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Erdur H, Weber JE, Angermaier A, Kinze S, Sotoodeh A, Gorski C, Bollweg K, Ernst S, Kandil FI, Behrens J, Ganeshan R, Keysers A, Kotlarz-Böttcher M, Peters D, Schlemm L, Stangenberg-Gliss K, Witt C, Hennig B, Reber KC, Schneider U, Franke C, Schmehl I, Straub HB, Flöel A, Theen S, Endres M, Kurth T, Audebert HJ. A Managed Care System with Telemedicine Support for Neurological Emergencies. Ann Neurol 2023; 93:511-521. [PMID: 36401341 DOI: 10.1002/ana.26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Telemedicine is frequently used to provide remote neurological expertise for acute stroke workup and was associated with better functional outcomes when combined with a stroke unit system-of-care. We investigated whether such system-of-care yields additional benefits when implemented on top of neurological competence already available onsite. METHODS Quality improvement measures were implemented within a "hub-and-spoke" teleneurology network in 11 hospitals already provided with onsite or telestroke expertise. Measures included dedicated units for neurological emergencies, standardization of procedures, multiprofessional training, and quality-of-care monitoring. Intervention effects were investigated in a controlled study enrolling patients insured at 3 participating statutory health insurances diagnosed with acute stroke or other neurological emergencies. Outcomes during the intervention period between November 2017 and February 2020 were compared with those pre-intervention between October 2014 and March 2017. To control for temporal trends, we compared outcomes of patients with respective diagnoses in 11 hospitals of the same region. Primary outcome was the composite of up-to-90-day death, new disability with the need of ambulatory or nursing home care, expressed by adjusted hazard ratio (aHR). RESULTS We included 1,418 patients post-implementation (55% female, mean age 76.7 ± 12.8 year) and 2,306 patients pre-implementation (56%, 75.8 ± 13.0 year, respectively). The primary outcome occurred in 479/1,418 (33.8%) patients post-implementation and in 829/2,306 (35.9%) pre-implementation. The aHR for the primary outcome was 0.89 (95% confidence interval [CI]: 0.79-0.99, p = 0.04) with no improvement seen in non-participating hospitals between post- versus pre-implementation periods (aHR 1.04; 95% CI: 0.95-1.15). INTERPRETATION Implementation of a multicomponent system-of-care was associated with a lower risk of poor outcomes. ANN NEUROL 2023;93:511-521.
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Affiliation(s)
- Hebun Erdur
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany
| | - Joachim E Weber
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Kinze
- Unfallkrankenhaus Berlin, Klinik für Neurologie, Berlin, Germany
| | - Ali Sotoodeh
- Epilepsiezentrum Berlin-Brandenburg, Epilepsieklinik Tabor, Bernau bei Berlin, Germany
| | - Claudia Gorski
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
| | - Kerstin Bollweg
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany
| | - Stefanie Ernst
- Department of Biostatistics, Parexel International GmbH, Berlin, Germany
| | - Farid I Kandil
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Biometry and Clinical Epidemiology, Berlin, Germany
| | - Janina Behrens
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany
| | - Ramanan Ganeshan
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany
| | - Anne Keysers
- Unfallkrankenhaus Berlin, Klinik für Neurologie, Berlin, Germany
| | | | - Daniel Peters
- Unfallkrankenhaus Berlin, Klinik für Neurologie, Berlin, Germany
| | - Ludwig Schlemm
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany
| | | | - Carl Witt
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | | | | | - Christiana Franke
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany
| | - Ingo Schmehl
- Unfallkrankenhaus Berlin, Klinik für Neurologie, Berlin, Germany
| | - Hans-Beatus Straub
- Epilepsiezentrum Berlin-Brandenburg, Epilepsieklinik Tabor, Bernau bei Berlin, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases, partner site, Rostock, Germany
| | - Sarah Theen
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
| | - Matthias Endres
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany.,Excellence Cluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Tobias Kurth
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
| | - Heinrich J Audebert
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany
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Riegler C, Behrens JR, Gorski C, Angermaier A, Kinze S, Ganeshan R, Rocco A, Kunz A, Müller TJ, Bitsch A, Grüger A, Weber JE, Siebert E, Bollweg K, von Rennenberg R, Audebert HJ, Nolte CH, Erdur H. 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. Front Neurol 2023; 13:1046564. [PMID: 36698874 PMCID: PMC9868735 DOI: 10.3389/fneur.2022.1046564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Christoph Riegler
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Janina R. Behrens
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,NeuroCure Clinical Research Center, Charité and Experimental and Clinical Research Center Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany,*Correspondence: Janina R. Behrens ✉
| | - Claudia Gorski
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany
| | - Anselm Angermaier
- Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany,Klinik und Poliklinik Für Neurologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stephan Kinze
- Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany,BG Klinik Unfallkrankenhaus Berlin, Institut für Telemedizin, Berlin, Germany,Klinik Für Neurologie, BG Klinik Unfallkrankenhaus Berlin, Berlin, Germany
| | - Ramanan Ganeshan
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany
| | - Andrea Rocco
- Klinik Für Neurologie und Klinische Neuropsychologie, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Alexander Kunz
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Klinik Für Neurologie, Asklepios Fachklinikum Brandenburg, Brandenburg, Germany
| | - Tobias J. Müller
- Klinik Für Neurologie, Universitätsklinikum Ruppin-Brandenburg, Neuruppin, Germany
| | - Andreas Bitsch
- Klinik Für Neurologie, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Albert Grüger
- Klinik Für Neurologie, GLG Martin Gropius Krankenhaus Eberswalde, Eberswalde, Germany
| | - Joachim E. Weber
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany,Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institut Für Neuroradiologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kerstin Bollweg
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Regina von Rennenberg
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J. Audebert
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany
| | - Christian H. Nolte
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Berlin, Germany,Deutsches Zentrum Für Herz-Kreislaufforschung DZHK, Berlin, Germany
| | - Hebun Erdur
- Klinik und Hochschulambulanz Für Neurologie, Charité—Universitätsmedizin Berlin, Berlin, Germany,Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany,Acute Neurological Care for North-East Germany With TeleMedicine Support (ANNOTeM), Berlin, Germany
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3
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Erdur H, Siegerink B, Leithner C, Franke C, Lorenz-Meyer I, Theen S, Angermaier A, Kinze S, Weber JE, Rohmann JL, Scheitz JF, Nolte CH, Endres M, Audebert HJ. Stroke Admissions, Stroke Severity, and Treatment Rates in Urban and Rural Areas During the COVID-19 Pandemic. Front Neurol 2021; 11:607193. [PMID: 33488501 PMCID: PMC7815522 DOI: 10.3389/fneur.2020.607193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Many regions worldwide reported a decline of stroke admissions during the early phase of the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether urban and rural regions experienced similar declines and whether deviations from historical admission numbers were more pronounced among specific age, stroke severity or treatment groups. Methods: We used registry datasets from (a) nine acute stroke hospitals in Berlin, and (b) nine hospitals from a rural TeleNeurology network in Northeastern Germany for primary analysis of 3-week-rolling average of stroke/TIA admissions before and during the COVID-19 pandemic. We compared course of stroke admission numbers with regional cumulative severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) infections. In secondary analyses, we used emergency department logs of the Berlin Charité University hospital to investigate changes in age, stroke severity, and thrombolysis/thrombectomy frequencies during the early regional Sars-CoV-2 spread (March and April 2020) and compared them with preceding years. Results: Compared to past years, stroke admissions decreased by 20% in urban and 20-25% in rural hospitals. Deviations from historical averages were observable starting in early March and peaked when numbers of regional Sars-CoV-2 infections were still low. At the same time, average admission stroke severity and proportions of moderate/severe strokes (NIHSS >5) were 20 and 20–40% higher, respectively. There were no relevant deviations observed in proportions of younger patients (<65 years), proportions of patients with thrombolysis, or number of thrombectomy procedures. Stroke admissions at Charité subsequently rebounded and reached near-normal levels after 4 weeks when the number of new Sars-CoV-2 infections started to decrease. Conclusions: During the early pandemic, deviations of stroke-related admissions from historical averages were observed in both urban and rural regions of Northeastern Germany and appear to have been mainly driven by avoidance of admissions of mildly affected stroke patients.
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Affiliation(s)
- Hebun Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Leithner
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christiana Franke
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lorenz-Meyer
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Theen
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Kinze
- Klinik für Neurologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Joachim E Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Jessica L Rohmann
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), partner site Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), partner site Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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4
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Weber JE, Angermaier A, Bollweg K, Erdur H, Ernst S, Flöel A, Gorski C, Kandil FI, Kinze S, Kleinsteuber K, Kurth T, Schmehl I, Theen S, Endres M, Audebert HJ. Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study. BMC Health Serv Res 2020; 20:755. [PMID: 32807159 PMCID: PMC7430113 DOI: 10.1186/s12913-020-05576-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 11/09/2022] Open
Abstract
Background Both diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions. Methods A “hub-and-spoke” network structure was implemented connecting three academic neurological centres (“hubs”) and rural hospitals (“spokes”) caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission. Discussion Beyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed. Study registration German Clinical Trials Register DRKS00013067, date of registration: November 16 th, 2017, URL: http://www.drks.de/DRKS00013068
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Affiliation(s)
- J E Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Clinical Research Unit, Berlin Institute of Health, Berlin, Germany.
| | - A Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - K Bollweg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany
| | - H Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Ernst
- Clinical Research Unit, Berlin Institute of Health, Berlin, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases, partner site, Rostock, Greifswald, Germany
| | - C Gorski
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F I Kandil
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Kinze
- Unfallkrankenhaus Berlin, Berlin, Germany
| | - K Kleinsteuber
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - I Schmehl
- Unfallkrankenhaus Berlin, Berlin, Germany
| | - S Theen
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Excellence Cluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - H J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
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5
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Kinze S. List of Drugs That Can Cause Depression. Dtsch Arztebl Int 2015; 112:420. [PMID: 26159221 PMCID: PMC4500060 DOI: 10.3238/arztebl.2015.0420a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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6
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Kinze S. Correspondence (letter to the editor): The Epley Maneuver. Dtsch Arztebl Int 2008; 105:747. [PMID: 19623299 PMCID: PMC2696978 DOI: 10.3238/arztebl.2008.0747a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Stephan Kinze
- *Unfallkrankenhaus Berlin, Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Warener Str. 7, 12683 Berlin, Germany,
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7
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Schuh-Hofer S, Reuter U, Kinze S, Einhäupl KM, Arnold G. Treatment of acute cluster headache with 20 mg sumatriptan nasal spray--an open pilot study. J Neurol 2002; 249:94-9. [PMID: 11954875 DOI: 10.1007/pl00007854] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We investigated the efficacy and tolerability of 20 mg sumatriptan nasal spray in the acute treatment of cluster headache attacks in an open-label study. 10 patients met the criteria of the International Headache Society (IHS) for episodic or chronic cluster headache and were enrolled in our study. The primary efficacy measure was "pain free" 30 minutes after treatment. Secondary end-points included "headache response" (defined as headache improvement from "very severe", "severe" or moderate" pain to "mild" or "no" pain) 15, 30, 45 and 60 minutes after treatment. We also assessed the participant's overall treatment satisfaction at the end of the study. Sumatriptan nasal spray was applied in 154 "moderate" to "very severe" cluster headache attacks. 30 minutes after nasal spray application, 50% of attacks were completely aborted and 58% of attacks responded to treatment. The overall efficacy of sumatriptan nasal spray was considered "excellent" in two, "good" in four, "reasonable" in two and "poor" in two patients. Eight patients indicated their intention to treat further attacks with intranasal sumatriptan. Seven patients were interviewed after a follow-up period of six months. Four patients continued to treat all cluster headache attacks with the intranasal sumatriptan formula, two patients had switched to subcutaneous sumatriptan and one patient was in remission since the end of the study. We conclude that 20 mg sumatriptan nasal spray might be an alternative therapy for the treatment of cluster headache attacks, but double-blind studies are needed to further evaluate its efficacy.
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Kinze S, Clauss M, Reuter U, Wolf T, Dreier JP, Einhäupl KM, Arnold G. Valproic acid is effective in migraine prophylaxis at low serum levels: a prospective open-label study. Headache 2001; 41:774-8. [PMID: 11576201 DOI: 10.1046/j.1526-4610.2001.01142.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We evaluated the efficacy of prophylactic valproic acid treatment (6 months) on the frequency of migraine attacks and the number of migraine headache days with respect to serum levels. BACKGROUND Valproic acid, a GABAergic drug, has been shown to be effective for migraine prophylaxis. Results from several dose- and serum level-adjusted studies have recommended valproic acid doses within a range of 500 to 1500 mg per day for migraine prophylaxis. DESIGN AND METHODS In this prospective open-label study, 52 patients received valproic acid doses of 300 to 1200 mg per day; 45 patients were treated per protocol. Valproic acid serum levels increased linearly in relation to the valproic acid dose and were between 21 and 107 microg/mL at the end of the treatment period. Patients were divided into two groups: those with valproic acid serum levels less than 50 microg/mL (group 1) and those with serum levels greater than 50 microg/mL (group 2). RESULTS The frequency of migraine attacks was significantly reduced in group 1 from 3.5 +/- 0.9 to 2.0 +/- 0.9 attacks per month. Migraine headache days also decreased (6.4 +/- 3.5 to 4.6 +/- 2.9 days per month). In the high serum level group, a reduction of migraine attacks from 3.5 +/- 0.9 to 2.8 +/- 1.0 attacks per month and only a slight decrease in headache days (6.4 +/- 3.5 to 6.1 +/- 2.4 days per month) was observed. The outcome of group 1 (low serum level) was significantly better than that of group 2 with respect to both parameters (P<.05). Side effects were generally mild and temporary. CONCLUSIONS Due to the lack of additional benefit from higher valproic acid doses (more than 600 mg per day), we recommend daily valproic acid doses of 500 to 600 mg with a target serum level less than 50 microg/mL for the prophylactic treatment of migraine.
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Affiliation(s)
- S Kinze
- Department of Neurology, Charité Clinic, Humboldt University of Berlin, Germany
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Abstract
A 26-year-old patient complained of a series of migraine attacks with aura accompanied by slight pleocytosis and gadolinium (Gd-DTPA) enhancement next to the left middle cerebral artery. The migraine attacks and Gd-DTPA enhancement were reversible during prophylactic treatment with flunarizine.
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Affiliation(s)
- G Arnold
- Department of Neurology, Humboldt-Universität, Charité, Berlin, Germany.
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Kinze S, Schöneberg T, Meyer R, Martin H, Kaufmann R. Pharmacological characterization of CCKB receptors in human brain: no evidence for receptor heterogeneity. Neurosci Lett 1996; 217:45-9. [PMID: 8905736 DOI: 10.1016/0304-3940(96)13026-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this paper, cholecystokinin (CCK) B-type binding sites were characterized with receptor binding studies in different human brain regions (various parts of cerebral cortex, basal ganglia, hippocampus, thalamus, cerebellar cortex) collected from 22 human postmortem brains. With the exception of the thalamus, where no specific CCK binding sites were found, a pharmacological characterization demonstrated a single class of high affinity CCK sites in all brain areas investigated. Receptor densities ranged from 0.5 fmol/mg protein (hippocampus) to 8.4 fmol/mg protein (nucleus caudatus). These CCK binding sites displayed a typical CCKA binding profile as shown in competition studies by using different CCK-related compounds and non peptide CCK antagonists discriminating between CCKA and CCKB sites. The rank order of agonist or antagonist potency in inhibiting specific sulphated [propionyl-3H]cholecystokinin octapeptide binding was similar and highly correlated for the brain regions investigated as demonstrated by a computer-assisted analysis. Therefore it is concluded that CCKB binding sites in human cerebral cortex, basal ganglia, cerebellar cortex share identical ligand binding characteristics.
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Affiliation(s)
- S Kinze
- Institute of Pharmacology and Toxicology, Medical faculty (Chartié), Humboldt University of Berlin, Germany
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