Time-to-care metrics in patients with interhospital transfer for mechanical thrombectomy in north-east Germany: primary telestroke centers in rural areas vs. primary stroke centers in a metropolitan area.

BACKGROUND: Mechanical thrombectomy (MT) is highly effective in large vessel occlusion (LVO) stroke. In north-east Germany, many rural hospitals do not have continuous neurological expertise onsite and secondary transport to MT capable comprehensive stroke centers (CSC) is necessary. In metropolitan areas, small hospitals often have neurology departments, but cannot perform MT. Thus, interhospital transport to CSCs is also required. Here, we compare time-to-care metrics and outcomes in patients receiving MT after interhospital transfer from primary stroke centers (PCSs) to CSCs in rural vs. metropolitan areas. METHODS: Patients from ten rural telestroke centers (RTCs) and nine CSCs participated in this study under the quality assurance registry for thrombectomies of the Acute Neurological care in North-east Germany with TeleMedicine (ANNOTeM) telestroke network. For the metropolitan area, we included patients admitted to 13 hospitals without thrombectomy capabilities (metropolitan primary stroke centers, MPSCs) and transferred to two CSCs. We compared groups regarding baseline variables, time-to-care metrics, clinical, and technical outcomes. RESULTS: Between October 2018 and June 2022, 50 patients were transferred from RTCs within the ANNOTeM network and 42 from MPSCs within the Berlin metropolitan area. RTC patients were older (77 vs. 72 yrs, p = 0.05) and had more severe strokes (NIHSS 17 vs. 10 pts., p < 0.01). In patients with intravenous thrombolysis (IVT; 34.0 and 40.5%, respectively), time from arrival at the primary stroke center to start of IVT was longer in RTCs (65 vs. 37 min, p < 0.01). However, RTC patients significantly quicker underwent groin puncture at CSCs (door-to-groin time: 42 vs. 60 min, p < 0.01). Despite longer transport distances from RTCs to CSCs (55 vs. 22 km, p < 0.001), there was no significant difference of times between arrival at the PSC and groin puncture (210 vs. 208 min, p = 0.96). In adjusted analyses, there was no significant difference in clinical and technical outcomes. CONCLUSION: Despite considerable differences in the setting of stroke treatment in rural and metropolitan areas, overall time-to-care metrics were similar. Targets of process improvement should be door-to-needle times in RTCs, transfer organization, and door-to-groin times in CSCs wherever such process times are above best-practice models

Age determination and pollen profile of sediment core Voulkaria 1966, Greece

Lake Voulkaria is situated in northwestern Greece in the Prefecture of Etoloakarnania, 6 km SW of the city of Vonitsa and 10 km east of the northern tip of the island of Levkás (Leukás, Lefkada). The lake is separated from the Ionian Sea on the West by a narrow limestone ridge ca 10 m high and has a size of 940 ha. An almost continuous fringe of Phragmites surrounds the open water. This reed bank is up to 500 m wide along the southern shore of the lake. Water depth is low, predominantly less than 2 m. In the south-eastern part of the lake a maximum depth of 3.1 m was measured in September 1997

Diskrepanzen zwischen berichteter und verifizierter Penicillinallergie: Mögliche Implikationen für den Patienten und das Gesundheitssystem

In der Literatur wird berichtet, dass ca. zehn Prozent der Patienten in den USA den Vermerk „Penicillinallergie“ tragen.1, 2 Andererseits soll sich nur bei bis zu zehn Prozent der Patienten mit der anamnestischen Angabe einer Penicillinallergie eine Sensibilisierung nachweisen lassen.2–4 Da ein Patient mit dem Vermerk Penicillinallergie in der Regel andere Antibiotika erhält, ergeben sich Konsequenzen für ihn, aber auf übergeordneter Ebene auch für das Gesundheitssystem. In der Literatur wurde diese Thematik schon vor über 15 Jahren5 beschrieben und die Bedeutung der Abklärung einer berichteten Penicillinallergie in Bezug auf Antibiotikaresistenzen und Kosten diskutiert.6, 7 Ziel dieses Artikels ist es, eine kurze Einführung in diese Thematik zu geben, die aufgrund der Entwicklung der Antibiotikaresistenzen8– 10 wieder an Aktualität und Relevanz gewonnen hat