Meeting Milano “Urgenze Neurologiche”

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  Presentati sommariamente i risultati della survey promossa dal Telestroke committee ESO di questa estate. Indicativa di difficoltà di accesso alle cure nella metà delle 20 reti ictus esaminate. Si riscontra altresì diffusione di sistemi per teleconsulto. Pochi sono dispositivi elettromedicali in uso, più frequenti le soluzioni improvvisate. Il mercato dei dispositivi appare eterogeneo e si patisce un vuoto organizzativo.

• Si concorda invio della survey alla rivista di Thierry Moulin /European Research in Telemedicine.
• Analisi più allargata (Elba, Roma altri eventuali) sarà inviata all’ESOC 2018 entro la deadline del congresso.
• Non vi sono pacchetti formativi in materia di telestroke/teleneurologia.
• ASL di Emilia Romagna, Abruzzo, Umbria e Toscana hanno mosso passi significativi per acquisire strumentazione per cifre maggiori al milione e mezzo di € spesso i medici non sono coinvolti nel processo organizzativo. 
• Si riscontrano carenze contrattuali con mancato riconoscimento anche finanziario in chi pratica telemedicina con particolare criticità nel telelavoro dal domicilio.
• I partecipanti si prodigheranno nel trasmettere alle organizzazioni sindacali ed ordini medici competenti territorialmente tali criticità nella prospettiva del rinnovo del CCNN di primavera e pressione su aziende sanitarie.
• Ci ripromettiamo di proporre a ditte del settore di sponsorizzare eventi specifici anche nelle prossime edizioni delle urgenze neurologiche parlandone con gli organizzatori.
• Concordiamo nel rivederci ove possibile a Göteborg ESOC 2018 e Milano ESOC 2019 per perseguire un significativo progresso in questo ambito di lavoro
• Durante la tavola rotonda I Prof Comi e Micieli, invitavano lo scrivente ad esporre alcune istanze e prefigurano la possibilità di corsi in materia tramite “ANEU”.
• Il Prof Toni raccomanda di segnalare le trombolisi effettuate in telemedicina affinché possano integrarsi con i registri già operativi.Gruppo Telestroke

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World Stroke Day 2017 la Giornata Mondiale dell’Ictus

Fare un salto in ospedale con l’auto d’epoca… per ricordarsi che un ictus … sei mesi fa rischiava di portarti via l’autonomia, la memoria e la libertà. Questo è il regalo che Loriano ci ha fatto lo scorso 29 Ottobre. E’ successo al San Giovanni Battista.

OLTRE 17 milioni di persone nel mondo – 200mila solo in Italia – vengono colpite da ictus cerebrale ogni anno (di queste ne muoiono 6 milioni). Senza contare poi che sono in molti quelli che seppur sopravvivono, dovranno convivere con gravi disabilità o con il terrore che l’ictus si ripresenti di nuovo. L’ictus cerebrale nel solo 2016 ha ucciso o reso invalida un’enorme quantità di persone, uomini, donne e persino bambini, rubando 116 milioni di anni di vita. E continua ad essere la seconda causa più probabile di morte nel mondo intero”.

·UNA GIORNATA PER INFORMARSI E PREVENIRE L’ICTUS
All’ictus (in inglese stroke, che significa “colpo”) viene dedicata ogni anno la Giornata mondiale (29 ottobre) e dal 2006 è stata istituita l’Organizzazione mondiale dell’ictus (World stroke organization, Wso), che coinvolge 85 Paesi nel mondo. Perché l’ictus – molto spesso invalidante – se si conosce, si può prevenire. “Investire in prevenzione oggi non è più solo intelligente, è obbligatorio – sottolinea l’associazione Alt – perché nessun governo avrà le risorse sufficienti per assistere tutti coloro che verranno colpiti da ictus o da un altro evento da trombosi nei prossimi anni. Dipende molto da noi: dobbiamo sapere quali sono le cause, modificare i fattori di rischio modificabili, imparare a riconoscere problemi nel battito del cuore in noi stessi o in chi ci sta accanto. Insomma, dobbiamo riconoscere i sintomi sospetti e agire immediatamente”.

Ricordarsi i sintomi dell’ictus può velocizzarne il riconoscimento, quindi la diagnosi e la sua cura. RAPIDO!

Ridi,

Alza il braccio,

Parla e DOmanda aiuto

queste le parole chiave che possono salvarci.

Teleneurology meeting in Erfurt

The issue of stroke is particularly noticeable in neurology due to the high prevalence rate and serious consequences. Accordingly, telenurology is also intensively concerned with this disease pattern and attempts to contribute to medical progress in the field of neurology, using knowledge of the use of modern technologies. In Thuringia, the stroke telemedicine network "SATELIT" has existed for almost 5 years and has shown during this time that telemedical developments and application can help to contribute to the improvement of care quality in neurological diseases by means of computer-supported communication and network technologies. In Umbria, Italy a stroke network was successfully deployed since 2016 using fix units in the west of the county and mobile units in the earthquake area to the east. In addition to acute stroke treatment, the German Society for Telemedicine, in cooperation with the Hans Berger Clinic for Neurology at the University Hospital of Jena, will also be discussing with the First German Telenurology Congress the health policy and socio-political significance of the Telemedicine in neurology. The conference is aimed at clinicians, doctors, nurses, therapists and costumers as well as companies interested in current medical developments in the field of neurology, rehabilitation and aftercare. The focus of the 2017 Congress will be telemedicine in stroke care as the most important field of application. Other neurological applications such as dizziness, Parkinson's disease, or epilepsy are also being investigated. In addition, telemedicine products and latest developments are presented in an accompanying industrial exhibition.

European Union Health Commission on Stroke

Brussels, 30th November 2016 – Jon Barrick SAFE President and Valeria Caso President of the European Stroke Organisation of Stroke Professionals had a meeting today at the European Union Health Commission to discuss the quality of Stroke prevention, care and support within the countries of Europe.

SAFE and ESO made a number of proposals aimed at gathering EU support for encouraging countries across Europe to improve stroke intervention. Stroke now accounts for more than 9% of all deaths in Europe and is the leading cause of long term severe disability.

Topics discussed included the Health Commissioners engagement with proceedings at a Stroke Summit meeting to be held in Brussels on May 11th 2017, the dissemination of the Burden of Stroke report with data on the stroke care pathway performance in each European country, and a report on the current situation  around acute stroke care. Also discussed were support for the SAFE, ESO and others initiative to produce a stroke European action plan to be launched in May 2018, and the potential for creation of an economic burden of stroke report by 2019.

The Stroke European action plan will be the sequel to the Helsingborg declaration of 2006, which set objectives to be achieved by 2015. This is now redundant and many new developments and treatments have occurred since its first appearance, and there is now an opportunity to create initiatives to drive down the death and disability rates from stroke.

Other topics covered were the need for greater awareness of stroke, more effort to be made in preventing stroke, and the need to allocate more resources for stroke research generally. SAFE and ESO were encouraged to provide more examples of good practice to be shared country to country, and questions were asked concerning possibilities of good practice pilot activity.

There was found to be a huge overlap between the work of SAFE and ESO, and that of the EU Health Commission, with all parties seeking to make sure stroke care is sustainable, efficient, and supports resilience within health care systems (the capacity to buffer change, learn and develop, enhance adaptive capacity in a situation of rapid treatment transformations).

As such there was agreement that more work to combat stroke makes a positive contribution to the Health programme aims of the EU http://ec.europa.eu/health/programme/policy/index_en.htm.

Airborne Stroke Unit

In the era of mechanical reperfusion, HEMS can be a powerful instrument for improving acute stroke delivery and research that is currently underutilized. The speed of HEMS may allow reperfusion for a large number of patients that would not have immediate access due to geography or traffic congestion. Also, HEMS critical early time period after a stroke where specific interventions to preserve penumbra and prevent reperfusion injury may have a significant influence on outcomes. The impact of physical factors generated by the helicopter on the ischemic brain needs to be studied. HEMS are also an opportunity to increase recruitment of patients in standard clinical trials. Addressing the HEMS stroke gap is necessary to homogenize the delivery of acute stroke care and research capabilities through all care settings, therefore minimizing disparities in outcomes based in geographical location.

European Stroke Journal Sept 2016

The European Stroke Journal

  European Stroke Journal announcement to ESO members

Dear Colleague,
Along with holding our first ESO conference in 2015, one of our major objectives was to create our own journal with the aim that it opens its pages in early 2016. I am delighted to announce that we have moved several steps closer to this target. Following an intensive period of negotiation, on the one hand, and review of a wonderfully strong field of applicants on the other hand, recent days have seen us sign a deal with a publisher and select our most senior editors to lead the formation of the new European Stroke Journal (ESJ).
Our publisher will be the respected UK based firm, SAGE. SAGE publishes a series of medical and scientific journals, is known for its ethical approach and was recently also chosen by our colleagues in the WSO to become the new publisher for International Journal of Stroke, with which we intend to have a friendly and co-operative rivalry.
Our new Editor in Chief will be Bo Norrving, from Lund in Sweden. Bo has impeccable credentials for this role. He is a former President of the World Stroke Organisation and has represented stroke at the World Health Organisation. He has been senior consulting editor for Stroke. He brings vast experience and huge commitment to stroke, to Europe and to the task before him. He will handle the political, ethical, scientific and practical aspects with assurance and diplomacy, and will draw huge credit to ESO and ESJ in the process.
We are equally delighted that Bo will not face this task alone. He will be supported by a vice editor who can claim similar distinction. Didier Leys from Lille in France has expressed his enthusiasm to work alongside Bo in building this exciting new venture for ESO. As well as editorial duties at JNNP for 7 years, Didier also has strong political credentials: he was President of ESO from 2010-2012, and served on the Executive Committee that took the tough decision to establish our independent conference.
We believe that we have a partnership that has the very best people and publisher available and I am sure that you will join in welcoming SAGE and congratulating Bo and Didier in their new roles. We also are confident that all of our fellows and members will do their utmost in practical ways to support the journal. We ask every fellow and member to consider to send just one of their best manuscripts to ESJ over the next year – one that you know is worthy of the top journals in our field – so that we can hit the ground running with a strong flow of first rate papers. Giving one great paper to a new journal will have a negligible effect on your personal publication ranking but will have a major effect on the journal’s chance of a rapid and notable rise into citation territory. It represents a small, inexpensive but tangible way of demonstrating support for ESO and for European stroke science. For the first two years (at least) there will be a prize for the unsolicited paper that attracts the highest number of citations in the 12 months from its first publication in ESJ.
With best regards
Ken Lees
Kennedy Lees

President
Bo Norrving Bo Norrving

Bo Norrving is Professor in Neurology at Lund University, Sweden. He has broad experience in stroke, from clinical research (including many seminar papers and books), publishing (associate/senior consulting editor positions for Stroke and Neuroepidemiology), stroke society leadership (past vice President of the ESO, immediate-past President of the World Stroke Organization), to governmental/ policy positions. The latter include acting as chair of stroke section for ICD 11 at WHO, the WSO Global Policy committee, the Swedish Stroke Register (Riksstroke), and co-chair of the WSO Guidelines and Quality Committee.

Didier Leys Didier Leys 

Didier is Professor of Neurology at the University of Lille, and a former President of the European Stroke Organisation. He has a long history of collaboration in the stroke field within Europe, especially with Finland, Germany, Switzerland and Italy. Didier’s research activity has 3 main orientations: the relationship between stroke and dementia, mechanisms of cervical artery-dissection, and thrombolysis in acute cerebral ischaemia. He has authored 466 publications attracting 15,541 external citations. His served for 7 years as associate Editor of the Journal of Neurology, Neurosurgery and Psychiatry (April 2004-March 2010), and has been editorial board member and reviewer for several other journals.

 
http://www.sagepub.com

Founded 50 years ago by Sara Miller McCune to support the dissemination of usable knowledge and educate a global community, SAGE is a leading international publisher of innovative, high-quality content. SAGE publishes more than 850 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore and Washington DC. http://www.sagepub.com

ISO meeting 2016 in Firenze

 

it was held as usual in Florence (CTO) we followed the top trial session. Ongoing RCT were presented mostly from larger international initiatives. Small national activities are also under construction. A large discussion was opened on the chance to address specific educational programs for interventional neurology. The national need of interventional neurologists is large: 100-200 doctors. Should be a radiologist to practice thrombectmy ? a Neurosurgeon (exceeding number in Italy) ? a well trained Neurologists ? The answer from the faculty board is to wait for a new medical figure that will be possibly available in 5-10 years from now.

Thrombectomy in Umbria

The regional Neurology meeting re-opened the issue of local pathways to thrombectomy. The access to most advanced techniques seems slowed by ETS procedures and lack of full week coverage 7/7.

ETT prognostic value in stroke/AF

Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06-4.29, p = 0.033) and CHA₂DS₂-VASc score (OR 1.22; 95 % CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

Paciaroni et AL JON 2015

A stroke awareness campaign in Italy

An awarness campaign in Italy by ARS and ALICE. Just developed a leaflet to help recognizing warning signs