Getting evidence into practice

The EAN 2022 meeting’s overarching theme was ‘Getting evidence into practice’. A range of workshops and symposia addressed this subject, including the plenary symposium ‘Improving lives and reducing burden: What evidence do we need to implement?’. Discussed was the need to speed up the process of implementing results from clinical trials into the practice. Neurologists themselves can play a part in this, as well as incorporating implementation science in training programmes. Also discussed was the EAN Campus, an e-learning platform meant to cover the full curriculum of the European Training Requirements in Neurology (ETRN) by 2026.

The plenary symposium moderated by Prof. Maurizio Leone (Casa Sollievo della Sofferenza, Italy) included lectures on how implementing evidence can improve lives and reduce disease burden [1].

The symposium first addressed the question if neurology trials inform everyday clinical practice well enough. Prof. Carl Clarke (University of Birmingham, UK) argued that there are often significant delays in the implementation of trial results, such as in the field of Stroke [2]. Risk factor management in TIA patients can reduce the risk of future events by 80%. This can and should be accomplished by the following 7 interventions: brain and carotid imaging, neurology consultation, anti-hypertensive treatment, anticoagulants for atrial fibrillation, anti-thrombotic medication, and statins. A recent American study showed that only a third (34.3%) of patients actually received these interventions without fail after a TIA [3].

Epilepsy care is another example where quality-of-care measures are not sufficiently adhered to in clinical practice, as Prof. Clarke illustrated by means of some of the quality-of-care measures from the American Academy of Neurology (AAN):

• Intractable epilepsy referrals to a major centre: 48%
• Annual reproductive counselling for women of child-bearing age: 46%
• Anxiety and depression screening: 55%
• Risk advice on Sudden Unexpected Death in Epilepsy (SUDEP): 14%
• In children: timely IV-benzodiazepine in status: 33%

Another example is the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, which assessed barriers to good medical care for chronic migraine [4]. Of 1,254 included patients, only <5% with chronic migraine traversed the 3 barriers –medical consultation, accurate diagnosis, and minimal pharmacologic treatment– to receiving proper care.

Focusing on factors that neurologists themselves may influence, Prof. Clarke explained that neurologists could stimulate the application of trial results into clinical practice by serving on committees of regulatory authorities or of regional, national, and international guidelines. Also direct clinical involvement can help, such as building coalitions, setting up clinical implementation groups, conducting local needs assessments, changing the infrastructure/finance, and implementing and monitoring change.

Furthermore, Prof. Clarke highlighted the importance of promoting the implementation of science in training programmes of neurologists, in order to improve the quality and effectiveness of health services. Implementation trials expand on explanatory and pragmatic clinical trials and focus on patients, providers, purchasers, organisation, and policy. Implementation trials can be designed as:

• Two-arm, parallel-design randomised trials;
• Multi-arm, randomised trials, for example testing 2 implementation strategies;
• Stepped-wedge cluster, randomised trials, in which clusters are sequentially randomised;
• Sequential trials with an adaptive design, in which the implementation strategy is modified at several stages according to pre-specified decision rules. Participants are re-randomised at each stage.

The outcome measures of implementation trials are very different from those of explanatory and pragmatic trials. Outcome measures can be acceptance, adoption, appropriateness, feasibility, fidelity, implementation costs, penetration, and sustainability.

The EAN Campus

Next, the symposium addressed how the general neurologist can select what is important and relevant from the avalanche of available information in an increasingly complex era. Prof. Barbara Tettenborn (Cantonal Hospital St. Gallen, Switzerland) identified the main advantages as well as limitations of e-learning in neurology [5]. Though easily available and accessible, it often presents an abundance of information, which is not peer-reviewed.

After a survey, conducted by EAN in 2020, showed that most responders used online learning materials, the EAN decided to develop a new e-learning platform, the EAN Campus. This initiative officially launched at the EAN 2022 meeting and is now freely available for all EAN members at https://eancampus.ean.org. The EAN Campus is already a fully-fledged interactive Learning Management System, with over 1,000 pieces of content. All 29 EAN topics (subspecialties) are represented on the platform on 3 levels of expertise: basic, advanced, and expert. Basic content is aimed at students and new neurological residents, advanced content is aimed at experienced residents and general neurologists, and expert content at specialists in specific topics.

Content is constantly added, after having been reviewed by experts and double-checked by editorial boards and panels. The goal of the EAN Campus is to cover the full curriculum of the European Training Requirements in Neurology (ETRN) by 2026 (basic and advanced levels). The content on the expert level is already maintained on a continuing basis to keep it up-to-date. Content varies from recordings of congress presentations, webcasts, and virtual master classes, to highly interactive case studies and lectures. Furthermore, short audio talks with 2 hosts and an additional expert on a specific topic (EAN Cast: Weekly Neurology) have been recently launched.

Prof. Tettenborn concluded: “We are very grateful for cooperation regarding new content, especially interactive modules.”

1. Leone MA (chair). Improving lives and reducing burden: What evidence do we need to implement? PLEN03, EAN 2022, 25‒28 April, Vienna, Austria.
2. Clarke CE. ‘Do neurology trials inform everyday clinical practice? If not, why not and what should be done to make sure that they do?’ PLEN03, EAN 2022, 25‒28 April, Vienna, Austria.
3. Damush TM, et al. J Gen Intern Med. 2021;36(2):322–32.
4. Dodick DW, et al. Headache. 2016;56(5):821–834.
5. Tettenborn B. How does the general neurologist find what is important and relevant in an era of information overload and increasing complexity? PLEN03, EAN 2022, 25‒28 April, Vienna, Austria.

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Posted on 22 August, 2022