By focusing on the small details like how to deliver existing therapies faster they are missing the massive failures in the rest of the stroke continuum.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=164621&CultureCode=en
There are more well-founded therapy options for the
treatment of strokes than ever before. Care has to be reorganised before
these innovations are actually used on patients. At the Congress of the
European Academy of Neurology in Copenhagen, experts are discussing
just how to do that successfully – from guidelines for the use of
thrombectomy procedures all the way to the structure and expansion of
stroke care units. Oftentimes, it is precisely the small organisational
changes that make the big difference.
Major advances are being made in stroke therapy. Experts at the
Second Congress of the European Academy of Neurology (EAN) in Copenhagen
are discussing whether or not these innovations are actually used on
patients. EAN Vice-President Franz Fazekas, professor at the University
Clinic in Graz, Austria: “The only way to make full use of the potential
of these new options is to adjust the structures and processes of
stroke care to fit the latest findings. This reorganisation must cover
the entire chain of care – from the ambulance ride to the precisely
defined use of the thrombectomies.”
Thrombectomy: new guidelines for application and organisation of care
An
increasing number of study results provide evidence of the high degree
of effectiveness of thrombectomy, the mechanical removal of blood clots
(thrombi) after a stroke. This procedure leads to good results
particularly with very long blood clots and large cerebral artery
occlusions. More than 60 per cent of patients survive a stroke thanks to
this procedure without or with only slight impairment. The relevant
European organisations of medical specialists just recently issued a
joint therapy recommendation. The consensus paper serves, among other
things, as orientation regarding the conditions under which the method
should be used and on what types of patients. It defines the ideal
window of time and clarifies when intravenous thrombolysis and
mechanical thrombectomies should be combined.
Preparations are
now underway on further international recommendations. They are supposed
to indicate how stroke care has to be organised for thrombectomies to
be successfully carried out. Prof Fazekas: “The new paper is supposed to
define, for instance, the organisational and personnel requirements
that a neurological centre has to meet and how much experience the
treating physicians have to bring to the task. The paper is also
supposed to describe in great detail how the thrombectomy itself should
be performed, from the selection of the suitable instruments to the
blood pressure of the patients during the procedure and beyond to
post-operative care. Open issues are also supposed to be indicated and
efforts made to clarify them through corresponding scientific studies.”
The guidelines incorporate the collective expertise of six relevant
societies, namely the European Academy of Neurology (EAN), the European
Association of Neurosurgical Societies (EANS), the European Society of
Emergency Medicine (EuSEM), the European Society of Minimally Invasive
Neurological Therapy (ESMINT), the European Society of Neuroradiology
(ESNR) and the European Stroke Organisation (ESO).
Prof
Fazekas: “We hope that health care managers throughout Europe will greet
the guidelines with open ears. Their implementation and the set-up of
specialised centres can prevent serious impairments after strokes and
save many lives.” Every year, 600,000 strokes are reported in Europe and
that number is on the rise.
Specialised centres reduce mortality after strokes
A
current study being presented at the EAN Congress confirms that
optimised care in specialised centres is the right approach to take.
Data from more than 9,500 patients from the Danish Stroke Registry shows
that the reorganisation of stroke care in Central Region Denmark (CRD)
has paid off. Since 2012, patients with typical stroke symptoms have no
longer been taken to one of five hospitals but rather to one of two
specialised stroke units. Prof Fazekas summarises the main results of
the study as follows: “Since this changeover, a larger percentage of
patients have received an intravenous thrombolysis within the desired
window of time of one hour after contact with the hospital and the
percentage of early procedures to eliminate stenosis in the carotid
artery have risen. Mortality within 30 days after the stroke was able to
be reduced from 10.4 to 8.2 per cent.”
MRI examination as an optimum way to support therapy
Which
diagnostic procedure yields the biggest benefit? That too is a question
being explored at the EAN Congress. Two Danish studies covering 444
stroke patients show, for example, that an MRI examination is an
essential aid for the treating physicians in helping them to take the
right decision regarding therapy. This examination to determine a stroke
takes an average of 7.5 minutes longer than a computer tomography,
however. Prof Fazekas comments on the findings of his Danish colleagues
as follows: “The ultimate principle is to minimize door-to-needle time,
i.e. the time between arrival at the hospital and the beginning of
thrombolysis. That said, the findings presented show that the better
imaging diagnostic method with a precisely fitting therapy decision
apparently pays off.” At the same time, the researchers also point out
ways to make up for the lost time, namely by eliminating other
organisational factors that cause delays; for instance, having only
experienced physicians indicate the examination and improving
organisational procedures.
An Italian study presented in
Copenhagen on the reorganisation of stroke care in Lombardy shows, in
addition, that patients with stroke symptoms end up undergoing a
thrombolysis if they are delivered by ambulance right away and
classified as an emergency with the highest priority. Prof Fazekas:
“This is another adjusting screw we can turn to make optimum use of the
new therapy options.”
No comments:
Post a Comment