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Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: Availability of reperfusion services around the world. Int J Stroke 2024; 19:253-270. [PMID: 37853529 PMCID: PMC10903148 DOI: 10.1177/17474930231210448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed. AIMS To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. METHODS We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary. RESULTS Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world. CONCLUSION Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jackie Bosch
- School of Rehabilitation Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Diana A De Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne K Christensen
- Department of Neurology, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Robert Mikulik
- Health Management Institute, Brno, Czech Republic
- Neurology Department, Bata Hospital, Zlin, Czech Republic
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Lebioda LA, Pedroso B, dos Santos MEC, Pinto GMC, Welling LC. Neurological telerehabilitation in the COVID-19 era - current perspectives through a bibliometric analysis. Front Neurol 2023; 14:1227846. [PMID: 37794878 PMCID: PMC10546771 DOI: 10.3389/fneur.2023.1227846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023] Open
Abstract
Objective To identify bibliometric parameters and research trends regarding to telerehabilitation of patients with stroke in the COVID-19 era. Methodology This is an integrative review carried out in the Scopus database, from June to July 2021, through the Biblioshiny graphical interface, provided by the Bibliometrix program. The search terms used were "Stroke," "COVID-19" and "Telerehabilitation." Results were filtered by publication date from 2019 onwards. No language restrictions were imposed. Results Twenty two articles were included in the study and the results were presented in the form of figures demonstrating that the journal Frontiers in Neurology was the one with the most relevant studies and the author with the highest number of citations. The Brazilian Academy of Neurology was the institution with the greatest number of studies and China ranked first as the country with the greatest scientific production. The authors used recent references in their work. A thematic map showed the centrality and density of the words presented and, finally, a three-field graph showed a strong intimacy between countries, keywords and authors. Conclusion A greater interest in the subject was observed in China with greater relevance of journals and institutions focused on neurology. However, despite telerehabilitation being an effective alternative in the context of the pandemic, few studies have explored this modality.
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Saigí-Rubió F, Borges do Nascimento IJ, Robles N, Ivanovska K, Katz C, Azzopardi-Muscat N, Novillo Ortiz D. The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews. J Med Internet Res 2022; 24:e40877. [DOI: 10.2196/40877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Several systematic reviews evaluating the use of telemedicine by clinicians, patients, and health authorities to improve the delivery of care in the 53 member states of the World Health Organization (WHO) European Region have been conducted in recent years. However, a study summarizing the findings of these reviews has not been conducted.
Objective
This overview of systematic reviews aimed to summarize findings regarding the use of telemedicine across the 53 member states and identify the medical fields and levels of care in and at which the effectiveness, feasibility, and applicability of telemedicine have been demonstrated. The barriers to and facilitators of telemedicine use were also evaluated and collated to help with the design and implementation of telemedicine interventions.
Methods
Through a comprehensive systematic evaluation of the published and unpublished literature, we extracted clinical, epidemiological, and technology-related data from each review included in the study. We focused on evaluating the barriers to and facilitators of the use of telemedicine apps across the 53 member states considered. We rated the methodological quality of each of the included reviews based on A Measurement Tool to Assess Systematic Review 2 approach and judged the overall certainty of evidence by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology. The entire process was performed by 2 independent authors.
Results
This overview drew on data from >2239 primary studies, with >20,000 enrolled patients in total, within the WHO European Region. On the basis of data from randomized trials, observational studies, and economic evaluations from several countries, the results show a clear benefit of telemedicine technologies in the screening, diagnosis, management, treatment, and long-term follow-up of a series of chronic diseases. However, we were unable to pool the results into a reliable numeric parameter because of the high heterogeneity of intervention methodologies, scheduling, primary study design discrepancies, settings, and geographical locations. In addition to the clinical outcomes of the interventions, the social and economic outcomes are highlighted.
Conclusions
The application of telemedicine is well established across countries in the WHO European Region; however, some countries could still benefit from the many uses of these digital solutions. Barriers related to users, technology, and infrastructure were the largest. Conversely, the provision of health services using technological devices was found to significantly enhance patients’ clinical outcomes, improve the long-term follow-up of patients by medical professionals, and offer logistical benefits for both patients and health workers.
Trial Registration
PROSPERO (International Prospective Register of Systematic Reviews) CRD42022309375; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309375
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Turner AC, Etherton MR. Utilization of Telestroke Prior to and Following the COVID-19 Pandemic. Semin Neurol 2022; 42:3-11. [PMID: 35576926 DOI: 10.1055/s-0041-1742181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. A successful telestroke system should include adequate protocols and training, equipment, documentation system, and tracking of quality metrics. Upfront costs of needed technology and devices, credentialing hurdles, and limited reimbursement are all reported barriers to the utilization of telestroke. Emphasis on safety measures during the COVID-19 pandemic resulted in the dramatic upscaling of telehealth utilization, although overall stroke volumes declined in many areas in the early phases of the pandemic. Going forward, continued reduction in cost of required devices and broadband connections, increased use of automated and advanced analytical software, and a universal licensing and credentialing system are needed to continue the expansion of telestroke use.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Constanzo F, Aracena-Sherck P, Peña L, Marrugo M, Gonzalez J, Vergara G, Alvarado C. Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano-Chile. Front Neurol 2020; 11:595577. [PMID: 33329347 PMCID: PMC7711163 DOI: 10.3389/fneur.2020.595577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Chile has a shortage of medical experts, including neurologists. The remote neurology program at Las Higueras Hospital in Talcahuano (HHT) was implemented in 2015 to decrease the number of patients waiting for their first appointment. Methods: This retrospective study analyzed a cohort of 2,904 ambulatory patients evaluated in the teleneurology program at the HHT between 2015 and 2019 who were referred from 16 primary and 3 tertiary healthcare centers. Results: Out of the 2,904 patients included in the study, 1,020 patients (35%) were male, and 1,884 (65%) were female. In total, 1,346 (46.0%) patients were under 60 years old (408 male and 938 female), and 1,558 (54%) were over 60 years old (612 male and 946 female). The patients were referred to a neurologist in the teleneurology program from different primary healthcare centers (93.5%) and tertiary healthcare centers (6.5%). The most common diseases diagnosed through teleneurology were, in decreasing order, headache (29.4%), Alzheimer's disease and other dementias (15.9%), and epilepsy (11.4%). From July 2018, we analyzed the patients' destination after the first teleneurology consultation. In the cohort of 634 patients who had their first consultation via the teleneurology program, 547 (86.3%) were instructed to continue follow-up via telemedicine. Conclusions: Data from this study show, for the first time in Chile, the significant contribution of the teleneurology program at the HHT to the diagnosis of a broad range of diseases in a substantial number of patients referred from primary and tertiary healthcare centers.
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Affiliation(s)
- Freddy Constanzo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Paula Aracena-Sherck
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
| | - Lorena Peña
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Mery Marrugo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Jonathan Gonzalez
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Gerardo Vergara
- Unit of Teleprocesses, Hospital Las Higueras, Talcahuano, Chile
| | - Cristóbal Alvarado
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
- Department of Basic Sciences, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
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Smith RJ, Bryant RG. Metal substitutions incarbonic anhydrase: a halide ion probe study. Biochem Biophys Res Commun 1975; 66:1281-6. [PMID: 0000-0003-1376-8556 PMCID: PMC10704303 DOI: 10.1016/0006-291x(75)90498-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 02/07/2023]
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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