Absolutely totally fucking appalling! GUIDELINES; NOT PROTOCOLS! Damn the WSO is completely hopeless, not even trying to solve stroke and cure survivors.
Systematic review and synthesis of global stroke guidelines for the World Stroke Organization
Abstract
Background
There
are multiple stroke guidelines globally. To synthesize these and
summarize what existing stroke guidelines recommend about the management
of people with stroke, the World Stroke Organisation (WSO) Guideline
committee, under the auspices of the WSO, reviewed available guidelines.
They identified areas of strong agreement across guidelines, and their
global coverage.
Aims
To
systematically review the literature to identify stroke guidelines
(excluding primary stroke prevention and subarachnoid haemorrhage) since
1st January 2011, evaluate quality (AGREE II), tabulate strong
recommendations, and judge applicability according to stroke care
available (minimal, essential, advanced).
Summary of review
Searches
identified 15400 titles, 911 texts were retrieved, 203 publications
scrutinized by the three subgroups (acute, secondary prevention,
rehabilitation), and recommendations extracted from most recent version
of relevant guidelines. For acute treatment, there were more guidelines
about ischaemic stroke than intracerebral haemorrhage; recommendations
addressed pre-hospital, emergency, and acute hospital care. Strong
recommendations were made for reperfusion therapies for acute ischaemic
stroke. For secondary prevention, strong recommendations included
establishing aetiological diagnosis, management of hypertension, weight,
diabetes, lipids, lifestyle modification; and for ischaemic stroke:
management of atrial fibrillation, valvular heart disease, left
ventricular and atrial thrombi, patent foramen ovale, atherosclerotic
extracranial large vessel disease, intracranial atherosclerotic disease,
antithrombotics in non-cardioembolic stroke. For rehabilitation there
were strong recommendations for organized stroke unit care,
multidisciplinary rehabilitation, task specific training, fitness
training, and specific interventions for post-stroke impairments.
Most
recommendations were from high income countries, and most did not
consider comorbidity, resource implications and implementation. Patient
and public involvement was limited.
Conclusions
The
review identified a number of areas of stroke care in there was strong
consensus. However there was extensive repetition and redundancy in
guideline recommendations. Future guidelines groups should consider
closer collaboration to improve efficiency, include more people with
lived experience in the development process, consider comorbidity, and
advise on implementation.
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