BackgroundClinical risk factors related to not administering thrombolysis to acute ischemic stroke patients with incidence dyslipidemia is not clear. This issue was investigated in telestroke and non-telestroke settings.MethodsWe analyzed retrospective data collected from a stroke registry to compare exclusion risk factors in the telestroke and non-telestroke. We performed multivariate analysis was performed to identify risk factors that may result in exclusion from rtPA. Variance inflation factors were used to examine multicollinearity and significant interactions between independent variables in the model, while Hosmer-Lemeshow test, Cox & Snell were used to determine the fitness of the regression models.ResultsA greater number of patients with acute ischemic stroke with incidence dyslipidemia were treated in the non-telestroke (285) when compared with the telestroke network (187). Although non-telestroke admitted more patients than the telestroke, the telestroke treated more patients with rtPA (89.30%) and excluded less (10.70%), while the non-telestroke excluded from rtPA (61.40%). In the non-telestroke, age (adjusted OR, 0.965; 95% CI, 0.942–0.99), blood glucose level (adjusted OR, 0.995; 95% CI, 0.99–0.999), international normalized ratio (adjusted OR, 0.154; 95% CI, 0.031–0.78),congestive heart failure(CHF) (adjusted OR, 0.318; 95% CI, 0.109–0.928), previous stroke (adjusted OR, 0.405; 95% CI, 0.2–0.821) and renal insufficiency (adjusted OR, 0.179; 95% CI, 0.035–0.908) were all directly linked to exclusion from rtPA. In the telestroke, only body mass index (adjusted OR, 0.911; 95% CI, 0.832–0.997) significantly excluded acute ischemic stroke patients with incidence dyslipidemia from thrombolysis therapy.ConclusionDespite having more patients with acute ischemic stroke that present incidence dyslipidemia, the non-telestroke patients had more clinical risk factors that excluded more patients from rtPA when compared with telestroke. Future studies should focus on how identified clinical risk factors can be managed to improve the use of rtPA in the non-telestroke setting. Moreover, the optimization of the risk-benefit ratio of rtPA by the telestroke technology can be advanced to the non-telestroke setting to improve the use of thrombolysis therapy.

Problem: Innovations within the medical education system often come from administration and leadership, in the traditional top-down approach to preparing students for the actualities of medical practice. There is a dearth of literature showing the power of students to design and advance innovations in this same arena. As incoming classes of students are increasingly more diverse, student efforts for diversity and inclusion initiatives must be explored as avenues to effect positive change within the system. Approach: Medical students at the University of South Carolina School of Medicine Greenville (UofSC SOM Greenville) formed the committee known as Student Advocates for Diversity and Inclusion (SADI) in Fall 2017, with the goals of enhancing the curriculum, increasing the visibility of diverse peoples within the medical school and the healthcare system, and supporting the experience of these peoples. Outcomes:The report herein describes the formation of the Student Advocates for Diversity and Inclusion and its initial steps, including the modification of curricular practices and the development of extracurricular programs.Conclusion: SADI may serve as one example of the power of students to transform medical education. Other students and schools can use the committee and its successes and challenges to implement similar programs at their respective institutions, with the goal of achieving diversity and inclusion more broadly across the medical education system. ProblemThe medical community has long grappled with the challenges of physician diversity and health disparities. In 2018, Moss J, Hardy E, Cooley K, Cuffe S, Lang M, Kennedy A MedEdPublish Eliza Hardy is a fourth-year medical student at the University of South Carolina School of Medicine Greenville and a founding member of the Student Advocates for Diversity and Inclusion. Student doctor Keiko Cooley is a third-year medical student at the University of South Carolina School of Medicine Greenville and a founding member of the Student Advocates for Diversity and Inclusion. Samantha Cuffe (Shelhoss) is a third-year medical student at the University of South Carolina School of Medicine Greenville and a founding member of the Student Advocates for Diversity and Inclusion. ORCID iD: https://orcid.org/0000-0001-9710-3572Madeline Lang is a fourth-year medical student at

Thank you to our reviewers who provided feedback on our manuscript. As per the reviewer suggestions we have included expanded examples and descriptions to provide a richer picture of the program. Additional information is also included about the program sustainability through faculty, staff, administration, and student support.

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