Dumitrașcu, Oana

Background Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Methods Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. Results One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. Conclusion In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.

Introduction Burnout in medicine is an occupational hazard and has emerged as a pressing concern in recent years. Organizational changes can be impactful in countering burnout (1). The factors leading to burnout in medicine are multifaceted, encompassing organizational factors such as workload, inadequate support, and inefficient administrative systems. The purpose of this study is to investigate current organizational measures to support physician well‐being. This study was an initiative led by the SVIN wellness committee. Methods A 39‐question online survey investigating current organizational well‐being practices was distributed to physicians both nationally and internationally practicing stroke, neurocritical care, and interventional neurology. Data analysis was performed using Python, utilizing the libraries “pandas” and “sklearn”. Results This study analyzed burnout among 109 healthcare professionals, predominantly from the U.S. (93.6%) and Canada (6.4%). The majority were neurointerventional specialists (53.2%), aged 35‐44 years (52.3%), and male (62.4%). Burnout frequency was measured on a 0 (Never) to 4 (Every day) scale. Using a Random Forest model, the study identified key burnout predictors from questions, which covered organizational leadership, wellness resources, compensation, and workload. The most influential predictors were: adequacy of compensation relative to specialty, workload, and stress (17.7% importance); leadership accountability for workforce wellbeing (9.1%); and establishment of wellness or burnout as a critical metric (7.5%). Other factors included provision of wellness screenings (7.1%), and dedication of resources toward professional well‐being (4.9%). Conclusion The study identifies compensation, leadership accountability, and wellness resources as key predictors of burnout among healthcare professionals. These findings highlight the need for targeted organizational strategies to enhance physician well‐being and mitigate burnout. Further research is warranted to validate and expand upon these findings.

Introduction: Branch retinal artery occlusion (BRAO) results from the blood flow compromise in of the branches of the central retinal artery. Data is limited on the outcome of patients with BRAO who received thrombolytic therapy as acute phase management protocol. Method: This study is a sub-analysis of our prior systematic review and meta-analysis on the visual outcome of patients with retinal artery occlusion who received intra-arterial (IA) or intra-venous (IV) thrombolytics within the first 24 hours. PubMed, Cochrane Library, ScienceDirect via Elsevier, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Trip Medical Database were systematically searched with a predefined protocol to record the change in the visual acuity (VA) after thrombolytic therapy. We limited this study to the patients with BRAO who received urokinase (UK) or tissue plasminogen activator (tPA). Results: Among 1153 identified studies, 771 patients with retinal artery occlusion received thrombolytic therapy. BRAO was observed in 19 patients (2.5%, mean age: 65 years). IAT-tPA was administered in 8 (42.1%), IVT-tPA in 7 (36.8%), and IVT-UK in 4 (21.1%). Median time from the onset of visual change to thrombolysis was 6.0 [4.5-10.5] hours. Patients had mean baseline logarithm of the Minimum Angle of Resolution (logMAR) of 0.9±0.8. VA improvement of ≥0.1 logMAR (one Snellen line) was seen among 17 (89.5%), VA improvement of ≥0.3 logMAR (three Snellen lines) among 13 (68.4%), and a final VA of 20/100 or better among 16 (84.2%). One (5.3%) patient had intra-ocular hemorrhage post thrombolysis. Conclusion: Compared to central retinal artery occlusion, patient with branched retinal occlusion have better visual recovery following IA or IV thrombolysis. These results can be affected by the small number of the patients in this study.