Implementing stroke care in a lower-middle-income country: results and recommendations based on an implementation study within the Nepal Stroke Project
BackgroundGlobally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained...
Gespeichert in:
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
24 October 2023
|
| In: |
Frontiers in neurology
Year: 2023, Jahrgang: 14, Pages: 1-11 |
| ISSN: | 1664-2295 |
| DOI: | 10.3389/fneur.2023.1272076 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3389/fneur.2023.1272076 Verlag, lizenzpflichtig, Volltext: https://www.frontiersin.org/articles/10.3389/fneur.2023.1272076 
|
| Verfasserangaben: | Christine Tunkl, Raju Paudel, Sunanjay Bajaj, Lekhjung Thapa, Patrick Tunkl, Avinash Chandra, Bhupendra Shah, Balgopal Karmacharya, Ashim Subedi, Pankaj Jalan, Pradesh Ghimire, Mahesh Raj Ghimire, Gampo Dorje, Nima Haji Begli, Jessica Golenia, Bikram Prasad Gajurel, Shirsho Shreyan, Nooma Sharma, Alexandra Krauss, Jeyaraj Pandian, Thomas Fischer, Jan van der Merwe, Wolfgang Wick, Werner Hacke and Christoph Gumbinger |
MARC
| LEADER | 00000caa a2200000 c 4500 | ||
|---|---|---|---|
| 001 | 1872328555 | ||
| 003 | DE-627 | ||
| 005 | 20250212130156.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231208s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3389/fneur.2023.1272076 |2 doi | |
| 035 | |a (DE-627)1872328555 | ||
| 035 | |a (DE-599)KXP1872328555 | ||
| 035 | |a (OCoLC)1425208586 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rda | ||
| 041 | |a eng | ||
| 084 | |a 33 |2 sdnb | ||
| 100 | 1 | |a Tunkl, Christine |d 1989- |e VerfasserIn |0 (DE-588)1082584290 |0 (DE-627)847686302 |0 (DE-576)455535906 |4 aut | |
| 245 | 1 | 0 | |a Implementing stroke care in a lower-middle-income country |b results and recommendations based on an implementation study within the Nepal Stroke Project |c Christine Tunkl, Raju Paudel, Sunanjay Bajaj, Lekhjung Thapa, Patrick Tunkl, Avinash Chandra, Bhupendra Shah, Balgopal Karmacharya, Ashim Subedi, Pankaj Jalan, Pradesh Ghimire, Mahesh Raj Ghimire, Gampo Dorje, Nima Haji Begli, Jessica Golenia, Bikram Prasad Gajurel, Shirsho Shreyan, Nooma Sharma, Alexandra Krauss, Jeyaraj Pandian, Thomas Fischer, Jan van der Merwe, Wolfgang Wick, Werner Hacke and Christoph Gumbinger |
| 264 | 1 | |c 24 October 2023 | |
| 300 | |a 11 | ||
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Gesehen am 08.12.2023 | ||
| 520 | |a BackgroundGlobally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months.MethodsThe NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices.ResultsBoth offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated.DiscussionWe identified six actions that may support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our results must be verified with process indicators of stroke care. | ||
| 700 | 1 | |a Paudel, Raju |e VerfasserIn |4 aut | |
| 700 | 1 | |a Bajaj, Sunanjay |d 1997- |e VerfasserIn |0 (DE-588)1353527352 |0 (DE-627)1914897552 |4 aut | |
| 700 | 1 | |a Thapa, Lekhjung |e VerfasserIn |4 aut | |
| 700 | 1 | |a Tunkl, Patrick |e VerfasserIn |4 aut | |
| 700 | 1 | |a Chandra, Avinash |e VerfasserIn |4 aut | |
| 700 | 1 | |a Shah, Bhupendra |e VerfasserIn |4 aut | |
| 700 | 1 | |a Karmacharya, Balgopal |e VerfasserIn |4 aut | |
| 700 | 1 | |a Subedi, Ashim |e VerfasserIn |4 aut | |
| 700 | 1 | |a Jalan, Pankaj |e VerfasserIn |4 aut | |
| 700 | 1 | |a Ghimire, Pradesh |e VerfasserIn |4 aut | |
| 700 | 1 | |a Ghimire, Mahesh Raj |e VerfasserIn |4 aut | |
| 700 | 1 | |a Dorje, Gampo |e VerfasserIn |4 aut | |
| 700 | 1 | |a Haji Begli, Nima |d 1991- |e VerfasserIn |0 (DE-588)1221530488 |0 (DE-627)173872574X |4 aut | |
| 700 | 1 | |a Golenia, Jessica |e VerfasserIn |4 aut | |
| 700 | 1 | |a Gajurel, Bikram Prasad |e VerfasserIn |4 aut | |
| 700 | 1 | |a Shreyan, Shirsho |e VerfasserIn |4 aut | |
| 700 | 1 | |a Sharma, Nooma |e VerfasserIn |4 aut | |
| 700 | 1 | |a Krauss, Alexandra |e VerfasserIn |4 aut | |
| 700 | 1 | |a Pandian, Jeyaraj |e VerfasserIn |4 aut | |
| 700 | 1 | |a Fischer, Thomas |e VerfasserIn |4 aut | |
| 700 | 1 | |a van der Merwe, Jan |e VerfasserIn |4 aut | |
| 700 | 1 | |a Wick, Wolfgang |d 1970- |e VerfasserIn |0 (DE-588)120297736 |0 (DE-627)080586929 |0 (DE-576)186221320 |4 aut | |
| 700 | 1 | |a Hacke, Werner |d 1948- |e VerfasserIn |0 (DE-588)12021699X |0 (DE-627)080530346 |0 (DE-576)164358854 |4 aut | |
| 700 | 1 | |a Gumbinger, Christoph |e VerfasserIn |0 (DE-588)138155178 |0 (DE-627)696381117 |0 (DE-576)306183927 |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Frontiers in neurology |d Lausanne : Frontiers Research Foundation, 2008 |g 14(2023) vom: Okt., Artikel-ID 1272076, Seite 1-11 |h Online-Ressource |w (DE-627)631498753 |w (DE-600)2564214-5 |w (DE-576)326550933 |x 1664-2295 |7 nnas |a Implementing stroke care in a lower-middle-income country results and recommendations based on an implementation study within the Nepal Stroke Project |
| 773 | 1 | 8 | |g volume:14 |g year:2023 |g month:10 |g elocationid:1272076 |g pages:1-11 |g extent:11 |a Implementing stroke care in a lower-middle-income country results and recommendations based on an implementation study within the Nepal Stroke Project |
| 856 | 4 | 0 | |u https://doi.org/10.3389/fneur.2023.1272076 |x Verlag |x Resolving-System |z lizenzpflichtig |3 Volltext |
| 856 | 4 | 0 | |u https://www.frontiersin.org/articles/10.3389/fneur.2023.1272076 |x Verlag |z lizenzpflichtig |3 Volltext |
| 951 | |a AR | ||
| 992 | |a 20231208 | ||
| 993 | |a Article | ||
| 994 | |a 2023 | ||
| 998 | |g 138155178 |a Gumbinger, Christoph |m 138155178:Gumbinger, Christoph |d 910000 |d 911100 |d 50000 |e 910000PG138155178 |e 911100PG138155178 |e 50000PG138155178 |k 0/910000/ |k 1/910000/911100/ |k 0/50000/ |p 25 |y j | ||
| 998 | |g 12021699X |a Hacke, Werner |m 12021699X:Hacke, Werner |d 910000 |d 911100 |d 50000 |e 910000PH12021699X |e 911100PH12021699X |e 50000PH12021699X |k 0/910000/ |k 1/910000/911100/ |k 0/50000/ |p 24 | ||
| 998 | |g 120297736 |a Wick, Wolfgang |m 120297736:Wick, Wolfgang |d 910000 |d 911100 |d 50000 |e 910000PW120297736 |e 911100PW120297736 |e 50000PW120297736 |k 0/910000/ |k 1/910000/911100/ |k 0/50000/ |p 23 | ||
| 998 | |g 1221530488 |a Haji Begli, Nima |m 1221530488:Haji Begli, Nima |d 50000 |e 50000PH1221530488 |k 0/50000/ |p 14 | ||
| 998 | |g 1353527352 |a Bajaj, Sunanjay |m 1353527352:Bajaj, Sunanjay |d 50000 |e 50000PB1353527352 |k 0/50000/ |p 3 | ||
| 998 | |g 1082584290 |a Tunkl, Christine |m 1082584290:Tunkl, Christine |d 910000 |d 911100 |d 50000 |e 910000PT1082584290 |e 911100PT1082584290 |e 50000PT1082584290 |k 0/910000/ |k 1/910000/911100/ |k 0/50000/ |p 1 |x j | ||
| 999 | |a KXP-PPN1872328555 |e 4428869401 | ||
| BIB | |a Y | ||
| SER | |a journal | ||
| JSO | |a {"title":[{"subtitle":"results and recommendations based on an implementation study within the Nepal Stroke Project","title_sort":"Implementing stroke care in a lower-middle-income country","title":"Implementing stroke care in a lower-middle-income country"}],"type":{"media":"Online-Ressource","bibl":"article-journal"},"language":["eng"],"note":["Gesehen am 08.12.2023"],"origin":[{"dateIssuedDisp":"24 October 2023","dateIssuedKey":"2023"}],"person":[{"given":"Christine","role":"aut","family":"Tunkl","display":"Tunkl, Christine"},{"display":"Paudel, Raju","family":"Paudel","role":"aut","given":"Raju"},{"display":"Bajaj, Sunanjay","family":"Bajaj","role":"aut","given":"Sunanjay"},{"display":"Thapa, Lekhjung","family":"Thapa","role":"aut","given":"Lekhjung"},{"display":"Tunkl, Patrick","role":"aut","given":"Patrick","family":"Tunkl"},{"display":"Chandra, Avinash","given":"Avinash","role":"aut","family":"Chandra"},{"given":"Bhupendra","role":"aut","family":"Shah","display":"Shah, Bhupendra"},{"family":"Karmacharya","given":"Balgopal","role":"aut","display":"Karmacharya, Balgopal"},{"display":"Subedi, Ashim","family":"Subedi","given":"Ashim","role":"aut"},{"display":"Jalan, Pankaj","role":"aut","given":"Pankaj","family":"Jalan"},{"role":"aut","given":"Pradesh","family":"Ghimire","display":"Ghimire, Pradesh"},{"display":"Ghimire, Mahesh Raj","given":"Mahesh Raj","role":"aut","family":"Ghimire"},{"family":"Dorje","role":"aut","given":"Gampo","display":"Dorje, Gampo"},{"given":"Nima","role":"aut","family":"Haji Begli","display":"Haji Begli, Nima"},{"given":"Jessica","role":"aut","family":"Golenia","display":"Golenia, Jessica"},{"display":"Gajurel, Bikram Prasad","family":"Gajurel","given":"Bikram Prasad","role":"aut"},{"display":"Shreyan, Shirsho","family":"Shreyan","given":"Shirsho","role":"aut"},{"family":"Sharma","role":"aut","given":"Nooma","display":"Sharma, Nooma"},{"display":"Krauss, Alexandra","family":"Krauss","role":"aut","given":"Alexandra"},{"family":"Pandian","given":"Jeyaraj","role":"aut","display":"Pandian, Jeyaraj"},{"given":"Thomas","role":"aut","family":"Fischer","display":"Fischer, Thomas"},{"display":"van der Merwe, Jan","role":"aut","given":"Jan","family":"van der Merwe"},{"display":"Wick, Wolfgang","role":"aut","given":"Wolfgang","family":"Wick"},{"display":"Hacke, Werner","family":"Hacke","given":"Werner","role":"aut"},{"family":"Gumbinger","given":"Christoph","role":"aut","display":"Gumbinger, Christoph"}],"relHost":[{"origin":[{"publisher":"Frontiers Research Foundation","publisherPlace":"Lausanne","dateIssuedKey":"2008","dateIssuedDisp":"2008-"}],"title":[{"title_sort":"Frontiers in neurology","title":"Frontiers in neurology"}],"language":["eng"],"type":{"media":"Online-Ressource","bibl":"periodical"},"note":["Gesehen am 18.08.20","Specialty sections: Autonomic Neuroscience; Brain Imaging Methods; Dementia; Endovascular and Interventional Neurology; Epilepsy; Headache Medicine and Facial Pain; Movement Disorders; Multiple Sclerosis and Neuroimmunology; Neurocritical and Neurohospitalist; Care; Neurodegeneration; Neurogenomics; Neurology Education; Neuromuscular Diseases; Neuro-Oncology; Neuro-Ophthalmology; Neuro-Otology; Neuropediatrics; Neuropharmacology; Neuroprosthetics; Neurotrauma; Sleep and Chronobiology; Spinal Cord Medicine; Sports Neurology; Stroke; Teleneurology"],"recId":"631498753","physDesc":[{"extent":"Online-Ressource"}],"disp":"Implementing stroke care in a lower-middle-income country results and recommendations based on an implementation study within the Nepal Stroke ProjectFrontiers in neurology","name":{"displayForm":["Frontiers Research Foundation"]},"pubHistory":["2008 -"],"titleAlt":[{"title":"Autonomic Neuroscience"},{"title":"Brain Imaging Methods"},{"title":"Dementia"},{"title":"Endovascular and Interventional Neurology"},{"title":"Epilepsy"},{"title":"Headache Medicine and Facial Pain"},{"title":"Movement Disorders"},{"title":"Multiple Sclerosis and Neuroimmunology"},{"title":"Neurocritical and Neurohospitalist Care"},{"title":"Neurodegeneration"},{"title":"Neurogenomics"},{"title":"Neurology Education"},{"title":"Neuromuscular Diseases"},{"title":"Neuro-Oncology"},{"title":"Neuro-Ophthalmology"},{"title":"Neuro-Otology"},{"title":"Neuropediatrics"},{"title":"Neuropharmacology"},{"title":"Neuroprosthetics"},{"title":"Neurotrauma"},{"title":"Sleep and Chronobiology"},{"title":"Spinal Cord Medicine"},{"title":"Sports Neurology"},{"title":"Stroke"},{"title":"Teleneurology"}],"id":{"zdb":["2564214-5"],"issn":["1664-2295"],"eki":["631498753"]},"part":{"volume":"14","text":"14(2023) vom: Okt., Artikel-ID 1272076, Seite 1-11","extent":"11","pages":"1-11","year":"2023"}}],"recId":"1872328555","physDesc":[{"extent":"11 S."}],"id":{"eki":["1872328555"],"doi":["10.3389/fneur.2023.1272076"]},"name":{"displayForm":["Christine Tunkl, Raju Paudel, Sunanjay Bajaj, Lekhjung Thapa, Patrick Tunkl, Avinash Chandra, Bhupendra Shah, Balgopal Karmacharya, Ashim Subedi, Pankaj Jalan, Pradesh Ghimire, Mahesh Raj Ghimire, Gampo Dorje, Nima Haji Begli, Jessica Golenia, Bikram Prasad Gajurel, Shirsho Shreyan, Nooma Sharma, Alexandra Krauss, Jeyaraj Pandian, Thomas Fischer, Jan van der Merwe, Wolfgang Wick, Werner Hacke and Christoph Gumbinger"]}} | ||
| SRT | |a TUNKLCHRISIMPLEMENTI2420 | ||