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1. The state of stroke services across the globe: Report of World Stroke Organization–World Health Organization surveys

Author

Owolabi, M, Thrift, A, Martins, S, Johnson, W, Pandian, J, Abd-Allah, F, Varghese, C, Mahal, A, Yaria, J, Phan, H, Roth, G, Gall, S, Beare, R, Phan, T, Mikulik, R, Norrving, B, Feigin, V, on behalf of the Stroke Experts Collaboration, G, Abera, S, Addissie, A, Adeleye, A, Adilbekov, Y, Adilbekova, B, Adoukonou, T, Aguiar, D, Akhmetzhanova, Z, Akinyemi, R, Akpalu, A, Ameriso, S, Andonova, S, Abanto, C, Awoniyi, F, Bakhiet, M, Basri, H, Bath, P, Bereczki, D, Beretta, S, Berkowitz, A, Bernhardt, J, Berzina, G, Bhavsar, B, Bisharyan, M, Bovet, P, Brainin, M, Budincevic, H, Cabral, N, Cadilhac, D, Caso, V, Chen, C, Chin, J, Christensen, H, Chwojnicki, K, Conforto, A, Cruz, V, D'Amelio, M, Danielyan, K, Davis, S, Demarin, V, Dempsey, R, Dichgans, M, Dokova, Donnan, G, Duran, J, Elizondo, M, Elkind, M, Endres, M, Etedal, I, Faris, M, Fischer, U, Gankpe, F, Gavidia, M, Gaye-Saavedra, A, Giroud, M, Gongora-Rivera, F, Hachinski, V, Hacke, W, Hamadeh, R, Hamzat, T, Hankey, G, Heldner, M, Ibrahim, N, Inoue, M, Jee, S, Jiann-Shing, J, Johnston, S, Kalkonde, Y, Kamenova, S, Kelly, P, Khan, T, Kiechl, S, Kondybayeva, A, Korv, J, Kravchenko, M, Krishnamurthi, R, Langhorne, P, Kang, Z, Kruja, J, Lavados, P, Lebedynets, D, Leung, T, Liebeskind, D, Lindsay, P, Liu, L, Lopez-Jaramillo, P, Lotufo, P, Machline-Carrion, J, Markus, H, Marquez-Romero, J, Medina, M, Medukhanova, S, Mehndiratta, M, Mirrakhimov, E, Mohl, S, Murphy, S, Musa, K, Nasreldein, A, Nogueira, R, Nolte, C, Noubiap, J, Novarro-Escudero, N, O'Donnell, M, Ogun, V, Oraby, M, Ovbiagele, B, Orken, D, Ozdemir, A, Ozturk, S, Paccot, M, Peters, A, Piradov, M, Platz, T, Potpara, T, Ranta, A, Rathore, F, Sacco, R, Sahathevan, R, Santos, I, Saposnik, G, Sarfo, F, Sharma, M, Sheth, K, Shobhana, A, Silva, S, Suwanwela, N, Sylaja, P, Thakur, K, Toni, D, Topcuoglu, M, Torales, J, Towfighi, A, Truelsen, T, Tsiskaridze, A, Tsong-Hai, L, Tulloch-Reid, M, Useche, J, Vanacker, P, Vassilopoulou, S, Venketasubramanian, N, Vukorepa, G, Vuletic, V, Wahab, K, Wang, W, Wijeratne, T, Wolfe, C, Yifru, M, Yock-Corrales, A, Yonemoto, N, Yperzeele, L, Owolabi M. O., Thrift A. G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H. T., Roth G., Gall S. L., Beare R., Phan T. G., Mikulik R., Norrving B., Feigin V. L., on behalf of the Stroke Experts Collaboration Group, Abera S. F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T. A., Aguiar D. S. D., Akhmetzhanova Z., Akinyemi R. O., Akpalu A., Ameriso S. F., Andonova S., Abanto C., Awoniyi F. E., Bakhiet M., Basri H., Bath P. M., Bereczki D., Beretta S., Berkowitz A. L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M. S., Bovet P., Brainin M., Budincevic H., Cabral N. L., Cadilhac D. A., Caso V., Chen C., Chin J. H., Christensen H., Chwojnicki K., Conforto A. B., Cruz V. T., D'Amelio M., Danielyan K. E., Davis S., Demarin V., Dempsey R. J., Dichgans M., Donnan G., Duran J., Elizondo M. A. B., Elkind M. S., Endres M., Etedal I., Faris M. E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R. R., Hamzat T. K., Hankey G. J., Heldner M. R., Ibrahim N. M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z. L., Kruja J., Lavados P. M., Lebedynets D., Leung T. W., Liebeskind D. S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P. A., Machline-Carrion J. M., Markus H. S., Marquez-Romero J. M., Medina M. T., Medukhanova S., Mehndiratta M. M., Mirrakhimov E., Mohl S., Murphy S., Musa K. I., Nasreldein A., Nogueira R., Nolte C. H., Noubiap J. J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M. I., Ovbiagele B., Orken D. N., Ozdemir A. O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F. A., Sacco R. L., Sahathevan R., Santos I. C., Saposnik G., Sarfo F. S., Sharma M., Sheth K. N., Shobhana A., Silva S. N., Suwanwela N., Sylaja P. N., Thakur K., Toni D., Topcuoglu M. A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J. N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K. W., Wang W., Wijeratne T., Wolfe C., Yifru M. Y., Yock-Corrales A., Yonemoto N., Yperzeele L., Owolabi, M, Thrift, A, Martins, S, Johnson, W, Pandian, J, Abd-Allah, F, Varghese, C, Mahal, A, Yaria, J, Phan, H, Roth, G, Gall, S, Beare, R, Phan, T, Mikulik, R, Norrving, B, Feigin, V, on behalf of the Stroke Experts Collaboration, G, Abera, S, Addissie, A, Adeleye, A, Adilbekov, Y, Adilbekova, B, Adoukonou, T, Aguiar, D, Akhmetzhanova, Z, Akinyemi, R, Akpalu, A, Ameriso, S, Andonova, S, Abanto, C, Awoniyi, F, Bakhiet, M, Basri, H, Bath, P, Bereczki, D, Beretta, S, Berkowitz, A, Bernhardt, J, Berzina, G, Bhavsar, B, Bisharyan, M, Bovet, P, Brainin, M, Budincevic, H, Cabral, N, Cadilhac, D, Caso, V, Chen, C, Chin, J, Christensen, H, Chwojnicki, K, Conforto, A, Cruz, V, D'Amelio, M, Danielyan, K, Davis, S, Demarin, V, Dempsey, R, Dichgans, M, Dokova, Donnan, G, Duran, J, Elizondo, M, Elkind, M, Endres, M, Etedal, I, Faris, M, Fischer, U, Gankpe, F, Gavidia, M, Gaye-Saavedra, A, Giroud, M, Gongora-Rivera, F, Hachinski, V, Hacke, W, Hamadeh, R, Hamzat, T, Hankey, G, Heldner, M, Ibrahim, N, Inoue, M, Jee, S, Jiann-Shing, J, Johnston, S, Kalkonde, Y, Kamenova, S, Kelly, P, Khan, T, Kiechl, S, Kondybayeva, A, Korv, J, Kravchenko, M, Krishnamurthi, R, Langhorne, P, Kang, Z, Kruja, J, Lavados, P, Lebedynets, D, Leung, T, Liebeskind, D, Lindsay, P, Liu, L, Lopez-Jaramillo, P, Lotufo, P, Machline-Carrion, J, Markus, H, Marquez-Romero, J, Medina, M, Medukhanova, S, Mehndiratta, M, Mirrakhimov, E, Mohl, S, Murphy, S, Musa, K, Nasreldein, A, Nogueira, R, Nolte, C, Noubiap, J, Novarro-Escudero, N, O'Donnell, M, Ogun, V, Oraby, M, Ovbiagele, B, Orken, D, Ozdemir, A, Ozturk, S, Paccot, M, Peters, A, Piradov, M, Platz, T, Potpara, T, Ranta, A, Rathore, F, Sacco, R, Sahathevan, R, Santos, I, Saposnik, G, Sarfo, F, Sharma, M, Sheth, K, Shobhana, A, Silva, S, Suwanwela, N, Sylaja, P, Thakur, K, Toni, D, Topcuoglu, M, Torales, J, Towfighi, A, Truelsen, T, Tsiskaridze, A, Tsong-Hai, L, Tulloch-Reid, M, Useche, J, Vanacker, P, Vassilopoulou, S, Venketasubramanian, N, Vukorepa, G, Vuletic, V, Wahab, K, Wang, W, Wijeratne, T, Wolfe, C, Yifru, M, Yock-Corrales, A, Yonemoto, N, Yperzeele, L, Owolabi M. O., Thrift A. G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H. T., Roth G., Gall S. L., Beare R., Phan T. G., Mikulik R., Norrving B., Feigin V. L., on behalf of the Stroke Experts Collaboration Group, Abera S. F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T. A., Aguiar D. S. D., Akhmetzhanova Z., Akinyemi R. O., Akpalu A., Ameriso S. F., Andonova S., Abanto C., Awoniyi F. E., Bakhiet M., Basri H., Bath P. M., Bereczki D., Beretta S., Berkowitz A. L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M. S., Bovet P., Brainin M., Budincevic H., Cabral N. L., Cadilhac D. A., Caso V., Chen C., Chin J. H., Christensen H., Chwojnicki K., Conforto A. B., Cruz V. T., D'Amelio M., Danielyan K. E., Davis S., Demarin V., Dempsey R. J., Dichgans M., Donnan G., Duran J., Elizondo M. A. B., Elkind M. S., Endres M., Etedal I., Faris M. E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R. R., Hamzat T. K., Hankey G. J., Heldner M. R., Ibrahim N. M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z. L., Kruja J., Lavados P. M., Lebedynets D., Leung T. W., Liebeskind D. S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P. A., Machline-Carrion J. M., Markus H. S., Marquez-Romero J. M., Medina M. T., Medukhanova S., Mehndiratta M. M., Mirrakhimov E., Mohl S., Murphy S., Musa K. I., Nasreldein A., Nogueira R., Nolte C. H., Noubiap J. J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M. I., Ovbiagele B., Orken D. N., Ozdemir A. O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F. A., Sacco R. L., Sahathevan R., Santos I. C., Saposnik G., Sarfo F. S., Sharma M., Sheth K. N., Shobhana A., Silva S. N., Suwanwela N., Sylaja P. N., Thakur K., Toni D., Topcuoglu M. A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J. N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K. W., Wang W., Wijeratne T., Wolfe C., Yifru M. Y., Yock-Corrales A., Yonemoto N., and Yperzeele L.

Abstract

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization–World Health Organization–Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Methods: Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Results: Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ∼ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusions: There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.

Published
2021

2. Large scale implementation of nurse-initiated protocols for fever, hyperglycaemia and swallowing management: The results of the Qasc Europe project.

Author

Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van De Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., Pfeilschifter W., Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van De Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., and Pfeilschifter W.

Abstract

Introduction: Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS) following stroke significantly reduces 90-day death and disability. We present results on FeSS protocol uptake in multiple European countries, including low-and-middle income countries, following implementation facilitation arising from our international collaboration with the European Stroke Organisation, Angels Initiative, and Registry of Stroke Care Quality. Method(s): Our multi-country, multi-centre, pre-test/post-test study was conducted between 2017- 2021. Data were provided at baseline and three months after FeSS protocol implementation. Nursing clinical champions, with support from the Project team (European Liaison Officer, Angels Consultants, Country Coordinators and the Nursing Research Institute) conducted multidisciplinary workshops to examine baseline results, identify barriers and facilitators to protocol implementation, and held education sessions. Outcomes were adjusted for clustering by country and hospital controlling for age/ sex/NIHSS. Result(s): Data from 76 hospitals (18 countries) were received for 3999 patients at baseline, and from 64 hospitals (17 countries) for 3257 patients post-implementation (Total n=7256). Significantly increased proportion of patients received care from pre to post according to the: fever protocol (Pre: 16%, Post: 51%, p<0.0001): hyperglycaemic protocol (Pre: 16%, Post: 52%, p<0.0001): swallow protocol (Pre: 41%, Post: 67%, p<0.0001); and the FeSS Protocols overall (Pre: 3.2%, Post: 35%, p<0.0001). Significant improvements were also found in low-and-middle income countries. Conclusion(s): Facilitated implementation of nurse-initiated FeSS protocols demonstrated successful large-scale translation of evidence into countries with different health care systems, many of which with no access to reperfusion therapies-a European first. This will reduce death and disability post-stroke.

Published
2022

3. Large scale implementation of nurse-initiated protocols for fever, hyperglycaemia and swallowing management: The results of the Qasc Europe project.

Author

Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van De Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., Pfeilschifter W., Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van De Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., and Pfeilschifter W.

Abstract

Introduction: Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS) following stroke significantly reduces 90-day death and disability. We present results on FeSS protocol uptake in multiple European countries, including low-and-middle income countries, following implementation facilitation arising from our international collaboration with the European Stroke Organisation, Angels Initiative, and Registry of Stroke Care Quality. Method(s): Our multi-country, multi-centre, pre-test/post-test study was conducted between 2017- 2021. Data were provided at baseline and three months after FeSS protocol implementation. Nursing clinical champions, with support from the Project team (European Liaison Officer, Angels Consultants, Country Coordinators and the Nursing Research Institute) conducted multidisciplinary workshops to examine baseline results, identify barriers and facilitators to protocol implementation, and held education sessions. Outcomes were adjusted for clustering by country and hospital controlling for age/ sex/NIHSS. Result(s): Data from 76 hospitals (18 countries) were received for 3999 patients at baseline, and from 64 hospitals (17 countries) for 3257 patients post-implementation (Total n=7256). Significantly increased proportion of patients received care from pre to post according to the: fever protocol (Pre: 16%, Post: 51%, p<0.0001): hyperglycaemic protocol (Pre: 16%, Post: 52%, p<0.0001): swallow protocol (Pre: 41%, Post: 67%, p<0.0001); and the FeSS Protocols overall (Pre: 3.2%, Post: 35%, p<0.0001). Significant improvements were also found in low-and-middle income countries. Conclusion(s): Facilitated implementation of nurse-initiated FeSS protocols demonstrated successful large-scale translation of evidence into countries with different health care systems, many of which with no access to reperfusion therapies-a European first. This will reduce death and disability post-stroke.

Published
2022

4. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys.

Author

Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Gall S.L., Beare R., Phan T.G., Mikulik R., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A., Aguiar D.S.D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A., Ameriso S.F., Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin M., Budincevic H., Cabral N.L., Cadilhac D.A., Caso V., Chen C., Chin J.H., Christensen H., Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis S., Demarin V., Dempsey R.J., Dichgans M., Dokova, Donnan G., Duran J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z.L., Kruja J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A., Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M.I., Ovbiagele B., Orken D.N., Ozdemir A.O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva S.N., Suwanwela N., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C., Yifru M.Y., Yock-Corrales A., Yonemoto N., Yperzeele L., Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Gall S.L., Beare R., Phan T.G., Mikulik R., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A., Aguiar D.S.D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A., Ameriso S.F., Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin M., Budincevic H., Cabral N.L., Cadilhac D.A., Caso V., Chen C., Chin J.H., Christensen H., Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis S., Demarin V., Dempsey R.J., Dichgans M., Dokova, Donnan G., Duran J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z.L., Kruja J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A., Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M.I., Ovbiagele B., Orken D.N., Ozdemir A.O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva S.N., Suwanwela N., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C., Yifru M.Y., Yock-Corrales A., Yonemoto N., and Yperzeele L.

Abstract

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Method(s): Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Result(s): Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ~ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusion(s): There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.Copyright © 2021 World Stroke Organization.

Published
2021

5. Reducing inequity in stroke outcomes in low-and-middle-income countries. implementation of nurse-initiated protocols for fever, sugar and swallow management (Qasc Europe project).

Author

Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van Der Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., Pfeilschifter W., Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van Der Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., and Pfeilschifter W.

Abstract

Background and Aims: The QASC Europe project significantly improved nurse-initiated management of: fever, hyperglycaemia (sugar) and swallowing (FeSS) in European stroke units with varying health care systems. We examined pre-post management for low-and-middle-income-countries (LMIC). Method(s): Data from this multi-site, multi-country, pre-test/post-test study (2018-2021) were collected at baseline and three months after FeSS protocol implementation. Clinical champions conducted multidisciplinary workshops to feedback baseline audit data results, provided education, and identified barriers to protocol implementation. Outcomes were adjusted for age, sex, NIHSS, country and within clustering by site. Result(s): Data were received from 76 hospitals in 18 countries (n=4196 patients); and post-implementation, 64 hospitals in 17 countries (3348 patients). 13 hospitals (pre-implementation, n=648 patients) and 9 hospital (post-implementation, n=444 patients) from six LMIC Significant improvements were achieved from pre-to-post implementation in LMIC for: monitoring of temperature at least four times on day three (26% vs 62%, p=0.018); venous blood glucose level (BLG) on admission (86% vs 98%, p=0.0256); BGL monitored four times/day on day of admission to stroke unit (51% vs 84%, p=0.001); swallow screen/assessment performed before oral medication (73% vs 94%, p=0.039); and swallow screen/assessment before being given oral food or fluid (76% vs 93%, p=0.007). Results from LMIC were broadly consistent with those from high-income countries. Conclusion(s): Our nurse-initiated intervention was highly effective in improving stroke outcomes in LMIC. While LMIC are known to have reduced thrombolysis rates, that they are providing comparable evidenced-based care for fever, hyperglycaemia and swallowing is noteworthy. Upscaling of effective stroke interventions is essential to improving stroke outcomes globally.

Published
2021

6. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys.

Author

Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Roth G., Gall S.L., Beare R., Phan T.G., Mikulik R., Norrving B., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Roth G., Gall S.L., Beare R., Phan T.G., Mikulik R., Norrving B., Feigin V.L., and on behalf of the Stroke Experts Collaboration Group

Abstract

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Method(s): Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Result(s): Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ~ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusion(s): There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.Copyright © 2021 World Stroke Organization.

Published
2021

7. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys.

Author

Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Gall S.L., Beare R., Phan T.G., Mikulik R., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A., Aguiar D.S.D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A., Ameriso S.F., Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin M., Budincevic H., Cabral N.L., Cadilhac D.A., Caso V., Chen C., Chin J.H., Christensen H., Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis S., Demarin V., Dempsey R.J., Dichgans M., Dokova, Donnan G., Duran J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z.L., Kruja J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A., Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M.I., Ovbiagele B., Orken D.N., Ozdemir A.O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva S.N., Suwanwela N., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C., Yifru M.Y., Yock-Corrales A., Yonemoto N., Yperzeele L., Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Gall S.L., Beare R., Phan T.G., Mikulik R., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A., Aguiar D.S.D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A., Ameriso S.F., Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin M., Budincevic H., Cabral N.L., Cadilhac D.A., Caso V., Chen C., Chin J.H., Christensen H., Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis S., Demarin V., Dempsey R.J., Dichgans M., Dokova, Donnan G., Duran J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., Gaye-Saavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Korv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z.L., Kruja J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu L., Lopez-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A., Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun V., Oraby M.I., Ovbiagele B., Orken D.N., Ozdemir A.O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva S.N., Suwanwela N., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C., Yifru M.Y., Yock-Corrales A., Yonemoto N., and Yperzeele L.

Abstract

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Method(s): Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Result(s): Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ~ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusion(s): There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.Copyright © 2021 World Stroke Organization.

Published
2021

8. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys.

Author

Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Roth G., Gall S.L., Beare R., Phan T.G., Mikulik R., Norrving B., Feigin V.L., on behalf of the Stroke Experts Collaboration Group, Owolabi M.O., Thrift A.G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H.T., Roth G., Gall S.L., Beare R., Phan T.G., Mikulik R., Norrving B., Feigin V.L., and on behalf of the Stroke Experts Collaboration Group

Abstract

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Method(s): Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Result(s): Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ~ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusion(s): There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.Copyright © 2021 World Stroke Organization.

Published
2021

9. Reducing inequity in stroke outcomes in low-and-middle-income countries. implementation of nurse-initiated protocols for fever, sugar and swallow management (Qasc Europe project).

Author

Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van Der Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., Pfeilschifter W., Middleton S., Dale S., Mcelduff B., Coughlan K., Mcinnes E., Fischer T., Van Der Merwe J., Halvalda R., Grecu A., Mikulik R., Cadilhac D., D'Este C., Levi C., Grimshaw J.M., Quinn C., Cheung N.W., and Pfeilschifter W.

Abstract

Background and Aims: The QASC Europe project significantly improved nurse-initiated management of: fever, hyperglycaemia (sugar) and swallowing (FeSS) in European stroke units with varying health care systems. We examined pre-post management for low-and-middle-income-countries (LMIC). Method(s): Data from this multi-site, multi-country, pre-test/post-test study (2018-2021) were collected at baseline and three months after FeSS protocol implementation. Clinical champions conducted multidisciplinary workshops to feedback baseline audit data results, provided education, and identified barriers to protocol implementation. Outcomes were adjusted for age, sex, NIHSS, country and within clustering by site. Result(s): Data were received from 76 hospitals in 18 countries (n=4196 patients); and post-implementation, 64 hospitals in 17 countries (3348 patients). 13 hospitals (pre-implementation, n=648 patients) and 9 hospital (post-implementation, n=444 patients) from six LMIC Significant improvements were achieved from pre-to-post implementation in LMIC for: monitoring of temperature at least four times on day three (26% vs 62%, p=0.018); venous blood glucose level (BLG) on admission (86% vs 98%, p=0.0256); BGL monitored four times/day on day of admission to stroke unit (51% vs 84%, p=0.001); swallow screen/assessment performed before oral medication (73% vs 94%, p=0.039); and swallow screen/assessment before being given oral food or fluid (76% vs 93%, p=0.007). Results from LMIC were broadly consistent with those from high-income countries. Conclusion(s): Our nurse-initiated intervention was highly effective in improving stroke outcomes in LMIC. While LMIC are known to have reduced thrombolysis rates, that they are providing comparable evidenced-based care for fever, hyperglycaemia and swallowing is noteworthy. Upscaling of effective stroke interventions is essential to improving stroke outcomes globally.

Published
2021

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