My Department-to-Department visit has a long history. After getting the award in 2021, my visit was postponed until 2023 due to the COVID-19 pandemic. At last, I was able to visit the Royal Infirmary in Edinburgh, Scotland, in June 2023.

During my stay, I had the opportunity to visit a centre of excellence for the care of stroke and particularly intracerebral haemorrhage. I was able to participate in all the activities of this centre and see its integration across clinics, the ward, and the University.

The centre opened me its doors and I could participate in the clinical case discussions, see the management of routine and urgencies during the stroke outreach run in the morning. During the afternoon, I had the opportunity to take part in the TIA clinics and interdisciplinary meetings with all the professional profiles involved in stroke care, as well as in the research meetings and one of the M&M meetings. I got very useful experiences for my professional growth, especially in team building, planning research, and running clinics. I knew all the great healthcare workers of the Unit with their diverse roles and styles.

I had the opportunity to see a really different way of taking care of stroke, very focused on clinics and outpatient research and less hospital-centred than the system in which I usually work.

The city welcomed me with lovely sunny days which I would not have expected from Scotland. I took my time to get around and admire the beautiful landscapes of Edinburgh and its surroundings.

I would like to thank Professor Rustam Al-Shahi Salman and all his clinical, administrative, and research team for their warm welcome. I really felt at home.

I am grateful for the support given by ESO within the Department-to-Department Visit Programme. I took back at home a refreshing experience, an opportunity for networking, and a load of suggestions to bring back home. I warmly recommend participating in such an activity to every young physician interested in stroke.

A Unique Learning Opportunity in the Stroke Department at Mater Misericordiae University Hospital

Hospital

I am delighted to share the successful completion of my participation in the Stroke Department at Mater Hospital from December 4^th to December 15^th 2023, made possible through the prestigious bursary awarded by the European Stroke Organisation (ESO). Under the expert supervision of Prof. Peter Kelly, this experience has been a transformative chapter in my specialty education.

Background:

The ESO’s commitment to advancing stroke research and care was evident in their support of junior medical professionals like myself. This bursary provided hands-on learning experiences in stroke subfields care.

Supervision by Prof. Peter Kelly:

Being under the guidance of Prof. Peter Kelly, a distinguished expert in the field of stroke medicine, significantly enhanced my learning experience and broadened my perspective on stroke care.

Clinical Exposure:

During my tenure at Mater Hospital, I had the privilege of immersing myself in the High Acuity Stroke Unit (HASU) and actively participating in FAST (Face, Arm, Speech, Time) calls. These experiences allowed me to witness the urgency and precision required in stroke interventions, highlighting the critical role of timely and coordinated responses.

Collaboration with SLT Team and PES:

Additionally, I collaborated with the Speech and Language Therapy (SLT) team, gaining insights into communication and swallowing challenges faced by stroke patients. Furthermore, I observed Pharyngeal Electrical Stimulation (PES) interventions for neurogenic dysphagia, witnessing the innovative approaches employed in the rehabilitation process.

Vascular Lab Experience:

To broaden my understanding of stroke diagnostics, I visited the Vascular Lab to observe the protocol for carotid studies ultrasound. This experience provided a firsthand look at the intricate procedures involved in assessing vascular health, contributing to my appreciation of the comprehensive approach to stroke care.

Guidance from Consultants:

Dr. Marnane and Dr. McCabe, prominent consultants in the Stroke Department, played a pivotal role in my learning journey in the morning clinical ward rounds. I spent significant time with them, gaining valuable insights into the latest trials and advancements in stroke medicine. Their mentorship enriched my understanding of the dynamic landscape of stroke research and clinical practice.

Clinical Observations:

In addition to my experiences in the High Acuity Stroke Unit and specialized interventions, I attended Transient Ischemic Attack (TIA) clinics, providing insights into the early stages of cerebrovascular events. Furthermore, I actively participated in two Multi-Disciplinary Team (MDT) meetings on Stroke imaging and Neurocardiology case-based discussions and a stroke clinic at the Dublin Neurological Institute, affording me a holistic view of patient management and care coordination.

Impressions of Stroke Nurses:

I was particularly impressed by the dedication and expertise of the stroke nurses, whose commitment to patient care was evident in their daily responsibilities. Their collaborative approach and compassionate care contributed significantly to the overall positive outcomes for stroke patients.

Regret about STROKE Team Party:

While immersed in the demanding and enriching environment, I regretted not having the opportunity to attend the STROKE team party. The camaraderie and celebration of shared accomplishments are vital aspects of fostering a supportive and cohesive healthcare team.

Desire to Implement Learning:

Looking ahead, I am enthusiastic about implementing the knowledge and skills acquired during this enriching experience in my future medical practice. I am committed to applying the best practices learned at Mater Misericordiae Hospital, contributing to the enhancement of stroke care in my hospital and beyond.

Anticipated Learning Outcomes:

My objective during this observation period was to gain a comprehensive understanding of the intricacies of a HASU, treatment particularities in different clinical scenarios and novel trials. I am eager to contribute to and learn from the collaborative efforts of medical professionals, nurses, therapists, and support staff in providing holistic care to stroke patients.

Conclusion:

I extend my heartfelt gratitude to the ESO for providing this invaluable opportunity, which aligned seamlessly with my career aspirations. My time in the Mater Misericordiae Hospital Stroke Department has been a cornerstone in my medical journey, and I look forward to sharing these experiences and contributing to the advancement of stroke care in my professional endeavors.

Within ESO TF4UKR D2D visit program I had a great chance to visit Stroke Unit of Hospital Vall d’Hebron in Barcelona,  at a kind invitation of PhD Dr.med. Marc Ribo, interventional neurologist, one of the main stroke researchers and really open-minded man.

With a great pleasure I had the unique opportunity to observe different aspects of one of the best Stroke Units. My direct interest was the organization of the process of stroke care, but the experience I gained turned out to be much broader. During this time, I had the opportunity to be part of the stroke team that admits the patient in the emergency department and completes the patient’s route in the hospital, performing neuroimaging, thrombectomy and discussing clinical cases. All the staff in the department was very kind and glad to share their experience, told about their work routine and answered my questions.

I met so friendly and warm-hearted people, I felt myself like a part of something really big. There are so many research activities and because of that you feel so free in decision-making, this process seems simple and obvious when performed by a team of professionals.

There are a lot of staff –  doctors -neurologists, their work is divided on emergency, the ward work, follow up and neurologists which perform ultrasound investigations, nurses, and other specialists work here to ensure high quality care for patients. Nurses’ work is extremely important, because their assistance is a key point in providing care. And I really hope that something like D2D will be available for nurses in the nearest future.

For several days I also worked with neurologist and neuroradiologist on call. After the ambulance call, the neurologist on duty informs all the staff about the expected patient through the mobile app. It gives us opportunity to see important information about the patient, with neuroimaging and it helps us to make a decision about IV-tPa treatment or thrombectomy.  And I could see the clinical result of our clinical decision during morning examinations. I want to say, that professionalism and working atmosphere created in the stroke center is something the hospital can be proud of.

One of the days I saw the presentation of new paradigm in acute stroke care – One step Ictus, in-hospital route was changed, it was really interesting, it is the best way to have the better in-hospital metrics and as a result-better functional outcome.

Additionally, staying in Barcelona, I had a chance to visit some activities during celebration of Merce, I can say that culture, people and architecture are so nice and beautiful and it is really an obvious benefit in an observership program.

That observership helps to make stroke care better not only in our hospital but in other hospitals of Ukraine. After that 2 weeks I have some ideas which I want to realize in the nearest future. Thanks to ESO TF4UKR D2D visit program, all staff of Stroke Unit of Hospital Vall d’Hebron and PhD Dr.med. Marc Ribo for this great opportunity.

Sincerely, Thanks from Ukraine Dmytro Hrynykha, MD

After several postponements caused by the pandemic, I was finally able to visit the highly recognized Inselspital in Bern from 24^th January to 1^st February 2023.

During my stay, I had the opportunity to participate in the morning ward rounds at the stroke unit, observe the work in the emergency department as well as the diagnostic work-up and treatment in a large hospital primary based on acute MRI imaging. My visit provided me with insight into a well-organized stroke unit in another European country, but also confirmed that we are doing most things in the same way in Switzerland and Norway. However, one thing is for sure – no stroke unit can beat the panoramic view of the Alps seen from the Inselspital.

The Bern stroke research group holds a strong reputation and we had plenty of time to discuss our on-going and to plan new projects. It was a pleasure to interact and discuss with so many people who are dedicated towards improving stroke diagnostics and treatment through high quality research.

In addition to the Department visit, I had the great pleasure of being invited to the annual 25^th meeting of the Swiss Stroke Society in Neuchâtel. The meeting was very well attended and covered new scientific developments and controversies in the field of stroke. Furthermore, young researchers were given the opportunity to present their research as oral or poster presentations. PhD student Bernard M. Siepen held a very nice talk about one of our Swiss-Norwegian collaborations.

The last two days of my visit in Bern coincided with the 10^th ESO-ESMINT-ESNR Stroke Winter School where I was able to participate as a guest on several interesting talks in addition to the daily routine at the stroke unit.

I would like to thank dr. Thomas Meinel and professor David Seiffge for their warm welcome at their hospital and for showing me around in the city of Bern and Switzerland. In addition, I would like to thank professor Urs Fischer for initially accepting me for a potential Department to Department visit to Bern back in 2019, and professor Marcel Arnold for making this possible in 2023. I am also grateful for the support of the ESO which gave me this opportunity. I have been so lucky that I have attended the ESO Stroke Summer School, ESO-ESMINT-ESNR Stroke Winter School and the ESO Edinburgh Stroke Research Workshop during the years and I will strongly encourage all younger stroke physicians to apply to these unique educational and networking activities.

In October 2023, I had a great chance from ESO Department to Department Visit Programme to spend one month in the Stroke Unit in Neurology Clinic of University Hospital of Innsbruck under the supervision of Prof. Michael Knoflach.

Every morning I had an opportunity to attend a morning conference where doctors, residents and students from different neurological departments were present and the condition of patients admitted during the night shift was discussed. Twice a week we could listen to young doctors sharing their research results or curious medical cases, which was followed by an interesting discussion.

During my visit, I spent most of the time in the acute stroke care unit which provides specialized services for people with new suspected stroke. Prof. Priv. Doz. Dr. Gregor Brössner and Dr. Wolfgang Nachbauer would lead morning rounds in the ward. Despite the busy and stressful environment, they were keen to explain everything to me and answer all my questions. Dr. Christian Böhme and Dr. Federico Carbone were kind and considerate, trying to make my stay in the clinic informative and diverse.

I also had an opportunity to spend some time at the Emergency Department, which is the first point of contact with the doctors for patients with neurological problems as well as suspected
cerebrovascular events. I had a chance take part in the management of acute stroke, where patients received thrombolysis and were transferred for thrombectomy. The process was very well organized and everyone was aware of their tasks.

First time I visited Innsbruck as a tourist in 2016. The city left a great impression on me. I was
amazed by the beauty of the mountains and always wanted to come back. A month spent in
Innsbruck introduced me to the Austrian culture. I attended the Austrian National Day on October 26 and really fell in love with Tyrol and especially the beautiful Innsbruck nestled in the Alps.

I should definitely mention that there is a beautiful atmosphere between residents, doctors, students and nurses in the hospital. They make a strong team with knowledge and experience of fighting against stroke.

Upon returning home, I shared the knowledge gained in Austria with my colleagues.

I will be forever grateful for this opportunity that ESO and Prof. Michael Knoflach gave me. It
was a really important step forward for my neurological career.

This is more of a thank you letter than a report. This year, I had the incredible privilege of being one of the ESO D2D awardees, and I was part of the stroke route at UCL in London, under the supervision of Prof. David Werring, at the beginning of September.

First and foremost, I would like to thank Prof. David Werring for organizing my entire stay. I was able to visit the Hyperacute and Emergency Stroke Unit, the Acute Stroke Unit, several clinics (stroke, TIA, ICH, and SVD clinics), the Stroke Research Centre, and attend multidisciplinary presentations and the Gowers Round Lecture. I felt like I was visiting a wonderful stroke and neurology sanctuary, for which I am thankful.

Secondly, I met a lot of wonderful people during my stay. I am grateful to them for being a part of my journey. Dr. Larysa Panteleienko was exceedingly gracious in introducing me to the Stroke Research Centre and its team. She was warm and welcoming, and she filled my schedule with activities related to stroke and other neurological disorders. The entire team at the Stroke Research Centre was amazing, and they were eager to show me and explain their findings. They were also a lot of fun, and lunch with them was full of laughs.

I would also like to thank the clinical trials team, who not only let me view the entire process of including and excluding participants in their research, but who were also always nice to me and greeted me with a big smile on their faces.

The clinical experience was no different. I had the opportunity to meet with some stroke consultants who discussed all my questions and included me in clinical matters. I am grateful to Dr. Arup Sen, Dr. Maneesh Bhargava, and Dr. Arvind Chandratheva for making my hospital stay so enjoyable.

Furthermore, all of the registrars there were really nice to me and provided me with a fantastic perspective on working in the NHS as a young physician. Despite the differences between our countries, this entire experience made me believe that we are all extremely similar and have similar interests when it comes to treating our patients.

I was quite nervous on my first day, but everyone took care of me, and I must say that I miss these people and can’t wait to see them again one day.

Finally, there is a significant difference in stroke care between Romania and the United Kingdom. It is a fantastic opportunity for a young physician to watch protocols and paths that result in a positive outcome, and I am grateful to ESO for making this accessible. It was an eye-opening experience, and I encourage anyone who is interested in stroke to apply for the award. It is appropriate for those interested in clinical aspects as well as those engaged in research. And I am confident that this type of experience will inspire excellent ideas in the future of stroke care.

I would like to express my profound gratitude to the European Stroke Organisation and the Neurology Department at Skane University Hospital, with special thanks to my host, Prof. Christine Kremer, for the invaluable opportunity provided through the Department-to-Department Visit Programme in September 2023.

Joining the Neurovascular and Acute Neurology team offered a comprehensive insight into acute stroke management and neurology care. A pivotal aspect of my visit was learning and taking part in acute stroke protocols, notably “code stroke,” which encompassed the patient’s journey from arrival through the decision-making process, coordination, and transfer system. This experience underscored the criticality of establishing organized, clear protocols and fostering seamless communication among medical teams to ensure expedient and thorough patient treatment. My focus also extended to the neurological intermediate care (Neuro-Observation) unit, where I engaged in morning rounds and learned about the operational processes of a multidisciplinary team and various aspects of acute stroke patient treatment.

Another focus for my visit was Neurosonology, under the dedicated mentorship of Prof. Kremer I joined the neurovascular outpatient service, including transcranial and extracranial Duplex sonography at follow-up, and ‘hands-on’ experience. I was also invited to participate in in a two-day Neurosonology course. This provided me with a comprehensive introduction to the field of Neurosonology, and it was truly a highlight for my final year as a Neurology resident.

As common research interest a research project is planned regarding sex differences in adherence to secondary prevention after stroke in men and women in diverse populations (Carmel Medical Center-Skåne University Hospital).

Throughout my stay, I was consistently impressed by the professionalism, organization, and warmth extended by every team member I encountered. This visit has not only enriched my knowledge and skills but also significantly influenced my future career trajectory. Eagerly, I anticipate integrating the vital elements of acute stroke care coordination and protocols into my home department and pursuing further training in Neurosonology.

As an early career physician, I am truly grateful for this unique experience and for the support of the European Stroke Organisation.

Adi Shemesh, MD

Neurology department

Carmel medical center, Haifa, Israel