KlausFassbender, Saarland University Medical Center, Homburg, GermanyKlaus.Fassbender@uks.eu
Stefan A. Helwig; Lamin E.S. Jaiteh, MD, Ousman Nyan, MD
Submitted September 20, 2017
We thank Dr. Chin for the comments on our study. [1] We agree that the study was performed under experimental conditions. This limitation, aimed to minimize by assessment conditions that were similar before and after standard operating procedure (SOP)-implementation and by the absence of provision of additional resources, was discussed. The statement that sub-Saharan African countries face crucial challenges that are, in the end, associated with the severe financial constrains is true. This has been documented in our study, [1] including the problem of CT performance due to unsettled payment questions. It has been discussed that SOPs are only one of several steps, among which include long-term international financial support and cooperation, structural measures (such as health insurance systems), and systematic training of neurologists (thereby avoiding brain drain). Yet, what can be done today? As long as the financial support and the structural frameworks remain suboptimal, SOPs to make better use of the still available, although limited, personnel and technical resources (eg, adjustment of physiologic parameters, aspirin prophylaxis, or physiotherapy) are a relevant step towards guideline- recommended stroke management. As suggested by Dr. Chin, these should be complemented by further SOPs that focus on post-emergency management and measures for prevention [2].
1. Jaiteh LES, Helwig SA, Jagne A, et al. Standard operating procedures improve acute neurologic care in a sub-Saharan African setting.Neurology 2017;89:144-152.
2. Chin JH. Stroke in sub-Saharan Africa: an urgent call for prevention. Neurology 2012;78:1007-1008.
For disclosures, please contact the editorial office at journal@neurology.org.
We thank Dr. Chin for the comments on our study. [1] We agree that the study was performed under experimental conditions. This limitation, aimed to minimize by assessment conditions that were similar before and after standard operating procedure (SOP)-implementation and by the absence of provision of additional resources, was discussed. The statement that sub-Saharan African countries face crucial challenges that are, in the end, associated with the severe financial constrains is true. This has been documented in our study, [1] including the problem of CT performance due to unsettled payment questions. It has been discussed that SOPs are only one of several steps, among which include long-term international financial support and cooperation, structural measures (such as health insurance systems), and systematic training of neurologists (thereby avoiding brain drain). Yet, what can be done today? As long as the financial support and the structural frameworks remain suboptimal, SOPs to make better use of the still available, although limited, personnel and technical resources (eg, adjustment of physiologic parameters, aspirin prophylaxis, or physiotherapy) are a relevant step towards guideline- recommended stroke management. As suggested by Dr. Chin, these should be complemented by further SOPs that focus on post-emergency management and measures for prevention [2].
1. Jaiteh LES, Helwig SA, Jagne A, et al. Standard operating procedures improve acute neurologic care in a sub-Saharan African setting.Neurology 2017;89:144-152.
2. Chin JH. Stroke in sub-Saharan Africa: an urgent call for prevention. Neurology 2012;78:1007-1008.
For disclosures, please contact the editorial office at journal@neurology.org.