Telemedicine for the acute management of stroke in Burgundy, France: an evaluation of effectiveness and safety

International audienceBackground:In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star-shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients.Methods:One hundred and thirty-two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012–2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011–2012) were included. Main outcomes were the modified Rankin scale (mRS) score and case fatality at 3 months. Comparisons between groups were made using multivariable ordinal logistic regression and logistic regression analyses, respectively.Results:Baseline characteristics of telethrombolysis patients were similar to those of patients undergoing thrombolysis locally except for a higher frequency of previous cancer and pre-morbid handicap, and a trend towards greater severity at admission in the former. The distribution of mRS scores at 3 months was similar between groups, as were case-fatality rates (18.9% in the telethrombolysis group versus 16.5%, P = 0.56). In multivariable models, telethrombolysis did not independently influence functional outcomes at 3 months (odds ratio for a shift towards a worse outcome on the mRS, 1.11; 95% confidence interval, 0.74–1.66, P = 0.62) or death (odds ratio, 0.86; 95% confidence interval, 0.44–1.69, P = 0.66).Conclusion:The implementation of a regional telemedicine network for the management of acute ischemic stroke appeared to be effective and safe. Thanks to this network, the proportion of patients who benefit from thrombolysis will increase. Further research is needed to evaluate economic benefits

In vivo evaluation of Adipose-Derived Stem Cells (ADSCs) using Nanofat technique and chitosan conduit for peripheral nerve defect repair.

Nerve autograft is the gold standard for reconstruction of peripheral nerve loss. The alternative is the interposition of a synthetic regeneration conduit. The purpose of the study was to evaluate the in vivo feasibility and interest of Adipose-Derived Stem Cells (ADSCs) using the Nanofat technique and chitosan conduit for peripheral nerve defect repair. In vivo, after the creation of a 10 mm defect of the sciatic nerve, 2 groups were defined according to the nerve repair in rats: "chitosan" group (n = 10) and "chitosan and ADSCs" group (n = 10) with a clinical and paraclinical evaluation at 7 weeks. The in vivo results seem to show that the adjunction of ADSCs was favorable clinically, histologically and functionally compare to a chitosan reconstruction alone. Peripheral nerve repair with defect using a chitosan conduit associated with ADSCs would constitute a surgical alternative in a single surgical step

Patient engagement with research: European population register study.

BACKGROUND: Lay involvement in implementation of research evidence into practice may include using research findings to guide individual care, as well as involvement in research processes and policy development. Little is known about the conditions required for such involvement. AIM: To assess stroke survivors' research awareness, use of research evidence in their own care and readiness to be involved in research processes. METHODS: Cross sectional survey of stroke survivors participating in population-based stroke registers in six European centres. RESULTS: The response rate was 74% (481/647). Reasons for participation in register research included responding to clinician request (56%) and to 'give something back' (19%); however, 20% were unaware that they were participating in a stroke register. Research awareness was generally low: 57% did not know the purpose of the register they had been recruited to; 73% reported not having received results from the register they took part in; 60% did not know about any research on stroke care. Few participants (7.6%) used research evidence during their consultations with a doctor. The 34% of participants who were interested in being involved in research were younger, more highly educated and already research aware. CONCLUSIONS: Across Europe, stroke survivors already participating in research appear ill informed about stroke research. Researchers, healthcare professionals and patient associations need to improve how research results are communicated to patient populations and research participants, and to raise awareness of the relationship between research evidence and increased quality of care.This paper was written on behalf of the European Implementation Score (EIS) project, funded by the EU 7th Framework Programme

P09.084C - Strong interest of exome sequencing in progressive neurological diseases

International audienceIntroduction: Neurogenetics represents a vast, complex, ever changing discipline whose diagnosis currently remains challenging, since clinical and/or imaging features frequently appear very unspecific, especially early in the evolution (cerebellar ataxia, tremor, dystonia...). In molecular diagnosis, current strategies usually include sequential investigations that may lead to long, tedious, expensive and disappointing patients care. Exome sequencing (ES) appears a promising approach for neurogenetics, apart from when nucleotide motif expansion disorders can be suspected. Materials and Methods: We recruited 48 individuals without cognitive development impairment, referred to our center for suspected neurogenetic disease: 20 cerebellar ataxia (42%), 12 neuromuscular diseases (25%), 8 spastic paraplegia (17%), 2 abnormal movements (4%) and 6 others (12%) for whom the phenotype could not be labelled under a usual neurological syndrome. ES was interpreted in a solo-based strategy (94%) or in trio with parental pool (6%). Results: ES identified a causal diagnosis in 4/8 individuals with spastic paraplegia (50%), 3/6 “other” (50%), 1/2 with abnormal movements (50%), 5/12 with neuromuscular diseases (42%), 4/11 with isolated cerebellar ataxia (37%) and 2/9 with spinocerebellar ataxia (22%). Overall diagnostic yield was of 40 %. Conclusions: With such overall diagnostic yield, this study reinforces the diagnostic interest of ES in neurogenetics, in all its fields, as this diagnostic yield ranges from 22% in spinocerebellar ataxia (which is higher than current yield of gene panels) to 50% in spastic paraplegia. It also includes situations in which clinical displays may be complex and hard to systematize. First-tier implementation would significantly improve diagnostic yield in neurogenetics

Specific Considerations Relevant to Critical Illness

Only recently it has been recognized that vitamin D, which in reality is a steroid prohormone, may be of great interest to various aspects of critical illness not only because of its classic function in the regulation of calcium homeostasis but of its suspected pleiotropic effects. Since 2011, several observational studies have demonstrated a strong association between vitamin D deficiency and adverse outcomes, specifically higher mortality in this vulnerable population. The major current vitamin D and nutrition guidelines do not specifically address vitamin D requirements of critically ill patients, and typical nutrition formulas and supplements contain only modest amounts that are likely insufficient to correct vitamin D deficiency or unable to cover even daily requirements of severely ill individuals. In this chapter, the current knowledge on vitamin D is summarized and an overview on data that are specifically relevant to a number of disease states in critically ill patients is given. Readers are also referred to the general aspects of vitamin D as it pertains to acute illness in the chapter by Dr Youssef et al