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Meretoja A, Acciarresi M, Akinyemi RO, Campbell B, Dowlatshahi D, English C, Henninger N, Poppe A, Putaala J, Saini M, Sato S, Wu B, Brainin M, Norrving B, Davis S. Stroke doctors: Who are we? A World Stroke Organization survey. Int J Stroke 2017; 12:858-868. [PMID: 28350278 DOI: 10.1177/1747493017701150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Specialist training provides skilled workforce for service delivery. Stroke medicine has evolved rapidly in the past years. No prior information exists on background or training of stroke doctors globally. Aims To describe the specialties that represent stroke doctors, their training requirements, and the scientific organizations ensuring continuous medical education. Methods The World Stroke Organization conducted an expert survey between June and November 2014 using e-mailed questionnaires. All Organization for Economic Co-operation and Development countries with >1 million population and other countries with >50 million population were included ( n = 49, total 5.6 billion inhabitants, 85% of global strokes). Two stroke experts from each selected country were surveyed, discrepancies resolved, and further information on identified stroke-specific curricula sought. Results We received responses from 48 (98%) countries. Of ischemic stroke patients, 64% were reportedly treated by neurologists, ranging from 5% in Ireland to 95% in the Netherlands. Per thousand annual strokes there were average six neurologists, ranging from 0.3 in Ethiopia to 33 in Israel. Of intracerebral hemorrhage patients, 29% were reportedly treated by neurosurgeons, ranging from 5% in Sweden to 79% in Japan, with three neurosurgeons per thousand strokes, ranging from 0.1 in Ethiopia to 24 in South Korea. Most countries had a stroke society (86%) while only 10 (21%) had a degree or subspecialty for stroke medicine. Conclusions Stroke doctor numbers, background specialties, and opportunities to specialize in stroke vary across the globe. Most countries have a scientific society to pursue advancement of stroke medicine, but few have stroke curricula.
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Affiliation(s)
- Atte Meretoja
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,2 The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,3 Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Monica Acciarresi
- 4 Stroke Unit and Division of Cardiovascular Medicine, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Rufus O Akinyemi
- 5 Neurosciences and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Campbell
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Dar Dowlatshahi
- 6 Department of Medicine (Neurology), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Coralie English
- 7 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
| | - Nils Henninger
- 8 Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.,9 Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandre Poppe
- 10 Department of Medicine (Neurology), Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Jukka Putaala
- 3 Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Monica Saini
- 11 Department of Medicine, Changi General Hospital, Singapore, Singapore.,12 Memory Ageing and Cognition Centre, National University of Singapore, Singapore, Singapore
| | - Shoichiro Sato
- 13 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,14 Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Bo Wu
- 15 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael Brainin
- 16 Center of Clinical Neurosciences, Danube University of Krems, Krems, Austria
| | - Bo Norrving
- 17 Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Stephen Davis
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
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Parker WA, Steyn NP, Levitt NS, Lombard CJ. Health promotion services for patients having non-comminicable diseases: feedback from patients and health care providers in Cape Town, South Africa. BMC Public Health 2012; 12:503. [PMID: 22762453 PMCID: PMC3433333 DOI: 10.1186/1471-2458-12-503] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken. METHODS A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. RESULTS Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. CONCLUSION The majority of patients attending PHC facilities want to receive lifestyle modification education. There is not however, one specific method that can be regarded as the gold standard. Patients' preferences regarding health education methods differ, and they are more likely to be susceptible to methods that do not involve much reading. Health education materials such as posters, pamphlets and booklets should be used to supplement information received during counselling or support group sessions.
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Affiliation(s)
- Whadi-ah Parker
- Centre for the Study of the Social and Environmental Determinants of Nutrition, Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa
| | - Nelia P Steyn
- Centre for the Study of the Social and Environmental Determinants of Nutrition, Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa
| | - Naomi S Levitt
- Diabetes and Endocrine Unit, Department of Medicine, University of Cape Town, Obervatory, 7925, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, Cape Town, South Africa
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They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals. Public Health Nutr 2010; 14:1429-38. [PMID: 20105391 DOI: 10.1017/s1368980009993272] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to evaluate the knowledge and practices of public-sector primary-care health professionals and final-year students regarding the role of nutrition, physical activity and smoking cessation (lifestyle modification) in the management of chronic diseases of lifestyle within the public health-care sector. DESIGN A comparative cross-sectional descriptive quantitative study was conducted in thirty primary health-care facilities and four tertiary institutions offering medical and/or nursing programmes in Cape Town in the Western Cape Metropole. Stratified random sampling, based on geographical location, was used to select the health facilities while convenience sampling was used to select students at the tertiary institutions. A validated self-administered knowledge test was used to obtain data from the health professionals. RESULTS Differential lifestyle modification knowledge exists among both health professionals and students, with less than 10 % achieving the desired scores of 80 % or higher. The majority of health professionals seem to be promoting the theoretical concepts of lifestyle modification but experience difficulty in providing practical advice to patients. Of the health professionals evaluated, doctors appeared to have the best knowledge of lifestyle modification. Lack of time, lack of patient adherence and language barriers were given as the main barriers to providing lifestyle counselling. CONCLUSIONS The undergraduate curricula of medical and nursing students should include sufficient training on lifestyle modification, particularly practical advice on diet, physical activity and smoking cessation. Health professionals working at primary health-care facilities should be updated by providing lifestyle modification education as part of continuing medical education.
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Wang MY, Lavine SD, Soukiasian H, Tabrizi R, Levy ML, Giannotta SL. Treating stroke as a medical emergency: a survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy. Neurosurgery 2001; 48:1109-15; discussion 1115-7. [PMID: 11334278 DOI: 10.1097/00006123-200105000-00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE A major impetus of the "brain attack" campaign is the early recognition and treatment of acute stroke. Critical to this goal is the education of physicians during their residency training. METHODS Resident physicians in Los Angeles who were in family practice (18%), internal medicine (51%), emergency medicine (20%), and neurology (11%) and had already completed their first year of training responded to a questionnaire on stroke and the treatment of carotid stenosis. RESULTS Of the 266 respondents, 76% had heard of the "brain attack" campaign, 22% did not identify dysarthria as a symptom of stroke, and 21% did not identify obtundation as a presentation of stroke. Twenty-eight percent chose not to use tissue plasminogen activator for acute ischemic stroke, and 60% recognized the need to begin treatment within 3 hours. More than 90% of respondents were able to identify correct screening tests for patients with suspected carotid stenosis. However, 56% responded that they would not advocate operating on patients with asymptomatic severe stenosis (>70%) until stenosis reached a critical value (85%). Conversely, 45% would recommend operative treatment for symptomatic patients who had less than 60% stenosis. Sixty-eight percent would refer patients to vascular surgeons, 14% to neurosurgeons, and 17% to both for carotid endarterectomy. CONCLUSION Recognition of stroke as a medical emergency is improving. However, significant progress can still be made in the recognition of stroke symptoms. Primary care and neurology residents remain skeptical about carotid endarterectomy for asymptomatic patients, whereas there is enthusiasm for treating stroke survivors. Education by members of the surgical community could promote the aggressive treatment of asymptomatic patients to prevent stroke.
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Affiliation(s)
- M Y Wang
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
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Blue AV, Barnette JJ, Ferguson KJ, Garr DR. Evaluation methods for prevention education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:S28-S34. [PMID: 10926038 DOI: 10.1097/00001888-200007001-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The knowledge, skills, and attitudes associated with prevention cut across clinical disciplines. Thus, they are often subsets of disciplines not otherwise present in the traditional curriculum (e.g., epidemiology or statistics) or considered the province of many disciplines (e.g., risk reduction or cancer screening). Evaluation of elements of prevention education can often become lost in the myriad other outcomes that are assessed in students, or they are intermingled with other content and skills. This article highlights the value of assessing students' competence in prevention knowledge, skills, and attitudes, provides general guidance for programs interested in evaluating their prevention instructional efforts, and gives specific examples of possible methods for evaluating prevention education. While it is important to tailor assessment methods to local institutional objectives, it is possible to share assessment methods and materials regionally and nationally. Sharing problems, as well as successes, encountered in developing appropriate assessment methods will advance the field of evaluation of prevention curricula.
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Affiliation(s)
- A V Blue
- Medical University of South Carolina, College of Medicine, Charleston 29425, USA
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Baberg HT, Jäger D, Kahrmann G, de Zeeuw J, Bojara W, Lemke B, von Dryander S, Barmeyer J, Kugler J. [Health promotion and cardiovascular risk factors. The level of knowledge among 510 inpatients of an acute coronary care unit]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2000; 95:75-80. [PMID: 10714122 DOI: 10.1007/bf03044987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PATIENTS AND METHODS A total of 510 patients hospitalized on a cardiologic ward were questioned on cardiovascular disease risk factors using a questionnaire. The knowledge on these risk factors was assessed with a score system. RESULTS Knowledge of patients on cardiovascular disease risk factors was generally low: One out of 5 did not know about the consequences of obesity, high blood cholesterol or smoking on the coronary vessels. Over 30% did not name hypertension. Only 1 out of 3 patients mentioned diabetes mellitus as a risk factor. There was no change in the knowledge during the hospital stay despite a standardized and intensive information program. The results of the second survey on the day of discharge were equal to the results of the admission day. Hospital stays in the past had no influence on the knowledge. Patients with a diagnosed coronary heart disease had the same results in the survey as patients with other diseases. The presence of risk factors had hardly any influence on the knowledge of these patients. CONCLUSION The result of this study emphasizes the need for better health information for patients. The repetitive information on health related issues during inpatient treatment does not seem to have a positive effect on patients' knowledge. Therefore other ways of health education have to be introduced and evaluated in acute care.
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Affiliation(s)
- H T Baberg
- Abteilung für Kardiologie und Angiologie, Ruhr-Universität Bochum.
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Thomas L, Harrington K, Rogers H, Langhorne P, Smith M, Bond S. Development of a scale to assess nurses' knowledge of stroke: a pilot study. Clin Rehabil 1999; 13:518-26. [PMID: 10588539 DOI: 10.1191/026921599673722884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop and test an evidence-based scale to assess nurses' knowledge of stroke. DESIGN Question development by a multidisciplinary group of experts in stroke. Two self-completion questionnaire surveys. SETTING Two stroke units, one general medical and two elderly care wards in three hospitals in the North-East of England. SUBJECTS Fifty-eight qualified nurses. INTERVENTIONS Scale to assess nurses' knowledge of stroke. RESULTS The overall response rate was 60%. Nurses on stroke units knew more about stroke than those in medical/elderly care wards. The scale was capable of discriminating between stroke units and medical /elderly care wards: mean difference was 4.18 (95% confidence intervals 1.68-6.69; p <0.001). Cronbach's alpha was 0.7 indicating adequate internal consistency. Item non-response did not exceed 10% for any question. CONCLUSIONS We have developed a knowledge of stroke scale capable of discriminating between nurses based in stroke units and medical/elderly care wards, with low item non-response and adequate internal consistency. The scale is suitable for use as a component of studies evaluating the nursing of stroke patients.
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Affiliation(s)
- L Thomas
- Centre for Health Services Research, University of Newcastle upon Tyne, UK.
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