Canadian Stroke Best Practice Recommendations: Virtual Stroke Rehabilitation Consensus Statement 2022

'Best practices', NOT PROTOCOLS LEADING TO 100% RECOVERY!  I would never allow lazy crapola like this to be published.  And look at all these supposedly smart people with PhD's behind their names.

Canadian Stroke Best Practice Recommendations: Virtual Stroke Rehabilitation Consensus Statement 2022

Salbach, Nancy M. PhD^1,2; Mountain, Anita MD^3,4; Lindsay, M. Patrice PhD⁵; Blacquiere, Dylan MD^6,7; McGuff, Rebecca MScOT⁵; Foley, Norine MSc⁸; Corriveau, Hélène PhD⁹; Fung, Joyce PhD¹⁰; Gierman, Natalie MHSc^5∗; Inness, Elizabeth PhD^2,11; Linkewich, Elizabeth MPA^12,13; O’Connell, Colleen MD^14,15; Sakakibara, Brodie PhD^16,17; Smith, Eric E. MD^18,19; Tang, Ada PhD²⁰; Timpson, Debbie MD²¹; Vallentin, Tina MSc.(A)²²; White, Katie MSc²³; Yao, Jennifer MD^24,25

Author Information

American Journal of Physical Medicine & Rehabilitation: June 29, 2022 - Volume - Issue - 10.1097/PHM.0000000000002062

doi: 10.1097/PHM.0000000000002062

• Open
• PAP

Abstract

The 7^th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) for Rehabilitation and Recovery following Stroke includes a new section devoted to the provision of virtual stroke rehabilitation. This consensus statement utilizes GRADE methodology and AGREE II principles. A literature search was conducted using PUBMED, EMBASE and COCHRANE databases. An expert writing group reviewed all evidence and developed recommendations, as well as consensus-based clinical considerations where evidence was insufficient for a recommendation. All recommendations underwent internal and external review. These recommendations apply to hospital, ambulatory care and community-based settings where virtual stroke rehabilitation is provided. This guidance is relevant to health professionals, people living with stroke, healthcare administrators and funders. Recommendations address issues of access, eligibility, consent and privacy, technology and planning, training and competency (for healthcare providers, patients and their families), assessment, service delivery and evaluation. Virtual stroke rehabilitation has been shown to safely and effectively increase access to rehabilitation therapies and care providers and uptake of these recommendations should be a priority in rehabilitation settings. They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location and personal circumstances in Canada.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

A Paradigm Shift for Acute Rehabilitation of Stroke

If you blithering idiots would write exact stroke protocols that specified exact number of repetitions survivors would start counting and do the work. Sedentary time wouldn't exist.  

A Paradigm Shift for Acute Rehabilitation of Stroke

Susan Camillieri

First Published August 28, 2019 Research Article

https://doi.org/10.1177/2516608519848948

Article information

Abstract

Abstract

Current best practice standards for rehabilitation after stroke call for increasing the dose and intensity of interventions for optimal therapeutic benefit. Despite this, those within inpatient rehabilitation during the acute phase are often sedentary, and they receive a lower dose and intensity of therapy than recommended. This may be due to the lack of therapeutic opportunities outside of therapies, program structure characteristics, or a lack of efficiency in therapeutic encounters, all of which have the potential to reduce therapeutic outcomes. Circuit class therapies and group therapies provide a method of increasing the dose and intensity of therapy provided, and may reduce redundancy and inefficiency within programs, but do not satisfy the 3-hour rule under the current Prospective Payment System in the United States. The Centers for Medicare and Medicaid Services require that individual therapy be the primary mode of intervention provision, which limits programs from providing these evidence-based interventions, at a higher volume in a group or circuit format. Providing an enriched environment outside of structured therapies should be mandated to maximize benefits experienced by patients and reduce sedentary time. Empirical study is required to determine which interventions may be effectively delivered when provided via a nonindividual basis, and to explore the feasibility and fiscal implication of alternative models of care. Reform of regulatory standards may be required to align with best practice standards.(We don't need standards you lazy bastards, we need protocols. Do you not understand how recovery occurs?)

Keywords KeywordsStroke rehabilitation, circuit class therapy, group therapy, enriched environment

Access Options

Best practice for stroke rehabilitation not being met in Wellington

It is even worse than that. Measuring rehab hours is worthless. You measure recovery results, nothing less. You need to replace the stroke leadership with someone who will pursue 100% recovery for all. Leaders tackle the tough problems. Do you want leaders or not? If you do, you need to fire a lot of people. 

Best practice for stroke rehabilitation not being met in Wellington

Stroke patients in Wellington are falling "well short" when it comes to meeting recommended rehabilitation hours and face longer-than-advised wait times for appointments.

Published on Friday in the New Zealand Medical Journal, a newly released audit report co-authored by Stephanie Thompson from Capital & Coast DHB, found new stroke patients received, on average, just over 30 minutes of rehabilitation per week.

Additionally, they waited 10 days after being discharged for a rehabilitation appointment.

The results are at odds with the New Zealand Stroke Network recommendations that patients should be seen within seven days of discharge, and receive a minimum of three hours of therapy per speciality per week.

Canines helping out with stroke therapy

Hutt DHB occupational therapist Kerry McKiernan and her dog Ollie after extensive training are taking stroke therapy to new levels.

READ MORE:
* ACC spent six months and $17,000 fighting a stroke victim's claim
* Stroke patients get new lease on life with 'miraculous' procedure
* Life after stroke leads young woman to start charity
* Worrying increase in young suffering strokes
* New hospital programme to help with stroke patients

Rehabilitation involved physiotherapy, speech therapy and occupational therapy sessions, among other things, with the global consensus that the sooner sessions began, the more likely someone was to regain lost abilities and skills.

Fifty patients with a new diagnosis of stroke were included in the 2016/17 audit, with all of them having been referred to the Wellington Community Older Adults, Rehabilitation and Allied Health (WCORA) team.

The report found that patients received an average of 4.3 visits from all required disciplines combined during the first four weeks after hospital discharge.

SUPPLIED

Most strokes are caused by an abrupt blockage of arteries leading to the brain but can also be caused by bleeding into brain tissue when a blood vessel bursts.

The average amount of rehabilitation time increased slightly to 43 minutes per week when the researchers looked more widely at the first three months following a stroke patients discharge.

Thompson and her team found was there were delays in providing an initial community rehabilitation appointment.

Julie Furfie from Stroke Central – an organisation which supports the region's stroke survivors in their recovery – said they received an average of 80-90 referrals a month with the majority of people requiring rehabilitation.

She said as much as "the girls" tried to point people in the right direction, sometimes it could be a struggle to find the right rehabilitation in a timely manner.

"There aren't enough physios, speech therapists ... We just don't have the manpower to give people what the need."

The support available in Wellington has been described by patients and their families as "fragmented and difficult to arrange".

"At the end of the day, the research for help and assistance eventually ends up the responsibility of the stroke survivor or their carer, leading to many hours on the computer, or at the local library, or on the phone," a parent of a stroke survivor said.

Thirty-seven per cent of patients surveyed for the audit met best practice guideline in being seen within seven days of hospital discharge but some waited up to a month to be seen for their first appointment.

That percentage falling well short of the Ministry of Health's indicator of 60 per cent.

While the results showed best practice wasn't being met in the region, it had pushed researchers to put forward recommendations for service improveme

nts to be made

"Service redesign may be needed to improve community stroke rehabilitation provision against the Ministry of Health indicators, and further work is required at a team level to implement suggested changes," the report said.

Certified Brain Injury Training: The Official Academy Of Certified Brain Injury Specialists (ACBIS) TWO-DAY COURSE

So NO PROTOCOLS, just 'care' and best practices.  With this you will never get to 100% recovery.  They are not even trying to get you to 100% recovery.  The tyranny of low expectations in full display here.

Certified Brain Injury Training: The Official Academy Of Certified Brain Injury Specialists (ACBIS)  TWO-DAY COURSE

TWO DAYS:  Friday & Saturday, 12 – 13 April 2019

TIME: FRI – 9:00 AM – 6:00 PM // SAT – 9:00 AM – 3:30 PM
Optional Exam: SAT – 4:00 – 6:00 PM

FORMAT:  2-Day Workshop

ROOM:  PDR#2

TOPIC AREAS:   Brain Injury, Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

CAREER LEVEL: Intermediate

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WHY ATTEND

• Brain injury-serving organizations value hiring and training CBIS certified staff, because this allows them to work with and promote clinicians who:
  • Understand the unique needs of persons recovering from brain injury and
  • staying abreast of current resources in the field.
• Get continuing education units/credits
• Network
• Pop into ACRM Community group meetings & experience what ACRM is all about

“I strongly believe that professionals who work with individuals with brain injury will definitely benefit from this useful and informative course, resulting in a more comprehensive understanding of brain injury and improved patient care.” —Mohan Ganesan, PT, PhD, Assistant Professor of Physical Therapy, Clarke University, Dubuque, Iowa

“The two-day course enables you to see the continuity of the topics (from anatomy-physiology to policy- regulations). The presenter’s personal experiences brought a context to the topics, which was helpful to remember the details.” —Course attendee, Asha K. Vas, PhD, OT, Assistant Professor, Texas Woman’s University

WHO SHOULD ATTEND

This Course and the CBIS Certification Exam are intended for direct-care paraprofessionals at all levels and experienced professionals who want a strong foundation in best practices for brain injury rehabilitation.

The ACBIS Course is designed to prepare participants to sit for the (optional) CBIS Certification Exam, which will be offered at the end of the course on 13 April.

Earn up to 12 hours of CME/CEUs

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Limited capacity: secure your seat

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DESCRIPTION

The Brain Injury Association of America offers a national certification program through its Academy of Certified Brain Injury Specialists (ACBIS). This two-day training is the official course designed to prepare participants to sit for the Certification Exam and join more than 6,000 Certified Brain Injury Specialists worldwide.
To obtain certification, candidates must complete the required work experience/training and pass an examination.
The (optional) proctored certification exam will be offered at the end of the course on 13 April to those who register for the ACBIS Training Course and pre-apply to sit for the exam (additional fee applies) by 1 April. No exceptions to the deadline will be made.
Those who wish to participate in the training without sitting for the exam or obtaining certification are welcome to do so and may register for the training course up until the day of the event without pre-application. All participants will be eligible for CME/CEUs.
The ACBIS Training Course will focus on:

• Diagnostic imaging
• Medical, physical, cognitive, neurobehavioral, and psychosocial consequences
• Pediatrics, adolescents, and aging with a TBI
• Concussions and mTBI
• Disorders of consciousness
• Rehabilitation philosophy, outcome measurement, and care management
• Effect of injuries on families
• Cultural, gender, and sexuality issues
• Military populations
• Neuropsychology
• Participation and return to work

The latest edition of the Essential Brain Injury Guide (EBIG 5.0) also supports preparation for the Certification Exam and is available for purchase from BIAA.

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Learning Objective

1. Define or describe topics including: diagnostic imaging; medical/physical/cognitive/neurobehavioral/psychosocial consequences; pediatrics/adolescents/aging/military populations; concussions/mTBI; disorders of consciousness; rehabilitation philosophy; outcome measurement; care management; family/cultural/gender/sexuality issues; neuropsychology; participation/return to work
2. Demonstrate learning in a written examination
3. Earn a national credential

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CME/CEUs

Continuing education hours will be offered for the following professionals:

1. Certified Case Managers (CCMC)
2. Disability Management Specialists (CDMS)
3. Occupational Therapists (AOTA)
4. *Physical Therapists (FSBPT)
5. **Physicians (ACCME)
6. Psychologist (APA Division 22)
7. Speech Language Professionals (ASHA)
8. Nurses (ANCC)
9. Rehabilitation Counselors (CRCC)
10. Social Workers (NASW)
11. Health Care Executives (ACHE)
12. *ACRM offers Physical Therapy credit through the Federation of State Boards of Physical Therapy – aPTitude.  States that accept FSBPT CEU credit include: AK, AR, AZ, CA, CO, DE, DC, GA, HI, ID, IL, IN, KS, KY, MI, MS, MO, MN,  MT, NE, NC, ND, OR, PA, SC, TN, UT, VT, VA, WI, WY.
     If your state does not accept FSBPT, you should verify whether or not they accept CME non-physician credit, which ACRM also offers.  ACRM is committed to helping you earn credit, so if you need additional documentation, please contact Kim Ruff at kruff@firminc.com or by calling +1. 217. 502. 1312.
    
    **Credits also apply to disciplines that accept NON-Physician CME (Acceptance may vary depending on state)
    

Or receive a GENERAL CERTIFICATE of ATTENDANCE to secure other CME/CEUs on your own.

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REGISTRATION INCLUDES

• 12 Hours CME / CEUs: Continuing Education credit in your choice of 11 disciplines.
• Downloadable slides: Password-protected access to downloadable training materials
• Opportunity to sit for CBIS Certification Exam (additional fee and pre-application required)
• NON-MEMBERS: receive 6-months introductory ACRM membership

BODY OF ABSTRACT

Brain injury-serving organizations value hiring and training CBIS certified staff, because it allows them to work with and promote clinicians who understand the unique needs of persons recovering from brain injury and staying abreast of current resources in the field.

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ACRM ACBIS Review Course and Exam Application & Payment Procedures 

A Certified Brain Injury Training: The Official Academy of Certified Brain Injury Specialists (ACBIS) Course will be held on 12 April 9:00 AM – 6:00 PM and 13 April 9:00 AM – 3:30 PM. The optional CBIS exam will be given at the end of the course on 13 April 4:00 PM – 6:00 PM for participants who pre-applied for certification.

The course is appropriate for paraprofessionals and professionals at all levels who simply want a strong foundation in the best practices in brain injury rehabilitation and/or CME/CEUs, but do not wish to sit for the certification exam.

The Brain Injury Association of America offers a voluntary national certification program for both direct-care level staff and experienced professionals working in brain injury services through the Academy for Certification of Brain Injury Specialists.

The CBIS credential is open to any profession or discipline serving people with brain injury. Eligibility requirements for taking the CBIS Exam can be found on the BIAA website.

The CBIS Exam is a 70 question, multiple choice exam, on which you must get 80% correct in order to earn your CBIS Certification. To pass the CBIS Exam you will need to study and prepare well in advance. This Review Course will review materials which may be covered in the test. The CBIS Review Course will be instructed by ACBIS Certified Brain Injury Specialist Trainers (CBISTs).

PLEASE NOTE: The deadline for applying to ACBIS to become eligible to take the CBIS Exam, and for registering to attend the Review Course is April 1, 2019. No exceptions to the deadline will be made.

TWO-PART PROCESS

To take the CBIS Training Course and CBIS Exam attendees should complete a TWO-PART PROCESS.

1. Complete the ACBIS Application Procedure and pay the $300 application fee directly to ACBIS (See Part I below for details)
2. Register with ACRM to attend the CBIS Training Course (See registration rates)

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The CBIS Training Course registration (to ACRM) and CBIS application (to ACBIS) are both due no later than 1 April 2019. 

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For questions on the ACBIS application or certification process, please see the ACBIS website. If further information or clarification is needed, please contact Christine Chen, ACBIS Coordinator.
It is highly recommended that you study prior to the CBIS Review Course and the examination. You may purchase the study guide titled: The Essential Brain Injury Guide Edition 5.0 published by Brain Injury Association of America (BIAA). Please note that by applying for the CBIS credential through ACBIS, The Essential Brain Injury Guide is discounted to $90.00 plus $20.00 s/h.

Managing LDL-C to Reduce Cardiovascular Disease Risk: Defining Best Clinical Practice

I don't want best clinical practice, that is just laziness. I want a protocol. For this objective starting point ; these exact interventions need to occur. Nothing should be left to chance and interpretation. But that is just my non-medical understanding. Prove me wrong and I can change my position.

Registration and Dinner: 6:30-7 p.m.
Symposium: 7-9 p.m., Sunday, Nov. 11
InterContinental Chicago Grand Ballroom, 7th Floor
Sponsor: Voxmedia - Supporter: Amgen

Program Overview: Nonstatin drugs (ezetimibe, PCSK9 inhibitors) further lower LDL-C and further reduce cardiovascular risk when added to statins, while demonstrating safety at low LDL-C levels. 

MORE

Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors

Lazy, lazy, lazy. 'Best practices'  are just a better term for guidelines. We still need protocols, until we get there our stroke medical 'professionals' are not taking any responsibility for solving stroke. 74 references which I bet your doctor has not read a single one.

Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors

Thousands of deaths and disabilities caused by strokes in Australia could have been avoided with better care and facilities, according to a new audit by the Stroke Foundation

You don't need best practices or 'care', you need protocols with defined efficacy ratings. That will give you RESULTS, not just better care. Ask for the correct intervention, not the lazy response of better care. YOU have to tell these hospitals they don't know a fucking thing about getting survivors to 100% recovery. That is the only goal, NOT BETTER CARE! 
https://tenplay.com.au/news/national/november-2017/disappointing-care-failing-thousands-of-stroke-patients

The study surveyed more than 30,000 stroke admissions to more than 120 hospitals in 2016 and found many patients were “denied best practice.”

Only 36 percent of stroke victims are reaching hospital within the crucial 4.5-hour window in order to receive essential ‘clot-busting’ medication, and just 30 percent received the medication within an hour of arriving at hospital - compared with 59 percent in the US and 62 percent in the UK. 

The medication, called thrombolysis, acts by dissolving clots of blood disrupting blood flow to the brain. The sooner it is administered after a stroke, the better the chances of recovery.

But the audit found the potentially life-saving medication is only being used in 13 percent of eligible cases Australia-wide - although this is up from seven percent in 2015.

This is despite it being available in more than 70 percent of hospitals in the country.

The report also found a “significant disparity” between regional and metro areas, with less than half of regional victims receiving care from a dedicated stroke unit, compared to more than 75 percent in metro areas.

Australians in regional areas were 19 percent more likely to suffer a stroke than city-dwellers, according to the audit.

Sharon McGowan, CEO of the Stroke Foundation, said there is a lot of work to be done to achieve best practice.

“Surviving and living well after stroke should not be determined by your post code,” she said.

“Australia has one of the most advanced trauma systems in the world, we need to apply the same thinking to emergency stroke treatment to ensure people living in regional and rural Australia have the best chance(Weasel words, You expect results) of making a meaningful recovery after a stroke.”

But there’s a silver lining: the report found the number of stroke units Australia-wide had increased from 87 in 2015 to 95 this year, and the use of thrombolysis increased from only 7 percent in 2015.

Ms McGowan says improvements to stroke care can be achieved.

“Stroke is a serious medical emergency which requires urgent attention, but with the right treatment at the right time many people are able to recover,” she said.

“We [must] ensure every patient with a stroke has a clear pathway to stroke treatment, whether that be at the regional hospital, utilising telehealth, or transported to the nearest comprehensive stroke service.

“This means clear processes between ambulances, emergency departments and stroke units enabling patients to be diagnosed and provided with appropriate treatment quickly,” she said.

Canadian Stroke Best Practice Recommendations Call for Writing Group Members

If you are Canadian ask them why they aren't writing 'Stroke Best Practice Results'. Survivors want RESULTS not lazy guidelines or 'recommendations' or 'care'. PROTOCOLS, PROTOCOLS, PROTOCOLS.
Efficacy is needed, I expect % success for each protocol.  I suggest joining the writing group as a stroke survivor so they stay focused on getting survivors 100% recovered rather that the current 10% full recovery. You can't let stroke medical 'professionals' write these, they will dumb down the necessary things needed to get to 100% recovery and won't even set 100% recovery as the goal for all stroke survivors.

http://mailchi.mp/d0fe799fb22a/cpsr-stroke-recovery-news-e-newsletter
An invitation to participate in the development of stroke best practice recommendations from our partners at Heart & Stroke
The Canadian Stroke Best Practice Recommendations (CSBPR) are considered among the strongest and most rigorous stroke guidelines available globally.  We have made remarkable progress in improving stroke care (What about results?) and educating healthcare professionals in evidence-based stroke care delivery over the past several years. 

We are now into our  6^th Edition of the CSBPR and starting our review and update of the Rehabilitation module.  This year, the writing group is being co-chaired by Dr. Robert Teasell  (London), and Dr. Nancy Salbach (Toronto).  Under their excellent leadership we will undergo the update process from October 2017- June 2018.

We are seeking experts in issues relating to rehabilitation following stroke to volunteer as part of this writing group.  You may nominate yourself or a colleague.  We work within a multidisciplinary cross-continuum model and welcome nominations from all healthcare disciplines that work with patients who have experiences a stroke and their families within all relevant setting (inpatient, ambulatory, community).

All names to be submitted to Elisabeth Smitko (elisabeth.smitko@heartandstroke.ca) no later than September 30, 2017.

(Kindly note that the size of the writing group is limited, therefore if you volunteer for this group and all the spots get filled, we will keep your name on file and you will be considered as a potential external reviewer later in the process, or for other modules when they begin).

Your involvement would include:

• Completion of the HSF Confidentiality and Conflict of Interest form prior to start of review process;
• Review evidence summary tables (evidence extractions provided to you already completed)prior to phone calls and identify other potentially relevant evidence to be included;
• Participate in writing group phone calls about every two to three weeks from end of October 2017 to June 2018 (some alterations may be made for holidays). During these calls all existing recommendations will be reviewed for continued relevance and assigned levels of evidence, evaluate new and emerging evidence, and discuss required additions, deletions or changes to the recommendations (note this is the most intense participation period);
• Review final draft recommendations and provide input;
• Participate in discussions and development of implementation materials as needed;
• Promote best practices with your professional colleagues.
• Be listed as a co-author on any publications of the guidelines; and as well participate in presentations where interested. 
• Participation on writing groups can be counted as part of your annual CME requirements for your professional college licensing and certificates of participation are provided to all members and reviewers
• Letters of participation and acknowledgement of your efforts sent to university and hospital department heads upon request.

 

Hospital based program launched to improve outcomes for stroke patients in China to impact world's largest population

You want results not lazy guidelines and best practices and care.
Big fucking whoopee.
http://www.pharmiweb.com/pressreleases/pressrel.asp?ROW_ID=226354#.WU8vZ-kpCM8
PR Newswire
BEIJING, June 24, 2017
BEIJING, June 24, 2017 /PRNewswire/ -- Delivering big, positive stroke outcomes for the world's largest population is the aim of the American Stroke Association (ASA) and Chinese Stroke Association (CSA) with the launch of a quality improvement program adapted from the American Heart Association's guidelines-based program called Get With The Guidelines®.

The program works to improve treatment for, and prevention of, cardiovascular and stroke events by helping hospitals and providers consistently adhere to the latest scientific treatment guidelines. In the last 15 years, Get With The Guidelines has transformed patient care for heart and stroke patients in the U.S., helping hospitals and providers learn the correct treatment and translate guidelines into practice. This program has saved lives and resulted in more than 400 scientific publications that advance heart and brain health around the world.
The adapted Get With The Guidelines program, designed through a collaboration of the ASA and the CSA, endorsed by the China National Health and Family Planning Commission, and supported by Medtronic, is a set of "best practices" that aim to continuously improve treatment, enhance the quality of care, and prevent future stroke events in China.
While several evidence-based, highly effective, guideline-recommended therapies are known, adherence to guidelines for stroke care remains incomplete and highly variable from region to region, and country to country.
This effort aims to solve for that in China. Specifically, this program addresses the need for:
1.     Enhanced education for EMS and pre-hospital caregivers, especially since analysis shows only 13 percent of Chinese stroke patients arrive at the hospital by EMS, versus 50 percent in the U.S.
2.     A reduction in "door-to-needle" times for patients to receive the clot-busting drug tPA. To-date, analysis for rates of compliance with evidenced based therapies notes significant gaps in timeliness to tPA treatment.
3.     Increased awareness and application of mechanical endovascular reperfusion therapies in appropriate patients.
4.     Increased awareness and application of secondary prevention in appropriate stroke patients to fill significant gaps in venous thromboembolism (VTE) prophylaxis, lipid lowering therapy, anticoagulation for atrial fibrillation and rehabilitation assessment in Chinese patients.
With a population of 1.4 billion, stroke is the leading killer and claims the lives of 1.6 million Chinese people annually. Today, China faces cardiovascular and stroke risk factors similar to those in Western nations. Among risk factors, hypertension remains the most important for all types of strokes.[1] Additionally, the concept of a "stroke belt" in China has emerged which identifies specific geographic regions where the mortality associated with stroke is 50 percent higher than that of other regions in the country. Currently, the areas with higher mortality are the northeast and the western/southwestern.[2]
In 2007, the Ministry of Health -- now National Health and Family Planning Commission -- sponsored the Chinese National Stroke Registry and a five-year plan to increase comprehensive stroke centers in China. Establishing the registry also led to creating the Stroke Screening, Prevention and Treatment Project in 2009, and more recently the National Center of Stroke Care Quality Control in 2011.

"The American Stroke Association is deeply committed to having a transformative impact on healthcare systems and patients worldwide by working alongside countries, governments and international cardiovascular and cerebrovascular societies to facilitate the application of the tools and knowledge of our quality programs," said Ying Xian, M.D., Ph.D, American Stroke Association spokesperson and Assistant Professor of Neurology and Medicine at the Duke University Medical Center and Duke Clinical Research Institute. "The U.S. marketplace has given us a road map to develop scalable and sustainable models for international quality improvement initiatives. Now, with our consult, the Chinese Stroke Association aims to adopt those models to achieve better outcomes for stroke patients in China."
"It is with great excitement that we announce the launch of this collaborative stroke quality improvement project between the CSA and ASA to further enhance cooperation on clinical research, education, and the impact of acute stroke science," said Jizong Zhao, President, CSA. "I congratulate both organizations' dedication to improving stroke outcomes in China."
Reaching healthcare providers with the Get With The Guidelines program at Chinese secondary and tertiary hospitals -- and at all stages of the chain of survival, from pre-hospital advanced medical care (also known as EMS or emergency medical services) to neurologists to even hospital administrators -- is the priority.
"Medtronic is a leading stroke care solution provider in stent retriever therapy with more than 20 years of experience in China. We provide clinical education and training systems for Chinese physicians and, together with medical societies, we consistently promote a hierarchical treatment system, raise public awareness, and speed up patient admission and treatment to ensure the proper care for patients," said Chris Lee, President, Medtronic Greater China. "We are very proud to collaborate with both the CSA and ASA, and we will continuously work together to improve China's stroke care quality."
Stroke has also had a significant impact on healthcare expenditures and the Chinese economy. The cost for stroke care by the government-funded hospitals was 1.17 billion RMB (approx. $170M USD) in 2003 and 8.19 billion RMB (approx. $1.3B USD) in 2009, a 117 percent increase annually. Now, the annual cost of stroke care in China is approximately 40 billion RMB ($5.8B USD).[3]
[1] http://stroke.ahajournals.org/content/42/12/3651
[2] http://stroke.ahajournals.org/content/strokeaha/44/7/1775.full.pdf
[3] http://stroke.ahajournals.org/content/42/12/3651  

New research highlights need to give greater consideration to sleep in stroke care

I was perpetually exhausted while in the hospital, one attempt using finger oximetry that totally missed my sleep apnea. I do wonder if sleeping pills actually create useful sleep. I had them almost every night, nurses would hand them out like candy. We need a stroke protocol here.
Maybe this might help; most of these were written in 2013 which shows you how appallingly slow stroke research is disseminated to clinical practice. That's because we have NO stroke leadership pushing best practices.

How sleep acts as a cleaning system for the brain

http://www.alphagalileo.org/ViewItem.aspx?ItemId=162152&CultureCode=en
Surrey, University of
Researchers identify sleep as a problem in patients with stroke, and highlight the need to give greater consideration to sleep in stroke care, and in particular stroke rehabilitation.
•             NICE guideline on stroke rehabilitation does not reference sleep at all
•             Sleep essential for learning, mental and physical health
•             Stroke care mainly focussed on daytime activity and ignores sleep altogether
Latest findings from the University of Surrey and University of Freiburg all point towards the important role of sleep in patients with stroke.  However, at present, sleep is rarely considered in in-patient and community-based stroke care.  The team of researchers also found that this is despite a number of studies that highlights patients with stroke often experience difficulties with their sleep.
Patients often report that going to sleep and staying asleep is difficult and aggravates the challenges of coping with everyday activities. But how much do we really know about the sleep of patients with chronic stroke and how their sleep compares to that of other older healthy people?  For the first time, the researchers have addressed this question by drawing together all existing research comparing patients with stroke with control populations using polysomnography, the gold standard method to study sleep.
The study, published in the journal PLOS ONE, revealed that sleep is poor in stroke patients, but the research also highlighted the lack of knowledge in particular with regard to older people and chronic patients. For example, the team found no study comparing the sleep physiology of chronic stroke patients with other people in their respective age group.  While there is some information on changes of sleep difficulties throughout stroke recovery, how stroke severity, lesion location, and sleep are linked to physical and mental health is generally unexplored.
“Sleep is essential for learning, mental and physical health in everybody but even more so for chronic stroke patients. A comprehensive and holistic understanding of sleep is therefore needed to improve rehabilitation effectiveness and ensure quality long term care,” said lead author Professor Annette Sterr from the University of Surrey.
“However, this link between sleep and stroke has not yet entered clinical practice.  The recent guideline for stroke rehabilitation issued by the UK National Institute for Health and Care Excellence (NICE) provides a detailed account of the medical, physical and psychological needs to be met through in-and outpatients stroke care, but these recommendations make no comment on sleep.  Moreover, stroke care is focussed on daytime activity and ignores sleep altogether.”
“In the UK, strokes are a major health problem. Every year, around 110,000 people have a stroke in England and it is the third largest cause of death.  One key theme emerging through our research is the need to give greater consideration to sleep in stroke care, and in particular in stroke rehabilitation.  By doing so this will ensure that each patient is treated fairly and an appropriate course of treatment is planned and implemented.”

• Full bibliographic informationPolysomnographic characteristics of sleep in stroke: A systematic review and meta-analysis; Chiara Baglioni, Christoph Nissen, Adrian Schweinoch1, Dieter Riemann, Kai Spiegelhalder, Mathias Berger, Cornelius Weiller, Annette Sterr; PLOS ONE; doi: 10.1371/journal.pone.0148496

Ontario Stroke Evaluation Report 2011: Improving System Efficiency by Implementing Stroke Best Practices

And not a single word in this report states that stroke care is a complete failure because only 10% get to almost full recovery. Just 'Happy talk'. If there are no problems found making things better will never occur. You don't compare yourself to the status quo, you compare yourself to the ideal recovery.  Best practices that only get 10% to full recovery is a complete failure. Own up to your failures. No best practice for anything to do with the neuronal cascade of death. I guess neurons dying in the first week is nothing to be concerned about.
http://www.ices.on.ca/Publications/Atlases-and-Reports/2011/Ontario-Stroke-Evaluation-Report-2011

Benefits of an E-learning Intervention for Implementing Stroke Rehabilitation Best Practices

It takes a graduate student thesis to describe the complete stupidity of lack of transmission of stroke knowledge and protocols. An obvious failing of our stroke associations. Its only 200 pages. Hell this is precisely the reason most survivors start blogs and stroke forums.
http://scholar.google.com/scholar_url?hl=en&q=https://tspace.library.utoronto.ca/bitstream/1807/43666/1/Menon_Anita_201311_PhD_thesis.pdf&sa=X&scisig=AAGBfm1cqX4IKvjU5UKuCDoSDfZqiomLdA&oi=scholaralrt

THE IMPACT OF MOVING TO STROKE REHABILITATION BEST PRACTICES IN ONTARIO

A dense and fairly incomprehensible report. Since the focus groups only contained medical staff this is a major failure. But survivors could have made this 100% better
http://www.gtarehabnetwork.ca/uploads/File/PublicationsLHINreports/The_impact_of_moving_to_stroke_rehabilitation_best_practices_in_Ontario_OSN_Final_Report_Sept_14_2012.pdf

canadian best practices for stroke care

http://www.strokebestpractices.ca/index.php/overview/
What Canada lists as best practices. It probably won't help any of us chronic survivors but at least you'll know more than your medical staff.

stroke guidelines around the world

best practices in stroke rehab
Canada has several
Strokengine
http://www.strokengine.ca/index.php
http://www.strokebestpractices.ca/
Canadian Stroke strategy for 2010
http://canadianstrokestrategy.com/
Australian stroke strategy
http://www.strokefoundation.com.au/images/stories/stroke%20support%20strategy%20low%20res.pdf
Britain stroke strategy
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Stroke/DH_099065
Stroke guidelines of the Royal College of Physicians
http://www.nice.org.uk/nicemedia/live/12018/41363/41363.pdf
Scottish Intercollegiate Guidelines Network
http://www.sign.ac.uk/pdf/sign118.pdf
And what the World Stroke Organization lists as international stroke guidelines for countries.
http://www.world-stroke.org/guidelines_hb02.asp
You will notice that the United states doesn't even have an entry
One would think that the WSO would put together a single guideline but that obviously will not occur until a survivor gets in power in the WSO.
Most of these have probably been put together with limited survivor input so take them with a grain of salt.
If your country has some please post them in the comment section.