scholarly journals Action Plan for Stroke in Europe 2018–2030

2018 ◽  
Vol 3 (4) ◽  
pp. 309-336 ◽  
Author(s):  
Bo Norrving ◽  
Jon Barrick ◽  
Antoni Davalos ◽  
Martin Dichgans ◽  
Charlotte Cordonnier ◽  
...  
Keyword(s):  
Action Plan ◽  
Scientific Evidence ◽  
Research Priorities ◽  
Stroke Care ◽  
Absolute Number ◽  
Stroke Research ◽  
Road Map ◽  
Preventive Actions ◽  
Chain Of Care ◽  
Stroke Services

Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21–23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.

scholarly journals Stroke Clinicians’ Priorities for Stroke Research

2012 ◽  
Author(s):  
Natasha Lannin ◽  
Louise Ada ◽  
Richard Lidney ◽  
Mark Longworth ◽  
Annie McCluskey ◽  
...  
Keyword(s):  
New South ◽  
Stroke Care ◽  
Survey Method ◽  
Research Topics ◽  
Post Discharge ◽  
Cross Sectional ◽  
Stroke Research ◽  
South Wales ◽  
Research Questions ◽  
Stroke Services

Purpose: The purpose of this study was to identify research questions perceived as important by clinicians who treat stroke survivors in New South Wales (NSW), Australia. Methods: A cross-sectional, 3-round Delphi survey method was used. Participants invited to respond in Round I included stroke researchers (n=26); Rounds II and III included stroke clinicians (n=470) identified from NSW Health Stroke Services and/or NSW Rural Stroke Service databases. Participants in Round I were asked to identify stroke research questions of the highest priority; participants in Rounds II and III then rated these research questions on both importance and feasibility using a 5-point Likert scale. Results: Responses were received from 14 expert stroke researchers during Round I (54%), 38 stroke clinicians (8%) in Round II, and 56 stroke clinicians (12%) in Round III. Research topics rated as “very important” were interventions that target life-long rehabilitation, best methods for providing post-discharge rehabilitation, and delivery of physical rehabilitation.Conclusions: Clinicians who provide day-to-day stroke care perceive that the effectiveness of rehabilitation interventions and delivery require investigation as a key priority.

scholarly journals EXPRESS: COVID-19 AND STROKE – UNDERSTANDING THE RELATIONSHIP AND ADAPTING SERVICES. A GLOBAL WORLD STROKE ORGANISATION PERSPECTIVE

2021 ◽  
pp. 174749302110064
Author(s):  
Hugh S Markus ◽  
Sheila Cristina Ouriques Martins
Keyword(s):  
Large Scale ◽  
Stroke Care ◽  
Long Term Effects ◽  
Vessel Occlusion ◽  
Stroke Incidence ◽  
Stroke Research ◽  
Incidence And Mortality ◽  
Research Initiatives ◽  
Global World

A year ago the World Stroke Organisation (WSO) highlighted the enormous global impact of the COVID-19 pandemic on stroke care. In this review we consider a year later where we are now, what the future holds, and what the long term effects of the pandemic will be on stroke. Stroke occurs in about 1.4% of patients hospitalised with COVID-19 infection, who show an excess of large vessel occlusion and increased mortality. Despite this association, stroke presentations fell dramatically during the pandemic, although emerging data suggests that total stroke mortality may have risen with increased stroke deaths at home and in care homes. Strategies and guidelines have been developed to adapt stroke services worldwide, and protect healthcare workers. Adaptations include increasing use of telemedicine for all aspects of stroke care. The pandemic is exacerbating already marked global inequalities in stroke incidence and mortality. Lastly the pandemic has had a major impact on stroke research and funding, although it has also emphasised the importnace of large scale collaborative research initiatives.

scholarly journals Disabling stroke in persons already with a disability

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. 306-310 ◽  
Author(s):  
Michael J. Young ◽  
Robert W. Regenhardt ◽  
Thabele M. Leslie-Mazwi ◽  
Michael Ashley Stein
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Clinical Practices ◽  
Acute Stroke Care ◽  
Persons With Disabilities ◽  
Stroke Research ◽  
Scant Attention

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

scholarly journals How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury

2016 ◽  
Vol 50 (17) ◽  
pp. 1030-1041 ◽  
Author(s):  
Torbjørn Soligard ◽  
Martin Schwellnus ◽  
Juan-Manuel Alonso ◽  
Roald Bahr ◽  
Ben Clarsen ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Scientific Evidence ◽  
Research Priorities ◽  
Well Being ◽  
International Olympic Committee ◽  
Load Management ◽  
Risk Of Injury ◽  
Practical Guidelines ◽  
Relationship Of ◽  
The Relationship

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

scholarly journals Oral care after stroke: Where are we now?

2018 ◽  
Vol 3 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Mary Lyons ◽  
Craig Smith ◽  
Elizabeth Boaden ◽  
Marian C Brady ◽  
Paul Brocklehurst ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Best Practice ◽  
Clinical Care ◽  
Oral Care ◽  
Research Priorities ◽  
Stroke Care ◽  
Weak Evidence ◽  
Perspective Drawing ◽  
Increased Risk ◽  
Risk Of Aspiration

Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities. Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.

Establishing Stroke Services in the Republic of Georgia

2021 ◽  
pp. 1-9
Author(s):  
Zaza Katsarava ◽  
Tamar Akhvlediani ◽  
Tamar Janelidze ◽  
Tamar Gudadze ◽  
Marina Todua ◽  
...  
Keyword(s):  
Treatment Process ◽  
Stroke Care ◽  
Subsequent Treatment ◽  
National Guidelines ◽  
Ethical Problems ◽  
Stroke Units ◽  
Systemic Thrombolysis ◽  
Stroke Services ◽  
The Republic ◽  
Quality Reports

<b><i>Introduction:</i></b> This article summarizes the medical experience in establishing stroke units and systemic thrombolysis in Georgia, which, like many other post-Soviet countries, still faces problems in organizing stroke care even after 30 years of independence. <b><i>Patients and Methods:</i></b> We created an example of treating acute stroke with systemic thrombolysis and introduced stroke units in several hospitals in the country, including standardization of the diagnostic and treatment process, consistent evaluation, and monthly feedback to the stroke unit staff. <b><i>Results:</i></b> Systemic thrombolysis has become a clinical routine in some large hospitals and is meanwhile reimbursed by the state insurance. The data of consecutive 1,707 stroke patients in 4 major cities demonstrated significant time lost at the prehospital level, due to failure in identifying stroke symptoms, delay in notification, or transportation. The consequent quality reports resulted in a dramatic increase in adherence to the European and national guidelines. A mandatory dysphagia screening and subsequent treatment led to a decrease in pneumonia rates. <b><i>Discussion:</i></b> We discuss our experience and suggestions on how to overcome clinical, financial, and ethical problems in establishing a stroke services in a developing country. <b><i>Conclusion:</i></b> The Georgian example might be useful for doctors in other post-Soviet countries or other parts of the world.

Abstract T MP75: Facilities Available in Chinese Hospitals From China Stroke Research Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Chunjuan Wang ◽  
Zixiao Li ◽  
Yilong Wang ◽  
Yong Jiang ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mainland China ◽  
Stroke Care ◽  
Research Network ◽  
Level Of Care ◽  
Minimum Level ◽  
Stroke Patients ◽  
Stroke Research ◽  
Primary Stroke Center ◽  
Stroke Center

Background and Purpose: Stroke is the first leading cause of death in China and millions of patients were admitted to various levels of hospitals each year. However, it is unknown how many of these hospitals are able to provide an appropriate level of care for stroke patients since the certification program of comprehensive stroke center (CSC) and primary stroke center (PSC) has not been initiated in China. Method: In 2012, we selected all 554 hospitals that joined into the China Stroke Research Network (CSRN) to start a survey. These hospitals were from 31 provinces or municipalities, covered nearly the entire Mainland China. A six-page questionnaire was sent to each of them to obtain the stroke facility information. We used the same criteria and definitions for CSC, PSC, and minimum level for any hospital ward (AHW) admitting stroke patients with that of the European Stroke Facilities Survey. Results: For all the hospitals in CSRN, 521 (94.0%) returned the questionnaire, 20 (3.8%) met criteria for CSC, 179 (34.4%) for PSC, 64 (12.3%) for AHW, and 258 (49.5%) met none of them and provided a lower level of care. Hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 70 052 (8.8%), 334 834 (42.2%), 88 364 (11.1%), and 299 806 (37.8%) patients in the whole of last year. There was no 24-hour availability for brain CT scan in 4.3% of hospitals not meeting criteria for AHW, while neither stroke care map nor stroke pathway for patients admission in 81.0% of them. Conclusions: Less than two fifths of Chinese hospitals admitting acute stroke patients have optimal facilities, and nearly half even the minimum level is not available. Our study suggests that only one half acute stroke patients are treated in appropriate centers in China, facilities for hospitals admitting stroke patients should be enhanced and certification project of CSCs and PSCs may be a feasible choice.

scholarly journals The “Road Map” of the Potential Development Assessment of the Component Machine Building in the Single-Industry Region

2019 ◽  
Vol 297 ◽  
pp. 06004
Author(s):  
Svetlana Kazachenko ◽  
Svetlana Kulay ◽  
Evgeniy Pudov ◽  
Evgeniy Shvakov
Keyword(s):  
Action Plan ◽  
Import Substitution ◽  
Development Program ◽  
Machine Building ◽  
The Road ◽  
Road Map ◽  
Single Industry ◽  
Key Factor ◽  
Personnel Needs ◽  
Development Assessment

The development of component machine building in mining regions can become a key factor in the economic diversification, as well as the implementation of the import substitution program in Russia. The aim of this study is to develop an action plan (“road map”). It is also to assess the possibility of developing component machine-building in the single-industry mining region (on the example of Kemerovo region). The objectives of the study include formulation of goals and objectives of the “road map”. The task is also to identify the key elements and main directions of the component machine-building development, to form the action plan taking into account the time factor. The results of the road map provide an information base for the initial stage of the component machine building development program. The production capabilities of the region, domestic demand for components and assemblies of the working equipment, personnel needs, and opportunities for placing innovative business as a resident of TOSER in single-industry town, all these should be taken into account.

Stroke Care Services in Africa: A Systematic Review

2018 ◽  
Vol 1 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Rufus O. Akinyemi ◽  
Olaleye A. Adeniji
Keyword(s):  
Large Scale ◽  
Systems Of Care ◽  
Care Delivery ◽  
Stroke Care ◽  
Developed Countries ◽  
High Morbidity ◽  
New Paradigm ◽  
African Countries ◽  
Care Services ◽  
Stroke Services

Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the continent to tackle this growing burden of stroke in its preventative and treatment aspects. Aims and Objectives: The aim of this study was to determine the scope of stroke care services, where they exist, and their relationship with currently existing health systems. Methods: A detailed literature search was undertaken referring to PubMed and Google Scholar for articles from January 1960 to March 2018, using a range of search terms. Of 93 publications, 45 papers were shortlisted, and 21 reviewed articles on existing stroke services were included. Results: The literature on models of stroke services in Africa is sparse. We identified focused systems of care delivery in the hyperacute, acute, and rehabilitative phases of stroke in a few African countries. There is a continent-wide paucity of data on the organization of prehospital stroke services. Only 3 African countries (South Africa, Egypt, and Morocco) reported experiences on thrombolysis. Also, the uptake of dedicated stroke units appears limited across the continent. Encouragingly, there are large-scale secondary prevention models on the continent, mostly within the context of experimental research projects, albeit with promising results. We found only 1 article on the interventional aspects of stroke care in our review, and this was a single-center report. Conclusions: The literature on the organization of stroke services is sparse in Africa. Dedicated action at policy, population, community, and hospital-based levels is urgently needed toward the organization of stroke services to tame the burgeoning burden of stroke on the African continent.

scholarly journals Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018143 ◽  
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Emma Villeneuve ◽  
Thomas Monks ◽  
Ken Stein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Travel Time ◽  
Stroke Unit ◽  
Stroke Care ◽  
Hyperacute Stroke ◽  
Geographical Access ◽  
Unit Model ◽  
Stroke Services ◽  
Time Critical ◽  
Institutional Size

ObjectivesThe policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.DesignModelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.Setting127 acute stroke services in England, serving a population of 54 million people.Participants238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).InterventionModelled reconfigurations of HASUs optimised for institutional size and geographical access.Main outcome measureTravel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.ResultsSolutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.

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