Background: Non-invasive direct current stimulation (DCS) of the brain induces functional plasticity in vitro and facilitates motor learning across species. The effect of DCS on structural synaptic plasticity is currently unknown. Objective: This study addresses the effects and the underlying mechanisms of anodal DCS on structural plasticity and morphology of dendritic spines in the sensorimotor cortex (M1/S1). Methods: A DCS electrode setup was combined with a chronic cranial window over M1/S1 in transgenic Thy1-GFP mice, to allow for in vivo 2-photon microscopy and simultaneous DCS. Contralateral electrical forepaw stimulation (eFS) was used to mimic the second synapse specific input, a previously shown requirement to induce functional plasticity by DCS. Changes in spine density and spine morphology were compared between DCS/eFS and sham, as well as two control conditions (sham-DCS/eFS, DCS/sham-eFS). Furthermore, the role of BDNF for stimulation-induced changes in spine density was assessed in heterozygous Thy1-GFP x BDNFþ/-mice. Results: Combined DCS/eFS rapidly increased spine density during stimulation and changes outlasted the intervention for 24 h. This effect was due to increased survival of original spines and a preferential formation of new spines after intervention. The latter were morphologically characterized by larger head sizes. The DCS-induced spine density increase was absent in mice with reduced BDNF expression. Conclusion: Previous findings of DCS-induced functional synaptic plasticity can be extended to structural plasticity in M1/S1 that similarly depends on a second synaptic input (eFS) and requires physiological BDNF expression. These findings show considerable parallels to motor learning-induced M1 spine dynamics.

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2–3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period.Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the “door-to-needle” time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire.Interventions: We are applying a multi-level intervention in cooperation with three “STREAM multipliers” from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2–3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings.Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251.

Background The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care. Methods The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre‐ and post‐interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct‐to‐center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke‐specific in situ simulation training. Primary outcome measure was the ‘door‐to‐needle’ time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre‐existing treatment algorithm. Results The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre‐intervention (interquartile range [IQR] 25–43 min) to 33 min (IQR 23–39 min, p = 0.03) post‐intervention achieved by simulation‐experienced stroke teams. Concerning EVT, we found significantly shorter door‐to‐groin times in patients who were treated by teams with simulation experience as compared to simulation‐naive teams in the post‐interventional phase (−21 min, simulation‐naive: 95 min, IQR 69–111 vs. simulation‐experienced: 74 min, IQR 51–92, p = 0.04). Conclusion An intervention combining workflow refinement and simulation‐based stroke team training has the potential to improve process times in acute stroke care.