IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

Autor:	Salunkhe M; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India., Haldar P; Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India., Bhatia R; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India., Prasad D; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India., Gupta S; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India., Srivastava MVP; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India., Bhoi S; Department of Neurology, All India Institute of Medical Sciences, Bhubaneshwar, India., Jha M; Department of Neurology, All India Institute of Medical Sciences, Bhubaneshwar, India., Samal P; Department of Neurology, All India Institute of Medical Sciences, Bhubaneshwar, India., Panda S; Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India., Anand S; Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India., Kumar N; Department of Neurology, All India Institute of Medical Sciences, Rishikesh, India., Tiwari A; Department of Neurology, All India Institute of Medical Sciences, Rishikesh, India., Gopi S; Department of Neurology, Andhra Medical College, Visakhapatnam, India., Raju GB; Department of Neurology, Andhra Medical College, Visakhapatnam, India., Garg J; Department of Neurology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India., Chawla MPS; Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India., Ray BK; Department of Neurology, Bangur Institute of Neurology, Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, India., Bhardwaj A; Department of Neurology, Dr Rajendra Prasad Government Medical College, Tanda, India., Verma A; Department of Neurology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India., Dongre N; Department of Neurology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India., Chhina G; Department of Medicine, Government Medical College, Amritsar, India., Sibia R; Department of Medicine, Government Medical College, Patiala, India., Kaur R; Department of Medicine, Government Medical College, Patiala, India., Zanzmera P; Department of Neurology, Government Medical College, Surat, India., Iype T; Department of Neurology, Government Medical College, Trivandrum, India., Sulena; Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, India., Garg R; Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, India., Kumar A; Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, India., Ranjan A; Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, India., Sardana V; Department of Neurology, Kota Medical College, Kota, India., Maheshwari D; Department of Neurology, Kota Medical College, Kota, India., Bhushan B; Department of Neurology, Kota Medical College, Kota, India., Saluja A; Department of Neurology, Lady Hardinge Medical College, New Delhi, India., Darole P; Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India., Bala K; Department of Neurology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India., Dabla S; Department of Neurology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India., Puri I; Department of Neurology, Sardar Patel Medical College, Bikaner, India., Shah S; Department of Neurology, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad, India., Ranga GS; Department of Medicine, University College of Medical Sciences, Delhi, India., Nath S; Department of Medicine, University College of Medical Sciences, Delhi, India., Chandan S; Department of Neurology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India., Malik R; Department of Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2024 Jan; Vol. 19 (1), pp. 76-83. Date of Electronic Publication: 2023 Aug 14.
DOI:	10.1177/17474930231189395
Abstrakt:	Background: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. Aim: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. Methods: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. Results: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. Conclusion: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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