This year, via the ESO newsletter, we are focusing the spotlight on prominent ESO members under 45. In January we introduced you to Georgios K. Tsivgoulis. For February, we learned more about Else Charlotte Sandset. This month we present Urs Fischer, ESO`s Secretary General.
- The past 20 years have revolutionised stroke medicine. If you look 20 years forward, what are the top three challenges in acute stroke medicine?
There are many challenges to be faced in the years to come. In my view, the three main challenges are as follows:
1) Implementation of current evidence
Within the past 20 years, randomised controlled trials have proven the efficacy of various secondary prevention strategies and acute stroke treatments. However, many of these achievements have not yet translated into clinical practice. We have recently surveyed stroke experts from 44 of 51 European countries on acute stroke treatment. The survey revealed major inequalities both in acute stroke treatment and prevention within Europe. Numbers and rates of acute stroke patients treated on stroke units and receiving intravenous thrombolysis or thrombectomy differ widely between countries. Another survey is currently assessing provision of secondary prevention services throughout Europe. Here too, preliminary results reveal major inequalities. Therefore, a tangible action plan with a clear road map for implementing and optimising acute stroke treatment and prevention throughout Europe is urgently needed. ESO is currently drawing up such an action plan.
2) Treatment of intracerebral haemorrhage
Prevention and treatment of intracerebral haemorrhage is another major challenge: although significant progress has made in the treatment of ischaemic stroke, measures to treat acute intracerebral haemorrhage are still scarce. Moreover, our pathophysiological understanding of the manifold causes of intracerebral haemorrhage and their prevention also needs special attention. Therefore, prevention and treatment of intracerebral haemorrhage should become one of the main priorities for stroke research over the coming years.
3) Individualised treatment approaches
Trials have shown the efficacy of interventions in well-defined populations. However, we are treating individuals. Further efforts should be made to establish more evidence for personalised treatment. As a clinician I would like to be able to identify the patients who are most likely to benefit from a specific intervention, especially if the number needed to treat of that intervention is high. Population based studies, randomised trials within cohorts, tailored randomised trials with stricter inclusion criteria and, eventually, advances in precision medicine should hopefully help to guide decisions on personalised treatment in the near future.
- What makes ESO so unique?
The European Stroke Organisation (ESO) is a relatively young and dynamic organisation. The spirit of ESO with its bottom-up approach is unique: members of ESO – independent of age, gender or geographical background – have the possibility to get involved in its educational, scientific and organisational activities. Many committees are led by enthusiastic people and I am not aware of any other medical organisation in Europe in which almost half of the members of the executive committee are younger than 45 years and where the future chair of the conference is even younger than 40! This provides a unique opportunity for young physicians to learn executive and organisational skills, mentored by experienced leaders. Further flagships of ESO are the newly established European Stroke Journal and the conference, which has become the biggest and most relevant stroke conference in Europe, focusing on science and education.
- What are the most important qualities that mentors for young stroke physicians and researchers should have?
In my personal career I was in the fortunate situation of being supported by several mentors – within my department and within ESO. Good mentors feel responsible for the success of their fellows and good mentors empower their mentees to develop their own strengths, beliefs and skills. I am very grateful for all the support I have received. This support has substantially contributed to my current situation. Now that I am trying to become a good mentor myself, I realise how difficult a task this is. Apart from qualities such as knowledge, expertise and skills, you need a lot of time – time to analyse, time to listen, time to discuss and time to build trust, for example. But as I have been fortunate with my own mentors I try to emulate them.
- How do you combine clinical and academic work, ESO activities and family?
To be successful in clinical and academic work you need strong teams, and I am in the lucky situation of having excellent partners and collaborators within the department, at the University and within ESO. Particularly when it comes to clinical trials you need a good team of research collaborators, trial managers, trial coordinators, research fellows, clinicians and friends, who support your enthusiasm for getting answers to the research questions. Furthermore, I try to be focused on whatever I am doing. ESO has a fantastic head office which offers excellent support in planning all ongoing activities. Last – and most importantly – my wife and my two daughters have been very supportive. But finding the right time balance between family, clinical and academic work is probably the biggest challenge.
Urs Fischer is Professor for Acute Neurology and Stroke at the University Hospital (Inselspital), Bern. He is chair of the Acute Neurological Inpatient Department, co-chair of the Stroke Center Bern, and Deputy Director of the Clinical Trial Unit (CTU) of the University of Bern.
Urs Fischer studied in Bern, London, San Francisco and Lomé and graduated in 2000. He trained as a neurologist in Bern. In 2009 he studied for a Master of Science by Research in Clinical Neurology at the University of Oxford. In 2015 he was elected as Professor for Acute Neurology and Stroke at the University of Bern (Extraordinarius).
Urs Fischer is a clinical researcher whose main research interests lie in the diagnosis, management, treatment and outcome of patients with acute neurological diseases, especially of patients with acute ischaemic and haemorrhagic stroke. He is co-principal investigator of the SWITCH study (www.switch-trial.ch), principal investigator of the ELAN trial (www.elan-trial.ch) and co-principal investigator of the SWIFT DIRECT trial (www.swift-direct.ch).
In 2015 he was elected as Secretary General of the European Stroke Organisation (ESO), he is a board member of the Swiss Neurological Society (SNG) and co-founder of the ESO ESMINT ESNR Stroke Winter School.