Stroke doctor
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The Role and Training of Stroke Doctors: A Global Perspective
Introduction to Stroke Medicine Specialization
Stroke medicine has rapidly evolved, necessitating a specialized workforce to manage the increasing burden of stroke globally. The World Stroke Organization conducted a comprehensive survey to understand the background, training, and specialization of stroke doctors worldwide. This survey revealed significant variability in the specialties treating stroke patients and the availability of stroke-specific training programs.
Specialties Involved in Stroke Care
Neurologists and Neurosurgeons
Neurologists predominantly treat ischemic stroke patients, with 64% of such cases managed by them globally. However, this percentage varies significantly by country, from as low as 5% in Ireland to as high as 95% in the Netherlands. On average, there are six neurologists per thousand annual strokes, with a range from 0.3 in Ethiopia to 33 in Israel. For intracerebral hemorrhage patients, neurosurgeons are involved in 29% of cases, with the highest involvement in Japan (79%) and the lowest in Sweden (5%).
Interventional Specialists
The increasing demand for rapid stroke intervention has led to the involvement of various interventional specialists, including interventional radiologists and cardiologists, in addition to those trained in endovascular surgical neuroradiology. These specialists are crucial for performing intracranial endovascular procedures, which are essential for treating large vessel occlusions and improving patient outcomes.
Training and Continuous Medical Education
Despite the critical role of specialized training, only 21% of countries have a dedicated degree or subspecialty for stroke medicine. Most countries, however, have a stroke society that promotes the advancement of stroke medicine through continuous medical education. This gap highlights the need for more structured training programs to ensure a skilled workforce capable of delivering optimal stroke care.
Stroke Literacy Among General Practitioners
A study in South Asia assessed the stroke literacy among the general public and general practitioners (GPs). It found that while a significant portion of the public was aware of stroke's vascular etiology, there was a lack of understanding about the affected organ and major risk factors. Among GPs, only a small fraction could accurately define stroke and its subtypes, and even fewer were aware of the therapeutic window for thrombolysis. This underscores the necessity for targeted educational strategies to improve stroke literacy among first-contact physicians.
Rehabilitation and Follow-Up Care
Role of Physical and Rehabilitation Medicine (PRM) Physicians
PRM physicians play a vital role in the rehabilitation of stroke survivors. Their responsibilities include organizing comprehensive rehabilitation programs that address all aspects of a patient's recovery, from physical impairments to participation restrictions. This holistic approach is essential for enhancing the quality of life of stroke survivors.
Follow-Up Practices
In Sweden, an observational study revealed that a significant portion of stroke patients did not receive timely follow-up care post-discharge. Factors such as high age, pre-stroke dependency, and prior stroke were associated with lower follow-up probabilities. This finding highlights the need for improved follow-up practices to ensure continuous care for stroke patients.
Conclusion
The management of stroke patients involves a multidisciplinary approach with significant variability in the involvement of different specialties and the availability of specialized training. While neurologists and neurosurgeons play primary roles, the inclusion of interventional specialists is becoming increasingly important. There is a critical need for enhanced stroke literacy among general practitioners and structured follow-up care to improve patient outcomes. Addressing these gaps through targeted education and comprehensive rehabilitation programs can significantly advance stroke care globally.
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