This site gives a short overview of interesting results from other stroke-related research projects.
Follow-up commission of the German Stroke Society publishes position papers
2022/01/31 The acute phase of stroke is often followed by a chronic phase, which is characterized by high demand for multi- and interprofessional care. In 2020 the German Stroke Society (DSG) founded a follow-up commission with the aim of presenting the current care situation and developing suggestions for improving care after the acute phase of stroke. This commission has now published three position papers in the journal “Der Nervenarzt” that reflect the current status of stroke aftercare in Germany and discuss comprehensive approaches for further development of future-oriented improvements in aftercare [1, 2, 3]. Part 1 depicts the reality of care and reveals care deficits along the treatment path from the acute hospital through the rehabilitation process to outpatient aftercare. Continuity of the treatment process is just as important as the patient’s perspective and the application of a multi-professional approach and transsectoral case management. Part 2 focusses on the implementation of a stroke specialist who considers diverse follow-up needs with a patient-centric perspective, planning and overseeing individual treatment. Part 3 addresses possible framework conditions for the implementation of optimized stroke aftercare; for example the advantages and disadvantages of integrated care and the disease management program will be discussed.
 Kaendler S, Ritter M, Sander D, Elstner M, Schwarzbach C, Wagner M, Meisel A, “Mitglieder Kommission Nachsorge der Deutschen Schlaganfall-Gesellschaft. Positionspapier Schlaganfallnachsorge der Deutschen Schlaganfall-Gesellschaft – Teil 1: Nachsorge nach einem Schlaganfall: Status quo der Versorgungsrealität und Versorgungsdefizite in Deutschland.” Nervenarzt, im Druck. doi: 10.1007/s00115-021-01231-9.
 Hotter B, Ikenberg B, Kaendler S, Knispel P, Ritter M, Sander D, Schwarzbach C, von Büdingen HJ, Wagner M, Meisel A, “Mitglieder Kommission Nachsorge der Deutschen Schlaganfall-Gesellschaft. Positionspapier Schlaganfallnachsorge der Deutschen Schlaganfall-Gesellschaft – Teil 2: Konzept für eine umfassende Schlaganfallnachsorge.” Nervenarzt, im Druck. German. doi: 10.1007/s00115-021-01232-8.
 Schwarzbach CJ, Michalski D, Wagner M, Winkler T, Kaendler S, Elstner M, Dreßing A, Claßen J, Meisel A, Grau A, “Mitglieder Kommission Nachsorge der Deutschen Schlaganfall-Gesellschaft. Positionspapier Schlaganfallnachsorge der Deutschen Schlaganfall-Gesellschaft – Teil 3: Strukturelle Konzepte für zukünftige Versorgungsformen der Schlaganfallnachsorge.” Nervenarzt, im Druck. doi: 10.1007/s00115-021-01230-w.
Insights in the design of stroke case manager digital solutions
2021/09/17 The 2021 conference “Biomedical and Health Informatics“ (BHI‘21), Dr-Ing Christian Lüpkes of OFFIS presented his contribution named “A Mobile Application for Documentation and Guiding of Stroke Patients – The LotsenApp”, , in the “Mobile Digital Solutions in Patient Care“ Special Session, led by Prof. Ivanova and co-chaired by Prof. Georgius Raptis. The LotsenApp is a mobile app developed and used in the STROKE OWL trial in Germany from 2017 to 2021. The purpose of this study was to assess how the LotsenApp could reduce the recurrence rate in post stroke patients.
The app, running on tablets, was used by the stroke case managers to collect patient data (personal information and questionnaires) and to assess their quality. At the end of STROKE OWL, the app was used by 17 stroke case managers and involved approximately 1530 patients. Data were collected for cares purposes, but also for health insurance entities as well as for university research.
Study results are being processed and a detailed survey should be available soon.
The LotsenApp from STROKE OWL has some requirements in common with the Lotsen Portal of the PostStroke Manager project, requirements which provided similar specifications but different implementations. Dr. Jean-Baptiste Tylcz of ICCAS presented in the same conference his contribution named “Toward an efficient mobile system for stroke case managers: requirements”, , introducing the most important requirements to keep in mind when designing a stroke case manager digital system. These requirements were mainly derived from the PostStroke Manager consortium work and cover a variety of needs from ergonomics and network connexion to data security and signal processing algorithms.
Once finalized, this architecture will be one important piece of the digital system being tested in the forthcoming stroke aftercare clinical trial, one of the first innovative intersectoral study in the field.
 C. Lüpkes, T. Wolters, A. Hein, “ A Mobile Application for Documentation and Guiding of Stroke Patients – The LotsenApp”, 2021 IEEE EMBS Int. Conf. Biomed. Health Inform, 2021.
 J.-B. Tylcz, A. Prost, D. Geisler, D. Urban, M. Schreiber, T. Handel, D. Michalski and G. Ivanova, “Toward an efficient mobile system for stroke case managers: requirements”, 2021 IEEE EMBS Int. Conf. Biomed. Health Inform, 2021.
Lecture series on stroke guide and aftercare projects
The people behind the likewise stroke-related research project STORKE OWL- Schlaganfall-Lotsen für Ostwestfalen-Lippe (stroke guides for East Westphalia-Lippe) and the Stiftung Deutsche Schlaganfall Hilfe (German Stroke Foundation) are currently organizing an online lecture series on the topic of “Stroke Pilots and Aftercare Projects”. For all those interested, you can find the dates and events here:
In a recently published international study leadingly conducted by Charité – Universitätsmedizin Berlin, the effect of structured aftercare after minor strokes and temporary circulatory disorders of the brain (so-called transitory ischemic attacks, TIA) was investigated. The researchers focused on the individual constellation of risk factors in the patients examined and accompanied those affected by regular appointments with experienced and specially trained nursing staff. The aim was to prevent a recurrence of stroke by changing lifestyle habits and regular intake of the prescribed medication.
Unfortunately, no direct effect on the occurrence of cardiovascular diseases could be achieved through the additional care of stroke patients within the follow-up period of about three and a half years. However, patients with more intensive and structured follow-up care showed a significant reduction in risk factors, which was reflected in better blood pressure values, lower cholesterol levels and more frequent successful smoking cessation. Therefore, a positive effect with regard to the occurrence of future cardiovascular diseases is very likely. It is highly probable that the study failed to show statistical evidence due to the comparatively short observation period under study conditions.
We are pleased that the topic of stroke aftercare is becoming increasingly important in current research and that innovative care concepts are being discussed and tested in clinical studies. The combined approach of personal contact and digital support envisaged in the PostStroke Manager project could be a decisive step in the further development of innovative care concepts and at the same time provide exciting new impetus.
Reference: Ahmadi M, Laumeier I, Ihl T, et al. A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial. Lancet Neurology 2020; 19: 49-60
2019/06/07 An integral part of the follow-up treatment of stroke patients is the secondary prophylactic medication. It is administered to prevent secondary strokes and is adjusted individually according to the patients risk profile. Patients with known atrial fibrillation will be treated according to guidelines with oral anticoagulants, meaning they will be given „blood-thinners“ in the form of tablets.
However, one group of patients is hard to categorize in this risk profile: Namely, patients with a diagnosis which points to an underlying heart condition or arrhythmia (atrial fibrillation), which however cannot be observed at the time of the stroke incident. This group is said to have an „embolic stroke of undetermined source“ (ESUS).
In two recently published studies (last of which was the RE-SPECT ESUS study, published last month) it was investigated to what extend ESUS-patients benefit from anticoagulation. More specifically the rate of secondary incidents was compared when the patient was given anticoagulants or the standard treatment, e.g. acetylsalicylic acid.
Unfortunately, no advantage could be found with the stronger „blood-thinners“. Hence, in future studies other diagnostic and treatment options have to be examined more closely. Furthermore the study shows how important follow-up treatment is for stroke patients, because a close post-incident supervision can help to identify additional risk-factors and to adjust the medication accordingly.
Reference: Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S, Kreuzer J, Cronin L, Cotton D, Grauer C, Brueckmann M, Chernyatina M, Donnan G, Ferro JM, Grond M, Kallmünzer B, Krupinski J, Lee BC, Lemmens R, Masjuan J, Odinak M, Saver JL, Schellinger PD, Toni D, Toyoda K; RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med 2019; 380: 1906-1917.