Empowering Stroke Research: Dr. Yasmin Aziz’s Journey with Nested Knowledge

Jeff Johnson

In the ever-evolving field of stroke research, new questions about different therapies, trial outcomes, and even metrics of procedural success are constantly emerging, meaning that systematic reviews are needed on a consistent basis to extract all information needed to inform both patient care and future research. In these projects, because of the major decisions that may result from the findings and because of how busy stroke physicians are, the efficiency and accuracy are paramount.

Recently, we sat down for a conversation with Dr. Yasmin Aziz, a practicing neurologist and Assistant Professor in the Neurology and Rehabilitation Medicine Department at the University of Cincinnati (UC) Gardner Neuroscience Institute. She shared her experience using Nested Knowledge to conduct two projects:

Asymptomatic Hemorrhage: A systematic literature review/meta-analysis examining asymptomatic intracerebral hemorrhage, an under-recognized safety event in stroke trials;
Trial Termination: An evidence synthesis project aimed at understanding some of the key factors that lead to clinical trials terminating prematurely.

Aziz and her team have made these reviews available to the physician and trialist communities, all while balancing her work as a full time physician. Her journey highlights not only significant findings in stroke treatment but also how innovative software can transform the research process. See below for a summary of As projects!

Project 1: Unveiling the Impact of Asymptomatic Intracerebral Hemorrhage after Thrombectomy

The Challenge

Endovascular thrombectomy (EVT) has revolutionized the treatment of acute ischemic stroke caused by large vessel occlusions. A key outcome that physicians track conventionally is symptomatic intracerebral hemorrhage (ICH), which can lead to patient morbidity and mortality. However, the occurrence of asymptomatic ICH post-procedure is both under-researched and under-reported in trials. Does this asymptomatic bleeding impact patient outcomes?

The Research

Dr. Aziz, along with her colleague Dr. Pablo Harker embarked on a systematic review and meta-analysis to explore this critical question. Utilizing Nested Knowledge, they sifted through a vast array of studies, focusing on those that reported on asymptomatic ICH after EVT.

Findings

The study revealed that asymptomatic ICH is not as benign as previously thought. Patients exhibiting this condition post-EVT showed worse functional outcomes and higher mortality rates—notably, patients with asymptomatic ICH had over double the odds of worsened neurological outcomes. This insight underscores the need for better detection, tracking, and reporting of asymptomatic ICH for both patients and trials, as well as potentially refining EVT techniques to minimize even asymptomatic bleeding.

How Nested Knowledge Helped

Efficient Screening: “The software made it incredibly efficient to screen a bunch of articles. I could breeze through them, even while on the go,” Dr. Aziz noted.
Dual Extraction Made Easy: She highlighted how the dual meta-analytical extraction feature was straightforward and user-friendly, streamlining the data extraction process.
Empowering Independence and Early Investigators: “Nested Knowledge empowers younger investigators. It allows us to execute ideas efficiently without heavily relying on others,” she added.

Read The Published Work

You can find Dr. Aziz’s published paper here.

Project 2: Deciphering the High Failure Rate of Acute Stroke Trials

The Challenge

Clinical trials are essential for advancing stroke treatment, yet many fail to reach completion. Dr. Aziz, alongside renowned neurologist and Director of the UC Gardner Neuroscience Institute Dr. Joe Broderick, sought to understand why a significant number of acute stroke trials terminate prematurely.

The Research

Focusing on randomized controlled trials (RCTs) involving acute ischemic or hemorrhagic strokes with over 100 patients, Dr. Aziz conducted a comprehensive analysis using Nested Knowledge. They examined various factors, including trial design, funding sources, and patient demographics.

Findings

The analysis revealed that nearly half of the trials were prematurely terminated. Key reasons included:

- Futility Stopping Rules: Trials with predefined futility criteria were more than four times more likely to stop early, emphasizing the need for realistic and flexible study designs.
- Funding Challenges: Lack of resources was a significant hurdle, particularly for non-industry-sponsored trials.
- Inclusion Criteria: Overly restrictive inclusion criteria limited patient enrollment, leading to under-enrollment and/or underpowered studies.

One positive reason– Termination for Efficacy: Twenty-seven percent of terminated trials were terminated because the efficacy of the intervention was proven, meaning no further recruitment was needed.

How Nested Knowledge Helped

Data Management: The platform’s ability to handle extensive data allowed Dr. Aziz to manage and analyze numerous variables efficiently.
Updating Made Simple: “When reviewers asked for the latest data, we didn’t have to reinvent the wheel. Nested Knowledge made it easy to update our database and pull out what we needed,” she mentioned.
Facilitating Collaboration: The software enabled seamless collaboration with colleagues, ensuring that everyone stayed on the same page throughout the research process.

Read The Published Work

You can find Dr. Aziz’s published paper here.

A Tool for Today's Researchers

Dr. Aziz’s experiences highlight the transformative power of Nested Knowledge in conducting rigorous and efficient systematic reviews and meta-analyses.

User-Friendly Interface: Even without extensive use of AI tools, the platform streamlined the research process.
Empowering Young Investigators: By simplifying complex tasks, Nested Knowledge allows emerging researchers to pursue their ideas independently.
Adaptable and Comprehensive: Whether dealing with clinical trials data or patient outcomes, the software adapts to various research needs.

Elevate Your Research with Nested Knowledge

In a field where time is brain, as Dr. Aziz aptly puts it, having the right tools is crucial. Nested Knowledge not only accelerates the research process but can also help enhance the quality and impact of the findings.

For academics and researchers aiming to make significant strides in their fields, Nested Knowledge offers an unparalleled platform to conduct systematic literature reviews with confidence and efficiency.

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