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Stroke: Working toward a Prioritized World AgendaHachinski V.1 · Donnan G.A.5, a, h · Gorelick P.B.8, b, h · Hacke W.30, c, h · Cramer S.C.10, d, h · Kaste M.33, e, h · Fisher M.14, f, h · Brainin M.36, g, h · Buchan A.M.37, a · Lo E.H.15, a · Skolnick B.E.17, a · Furie K.L.15, b · Hankey G.J.7, b · Kivipelto M.41, b · Morris J.18, b · Rothwell P.M.38, b · Sacco R.L.19, b · Smith, Jr. S.C.21, 43, b · Wang Y.12, b · Bryer A.44, c · Ford G.A.39, c · Iadecola C.25, c · Martins S.C.O.45, c · Saver J.13, c · Skvortsova V.46, c · Bayley M.3, d · Bednar M.M.26, d · Duncan P.22, d · Enney L.23, d · Finklestein S.16, d · Jones T.A.27, d · Kalra L.40, d · Kleim J.20, d · Nitkin R.28, d · Teasell R.2, d · Weiller C.31, d · Desai B.11, e · Goldberg M.P.18, e · Heiss W.-D.32, e · Saarelma O.34, e · Schwamm L.H.15, e · Shinohara Y.47, e · Trivedi B.9, e · Wahlgren N.41, e · Wong L.K.48, e · Hakim A.4, f · Norrving B.42, f · Prudhomme S.29, f · Bornstein N.M.49, g · Davis S.M.6, g · Goldstein L.B.24, g · Leys D.50, g · Tuomilehto J.35, g
Working Groups:aBasic Science, Drug Development, and Technology; bStroke Prevention: Broadening the Approach and Intensifying the Efforts; cAcute Stroke Management: Applying and Expanding What We Know; dBrain Recovery and Rehabilitation: Harnessing the Regenerative Powers of the Brain and the Individual; eInto the 21st Century: The Web, Technology, and Communications: New Tools for Progress; fFostering Cooperation Among Stakeholders to Enhance Stroke Care; gEducating and Energizing Professionals, Patients, the Public, and Policymakers. hThe coordinator of each group. The work of the coordinators is deemed to have been equal. The other authors are listed according to the sequence of their groups and alphabetically, and their work is also deemed to be equal to each other’s.1 Department of Clinical Neurological Sciences, London Health Sciences Center, University of Western Ontario, and2 St. Joseph’s Healthcare London, London, Ont.,3 Toronto Rehabilitation Institute, Toronto, Ont., and4 The Canadian Stroke Network, The University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ont., Canada;5 Florey Neurosciences Institutes, Carlton South Victoria, and6 Director of Neurology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Vic., and7 Royal Perth Hospital, Perth, W.A., Australia;8 University of Illinois at Chicago, Chicago, Ill.,9 Southern Illinois Healthcare, Carbondale, Ill.,10 University of California – Irvine, Orange, Calif.,11 Pomona Valley Hospital Medical Center, Pomona, Calif.,12 InTouch Health, Goleta, Calif.,13 University of California at Los Angeles Stroke Center, Los Angeles, Calif.,14 University of Massachusetts Medical School, Worcester, Mass.,15 Massachusetts General Hospital, Charlestown, Mass.,16 Biotrofix, Inc., Waltham, Mass.,17 Novo Nordisk, Princeton, N.J.,18Washington University School of Medicine, St. Louis, Mo.,19 President-elect, AHA, University of Miami, Miami, Fla.,20 University of Florida, Gainesville, Fla.,21 Center for Cardiovascular Science and Medicine, University of North Carolina, Chapel Hill, N.C.,22 Duke University, Durham, N.C.23 GlaxoSmithKline, Durham, N.C.,24 Duke University and Durham VA Medical Center, Durham, N.C.,25 Weill Cornell Medical College, New York, N.Y.,26 Neuroscience Research Unit, Pfizer Inc., Groton, Conn.,27 University of Texas at Austin, Austin, Tex.,28 National Center for Medical Rehabilitation, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Md., and29 American Heart Association, Dallas, Tex., USA;30 University of Heidelberg, Heidelberg,31 University of Freiburg, Freiburg, and32 Max Planck Institute for Neurological Research, Köln, Germany;33 Helsinki University Central Hospital, University of Helsinki,34 Terveystalo Medical Center, and35 University of Helsinki, Helsinki, Finland;36 University Donau-Universität Krems, Krems, Austria;37 University of Oxford, and38 John Radcliffe Hospital, Oxford,39 Newcastle University, Newcastle upon Tyne, and40 Kings College London, London, UK;41 Karolinska Institute, Stockholm, and42 Lund University Hospital, Lund, Sweden;43 President-elect, World Heart Federation, Geneva, Switzerland;44 Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa;45 Hospital De Clinicas, Porto Alegre, Brazil;46 Russian State Research Stroke Institute, Moscow, Russian Federation;47 Tachikawa Hospital, Tokyo, Japan;48 Chinese University of Hong Kong, Sha Tin, Hong Kong, China;49 Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel;50 University Lille Nord de France, Lille, France Corresponding Author
Vladimir Hachinski, MD, FRCPC, DSc
University of Western Ontario, University Hospital
339 Windermere Road
London, Ont. N6A 5A5 (Canada)
Background and Purpose: The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods: Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results: Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a ‘Brain Health’ concept that enables promotion of preventive measures. Conclusions: To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
© 2010 American Heart Association. Inc., S. Karger AG, Basel, and John Wiley & Sons, Inc.