Neurological research and practice最新文献

{"title":"Mind the guideline gap: emergent CT in patients with epilepsy for trauma rule-out-A retrospective cohort study.","authors":"Kristina Szabo, Udo Obertacke, Vesile Sandikci, Sarah Ghanayem, Angelika Alonso, Johann S Rink, Annika Marzina, Michael Platten, Carolin Hoyer","doi":"10.1186/s42466-025-00370-7","DOIUrl":"10.1186/s42466-025-00370-7","url":null,"abstract":"<p><strong>Background: </strong>Patients with epileptic seizures represent a significant proportion of emergency department (ED) admissions and are often referred for cranial imaging due to suspected or observed trauma. Neurological guidelines provide limited advice on indications for imaging in this scenario, and traumatological clinical decision rules on the use of CT in mild traumatic brain injury explicitly exclude patients with seizures preceding the trauma. This gap in recommendations may contribute to overimaging for trauma rule-out after a seizure.</p><p><strong>Methods: </strong>We analysed medical records of patients with known epilepsy admitted to our ED after a seizure between January 2022 and March 2024. Using clinical data including the findings from cranial CT and risk factors for traumatic brain injury, we re-assessed the need for CT imaging by application of the Canadian CT head rule (CCHR) or in the context of head trauma under anticoagulation.</p><p><strong>Results: </strong>During the observational period, 683 patients with known epilepsy were referred to our hospital due to a seizure (mean age 48.8 years, 57.7% male). A head CT scan was obtained in 337 (49.3%) of all encounters. In only two patients, CT diagnosed an acute seizure-related traumatic lesion, one focal subarachnoid haemorrhage and one skull base fracture. Twenty-six cases (3.8%) with seizure-related trauma were reassessed as requiring a CT for trauma-related injury evaluation. Particularly in the absence of head impact or risk factors, a high degree of variability regarding CT ordering practice was observed.</p><p><strong>Conclusions: </strong>Our results demonstrate frequent use and low diagnostic yield of CT in ED seizure patients with respect to trauma-related head injury. Circumstantial factors, clinical signs or symptoms and medical risk factors variedly impact on clinicians' decision to perform imaging. The absence of clear recommendations regarding imaging for trauma apparently provokes frequent diagnostic rule-out even in patients with low risk for traumatic brain injury. We suggest an approach to identify patients not requiring a head CT by considering the CCHR, presence of anticoagulation and appreciating the postictal state as a feature specific to patients with seizures.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on brain death detection in German hospitals: a state-wide analysis of health data.","authors":"Daniela Schoene, Martin Roessler, Katharina Eder, Albrecht Günther, Konrad Pleul, Axel Rahmel, Kristian Barlinn","doi":"10.1186/s42466-025-00368-1","DOIUrl":"10.1186/s42466-025-00368-1","url":null,"abstract":"<p><strong>Background: </strong>The low rate of organ donation in Germany has been linked to a deficit in the detection of patients with brain death (BD) in hospitals. It is unclear how crisis-related health system disruptions, such as the COVID-19 pandemic, affect this detection deficit.</p><p><strong>Methods: </strong>Secondary data analysis of anonymized data from deceased patients with acute brain injury from Saxony, Saxony-Anhalt and Thuringia during the pre-pandemic and pandemic period (01/2019-12/2022). Pandemic phases were stratified according to the predominant SARS-CoV-2 variant. Logistic multilevel models were employed to assess outcomes including diagnosis of BD, deceased organ donations, missed cases with potential BD and organ donation-related interactions with the German Organ procurement organization. Models accounted for regional COVID-19 incidence and first-dose vaccination rates, as well as age, gender and types of brain injuries.</p><p><strong>Results: </strong>A total of 11,100 deceased individuals from 136 hospitals were analyzed. An inverse association was observed between COVID-19 incidence and the determination of BD (adjusted odds ratio [aOR] 0.94, 95%CI [0.91; 0.97]; p < 0.001) as well as deceased organ donation (aOR 0.94, 95%CI [0.90; 0.98]; p = 0.001). When stratified by pandemic phases, this inverse association was evident for both BD determination (aOR 0.92, 95%CI [0.87; 0.99]; p = 0.02) and deceased organ donation (aOR 0.90, 95%CI [0.83; 0.97]; p = 0.01) during the initial wild-type phase. In the alpha phase, the association was observed only for BD determination (aOR 0.76, 95%CI [0.59; 0.98]; p = 0.03). No association was found in subsequent pandemic phases.</p><p><strong>Conclusion: </strong>The initial impact on BD detection during the pandemic highlights the importance of the health system's adaptive capacity in times of crisis.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No disadvantages for women in acute stroke care in Germany: an analysis of access to stroke treatment services in Germany from 2017 to 2022.","authors":"Matthias N Ungerer, Dirk Bartig, Christine Tunkl, Daniel Richter, Aristeidis Katsanos, Christos Krogias, Werner Hacke, Christoph Gumbinger","doi":"10.1186/s42466-025-00365-4","DOIUrl":"10.1186/s42466-025-00365-4","url":null,"abstract":"<p><strong>Background: </strong>Several publications have raised concerns that female stroke patients may be at a disadvantage when accessing stroke treatment services. These publications have found significant regional differences in the provision of stroke treatment to male and female patients. In this study, we provide current nationwide data on stroke management differences between men and women in Germany.</p><p><strong>Methods: </strong>This large retrospective cohort study used national datasets from the German Federal Statistical Office for 2017-2022. We examined differences between female and male stroke patients in terms of case volume, intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), stroke unit (SU) treatment, intrahospital mortality, and prevalence of atrial fibrillation (AF).</p><p><strong>Results: </strong>Data from more than 1.3 million hospitalised stroke patients were included. Forty-seven percent of the patients were female. Female patients were older and more frequently ≥ 80 years old (50.3% versus 29.4%). Rates of IVT (16.3% versus 16.3%) were similar for both sexes but higher in females when adjusted for age. MTE rates (8.2% versus 6.3%) were consistently higher in female patients across all age groups. Female patients had higher rates of intrahospital mortality (9.1% versus 6.2%), and admission to SUs (73.6% versus 76.0%) was less common. Treatment rates in intensive care units were similar (10.6% versus 10.5%). AF, a surrogate for embolic (and more severe) strokes, was more prevalent in females (32.6% versus 25.4%).</p><p><strong>Conclusions: </strong>We found no evidence that female stroke patients in Germany face any disadvantage in accessing stroke treatment services. Acute stroke treatment rates were generally similar or higher when compared to males. Higher intrahospital mortality and lower SU rates were attributed to greater age, comorbidities, and stroke severity. However, the differences were not fully explained when adjusting for AF and age. Further research is needed on sex differences in stroke mechanisms and outcomes.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI and Neurology.","authors":"Julian Bösel, Rohan Mathur, Lin Cheng, Marianna S Varelas, Markus A Hobert, José I Suarez","doi":"10.1186/s42466-025-00367-2","DOIUrl":"10.1186/s42466-025-00367-2","url":null,"abstract":"<p><strong>Background: </strong>Artificial Intelligence is influencing medicine on all levels. Neurology, one of the most complex and progressive medical disciplines, is no exception. No longer limited to neuroimaging, where data-driven approaches were initiated, machine and deep learning methodologies are taking neurologic diagnostics, prognostication, predictions, decision making and even therapy to very promising potentials.</p><p><strong>Main body: </strong>In this review, the basic principles of different types of Artificial Intelligence and the options to apply them to neurology are summarized. Examples of noteworthy studies on such applications are presented from the fields of acute and intensive care neurology, stroke, epilepsy, and movement disorders. Finally, these potentials are matched with risks and challenges jeopardizing ethics, safety and equality, that need to be heeded by neurologists welcoming Artificial Intelligence to their field of expertise.</p><p><strong>Conclusion: </strong>Artificial intelligence is and will be changing neurology. Studies need to be taken to the prospective level and algorithms undergo federated learning to reach generalizability. Neurologists need to master not only the benefits but also the risks in safety, ethics and equity of such data-driven form of medicine.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Research and Practice - the premier journal of the German Society of Neurology: recent development and future perspectives.","authors":"Werner Hacke, Wolf-Rüdiger Schäbitz","doi":"10.1186/s42466-025-00372-5","DOIUrl":"10.1186/s42466-025-00372-5","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe subacute combined degeneration of the spinal cord resulting from nitrous oxide (N2O) abuse: a case series.","authors":"Lucas C Adam, Anuschka Grobelny, Katrin Hahn, Heinrich J Audebert, Patricia Krause, Christiana Franke, Klemens Ruprecht","doi":"10.1186/s42466-024-00364-x","DOIUrl":"10.1186/s42466-024-00364-x","url":null,"abstract":"<p><strong>Objective: </strong>To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD).</p><p><strong>Methods: </strong>Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024.</p><p><strong>Results: </strong>The median age (range) of the seven patients (one woman, six men) was 24 (18-33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160-9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0-4.0) at baseline to 1.0 (1.0-2.0; p < 0.05, Wilcoxon matched-pairs signed-rank test) at follow-up after the start of vitamin B12 supplementation, all five patients who could be examined on follow-up exhibited persistent deficits on the last follow-up assessment at a median (range) of 5 (3-116) months after disease onset.</p><p><strong>Conclusions: </strong>N2O abuse over a few weeks can lead to severe SACD. The diagnosis is supported by characteristic findings on spinal MRI and elevated methylmalonic acid levels, while normal vitamin B12 levels do not rule out N2O-induced SACD. Although there was some clinical improvement upon cessation of N2O abuse and vitamin B12 supplementation, residual deficits persisted.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of oral anticoagulants with risk of brain haemorrhage expansion compared to no-anticoagulation.","authors":"Roland Veltkamp, Kirsten Haas, Viktoria Rücker, Uwe Malzahn, Adrian Heeger, David Kinzler, Patrick Müller, Pascal Rappard, Timolaos Rizos, Johannes Schiefer, Christian Opherk, Waltraud Pfeilschifter, Katharina Althaus, Peter Schellinger, Bernadette Gaida, Maria Magdalena Gabriel, Georg Royl, Darius G Nabavi, Karl Georg Haeusler, Christian H Nolte, Marc E Wolf, Sven Poli, Marilen Sieber, Pascal Mosimann, Peter U Heuschmann, Jan C Purrucker","doi":"10.1186/s42466-024-00358-9","DOIUrl":"10.1186/s42466-024-00358-9","url":null,"abstract":"<p><strong>Background: </strong>The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.</p><p><strong>Methods: </strong>The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.</p><p><strong>Results: </strong>Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.</p><p><strong>Conclusion: </strong>Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared prognostic information in amyotrophic lateral sclerosis - systematic assessment of the patients' perception of neurofilament light chain and the ALS functional rating scale.","authors":"Lukas Maximilian Möhwald, André Maier, Torsten Grehl, Ute Weyen, Patrick Weydt, René Günther, Paul Lingor, Bettina Göricke, Susanne Petri, Julian Grosskreutz, Matthias Boentert, Isabell Cordts, Jochen H Weishaupt, Johannes Dorst, Christoph Münch, Thomas Meyer, Petra Baum","doi":"10.1186/s42466-024-00363-y","DOIUrl":"10.1186/s42466-024-00363-y","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), neurofilament light chain (NfL) was introduced as a prognostic biomarker. More recently, NfL values can be shared on the patient's ALS app. Also, the ALS functional rating scale (ALSFRS-R) is an established patient-reported assessment of disease progression. The scale can be obtained during clinic visits or remotely. However, few systematic data are available on the patients' perception of prognostic information about NfL and ALSFRS-R and the remote sharing of these data.</p><p><strong>Methods: </strong>In a multicenter study, 149 ALS patients were assessed for their perception of shared information about NfL and ALSFRS-R using an investigator-designed survey and established questionnaires. The recommendation of NfL and ALSFRS-R to fellow patients was assessed using the Net Promoter Score (NPS). Burden by shared information was investigated in two distinct settings: (1) clinic information when receiving results on NfL and/or ALSFRS-R during clinic visits and (2) remote information about NfL values and self-rating of the ALSFRS-R via the ALS app. General anxiety was measured by the Fear of Progression Questionnaire - Short Form (FoP-Q-SF).</p><p><strong>Results: </strong>Information about NfL and ALSFRS-R, respectively (n = 149), were regarded as relevant for patients themselves (75.2% and 77.2%) and for research (98% and 96%). The NPS showed a high recommendation rate for NfL (+ 21) and ALSFRS-R (+ 26). Only a minority of patients perceived shared information about NfL as burdensome, with a lower burden in the clinic setting (n = 1, 4.2%) than in the remote setting (n = 8, 12%; p = 0.015). Remote digital assessment of the ALSFRS-R was well received, with a reported burden in 9.8% (n = 9) of the participants. The FoP-Q-SF revealed fear of progression in 40% of the respondents (n = 60).</p><p><strong>Conclusions: </strong>This study underscored the relevance of information about NfL and ALSFRS-R from the patient's perspective. Furthermore, patients proved to appreciate the relevance of this data for ALS research. Sharing information about NfL or ALSFRS-R was rarely perceived as burdensome even in a remote setting using the ALS app. These findings pave the way for further development of the patient-centered approach to sharing prognostic information in ALS.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and application of a clinical core data set for deep brain stimulation in Parkinson's disease, dystonia or tremor: from data collection to data exchange and data sharing.","authors":"Anna-Lena Hofmann, Jonas Widmann, Lilly Brandstetter, Udo Selig, Fabian Haug, Julian Haug, Rüdiger Pryss, Jasper Mecklenburg, Andrea Kreichgauer, Philipp Capetian, Christian J Hartmann, Christian Niklas, Petra Ritter, Patricia Krause, Alfons Schnitzler, Jens Volkmann, Andrea A Kühn, Peter Heuschmann, Kirsten Haas","doi":"10.1186/s42466-024-00362-z","DOIUrl":"10.1186/s42466-024-00362-z","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive clinical data regarding factors influencing the individual disease course of patients with movement disorders treated with deep brain stimulation might help to better understand disease progression and to develop individualized treatment approaches.</p><p><strong>Methods: </strong>The clinical core data set was developed by a multidisciplinary working group within the German transregional collaborative research network ReTune. The development followed standardized methodology comprising review of available evidence, a consensus process and performance of the first phase of the study. To ensure high data quality, measures for standardized training, monitoring as well as plausibility and data quality tests were implemented.</p><p><strong>Results: </strong>The clinical core data set comprises information about medical history, clinical symptoms, information about deep brain stimulation surgery, complications and outcome for the main neurological movement disorders Parkinson's disease, tremor, and dystonia. Its applicability as well as data exchange and quality control was tested within the first phase of the study in 51 patients from Würzburg.</p><p><strong>Conclusions: </strong>Within the ReTune project, a standardised clinical core data set for Parkinson's disease, dystonia and tremor was developed. The collection as well as concepts for the implementation of monitoring and data exchange were elaborated and successfully tested. Trial registration number ClinicalTrials.gov (DRKS-ID: DRKS00031878).</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process evaluation of a cross-sectoral, coordinated follow-up care of stroke patients: a qualitative study.","authors":"Theresa Schrage, Claudia Glissmann, Götz Thomalla, David Leander Rimmele, Holger Schmidt, Michael Rosenkranz, Stefan Boskamp, Martin Härter, Levente Kriston","doi":"10.1186/s42466-024-00360-1","DOIUrl":"10.1186/s42466-024-00360-1","url":null,"abstract":"<p><strong>Background: </strong>Implementation of interventions to improve follow-up stroke care is complex due to the involvement of various stakeholders and challenges of health care coordination. The aim of this study was to evaluate the process of implementing a cross-sectoral, coordinated follow-up care for stroke patients (the StroCare intervention).</p><p><strong>Methods: </strong>As part of a multicenter interventional trial, this qualitative study was performed in a pre-post design with semi-structured interviews conducted with patients and health care employees. The multicomponent intervention was implemented in eight participating acute care and rehabilitation clinics. The interviews were analyzed using qualitative content analysis. Contents were coded using eight a priori defined categories (acceptability, adoption, appropriateness, feasibility, fidelity, sustainability, patient-centeredness, satisfaction with treatment, and pandemic-related effects) with the possibility of inductively developed categories.</p><p><strong>Results: </strong>Interviews with 21 patients and 34 interviews with 23 employees were conducted. In addition to the deductive categories, three inductive categories (psychosocial implications, interconnectedness, and potential for improvement) emerged. Acceptability, adoption, and appropriateness were assessed positively before the intervention. However, poor feasibility had a negative impact on adoption and appropriateness. In contrast, outcomes related to patient care (patient-centeredness and psychosocial implications) were independent from this effect.</p><p><strong>Conclusions: </strong>Similar to other implementation studies of stroke care interventions, implementation of eHealth Services in the StroCare project met barriers in usability and adaptability of new software. However, high adoption and appropriateness in regard to patient-centeredness, psychosocial implications, and an overall benefit for the patients supported continuation of the remaining intervention components. Trial registration The trial is registered at ClinicalTrials.gov (NCT04159324), registration date 12/11/19.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}