D2D Visit Report – Dr. Anna Gardin

Do you feel lost in the world of stroke protocols, and are you looking for a guide? Are you interested in the research but don’t know how to do the first steps? Would you like to get in contact with a different culture from yours? The Department-to-Department Visiting Programme promoted by the European Stroke Organization is for you!

With these aims, I sent my application, and I had the great honour of being hosted for two weeks by Dr. Else Charlotte Sandset at the Oslo University Hospital. I can definitively say that she has been my lighthouse in the dark! Despite her vast and brilliant career, she is one of the most friendly and easy-going people I have ever met. She immediately made me feel welcome, arranging an amazing program for my stay according to my interests, and involving me in every activity of her team.

Morning meetings

On my first day, Dr Kristian Kraglund, one of Dr Sandset’s colleagues, picked me up at the Oslo University Hospital Ullevål, introduced me to the team and took me to the morning meeting, where seniors and juniors discussed admitted patients, all of them with a lovely cup of coffee/tea in their hands. Of course, the main spoken language is Norwegian, but after two weeks, I was able to catch the general meaning of the discussion, and everyone was open to answering my questions in English. Anyway, English talks have not been missing, thanks to the “International Friday”, an initiative involving foreign professors, milestones of the stroke community, who are invited to present the most cutting-edge topics of stroke care. In my case, I had the great opportunity to listen to Prof. Jens Fiehler from Germany talking about the management of patients with extended ischemic lesions (ASPECT < 6). And if you think of passively participating in these meetings, be prepared to change your mind! I was asked to give an update on stroke care in Italy: this pushed me to overcome the first embarrassment, and finally, it was a great occasion to test my ability to talk in front of an audience.

Ultrasound service

Because I am particularly interested in ultrasound, I followed Dr. Lars Alteheld and Dr. Kristine Stø during their activities. They shared with me all their knowledge about ultrasound techniques. But first of all, a tricky question: which position do you think is the most useful for ultrasonographers to perform examinations? Behind the patients’ heads or by their sides? Experiencing both of them, now I am on the fence. In addition to routine carotid and intracranial ultrasound for stroke patients, Drs Alteheld and Stø use intracranial ultrasound to monitor children with sickle cell anaemia, assessing their annual stroke risk.

Rehabilitation Clinic

During my visit to Aker Hospital, I had the great pleasure of meeting Dr. Georgios Vlachos. He explained to me how the Rehabilitation Clinic usually works and shared with me his experience as a Greek physician working in Norway. All his suggestions have been precious, as well as his Ph.D. thesis that he gave me as a present: I have loved the relationship that we have built so quickly! For a couple of days, I joined the occupational therapist during his work: this kind of professional is not usually involved in the rehabilitation program of our centre, therefore it has been a completely new experience for me. I gradually gained the awareness that occupational therapy carries a relevant role in the patient’s rehabilitation, and it should not be left off.

Rikshospitalet

Prof. Mona Skjelland guided me through the Stroke Unit at Rikshospitalet, and the morning activity started with an interesting case: a young woman who recently had a major surgery (repairment of atrial septum defect) presented with an M2 occlusion. She directly underwent a thrombectomy, but after recanalisation, she developed an important vasospasm. After several attempts with intraarterial drug injections, interventional radiologists opted for stenting both M2 branches. There has been excellent teamwork between radiologists, anesthesiologists, neurologists and thorax surgeons, all present in the operating theatre and ready to support each other with their different competencies.

Research activities

But what about research? Dr. Sandset’s team is actively involved in several research projects, covering a huge range of topics. One of their piece of resistance is the pre-hospital assessment of stroke patients, thanks to the work and dedication of Dr. Maren Ranhoff Hov, who strives to improve paramedics’ knowledge about stroke and mimics. All staff members periodically question themselves about their work, also consulting external evaluators, like Prof Heinrich Audebert from Charité University (Berlin), who was present during my visit. He participated in the research team meeting and gave inspiring tips to all of them about their projects. The day concluded with a delicious dinner altogether, and on that occasion, Prof Audebert delighted us with personal life stories (his one-year experience in Paraguay was completely unexpected!)

In conclusion, this has been one of the most inspiring experiences I’ve ever had. I would like to express my sincere thanks to Dr. Sandset and the European Stroke Organisation for supporting this incredible project which is the Department-to-Department Visit Program, and for making a dream come true!