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Medical Technology and its role in Establishing Stroke Care Services Globally: World Stroke Organization and WHO Perspective Dr Jeyaraj D Pandian MD DM FRACP FRCP FESO Vice-President, World Stroke Organization Principal/Dean, Professor of Neurology, Christian Medical College, Ludhiana, Punjab India
Disclosure • Received Research Grants from Indian Council of Medical Research; Department of Biotechnology; National Health and Medical Research Council, Australia; National Institute of Health Research, United Kingdom
Stroke • Stroke is the major cause of death and disability globally • Stroke care services are not well developed in Low- and middle-income countries (LMICs) • World Stroke Organization (WSO) had published a road map and action plan for stroke care services across all levels of health care (minimal, essential and advanced) • The objectives were to merge the WSO action plan with World Health Organization (WHO) stroke intervention list
Search Strategy • All published latest Stroke Guidelines • High Income and Low and Middle Income countries • Evidence based medical technologies • Minimal (Primary care), Essential (Secondary care), Advanced (Tertiary)
WSO Roadmap and Action Plan Lindsay et al. Int J Stroke. 2014 Oct;9 Suppl A100:4-13.
Minimal/Primary Health Care Level • Public awareness: Charts, educational materials, Videos etc • Emergency alert system: Facilities to call ambulance services • Acute care: FAST training
Minimal/Primary Health Care Level • BP apparatus, Glucometer, 12 lead ECG machine • Referral to Secondary/Essential care services • Prevention: Screening for risk factors: Mobile app: Stroke Riskometer • Monitoring of BP, Sugar etc by mHealth algorithms
Minimal/Primary Health Care Level Essential medicines • Antiplatelets (Aspirin), Antihypertensives (Ramipril, Amlodipine), Antidiabetics (Metformin), Lipid lowering drug (Atorvastatin)
Essential/Secondary Health Care Level • Public awareness: Charts, educational materials, videos • Emergency alert: Availability of ambulance • Emergency department protocols • Imaging: CT Scan machine
Essential/Secondary Health Care Level • Stroke unit treatment protocols (Swallow assessment, FESS protocol, DVT prophylaxis, depression screening) • Cardiac monitors • 12 Lead ECG machine • Carotid Ultrasound • Echocardiogram • Facilities to do Complete blood count, Lipid profile, Blood sugar, Renal functions, Coagulation parameters (PT/PTTK/INR) • Lumbar puncture if there is a suspicion of neuroinfections
Essential/Secondary Health Care Level Essential Medicines • Antiplatelet drugs, Antihypertensives, Antidiabetic drugs, Lipid lowering drugs, Parenteral antihypertensives (Labetolol, Glyceryl Trinitrate) • Thrombolytic agent: recombinant Tissue Plasminogen Activator
Advanced/Tertiary Level Care Technology • Emergency department protocols • CT/CTA, MRI/MRA • DSA Lab • Echocardiogram, Transesophageal Echo • Carotid Doppler ultrasound • Transcranial Doppler
Advanced/Tertiary Level Care Lab facilities • Lumbar puncture: suspected cases of neuroinfections (molecular techniques) • Stroke unit: Cardiac monitoring, stroke unit protocols (FESS, Dysphagia screening, DVT prophylaxis) • Facilities for Telestroke • Rehabilitation center
Advanced/Tertiary Level Care Essential medicines and interventions • Antiplatelets (Asprin, Clopidogrel), Antihypertensives, Antidiabetics, Lipid lowering drug • Parenteral antihypertensives: Labetalol, Glyceryl Trinitrate, Sodium Nitroprusside, Nicardipine • Mechanical thrombectomy (Stent retrievers)
Advanced/Tertiary Level Care • Endovascular Aneurysm coiling • Aneurysmal clipping • Facilities for decompressive hemicraniectomy • Cardiac valve repair • Transcutaneous closure of PFO, Atrial appendage • Carotid endarterectomy/angioplasty