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Background: The medical research community widely endorses the importance of ensuring that research outputs are relevant and accessible to knowledge users, as well as the value of engaging the latter in the conduct of research to achieve these goals. However, it appears these principles are reflected in actual medical research practices to a limited extent. To better understand this dissonance, we conducted a qualitative investigation into the perspectives of key stakeholders on bridging the knowledge-to-action gap and patient and public engagement. Methods: The Priorities and Expectations of Researchers, Donors, Patients and the Public Regarding the Funding and Conduct of Medical Research (PERSPECT) qualitative study involved in-depth, semi-structured interviews with representatives of four stakeholder groups. Among other topics, participants were asked to discuss issues related to moving medical research knowledge into action (knowledge translation), including patient and public engagement during the research journey as a prerequisite to the success of this process. We analysed collected data employing an interpretative grounded theory approach. Data collection was ended once thematic saturation had been attained. Results: A total of 41 interviews were completed and analysed (with 10 patients, 10 members of the general public, 11 researchers and 10 funders). Many participants expressed a belief in the importance of engaging patients in the research process, as well as ensuring that study findings reach beyond academic communities. However, multiple challenges and barriers were identified to implementing these values in practice, including: researchers having limited knowledge and tools to foster partnerships with community members; research outputs being inaccessible to the wider public; and the public having insufficient capacity – in view of the required time, effort and knowledge – to assimilate findings and contribute to ongoing research. Cumulatively, interviews indicated a continuing disconnect between research and lay communities, where each stakeholder group holds some responsibility for improving the current paradigm. Conclusions: Existing gaps in communication, knowledge and relevant competencies are fuelling a disconnect between research and lay communities. Successfully moving research knowledge into action requires joint efforts of multiple stakeholder groups with support from external resources to ensure necessary training, expertise and credible dissemination platforms. [ABSTRACT FROM AUTHOR]

Background Incomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. Methods Patients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b) were compared with those with complete or near-complete reperfusion (eTICI 2c-3) on the final angiography run. Final runs were assessed for (a) an MT-accessible occlusion, or (b) a non-MT-accessible occlusion pattern. The primary clinical outcome was modified Rankin Scale (mRS) 0--2 at 90 days. Our imaging outcome was infarction in IR territory on follow-up imaging. Unadjusted and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI) were obtained. Results Of 1105 patients, 443 (40.1%) with IR and 506 (46.1%) with complete or near-complete reperfusion were included. An MT-accessible occlusion was identified in 147/443 patients (33.2%) and a non-MT-accessible occlusion in 296/443 (66.8%). As compared with patients with near-complete/complete reperfusion, patients with IR had significantly lower chances of achieving mRS 0--2 at 90 days (aIRR 0.82, 95% CI 0.74 to 0.91). Rates of mRS 0--2 were lower in the MT-accessible occlusion group as compared with the non-MT-accessible occlusion pattern group (aIRR 0.71, 95% CI 0.60 to 0.83, and aIRR 0.89, 95% CI 0.81 to 0.98, respectively). More patients with MT-accessible occlusion patterns developed infarcts in the non-reperfused territory as compared with patients with non-MT occlusion patterns (68.7% vs 46.3%). Conclusion IR was associated with worse clinical outcomes than near-complete/complete reperfusion. Two-thirds of our patients with IR had non-MT-accessible occlusion patterns which were associated with better clinical and imaging outcomes compared with those with MT-accessible occlusion patterns. [ABSTRACT FROM AUTHOR]

Background & Purpose: Neurovascular research is underfunded, imposing substantial challenges on clinical researchers in the field of neurovascular diseases. We explored what physicians perceive to be the greatest challenges with regard to neurovascular research funding, and how they think the funding crisis in neurovascular research could be overcome. Methods: We performed an international, multi-disciplinary survey among physicians involved in the medical care of patients with neurovascular diseases. After providing their demographic data, physicians were asked closed-ended questions on their personal opinion regarding challenges in neurovascular research funding, and how these challenges could be overcome. Physicians also described in their own words what they perceived to be the biggest challenges in obtaining funding. Data were analyzed using descriptive statistics and response clustering. Results: Of 233 participating physicians (70.4% male,82.8% senior staff) from 48 countries, 217(97.4%) perceived the discrepancy between required and available funding to be a problem;172(73.8%) considered it a major problem. High competitiveness (61/118 available free text responses[51.7%]), time-consuming application processes (28/118[23.7%]) and administrative requirements (25/118[21.1%]) were identified as key obstacles. Traditional big funding agencies were perceived to be most capable of closing the neurovascular research funding gap, followed by specialty-specific organizations and industry, while philanthropy and crowdfunding were perceived to be less important. Conclusion: The gap between required and available funding was perceived to be a major problem in neurovascular research, with high competitiveness, time-consuming funding processes and excessive administrative requirements being the key obstacles to obtaining funding. Traditional funding agencies were perceived to be most capable of closing this funding gap. [ABSTRACT FROM AUTHOR]

Introduction: The optimal anaesthesia approach for endovascular treatment (EVT) in acute ischaemic stroke is currently unknown. In stroke due to medium vessel occlusions (MeVO), the occluded vessels are particularly small and more difficult to access, especially in restless or uncooperative patients. In these patients, general anaesthesia (GA) may be preferred by physicians to prevent complications due to patient movement. We investigated physicians' approaches to anaesthesia during EVT for MeVO stroke. Methods: In a worldwide, case-based, online survey, physicians' preferred anaesthesia approach during EVT for MeVO stroke was categorized as "initial GA", "initial GA if necessary" (depending on patient cooperation), "no initial GA, but conversion if necessary" (start with local anaesthesia or conscious sedation), and "no GA". Preferred anaesthesia approaches were reported overall and stratified by physician and patient characteristics. Results: A total of 366 survey participants provided 1464 responses to 4 primary MeVO EVT case-scenarios. One-third of responses (489/1464 [33%]) favoured no initial GA, but conversion if necessary. Both initial GA and initial GA if necessary were preferred in 368/1464 (25%) of responses respectively. No GA was favoured in 244/1464 (17%). Occlusion location, respondent specialization (interventional neuroradiology), higher age, and female respondent sex were significantly associated with GA preference. GA was more often used in Europe than in other parts of the world (p < 0.001). Conclusions: Anaesthesia approaches in MeVO EVT vary across world regions and patient and physician factors. Most physicians in this survey preferred to start with local anaesthesia or conscious sedation and convert to GA if necessary. [ABSTRACT FROM AUTHOR]

Aims  Intrinsic sex differences in fundamental blood attributes have long been hypothesized to contribute to the gap in cardiorespiratory fitness between men and women. This study experimentally assessed the role of blood volume and oxygen (O2) carrying capacity on sex differences in cardiac function and aerobic power. Methods and results  Healthy women and men (n  =   60) throughout the mature adult lifespan (42–88 yr) were matched by age and physical activity levels. Transthoracic echocardiography, central blood pressure, and O2 uptake were assessed throughout incremental exercise (cycle ergometry). Main outcomes such as left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (Q), and peak O2 uptake (VO2peak), as well as blood volume (BV) were determined with established methods. Measurements were repeated in men following blood withdrawal and O2 carrying capacity reduction matching women's levels. Prior to blood normalization, BV and O2 carrying capacity were markedly reduced in women compared with men (P  <   0.001). Blood normalization resulted in a precise match of BV (82.36 ± 9.83 vs. 82.34 ± 7.70 ml·kg−1, P  =   0.993) and O2 carrying capacity (12.0 ± 0.6 vs. 12.0 ± 0.7 g·dl−1, P  =   0.562) between women and men. Body size-adjusted cardiac filling and output (LVEDV, SV, Q) during exercise as well as VO2peak (30.8 ± 7.5 vs. 35.6 ± 8.7 ml·min−1·kg−1, P  <   0.001) were lower in women compared with men prior to blood normalization. VO2peak did not differ between women and men after blood normalization (30.8 ± 7.5 vs. 29.7 ± 7.4 ml·min−1·kg−1, P  =   0.551). Conclusions  Sex differences in cardiorespiratory fitness are abolished when blood attributes determining O2 delivery are experimentally matched between adult women and men. [ABSTRACT FROM AUTHOR]

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Background: Ideally, medical research provides crucial data about disease processes, diagnoses, prognoses, treatment targets and outcomes, and systems of care. However, medical research is costly, and funding is difficult to receive because the processes are highly competitive. There is a paucity of data on the perspectives of researchers, funders, patients and the public about current funding paradigms. This study sought to understand the priorities and opinions of each group to better guide meaningful innovation in research funding processes., Method: In this Priorities & Expectations of Researchers, Funders, Patients and the Public Regarding the Funding & Conduct of Stroke Research study, we conducted in-depth interviews with medical researchers, funders, patients and members of the general public to learn their opinions of the current funding process and thoughts about alternative approaches. We used both purposive and snowball sampling to recruit participants and conducted semistructured interviews. The study ended when thematic saturation was attained. Qualitative analysis followed inductive grounded theory methodology., Results: 41 interviews were completed (11 researchers, 10 funders, 10 patients, 10 members of the general public; 61% female). Interviewees expressed a high interest in supporting a comprehensive evaluation of the research grant funding process while integrating funding mechanisms that are more inclusive and reduce bias in topic selection and researchers who receive funds. Participants acknowledged a gap in patient and public involvement in setting a research agenda, choosing topics to be studied and focusing on specific outcomes. Crowdfunding was identified as an alternative strategy that could facilitate research democratisation; however, participants emphasised the importance of expert review of research proposals, as in current processes to continue to support rigour and trust in research proposal quality., Conclusion: Our research revealed stakeholder concerns about the transparency and equity of current research funding paradigms. Suggestions to democratize research and explore alternative fundraising platforms necessitate a fundamental shift in traditional research funding processes., Competing Interests: Competing interests: A. Ganesh reports membership in the editorial boards of Neurology, Stroke, and Neurology: Clinical Practice; consulting fees from Atheneum, MD Analytics, Figure 1, Alexion, Biogen, Servier Canada, MyMedicalPanel, and CTC Communications Corp; research support from the Canadian Institutes of Health Research, Alberta Innovates, Brain Canada, Canadian Cardiovascular Society, Campus Alberta Neuroscience, the Heart and Stroke Foundation of Canada, the Government of Canada INOVAIT program and New Frontiers in Research Fund, the France-Canada Research Fund; stock/stock options from SnapDx and Let’s Get Proof . (Collavidence Inc.); and has a patent application (US 17/317771) for a system for remote patient monitoring and cuff-based therapies. G. Mayank is the founder of Let’s Get Proof. J, Fladt and R. McDonough have shares in Let’s Get Proof. N. Cristall, B. A. Drozdowska, J. Tanaporn, and A. Sehgal, have no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Hemorrhagic transformation can occur as a complication of endovascular treatment for acute ischemic stroke. This study aimed to determine whether ischemia depth as measured by admission CTP metrics can predict the development of hemorrhagic transformation at 24 hours., Materials and Methods: Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes., Results: Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02-1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06-1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction., Conclusions: Larger "core" volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications., (© 2024 by American Journal of Neuroradiology.)