Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of General Surgery, Palestine Medical Complex, Ramallah, Palestine.
Curr Atheroscler Rep. 2017 Nov 8;19(12):61. doi: 10.1007/s11883-017-0694-6.
Most strokes occur in low- and middle-income countries where resources to manage patients are limited. We explore the resources required to providing optimal acute stroke care and review barriers to implementing evidence-based stroke care in settings with limited resources using the World Stroke Organization's Global Stroke Services Action Plan framework.
Major advances have been made during the past few decades in stroke prevention, treatment, and rehabilitation. These advances have been translated into practice in many high-income countries, but their uptake remains suboptimal in low- and middle-income countries. The review highlights the resources required to providing optimal acute stroke care in settings with limited resources. These resource levels were divided into minimal, essential, and advanced resources depending on the availability of stroke expertise, diagnostics, and facilities. Resources were described for the three stages of acute care: early diagnosis and management, acute management and prevention of complications, and early discharge and rehabilitation. Barriers to providing acute care at each of these stages in low- and middle-income countries are reviewed, explaining that some barriers persist in essential or advanced settings where some aspects of organized stroke units are available.
大多数中风发生在资源有限的中低收入国家。我们利用世界卒中组织的全球卒中服务行动计划框架，探讨了在资源有限的环境中提供最佳急性卒中护理所需的资源，并综述了实施基于证据的卒中护理的障碍。
在过去几十年中，卒中的预防、治疗和康复方面取得了重大进展。这些进展已在许多高收入国家付诸实践，但在中低收入国家的应用仍不尽人意。本综述强调了在资源有限的环境中提供最佳急性卒中护理所需的资源。这些资源水平根据卒中专业知识、诊断和设施的可用性分为最低限度、基本和高级资源。还描述了急性护理三个阶段的资源：早期诊断和管理、急性管理和并发症预防，以及早期出院和康复。综述了在中低收入国家的每个阶段提供急性护理的障碍，并解释说，一些障碍在基本或高级环境中仍然存在，在这些环境中，已经具备了有组织的卒中单元的某些方面。
