TY - JOUR A1 - Gabriel, Katharina M. A. A1 - Jírů-Hillmann, Steffi A1 - Kraft, Peter A1 - Selig, Udo A1 - Rücker, Victoria A1 - Mühler, Johannes A1 - Dötter, Klaus A1 - Keidel, Matthias A1 - Soda, Hassan A1 - Rascher, Alexandra A1 - Schneider, Rolf A1 - Pfau, Mathias A1 - Hoffmann, Roy A1 - Stenzel, Joachim A1 - Benghebrid, Mohamed A1 - Goebel, Tobias A1 - Doerck, Sebastian A1 - Kramer, Daniela A1 - Haeusler, Karl Georg A1 - Volkmann, Jens A1 - Heuschmann, Peter U. A1 - Fluri, Felix T1 - Two years' experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke) JF - BMC Neurology N2 - Background Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. Methods The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. Results Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. Conclusion The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals. KW - pilot project KW - care tempis KW - ischemic stroke KW - thrombolysis KW - areas KW - time KW - hospitals KW - mortality KW - outcomes KW - quality Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229214 VL - 20 ER - TY - JOUR A1 - Hillmann, Steffi A1 - Wiedmann, Silke A1 - Fraser, Alec A1 - Baeza, Juan A1 - Rudd, Anthony A1 - Norrving, Bo A1 - Asplund, Kjell A1 - Niewada, Maciej A1 - Dennis, Martin A1 - Hermanek, Peter A1 - Wolfe, Charles D. A. A1 - Heuschmann, Peter U. T1 - Temporal changes in the quality of acute stroke care in five national audits across Europe JF - BioMed Research International N2 - Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care. KW - ischemic stroke KW - indicators KW - thrombolysis KW - registries KW - outcomes KW - mortality KW - implementation KW - German Stroke Registers Study Group Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149059 VL - 2015 IS - 432497 ER - TY - THES A1 - Lange, Martin T1 - Die aktuelle Therapie des akuten Koronarsyndroms T1 - The current treatment of acute coronary syndroms - one year at the medical clinic of Julius-Maximilians-University Wuerzburg N2 - Zur Behandlung akuter koronarer Syndrome sind eine Fülle von Therapiekonzepten verfügbar. Ziel dieser prospektiven Studie war es Vor- und Nachteile einzelner Optionen herauszufinden und sie mit Daten der anerkannten Literatur zu vergleichen. Hierzu wurden im Zeitraum eines Jahres 412 Patienten, die mit dem Verdacht auf ein akutes Koronarsyndrom in die Universitätsklinik Würzburg kamen in die Studie eingeschlossen. 165 Patienten hatten einen Myokardinfarkt, 44 eine instabile Angina pectoris. Die Patienten erhielten als primäre Therapie entweder eine Thrombolyse (22 rt-PA, 7 Streptokinase), oder eine Akut-PTCA (54) oder wurden medikamnetös konservativ behandelt. 6 Monate nach Lyse bzw. Akut-PTCA fand eine Verlaufsbeobachtung statt. Es wurden die Verlaufsendpunkte Tod, nicht-tödlicher Reinfarkt, Reintervention oder keine erneute Intervention unterschieden. Die mediane präklinische Verzögerungszeit vom Symptombeginn bis zur Ankunft in der Klinik betrug bei den Infarktpatienten 3h 18min. Die mediane door-to-needle Zeit lag bei 20min, die mediane door-to-balloon Zeit bei 90min. Ein halbes Jahr nach der Lyse waren 5 Patienten (17%) verstorben, 2 (7%) erhielten eine Bypass-OP, 10 (34%) eine PTCA und 12 (42%) waren ohne Reintervention. Im Vergleich dazu ergiebt der Verlauf nach Akut-PTCA, dass 1 Patient (2%) verstarb (p=0,014), 2 (4%) einen Reinfarkt erlitten, 2 (4%) eine Bypass-OP, 7 (14%) eine erneute PTCA hatten und 38 (76%) ohne Reintervention (p=0,002) blieben. Die Verweildauer auf der medizinischen Intensivstation betrug nach Akut-PTCA 40h, nach Lyse 92h (p<0,001) und bei konservativer Therapie 60h. Die Gesamtverweildauer lag nach Akut-PTCA bei 9d, nach Lyse bei 15d (p=0,024) und bei konservativer Therapie bei 11d. Trotz der geringen Fallzahl stellte sich die Akut-PTCA der Thrombolyse als signifikant überlegene Myokardinfarkttherapie in puncto Krankenhausverweildauer, Reinterventionshäufigkeit und Letalität dar. N2 - The aim of this prospective study was to find out the advantage and disadvantage of the different therapy options for acute coronary syndroms. In the period of one year 412 patients were included, who came with suspicious acute coronary syndrom to Wuerzburg University Hospital. 165 patients had a myocardial infarction, 44 unstable angina pectoris. The patients received as primary therapy either thrombolysis (22 rt-PA, 7 Streptokinase), or primary-PTCA or conservative drug treatment. There was a follow up 6 months after thrombolysis or primary-PTCA. The endpoints death, non-fatal reinfarction, reintervention or no reintervention were distinguished. The median preclinical delay from symptom onset to hospital arrival of the myocardial infarction patients was 3h 18min. The median door to needle time was 20min, the median door to balloon time 90min. Half a year after thrombolysis 5 patients (17%) had died, 2 (7%) had ACBG, 10 (34%) a PTCA and 12 (42%) were without reintervention. Compared with this, after primary-PTCA 1 patient (2%) had died (p=0.014), 2 (4%) had a non-fatal reinfartion, 2 (4%) an ACBG, 7 (14%) a Re-PTCA and 38 (76%) were without reintervention (p=0.002). The length of stay on intensive-care unit was 40h after primary-PTCA, 92h after thrombolysis (p<0.001) and 60h after conservative drug treatment. The complete hospital stay after primary-PTCA was 9d, after thrombolysis 15d (p=0.024) and 11d after conservative drug treatment. In these small study primary-PTCA was the significant superior treatment of myocardial infarction with regard to hospital stay, reintervention and mortality. KW - Würzburg KW - Medizinische Klinik KW - Koronare Herzkrankheit KW - Therapie KW - akutes Koronarsyndrom KW - Myokardinfarkt KW - Angina pectoris KW - PTCA KW - Thrombolyse KW - acute coronary syndrom KW - myocardial infarction KW - angina pectoris KW - PTCA KW - thrombolysis Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-4111 ER - TY - THES A1 - Rosen, Sandra T1 - Der Einsatz von Abciximab (ReoPro®) in der Akutbehandlung von ischämischen Hirninfarkten mit und ohne vorangehende Thrombolysebehandlung mit rt-PA T1 - Abciximab (Reopro®) in treatment of acute ischemic stroke with or without previous thrombolysis with rt-PA N2 - Abciximab wurde, in Phase II-Studien, in der Behandlung der akuten cerebralen Ischämie erprobt und es erscheint bisher sicher und effektiv. Obwohl die Effektivität in der Abciximab in Acute Ischemic Stroke Studie nicht prospektiv untersucht wurde, ist jedoch ein Trend zu einem verbessertem Outcome zu beobachten. In unserer Untersuchung wurden 65 Patienten mit cerebralen Ischämien in verschiedenen Gefäßterritorien mit Abciximab behandelt. Die Patienten zeigten entweder Zeichen und Symptome einer Crescendo-TIA, eines progressive stroke außerhalb des "3-Stunden-Zeitfensters" für eine Thrombolyse oder eine erneute Verschlechterung nach zunächst erfolgreicher Thrombolyse. Alle Patienten wurden anhand der modified Rankin Scale (mRS) zum Zeitpunkt des Eintreffens in der Klinik und am Tag der Entlassung von der Stroke Unit untersucht. Ergebnisse: 88% der Patienten (57/65) verbesserten sich um im Mittel 2,3 Punkte bezogen auf die mRS. 71% der Patienten (46/65) erreichten eine mRS von 0-2. Es wurden keine fatalen oder symptomatischen intracerebralen Blutungen beobachtet. Fazit: In dieser nicht-randomisierten Untersuchung über die Akuttherapie der cerebralen Ischämie, zeigte die Behandlung mit Abciximab alleine oder in Kombination mit Thrombolyse eine klinische Verbesserung in 88% der Patienten. Blutungskomplikationen waren selten und nie schwerwiegend. Diese Ergebnisse unterstützen die Forderung nach weiteren placebokontrollierten, randomisierten Studien von Abciximab in der Akutbehandlung der cerebralen Ischämie. N2 - Abciximab has been studied, in phase II trials, for the treatment of acute ischemic stroke and appears to have a favorable safety profile. Although efficacy was not prospektively evaluated in the Abciximab in Acute Ischemic Stroke trial, a trend towards improved outcome was observed. In our experience, sixty-five patients, diagnosed with ischemic stroke in various vascular territories, were treated with abciximab. Patients demonstrated signs and symptoms of either crescendo TIA, progressive stroke outside the time window indicated for thrombolysis or reocclusion after initial successful thrombolysis. All patients were assessed according to the modified Rankin Scale (mRS) at the time of admission and at the time of discharge from the stroke unit. Results: Clinical improvement was seen in 88% of patients (57/65) with the mean mRS decreasing from 4.2 to 1.9. 71% of patients (46/65) achieved mRS 0-2. There were no fatal or symptomatic intracerebral bleeding complications. Conclusion: In this non-randomized, open-label study of acute cerebral ischemia, abciximab alone or in combination with thrombolytic therapy demonstrated clinical improvement in 88% of patients. Hemorrhagic complications were rare and never serious. These results support the need for additional well-controlled, randomized trials evaluating abciximab for the treatment of acute ischemic stroke. KW - Abciximab KW - GP-IIb/IIIa-Antagonist KW - cerebrale Ischämie KW - Thrombolyse KW - abciximab KW - GP-IIb/IIIa-antagonist KW - ischemic stroke KW - thrombolysis Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17514 ER -