2024-07-10 15:35:34
More about the problem of stroke treatment, necessary innovations, training for foreign doctors and future plans – interview with Assoc. Dr. A. Vilionskiu.
– The RVUL Stroke Center under your leadership has received the international “ESO Angels Status” award for achievements in the field of stroke treatment for several years in a row. What are the outcomes of this award and how do you achieve them?
– in 2019 for the first time in the history of Lithuania, the RVUL Stroke Center was awarded a gold award for the quality indicators of acute stroke treatment, and this year, for the second year in a row, its activities were given the highest, diamond status. The award is based on an assessment of 10 criteria that determine the quality of care for stroke patients, such as the time it takes for stroke patients to receive help, the volume of diagnostic procedures performed, ensuring continuity of care, etc.
I want to emphasize that it is not only the Department of Neurology with cerebrovascular disorders that is evaluated, but the entire institution – the Emergency Department and the staff working there, including nurses and their assistants, the Radiology Department and the radiology technologists working there, etc. The award therefore shows that all services are working to provide high quality care for acute stroke patients. It took many years of work to achieve such results.
It is also necessary to mention that during the COVID-19 pandemic, despite all the restrictions, the number of stroke patients treated in our hospital and the time from arrival at the hospital to the start of treatment did not change significantly. This shows the professionalism of our center team, the ability to adapt to extreme conditions and provide quality assistance.
– What are the goals you mentioned? Is this a “golden time” rule?
– Our main goal is to ensure high-quality and comprehensive care for a stroke patient. This award reflects not only the treatment of acute stroke, but the entire process – examination of patients, treatment, care and application of secondary prevention, recommendations when the patient is discharged from the hospital.
Unfortunately, reperfusion treatment (intravenous thrombolysis and/or mechanical thrombectomy) can only be applied to 20-30% of cases due to objective reasons. patients who experience a stroke. So time is only one goal, but not the only requirement in stroke treatment.
Rapid and complete examination of the patient, early rehabilitative treatment and initiation of repeated stroke prevention are very important. Therefore, we aim to keep as many patients as possible in the medical facility where they can receive the highest level of care, even if they do not receive reperfusion therapy. All of this goes into the quality of stroke care.
– A few months ago, together with colleagues from other medical institutions, you received the “Spirit of Excellence Award 2024” award for your personal contribution to the development of stroke treatment in Lithuania, educational activities, outstanding contribution to raising the standards of treatment in health care institutions.
– I received this award together with Prof. Prof. Dr. Antanus Vaitkumi and Head of the Stroke Sector of the Department of Neurology, prof. Vaidu Matijošaičius and neurologist doctor of VUL Santaras Clinics Neurology Center, VU Faculty of Medicine dean prof. Partly in Jatužiu.y
About 8 years ago, we were the first in Lithuania to go to the training organized by “Angels” in Germany, the purpose of which is to prepare specialist doctors who could train medical personnel in the treatment of acute stroke. After finishing them, we had the idea to create and organize training in Lithuania.
Using the LSMU database, we created a theoretical training program and created simulations. The simulation course was originally designed for neurology and emergency medicine residents. Over time, we presented our activities at international events – it attracted interest, we received offers to prepare simulations for neurologists from other countries as well.
After the first trainings, we received very favorable feedback, which gave us the opportunity to expand our activities. Training has become regular and takes place 2-3 times a year. Groups from Ukraine, Sakartveli, Armenia, Bulgaria, Greece and other countries took part in them. Training is also continued for Lithuanian doctors. And recently we have been receiving invitations to conduct courses in other countries as well. Thanks to “Angels”, we managed to implement two-day conferences specifically for nurses of stroke centers and intermediate care hospitals. This is one of the very good examples where cooperation between several institutions leads to good results.
Our latest project is the opening of a simulation center in Kazakhstan. We have been invited to evaluate their newly opened stroke center, based on which a simulation center is being developed, provide training and share our experience in organizing and conducting stroke simulations. This is already the second foreign country to which we provide such consultations. The first was Moldova, and the Croatian delegation will arrive in the fall. So we were students for a very short time – very quickly we became extremely popular teachers.
– You are constantly visiting various countries of the world, participating in conferences. How does the RVUL Stroke Center compare to Western Europe, Asia or America?
– In the general context, we really do not compromise on treatment options and equipment. However, one of the fundamental things that differentiates us from Western Europe is human resources and payment to the hospital for the services provided. Quantitatively, they are on a whole other level.
Many of the problems we face in Lithuania are well known in Western Europe as well. Most of these are not hospital problems, but national problems. For example, both in Lithuania and abroad, the care of patients after a stroke (“life after stroke”) and rehabilitation is not always adequately ensured. Another problem is the collection, storage and systematization of data, the absence of national registers, although all this is necessary. Here we are talking about the lack of legal framework and human resources.
– What is the importance of the national patient registry?
– If we do not know the real situation, we cannot see the broad picture – we cannot say what should be changed and improved on a national scale. A national patient registry would solve this problem. We collect some data at the hospital level, but to have a comprehensive statistical picture of the whole country, we would need to collect significantly more data from all facilities involved in stroke care.
The first problem is that such work, of course, requires a lot of human resources. Although we can get some data from digital medical records, there is still a lot of manual work involved, which requires a lot of time. At the national level, the question is how many hospitals provide data in general, how it is collected, where it is stored, etc. Another problem related to the registry is the legal framework, which does not always allow monitoring the further path of a patient discharged from the hospital.
– Reperfusion therapy may be used after a stroke. Is the world talking about possible new treatment methods? Do you think there will be changes in the near future?
– The breakthrough in stroke treatment was in 2002. after the introduction of intravenous thrombolysis, and in 2014-2016 – mechanical thrombectomy. Therefore, I think there will be no revolution anytime soon. Currently, most of the debate is about how to expand the range of patients to whom reperfusion therapy can be applied.
Three years ago, the European Stroke Organization (ESO) approved recommendations that, in certain cases, intravenous thrombolysis could be used until 9:00 a.m. since the onset of the stroke.
For now, this recommendation is not valid in Lithuania, we apply reperfusion treatment for 4.5 hours. since the onset of illness. We are currently discussing the unification of recommendations, but there are problems at the legal level regarding the reimbursement of medicines. This issue is one of the priority areas of activity of the Lithuanian Stroke Association.
Another innovation that we can talk about in the treatment of stroke is the use of the drug tenecteplase (this drug is used in cardiology to treat heart attacks). It was recently approved by the European Medicines Agency (EMA), but tenecteplase is not yet approved in Lithuania. Therefore, this is another work that awaits the Lithuanian Stroke Association – to achieve that treatment with this drug is possible in Lithuania as well.
– You are engaged in educational activities. Do you think people’s awareness of stroke has increased?
– We notice that people’s knowledge has changed when we work with the Emergency Department – people seeking help and their relatives need to be explained less and less what a stroke is and what its consequences might be. In addition, if a dozen years ago, intravenous thrombolysis was used in Lithuania by only 1-2%. of all stroke patients, today this number already reaches 15%. This is a very high rate, in line with the goals set by European stroke organizations to be achieved by 2030. We have already achieved the set goal ahead of schedule. The same can be said about mechanical thrombectomy. This suggests that significantly more people recognize the symptoms of a stroke and seek help immediately.
– WHO states that as many as 2 million strokes per year could be prevented through primary prevention measures. Is there enough information about prevention measures?
– Prevention is another sensitive issue that is relevant all over the world. Primary prevention – the identification, assessment and adequate correction of stroke risk factors – is the domain of the family physician. It is not necessarily a medical treatment, but more often a lifestyle adjustment – healthy diet, movement, giving up bad habits, control of chronic diseases.
In order to show the initiative, this year, together with our colleagues at RVUL, we prepared a stroke memo, in which we paid a lot of attention to both primary and secondary prevention. This memo is available both electronicallyboth in paper format.
– In May, you were elected president of the Lithuanian Stroke Association. What are your and the association’s next plans?
– Regarding the goals of the association, we hope to achieve the aforementioned changes at the state level and continue to improve the quality of services provided to stroke patients. For this, we plan to communicate more actively with various state institutions, including the Ministry of Health and the Seimas. We will strive to actively involve not only neurologists, but also doctors of other specialties, as well as nurses, in the activities of the Association.
Most recently, I participated in a project in Moldova to create a national network of stroke centers. This country took many elements of its health care system from Lithuania, the creation of a network of stroke centers is no exception. The purpose of my visits to Moldova was to assess the current situation and make recommendations regarding standardization of procedures, GMP work, coordination of activities of stroke centers and primary centers, training of doctors.
Indeed, it is very nice when Lithuanian experience is appreciated and can be shared and implemented in other countries. It is even more pleasant to see that the situation is changing, that the advice given is being implemented and bearing fruit.
2024-07-10 15:35:34