Workflow optimization in vertebrobasilar occlusion.

OBJECTIVE: In vertebrobasilar occlusion, rapid recanalization is the only substantial means to improve the prognosis. We introduced a standard operating procedure (SOP) for interventional therapy to analyze the effects on interdisciplinary time management. METHODS: Intrahospital time periods between hospital admission and neuroradiological intervention were retrospectively analyzed, together with the patients' outcome, before (n=18) and after (n=20) implementation of the SOP. RESULTS: After implementation of the SOP, we observed statistically significant improvement of postinterventional patient neurological status (p=0.017). In addition, we found a decrease of 5:33 h for the mean time period from hospital admission until neuroradiological intervention. The recanalization rate increased from 72.2% to 80% after implementation of the SOP. CONCLUSION: Our results underscore the relevance of SOP implementation and analysis of time management for clinical workflow optimization. Both may trigger awareness for the need of efficient interdisciplinary time management. This could be an explanation for the decreased time periods and improved postinterventional patient status after SOP implementation.

Activation of working memory in patients at the earliest stage of multiple sclerosis--an fMRI study.

OBJECTIVE: Previous fMRI studies on activation of working memory in multiple sclerosis (MS) patients presented heterogeneous results. Patients were reported to have altered brain activation patterns either in typical working memory circuits or in other brain regions even if they did not have any cognitive impairment according to the test batteries. We hypothesized that brain activation patterns in patients at a very early stage of the disease at very low EDSS-Score would not differ from healthy subjects. METHODS: We examined 13 patients at an early stage of MS matched with 13 healthy controls with a detailed psychometric test battery and an fMRI working memory paradigm. RESULTS: Patients and healthy controls did not differ in psychometric test batteries. In both groups those cortex areas typically involved in working memory processes like dorso-lateral prefrontal (DLPFC), ventro-lateral-prefrontal (VLPFC), fronto-medial and parietal cortex areas (Brodmann 6, 7, 8, 9, 10, 32, 40, 45, 46, 47) were equally activated. CONCLUSION: In contrast to former studies we found no differences in activation patterns in the fMRI scanning measuring working memory tasks between psychometrically tested homogenous groups of patients in early stages of MS and control subjects.