Stroke: Working Toward a Prioritized World Agenda

Abstract

Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent “silo” mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a “Brain Health” concept that enables promotion of preventive measures. Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.

Using Insights From Behavioral Economics and Social Psychology to Help Patients Manage Chronic Diseases

“…[7][8][9][10] According to the Health Belief Model (HBM), individual perceptions (perceived disease susceptibility and severity) and modifying factors (demographic, sociopsychological variables, and other people and information sources that modify the perceived disease threat) predict likelihood of patient action (including perceived benefits of and barriers to action). 11 For instance, more accurate health beliefs have been associated with better medication adherence in diabetes.…”

Improving reperfusion therapy for acute ischaemic stroke

“…In much of Asia, individual hospitals are well-organised, but rationalised ambulance routing is fragmentary. In low and middle income nations of the world, access to recanalisation therapy is limited [5]. Fortunately, with increasing recognition that acute stroke systems pay for themselves by reducing long-term health system costs associated with post stroke disability, more and more national healthcare systems are devoting appropriate resources to build out of regional systems of care.…”

Telemedicine in Stroke: Potentials, Limitations and Ongoing Issues

“…Telestroke has the potential to improve the care of the stroke patient in the acute phase, the subacute phase, the rehabilitation phase and in the long term for the prevention of recurrence of cerebrovascular or cardiovascular events. Attention at all these levels can substantially lower the net cost of the condition to society by reduction of lost productivity, nursing home costs and rehabilitation (Hachinski et al 2010). So, although in the past telemedicine has mainly focused on the area of thrombolysis in the acute stage of the disease, it has now been acknowledged to have the potential to also bring substantial benefits to the remaining stages of the stroke victim's journey.…”

“…In a study comparing the initial diagnosis, before imaging, between emergency physicians, primary care doctors and stroke experts, the rate of misdiagnosis by non-stroke doctors was 30%. This area of real-time video consultation by experienced neurologists has significant implications both in terms of cost-saving as well as patient welfare (Hachinski et al 2010).…”