Leptomeningeal collaterals regulate reperfusion in ischemic stroke

Recanalization is the mainstay of ischemic stroke treatment. However, even with timely clot removal, many stroke patients recover poorly. Leptomeningeal collaterals (LMCs) are pial anastomotic vessels with yet unknown functions. Utilizing a thrombin-based mouse model of stroke and the gold standard fibrinolytic treatment rt-PA, we here show that LMCs play a critical role in preserving vascular function in ischemic territories. We applied laser speckle contrast imaging, ultrafast ultrasound, and two-photon microscopy, to show that after thrombolysis, LMCs allow for gradual reperfusion resulting in small infarcts. On the contrary, in mice with poor LMCs, distal segments of recanalized arteries collapse and deleterious hyperemia causes hemorrhage and mortality. Accordingly, in stroke patients with poor collaterals undergoing thrombectomy, rapid reperfusion resulted in hemorrhagic transformation and unfavorable recovery. Thus, we identify LMCs as key components regulating reperfusion after stroke. Future therapeutic interventions should aim to enhance collateral function, allowing for gradual reperfusion of ischemic tissues after stroke

Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization.

Recanalization is the mainstay of ischemic stroke treatment. However, even with timely clot removal, many stroke patients recover poorly. Leptomeningeal collaterals (LMCs) are pial anastomotic vessels with yet-unknown functions. We applied laser speckle imaging, ultrafast ultrasound, and two-photon microscopy in a thrombin-based mouse model of stroke and fibrinolytic treatment to show that LMCs maintain cerebral autoregulation and allow for gradual reperfusion, resulting in small infarcts. In mice with poor LMCs, distal arterial segments collapse, and deleterious hyperemia causes hemorrhage and mortality after recanalization. In silico analyses confirm the relevance of LMCs for preserving perfusion in the ischemic region. Accordingly, in stroke patients with poor collaterals undergoing thrombectomy, rapid reperfusion resulted in hemorrhagic transformation and unfavorable recovery. Thus, we identify LMCs as key components regulating reperfusion and preventing futile recanalization after stroke. Future therapeutic interventions should aim to enhance collateral function, allowing for beneficial reperfusion after stroke

Patient priorities in coordinated care: a literature review to identify patients' preferences

BACKGROUND: Delivering efficient healthcare within limited budgets requires an understanding of patient priorities. Designing services that are sensitive to patients' preferences in the context of limited resources may require policy and decision-makers to choose between attributes. Aligning clinical practice and health policy with patient preferences will improve the effectiveness of health interventions. Coordinated care aims to achieve higher-quality care, lower costs and greater patient satisfaction. Heterogeneity within preferences due to racial and ethnic disparities, age or illness has to be documented and considered in the design of healthcare services. Conjoint analysis or discrete choice studies can be used to elicit preferences for interventions or technologies. RESEARCH QUESTION: This study intends to provide health policy and decision-makers with a literature review of patients' priorities in the relative value of coordinated care. In order to promote coordinated care, policy-makers need to understand patients' priorities. Therefore this study aims to use a literature review to assess patient preferences. METHOD: As a research in the database PubMed has shown the available literature analyzing patient-centered outcomes in coordinated care is very limited. The searches for ‘(patient-centered coordinated care) and (discrete choice)’, ‘(patient-centered coordinated care) and (conjoint analysis)’, ‘(patient-centered medical home) and (discrete choice)’ as well as ‘(patient-centered medical home) and (conjoint analysis)’ all ended up in no results found. Merely the searches for ‘(patient-centered care) and (discrete choice)’ and the one for ‘(patient-centered care) and (conjoint analysis)’ were successful. RESULTS: The term ‘patient preferences’ still lacks a consistent definition; despite this, there appears to be convergence in the view that patient preferences are statements made by individuals regarding their needs, values and expectations and the relative importance of treatment properties. Therefore these preferences refer to the individual evaluation of dimensions of health outcomes. Based on the existing literature, coordinated care can be differentiated into attributes, such as: organization of care, patient self-management, interpersonal care, and technical care. CONCLUSION: Patient-centered outcomes will provide objective information about the impact on patient involvement, the experiences, and the needs and wants of patients. Patient preference data will help insurers, policy-makers and others to promote patient-centered coordinated care as the new standard of primary care

Preferences of overweight and obese patients for weight loss programs: a discrete-choice experiment

Introduction: Obesity is associated with increased risk of morbidity and mortality and also appears to have an adverse effect on health-related quality of life. Though advances in obesity therapy and rehabilitation can be observed, the long-lasting outcome is dissatisfying to most of the patients and therefore the whole healthcare system.Theory and Methodology: The study aims to identify key attributes of coordinated weight loss programs and elicit patients’ preferences for overweight and obesity therapy in rehabilitation programs. A self-administered survey measuring attitudes and preferences was conducted in Germany in 2009. Discrete-Choice Experiment scenarios were developed using a fractional factorial design and results analysed using a random effects logit model.Results: N=110 patients completed the questionnaire, 51.82% of these were male, the mean age was 53.05 years and mean BMI was 33.54 kg/m² (SD 7.73). 823 choices could be included in the final estimation. The most important aspects for the respondents’ selection were care coordination (coefficient 1.473;SE 0.185) and individual therapy (coefficient 1.446;SE 0.188). The aspect ‘infrastructure of care’ (coefficient 0.570; SE 0.175) was less relevant. All attributes led to significant coefficients.Conclusion: Patients value coordination of care and individual therapy most highly. So weight reduction therapy should enable patients to receive a structured, coordinated and interpersonal therapy that is tailored to their personal needs, behaviour and circumstances. Patients are willing to forego infrastructure quality in favour of better coordination and structure in their therapy.

Preferences of overweight and obese patients for weight loss programs: a discrete-choice experiment

<strong>Introduction: </strong>Obesity is associated with increased risk of morbidity and mortality and also appears to have an adverse effect on health-related quality of life. Though advances in obesity therapy and rehabilitation can be observed, the long-lasting outcome is dissatisfying to most of the patients and therefore the whole healthcare system. <strong>Theory and Methodology: </strong>The study aims to identify key attributes of coordinated weight loss programs and elicit patients’ preferences for overweight and obesity therapy in rehabilitation programs. A self-administered survey measuring attitudes and preferences was conducted in Germany in 2009. Discrete-Choice Experiment scenarios were developed using a fractional factorial design and results analysed using a random effects logit model. <strong>Results: </strong>N=110 patients completed the questionnaire, 51.82% of these were male, the mean age was 53.05 years and mean BMI was 33.54 kg/m² (SD 7.73). 823 choices could be included in the final estimation. The most important aspects for the respondents’ selection were care coordination (coefficient 1.473;SE 0.185) and individual therapy (coefficient 1.446;SE 0.188). The aspect ‘infrastructure of care’ (coefficient 0.570; SE 0.175) was less relevant. All attributes led to significant coefficients. <strong>Conclusion: </strong>Patients value coordination of care and individual therapy most highly. So weight reduction therapy should enable patients to receive a structured, coordinated and interpersonal therapy that is tailored to their personal needs, behaviour and circumstances. Patients are willing to forego infrastructure quality in favour of better coordination and structure in their therapy. <p class="MsoNormal" style="text-align: justify;">  <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normale Tabelle"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} > <! [endif] --