Center San Francisco CA
UCSF Medical Center San Francisco CA
WellStar Cobb Hospital Marietta GA
Good Samaritan Hospital LP San Jose CA
O'Connor Hospital San Jose CA
Kaiser Foundation Hospital - San Jose San Jose CA
St. Francis Hospital, Inc. Columbus GA
Kaiser Foundation Hospital - Santa Clara Santa Clara CA
Hamilton Medical Center Dalton GA
John Muir Medical Center, Walnut Creek Campus Walnut Creek CA
Kaiser Foundation Hospital - Walnut Creek Walnut Creek CA
Emory University Hospital Atlanta GA
Gwinnett Hospital System, Inc. Lawrenceville GA
The Medical Center of Central Georgia, Inc. Macon GA
Floyd Healthcare Management, Inc Rome GA
Memorial Health University Medical Center, Inc. Savannah GA
Bethesda Memorial Hospital, Inc. Boynton Beach FL
Cape Canaveral Hospital, Inc. Cocoa Beach FL
North Austin Medical Center Austin TX
Mease Health Care Dunedin FL
Aventura Hospital and Medical Center Aventura FL
CJW Medical Center Richmond VA
Baptist Medical Center/ Wolfson Children's Hospital Jacksonville FL
Shands Jacksonville Medical Center Jacksonville FL
Mayo Clinic Jacksonville FL
Osceola Regional Medical Center Kissimmee FL
Northwest Medical Center Margate FL
Kendall Regional Medical Center Miami FL
United Regional Health Care System Wichita Falls TX
Holmes Regional Medical Center, Inc. Melbourne FL
Gulf Coast Medical Center Panama City FL
Bay Medical Center Panama City FL
Baptist Hospital, Inc. Pensacola FL
Sacred Heart Health System, Inc. Pensacola FL
Jupiter Medical Center Jupiter FL
Community Hospital New Port Richey FL
Summa Health System Hospitals Akron OH
Aultman Hospital Canton OH
Cleveland Clinic Cleveland OH
Aurora BayCare Medical Center Green Bay WI
Swedish Medical Center/Cherry Hill Seattle WA
University Hospitals-Case Medical Center Cleveland OH
The Ohio State University Hospital Columbus OH
Marymount Hospital Garfield Heights OH
Centura Health-Littleton Adventist Hospital Littleton CO
St. Joseph's/ Candler Health System Savannah GA
Atrium Medical Center Franklin OH
Bloomington Hospital Bloomington IN
Columbus Regional Hospital Columbus IN
Community Hospital East Indianapolis IN
St. Vincent Hospital and Health Care Services, Inc. Indianapolis IN
Saint Joseph Regional Medical Center South Bend Campus South Bend IN
Rush-Copley Medical Center Aurora IL
Northwestern Memorial Hospital Chicago IL
University of Chicago Medical Center Chicago IL
Ingalls Memorial Hospital Harvey IL
Edward Health Services Corporation Naperville IL
Advocate Lutheran General Hospital Park Ridge IL
OSF Saint Anthony Medical Center Rockford IL
St. John's Hospital Springfield IL
Central DuPage Hospital Winfield IL
Bay Regional Medical Center Bay City MI
Oakwood Hospital and Medical Center Dearborn MI
Providence Hospital and Medical Centers Southfield MI
Saint Mary's Health Care Grand Rapids MI
W.A. Foote Memorial Hospital Jackson MI
Borgess Medical Center Kalamazoo MI
Legacy Salmon Creek Hospital Vancouver WA
William Beaumont Hospital Royal Oak MI
Luther Hospital Eau Claire WI
Bellin Health Green Bay WI
St. Mary's Hospital Medical Center Green Bay WI
St. Vincent Hospital Green Bay WI
Gundersen Lutheran Medical Center, Inc. La Crosse WI
St. Mary's Hospital Madison WI
University of Wisconsin Hospitals and Clinics Authority Madison WI
Aurora St. Luke's Medical Center Milwaukee WI
Oconomowoc Memorial Hospital Oconomowoc WI
Aurora Health Care Central Inc Sheboygan WI
Waukesha Memorial Hospital, Inc. Waukesha WI
The St. Luke Hospitals, Inc. Fort Thomas KY
Central Baptist Hospital Lexington KY
University of Kentucky Hospital Lexington KY
Wellmont Bristol Regional Medical Center Bristol TN
Johnson City Medical Center Johnson City TN
Fort Sanders Regional Medical Center Knoxville TN
Middle Tennessee Medical Center, Inc. Murfreesboro TN
Vanderbilt University Hospital and The Vanderbilt Clinic Nashville TN
Decatur General Hospital Decatur AL
University of South Alabama Medical Center Mobile AL
Memorial Hospital at Gulfport Gulfport MS
Abbott Northwestern Hospital Minneapolis MN
Mercy Medical Center Des Moines IA
The University of Iowa Hospitals and Clinics Iowa City IA
Mercy Medical Center - Sioux City Sioux City IA
Saint Francis Medical Center Cape Girardeau MO
Saint Louis University Hospital Saint Louis MO
Barnes-Jewish Hospital Saint Louis MO
St. Anthony's Medical Center Saint Louis MO
Lester E. Cox Medical Centers Springfield MO
Avera McKennan Hospital & University Health Center Sioux Falls SD
Saint Elizabeth Regional Medical Center Lincoln NE
University of Kansas Hospital Authority Kansas City KS
Sparks Regional Medical Center Fort Smith AR
Baptist Health Medical Center - Little Rock Little Rock AR
West Jefferson Medical Center Marrero LA
Ochsner Clinic Foundation New Orleans LA
Mercy Health Center Oklahoma City OK
INTEGRIS Southwest Medical Center Oklahoma City OK
Arlington Memorial Hospital Arlington TX
Medical Center of Arlington Arlington TX
University Medical Center at Brackenridge Austin TX
St. David's Hospital Austin TX
Seton Medical Center Austin Austin TX
Memorial Hermann Baptist Hospital Beaumont Beaumont TX
St. Joseph Regional Health Center Bryan TX
Memorial Hermann The Woodlands Hospital The Woodlands TX
Baylor University Medical Center (BUMC) Dallas TX
Texoma Medical Center Denison TX
Las Palmas Medical Center El Paso TX
Tarrant County Hospital District Fort Worth TX
Valley Baptist Medical Center Harlingen TX
Memorial Hermann Hospital Houston TX
St. Luke's Episcopal Hospital Houston TX
West Houston Medical Center Houston TX
Medical Center of McKinney McKinney TX
Tomball Hospital Authority Tomball TX
Billings Clinic Billings MT
St. Patrick Hospital and Health Sciences Center Missoula MT
Saint Alphonsus Regional Medical Center Boise ID
University of Colorado Hospital Authority Aurora CO
St. Mary Corwin Medical Center Pueblo CO
Parkview Medical Center Pueblo CO
Exempla Lutheran Medical Center Wheat Ridge CO
Banner Baywood Medical Center Mesa AZ
St. Joseph's Hospital and Medical Center Phoenix AZ
McKay-Dee Hospital Center Ogden UT
Utah Valley Regional Medical Center/Orem Community Hospital Provo UT
Sunrise Hospital and Medical Center Las Vegas NV
Overlake Health Care Association Bellevue WA
Providence Everett Medical Center Everett WA
Evergreen Hospital Medical Center Kirkland WA
Valley Medical Center Renton WA
Northwest Hospital and Medical Center Seattle WA
Swedish Medical Center Seattle WA
Sacred Heart Medical Center Eugene OR
Rogue Valley Medical Center Medford OR
Providence Portland Medical Center Portland OR
Providence St. Vincent Medical Center Portland OR
Oregon Health & Science University Portland OR
Legacy Meridian Park Hospital Tualatin OR
San Joaquin Community Hospital Bakersfield CA
Mills-Peninsula Health Services Burlingame CA
Sharp Grossmont Hospital La Mesa CA
Scripps Green Hospital La Jolla CA
Long Beach Memorial Medical Center Long Beach CA
Ronald Reagan UCLA Medical Center Los Angeles CA
Mission Hospital Regional Medical Center Mission Viejo CA
Washington Hospital Healthcare System Fremont CA
Tri-City Medical Center Oceanside CA
Stanford Hospital and Clinics Stanford CA
Shasta Regional Medical Center, LLC Redding CA
Kaiser Foundation Hospital - Redwood City Redwood City CA
Alvarado Hospital San Diego CA
University of California San Diego Medical Center San Diego CA
Kaiser Foundation Hospital - San Francisco San Francisco CA
Regional Medical Center of San Jose San Jose CA
Kaiser Foundation Hospital - San Rafael San Rafael CA
Kaiser Foundation Hospital - South San Francisco South San Francisco CA
Woodland Memorial Hospital Woodland CA
Alaska Regional Hospital Anchorage AK
Providence Alaska Medical Center Anchorage AK
The Queen's Medical Center Honolulu HI
Genesis Medical Center, Davenport Davenport IA
Community Health Partners Regional Medical Center Lorain OH
Saint Clare's Hospital Denville NJ
Legacy Portland Hospitals Portland OR
Theda Care Hospitals Neenah WI
The Nebraska Medical Center Omaha NE
Clarian Health Partners, Inc. Indianapolis IN
Capital Health System Trenton NJ
Aurora Health Care Southern Lakes, Inc. Kenosha WI
Kaleida Health Buffalo NY
Hahnemann University Hospital Philadelphia PA
Mayo Clinic Hospital Phoenix AZ
St. Vincent Charity Hospital/Saint Luke's Medical Center Cleveland OH
Spectrum Health Grand Rapids MI
St. John's Hospital Maplewood MN
St. Joseph's Hospital Saint Paul MN
Virtua Health, Inc. Marlton NJ
Woodwinds Health Campus Woodbury MN
Wuesthoff Medical Center - Melbourne Melbourne FL
Metro Health Hospital Grand Rapids MI
Medical Center of Plano Plano TX
Our Lady of Lourdes Camden NJ
John C. Lincoln NM Phoenix AZ
BryanLGH Medical Center Lincoln NE