BACKGROUND:Endovascular thrombectomy (EVT) has transformed acute ischemic stroke (AIS) care, with onset-to-puncture (OTP) time widely recognized as a critical determinant of outcome. However, emerging evidence suggests that in-hospital procedure time (PT)-from arterial puncture to final recanalization-may have an equally or more significant impact. This study examines the relative contribution of PT versus OTP to functional outcomes in patients with AIS undergoing EVT. METHODS:A retrospective analysis was conducted of 6644 patients with AIS treated at 44 international stroke centers from the Stroke Thrombectomy and Aneurysm Registry (STAR; 2016-2023). Multivariable regression, time-equivalence analysis, and marginal effects modeling were used to assess associations between PT, OTP, and 90-day modified Rankin Scale (mRS) outcomes. Centers were stratified by procedural efficiency and compared using propensity score matching (PSM). Mediation analysis evaluated whether PT accounted for inter-center differences. RESULTS:PT and OTP were independently associated with functional outcomes; however, PT had a significantly stronger effect (adjusted OR for mRS 0-2: PT=0.56 vs OTP=0.96 per hour). Each 5 min increase in PT was equivalent to 78-100 min of additional OTP in outcome impact. Centers with faster average PT had higher rates of functional independence (number needed to treat (NNT)=10), fewer complications, and lower symptomatic intracranial hemorrhage rates. PT significantly mediated the relationship between center tier and outcomes (Sobel's P<0.001). CONCLUSION:While minimizing OTP remains important, PT exerts a greater influence on outcomes after EVT. Procedural efficiency should be emphasized in stroke systems of care and included in center performance metrics to improve patient outcomes.
INTRODUCTION AND OBJECTIVES:Although severe asthma multidisciplinary units (SAMUs) are increasingly important for providing comprehensive, patient-centred care, quality metrics to assess their impact remain insufficient. We aimed to develop consensus-based recommendations for key performance indicators (KPIs) for SAMUs in Portugal. MATERIAL AND METHODS:A modified three-round Delphi study was performed (May-October 2024). The scientific committee developed 54 initial statements covering seven domains: I - Referral; II - Diagnosis; III - Treatment; IV - Monitoring; V - Administrative Tasks; VI - Nursing Care; VII - Research/Training. Participants rated agreement on a 5-point Likert scale, with consensus threshold of ≥90% (round 1) and ≥85% (round 2).The level of consensus achieved was discussed by the scientific committee. RESULTS:Forty-five out of 56 invited experts completed the exercise (80.4% response rate). Round 1 achieved consensus on 28/54 statements (51.9%), mostly on treatment (70%) and monitoring (69.2%) items. Moderate consensus was found on referral (50%) and diagnosis (42.9%). In round 2, half of the remaining items ( 13/26) achieved agreement. Statements not reaching consensus were mostly from Research and Training (50%). Only one item from Diagnosis (14.3%) and one - Monitoring (7.7%) didn't achieve consensus. CONCLUSIONS:While SA experts in Portugal reached consensus on KPIs for SAMUs related to innovative treatment, monitoring and administrative tasks, challenges persist in the areas of telemedicine, research/training, nursing care and patient referral. Standardising practices, improving access to target therapies, and adapting global metrics to the local context, could provide clearer guidance for developing future SAMU quality frameworks.
Objective: To map and synthesise the available scientific evidence on multidimensional swallowing assessment in older adults, identifying key domains, assessment tools, and implications for clinical practice. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the PRISMA-ScR guidelines. Studies published between 2013 and 2024 in English or Portuguese were included. Searches were performed in PubMed, Scopus, Web of Science, CINAHL, and B-on. Eligibility criteria were defined using the PCC framework: older adults (Population), multidimensional swallowing assessment (Concept), and any healthcare setting (Context). Study selection and data extraction were performed by two independent reviewers. Results: Twenty-four studies were included. The findings demonstrate that swallowing assessment in older adults encompasses multiple interrelated domains, including clinical history, cognitive status, cranial nerve function, respiratory status, nutritional condition, and socioeconomic factors. A range of validated tools was identified, with the Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), Penetration–Aspiration Scale (PAS), Dysphagia Handicap Index (DHI), and the International Dysphagia Diet Standardisation Initiative (IDDSI) being the most frequently reported. Despite this, substantial heterogeneity was observed in both the domains assessed and the selection of instruments, reflecting variability in clinical practice. Conclusion: Swallowing assessment in older adults requires a structured, multidimensional approach integrating clinical, functional, instrumental, and contextual factors. The current variability in assessment practices highlights the need for standardised frameworks to support clinical reasoning, improve diagnostic accuracy, and enhance patient outcomes. The integration of validated tools within comprehensive assessment models may strengthen person-centred care and reduce the risk of adverse events associated with dysphagia.
BACKGROUND AND OBJECTIVES:Aspiration catheters are an integral component of mechanical thrombectomy for acute ischemic stroke (AIS). Following early series demonstrating increasing procedural efficiency and improved outcomes with use of large-bore (LB) aspiration catheters, there is increased interest in the use of emerging superlarge-bore (SLB) catheters. METHODS:We retrospectively analyzed AIS patients with large vessel occlusion treated at 34 international centers (2018-2025) using SLB or LB aspiration catheters on the first attempt. We used propensity score matching (1:6) to define a balanced cohort based on baseline and technical confounders between the catheter groups. Safety, efficacy, and technical outcomes were compared, with the primary outcome being the first pass effect (FPE). RESULTS:A total of 2032 patients treated with aspiration as the frontline technique were included (SLB n = 107; LB n = 1925). After propensity score matching (SLB n = 107; LB n = 642), there was no significant difference in FPE between the SLB and LB groups (56.1% vs 54.8%; odds ratio [OR] 1.05, P = .8). Secondary efficacy outcomes were similarly comparable, including functional independence at 90 days (50.0% vs 46.9%; OR 1.13, P = .586), successful recanalization (modified thrombolysis in cerebral infarction ≥2b) (96.3% vs 93.5%; OR 1.78, P = .3), and median time to modified thrombolysis in cerebral infarction ≥2b (22.0 vs 22.8 minutes; β = -5.94, P = .7). Safety outcomes were also comparable, including intraprocedural complications (10.3% vs 8.2%, P = .5), symptomatic intracranial hemorrhage (8.7% vs 6.6%, P = .4), embolization to new territory (15.9% vs 13.1%, P = .4), and 90-day mortality (21.6% vs 27.1%, P = .3). Using a 10% noninferiority margin, LB aspiration catheters met the prespecified noninferiority criterion compared with SLB aspiration catheters for successful recanalization and FPE. Our findings remained consistent in the subgroup restricted to internal carotid artery and M1 occlusions. CONCLUSION:The use of SLB aspiration catheters showed comparable safety and efficacy with standard LB catheters for mechanical thrombectomy in AIS.
