Assessment of neurologists' knowledge regarding intravenous fibrinolytic therapy for acute stroke in Shanxi province in China

Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID-19 pandemic

BACKGROUND

Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect.

METHODS

One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), door-to-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies.

RESULTS

A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect.

CONCLUSIONS

A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.

Limitations on knowledge of autoimmune encephalitis and barriers to its treatment among neurologists: a survey from western China

BACKGROUND

Autoimmune encephalitis (AE) is a group of severe antibody-mediated brain diseases. The understanding of clinical management of AE has developed rapidly. However, the knowledge level of AE and barriers to effective treatment among neurologists remains unstudied.

METHODS

We conducted a questionnaire survey among neurologist in western China on knowledge of AE, treatment practices, and perspectives on barriers to treatment.

RESULTS

A total of 1113 neurologists were invited and 690 neurologists from 103 hospitals completed the questionnaire with a response rate of 61.9%. Respondents correctly answered 68.3% of medical questions about AE. Some respondents (12.4%) never assayed for diagnostic antibodies if patients had suspected AE. Half (52.3%) never prescribed immunosuppressants for AE patients, while another 7.6% did not know whether they should do so. Neurologists who never prescribed immunosuppressants were more likely to have less education, a less senior job title, and to practice in a smaller setting. Neurologists who did not know whether to prescribe immunosuppressants were associated with less AE knowledge. The most frequent barrier to treatment, according to respondents, was financial cost. Other barriers to treatment included patient refusal, insufficient AE knowledge, lack of access to AE guidelines, drugs or diagnostic test, etc. CONCLUSION: Neurologists in western China lack AE knowledge. Medical education around AE is urgent needed and should be more targeted to individuals with less educated level or working in non-academic hospitals. Policies should be developed to increase the availability of AE related antibody testing or drugs and reduce the economic burden of disease.

Knowledge of the Egyptian emergency physicians about the use of rt-PA in acute ischemic stroke

Background

The administration of recombinant tissue plasminogen activator (rt-PA) has increased the focus on acute ischemic stroke (AIS) as an emergency condition. The emergency physicians have to rapidly recognize the patients who are candidates for rt-PA and refer them to the specialized stroke team within the proper time window. The knowledge of the emergency physicians about the benefit and the drawbacks of this therapy is crucial and it affects their attitudes towards its use.

Objective

To apply a survey on the Egyptian emergency physicians aiming to investigate their knowledge about the use rt-PA therapy in AIS.

Methodology

A self-administered questionnaire was sent to the emergency physicians who are working in three Egyptian governorates.

Results

Out of 120 emergency physicians, the total knowledge of the study group was good with a score of 7 ± 1.8/11. Most of the participants mentioned the correct answers (over 50%) for all items except for one question regarding the blood glucose control before the use of rt-PA. Significant positive correlation was noted between the knowledge score and the age.

Conclusions

The surveyed emergency physicians had a good knowledge about the use of rt-PA in AIS, yet, this knowledge is mainly theoretical. Therefore, tutorials, clinical training, and active engagement in the stroke care team are warranted to improve their clinical practice.

Saudi neurology residents' knowledge and attitudes toward intravenous thrombolysis in patients with acute ischemic stroke

Background

Although intravenous (IV) thrombolysis is an effective treatment for patients with acute ischemic stroke (AIS), it remains underused by neurologists worldwide. This study assessed the knowledge and attitudes toward IV thrombolysis in patients with AIS among neurology residents in Saudi Arabia.

Materials and Methods

An online survey was conducted using a sample of 81 neurology residents in and around Saudi Arabia. Statistical analysis included descriptive studies and Chi-square or Fisher's exact test.

Results

Of the 81 respondents, 50 (61.7%) were males and 31 (38.3%) females. Regarding IV thrombolysis use in AIS patients; 61.7% thought that they would consider it, a vast majority about 72.8% showed positive attitudes toward performing IV thrombolysis for AIS patients, 69.1% thought that IV thrombolysis is safe, 79.0% did not think that they have good knowledge about IV thrombolysis, and 53.1% felt not confident about their ability to employ IV thrombolysis. Confidence with knowledge was associated with the residency stage (P = 0.000). Attitudes toward IV thrombolysis was found associated with sex (P = 0.044) and residency stage (P = 0.002). Residents from the central region were more likely to have positive attitudes (P = 0.043).

Conclusion

The surveyed neurology residents showed a positive attitude towards the safety and use of IV thrombolysis for AIS patients. However, knowledge and confidence along with knowledge about the treatment are lacking. Therefore, theoretical and practical training is warranted to improve knowledge about IV thrombolysis.