World Stroke Organization Global Stroke Services Guidelines and Action Plan
World Stroke Organization Global Stroke Services Guidelines and Action Plan
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DOI：
10.1111/ijs.12371
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发表时间：
2014-10-01
影响因子：
6.7
通讯作者：
Norrving, Bo
中科院分区：
文献类型：
--
作者：
Lindsay, Patrice;Furie, Karen L.;Norrving, Bo
每两秒钟，地球仪上就有一个人患上有症状的中风。"无症状"脑血管疾病通过在老年人中引起认知障碍而潜在地导致全球残疾。在低收入和中等收入国家，脑血管疾病的风险高得不成比例，这些国家可能存在中风护理障碍。在过去的二十年里，随着循证方法在卒中预防、急性卒中管理和卒中康复方面的出现，卒中领域发生了重大转变。目前的挑战在于实施这些干预措施，特别是在中风发病率高和医疗资源有限的地区。全球卒中服务行动计划被认为是一种工具，用于确定卒中护理中的关键要素，包括一系列健康模式。在最低水平的资源可用性下，卒中护理提供基于主要由非医生组成的当地诊所。在这种环境下，实验室测试和诊断研究是稀缺的，重点放在床边的临床技能，教学和预防。基本服务水平提供了CT扫描、医生和急性溶栓治疗的可能性，但卒中专业知识可能仍然难以获得。在先进的中风服务水平，多学科中风专业知识，多模式成像和综合治疗是可用的。国家卒中护理计划应结合当地和区域优势，并建立在他们的基础上。本临床实践指南是对核心建议和质量指标的概要，这些建议和质量指标改编自10个高质量的多国卒中指南。它可用于建立卒中服务的当前水平，扩大卒中资源的目标，并确保卒中护理的所有阶段都得到充分解决，即使是在先进的卒中服务水平。这份文件是一个开始，但还有更多的工作要做，特别是在初级预防领域。尽管资源的可用性不同，我们希望传达的信息是，中风的认识，教育，预防和治疗应该始终是可行的。社区和机构应设定目标，不断扩大其中风服务能力。本文件旨在加强全世界的卒中宣传工作，为优化卒中结局提供战略计划。
Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention, acute stroke management, and stroke recovery. The current challenge lies in implementing these interventions, particularly in regions with high incidences of stroke and limited healthcare resources. The Global Stroke Services Action Plan was conceived as a tool to identifying key elements in stroke care across a continuum of health models.At the minimal level of resource availability, stroke care delivery is based at a local clinic staffed predominantly by non-physicians. In this environment, laboratory tests and diagnostic studies are scarce, and much of the emphasis is placed on bedside clinical skills, teaching, and prevention. The essential services level offers access to a CT scan, physicians, and the potential for acute thrombolytic therapy, however stroke expertise may still be difficult to access. At the advanced stroke services level, multidisciplinary stroke expertise, multimodal imaging, and comprehensive therapies are available. A national plan for stroke care should incorporate local and regional strengths and build upon them.This clinical practice guideline is a synopsis of the core recommendations and quality indicators adapted from ten high quality multinational stroke guidelines. It can be used to establish the current level of stroke services, target goals for expanding stroke resources, and ensuring that all stages of stroke care are being adequately addressed, even at the advanced stroke services level. This document is a start, but there is more to be done, particularly in the realm of primary prevention.Despite differences in resource availability, the message we wish to convey is that stroke awareness, education, prevention, and treatment should always be feasible. Communities and institutions should set goals to continuously expand their stroke service capabilities. This document is intended to augment stroke advocacy efforts throughout the world, providing a strategic plan for optimizing stroke outcomes.