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Featured Publications

Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport

Daniel A. Paydarfar*, Jessalyn K. Holodinsky, Huda Abbas, Thalia S. Field, Lily W. Zhou, and Noreen Kamal. "Quantifying improved outcomes, cost savings, and hospital volume changes from optimized emergency stroke transport." Stroke. 2022; 53(12), 3644-3651.


Background: A previously published conditional probability model optimizes prehospital emergency transport protocols for patients with suspected large-vessel occlusion by recommending the transport strategy, drip-and-ship or mothership, that results in a higher probability of an excellent outcome. 

Is improved access to magnetic resonance imaging imperative for optimal ischemic stroke care? 

Kumar M., Hu S., Beyer S., Kamal N. (2023).  Is improved access to magnetic resonance imaging imperative for optimal ischemic stroke care? Journal of Neurological Sciences. 446, 1-5 1-12. 


Neuroimaging, including CT and MRI, is integral to ischemic stroke (IS) treatment, management, and prevention. However, the use of MRI for IS patients is limited despite its potential to provide high-quality images that yield definitive information related to the management of IS.  MRI is beneficial when the information provided by CT is insufficient for decisions related to the diagnosis, etiology, or treatment of IS.

Selected Publications

Mirpouya M, Kamal N. The application of data envelopment analysis to emergency departments and management of emergency conditions: a narrative review. Healthcare. 2023; 11:18, 1-28. 

Kumar M, Hu S, Beyea S, Kamal N. Is improved access to magnetic resonance imaging imperative for optimal ischemic stroke care?. Journal of the Neurological Sciences. 2023 Feb 18:120592.

Kamal, N., Yu, A.Y.Z. (2023). Addressing Access to Stroke Treatment for Patients with Pre-Existing Disabilities. Canadian Journal of Neurological Sciences 

Paydarfar, D.A., Holodinsky, J.K., Abbas, H., Field, T.S., Zhou, L.W., Kamal, N. (2022). Quantifying Improved Outcomes, Cost Saving, and Hospital Volume Changes From Optimized Emergency Stroke Transport. Stroke. 53(12). 3644-3651.

Kamal N., Aljendi S., Cora E.A, Chandler T., Clift F., Fok P.T., Goldstein J., Gubitz G., Hill M.D., Menon B.K., Metcalfe B., Mrklas K.J., Phillips S., Theriault S., Van Der Linde E., Volders D., Williams H., ACTEAST Collaborators. (2022). Improving Access and Efficiency of Ischemic Stroke Treatment Across Four Canadian Provinces Using a Stepped Wedge Trial: Methodology. Frontiers in Stroke. 1, 1-12.

Kamal, N. Lakshminarayan, K. (2022). Simulation and Machine Learning Provide New Approaches to Examine Quality of Acute Stroke Management. Stroke. 53(9), 2768-2769.

Wheaton, A., For, P.T., Holodinsky, J.K., Vanberkel, P., Volders, D., Kamal, N. (2021). Optimal Transport Scenario with Rotary Air Transport for Access to Endovascular Therapy Considering Patient Outcomes and Cost: A Modelling Study. Frontiers in Neurology. 2021; 17:article769381. 

Bulmer, T., Volders, D., Blake, J., Kamal, N. (2021). Discrete-event simulation to model the thrombolysis process for acute ischemic stroke patients at urban and rural hospitals. Frontiers in Neurology. 2021;12:article746404.

Gillis, M., Saif, A., Murphy, M., Kamal, N. (2021). Effects of Various Policy Options on Covid-19 Cases in Nova Scotia Including Vaccination Rollout Schedule: A Modelling Study, MedRxIV, July.

Bulmer, T., Volders, D., & Kamal, N. (2021). Analysis of thrombolysis process for acute ischemic stroke in urban and rural hospitals in Nova Scotia Canada. Frontiers in Neurology, 12. doi:

Kamal, N., Jeerakathil, T., Stang, J., Liu, M., Rogers, E., Smith, E. E., ... & Hill, M. D. (2020). Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population. Stroke, 51(8), 2339-2346. doi:

Holodinsky JK, Kamal N, Zerna C, Ospel JM, Zhu L, Wilson LT, Hill MD, and Goyal M. (2020). In what scenarios does a mobile stroke unit predict better patient outcomes? A modelling study. Stroke, 51(6), 1805-1812. doi:

Kamal N, Rogers E, Stang J, Mann B, Butcher KS, Rempel J, Jeerakathil T, Shuaib A, Goyal M, Menon BK, Demchuk AM, Hill MD. (2019). 1-Year Healthcare Utilization for Patients that Received Endovascular Treatment Compared to Control. Stroke, 50, 1883-1886. doi:

Kamal N, Shand E, Swanson R, Hill MD, Jeerakthil T, Imoukhuede O, Heinrichs I, Bakker J, Stoyberg C, Fowler L, Duckett S, Holsworth S, Mann B, Valaire S, Bestard J. (2019). Reducing door-to-needle times for acute ischemic stroke to a median of 30 minutes at a community hospital: a cohort study. Canadian Journal of Neurosciences, 46(1), 51-56. doi:

Holodinsky JK, Williamson TS, Demchuk AM, Zhao H, Zhu L, Francis MJ, Goyal M, Hill MD, Kamal N. (2018). Drip ‘n ship vs. mothership: modelling stroke patient transport for all suspected large vessel occlusion patients. JAMA Neurology, 75(12), 1477-1486. doi:

Kamal N, Wiggam MI, Holodinsky JK, Francis MJ*, Hopkins E, Frei D, Baxter B, Williams M, Nygren A, Goyal M, Hill MD, Jayaraman M. (2018). Geographic Modeling of Best Transport Options for Treatment of Acute Ischemic Stroke Patients: Applied to Influencing Health Policy in the USA and Northern Ireland. IISE Transactions on Healthcare Systems Engineering, 8(3), 220-226. doi:

Kamal N, Sheng S, Xian Y, Matsoualka R, Hill MD, Bhatt D, Saver J, Reeves M, Fonarow GC, Schwamm LH, and Smith EE. (2017). Delays in door-to-needle times and their impacton treatment time and outcomes in Get With the Guidelines Stroke. Stroke, 48, 946-954. doi:

Kamal N, Smith EE, Jeerakathil T, Hill MD. (2017). Thrombolysis: Improving door-to-needle times for ischemic stroke treatment, a narrative review. International Journal of Stroke, 13(3), 268–276. doi:

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