Semin Neurol 2024; 44(02): 105-118
DOI: 10.1055/s-0043-1778638
Review Article

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

Gentle Sunder Shrestha
1   Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
,
Gaurav Nepal
2   Department of General Medicine, Rani Primary Healthcare Centre, Rani, Biratnagar, Nepal
,
Morgan Lippitt Prust
3   Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
› Author Affiliations

Abstract

Neurologic diseases represent a significant global health challenge, leading to disability and mortality worldwide. Healthcare systems in low- and middle-income countries are disproportionally affected. In these resource-limited settings, numerous barriers hinder the effective delivery of emergency and inpatient neurologic care, including shortages of trained personnel, limited access to diagnostics and essential medications, inadequate facilities, and absence of rehabilitation services. Disparities in the neurology workforce, limited access to neuroimaging, and availability of acute interventions further exacerbate the problem. This article explores strategies to enhance global capacity for inpatient neurologic care, emphasizing the importance of workforce development, context-specific protocols, telehealth solutions, advocacy efforts, and collaborations.



Publication History

Article published online:
14 March 2024

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  • References

  • 1 Ding C, Wu Y, Chen X. et al. Global, regional, and national burden and attributable risk factors of neurological disorders: the Global Burden of Disease study 1990-2019. Front Public Health 2022; 10: 952161
  • 2 Feigin VL, Stark BA, Johnson CO. et al; GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20 (10) 795-820
  • 3 Beghi E, Giussani G, Nichols E. et al; GBD 2016 Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18 (04) 357-375
  • 4 GBD 2016 Meningitis Collaborators. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17 (12) 1061-1082
  • 5 Bragazzi NL, Kolahi A-A, Nejadghaderi SA. et al. Global, regional, and national burden of Guillain-Barré syndrome and its underlying causes from 1990 to 2019. J Neuroinflammation 2021; 18 (01) 264
  • 6 WHO. Atlas - Country resources for neurological disorders. 2nd ed.. 2017: 76 Accessed November 16, 2023 at: http://www.who.int/mental_health/neurology/atlas_second_edition/en/%0Ahttp://www.who.int/tb/country/data/profiles/en/index.html
  • 7 Punchak M, Mukhopadhyay S, Sachdev S. et al. Neurosurgical care: availability and access in low-income and middle-income countries. World Neurosurg 2018; 112: e240-e254
  • 8 Prust ML, Saylor D, Zimba S. et al. Inpatient management of acute stroke of unknown type in resource-limited settings. Stroke 2022; 53 (03) e108-e117
  • 9 McLane HC, Berkowitz AL, Patenaude BN. et al. Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries. Neurology 2015; 85 (18) 1614-1622
  • 10 World Health Organization. Global atlas of medical devices. Geneva PP - Geneva: World Health Organization; 2017. (WHO Medical device technical series). Accessed November 15, 2023 at: https://apps.who.int/iris/handle/10665/255181
  • 11 Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology 2021; 97 (20, suppl 2): S6-S16
  • 12 Ma X, Vervoort D. Critical care capacity during the COVID-19 pandemic: global availability of intensive care beds. J Crit Care 2020; 58: 96-97
  • 13 Phua J, Faruq MO, Kulkarni AP. et al; Asian Analysis of Bed Capacity in Critical Care (ABC) Study Investigators, and the Asian Critical Care Clinical Trials Group. Critical care bed capacity in Asian countries and regions. Crit Care Med 2020; 48 (05) 654-662
  • 14 Langhorne P, O'Donnell MJ, Chin SL. et al; INTERSTROKE Collaborators. Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. Lancet 2018; 391 (10134): 2019-2027
  • 15 Owolabi MO, Thrift AG, Martins S. et al; Stroke Experts Collaboration Group. The state of stroke services across the globe: report of World Stroke Organization-World Health Organization surveys. Int J Stroke 2021; 16 (08) 889-901
  • 16 Pironi V, Ciccone O, Beghi E. et al; ILAE Task Force on Access to Treatment. Survey on the worldwide availability and affordability of antiseizure medications: report of the ILAE Task Force on access to treatment. Epilepsia 2022; 63 (02) 335-351
  • 17 Neumann I, Schünemann HJ, Bero L, Cooke G, Magrini N, Moja L. Global access to affordable direct oral anticoagulants. Bull World Health Organ 2021; 99 (09) 653-660
  • 18 Yaria J, Gil A, Makanjuola A. et al; Stroke Experts Collaboration Group. Quality of stroke guidelines in low- and middle-income countries: a systematic review. Bull World Health Organ 2021; 99 (09) 640-652E
  • 19 Hollingsworth J, Mirabelli MM. Neurologic emergencies on computed tomography of the head. Semin Ultrasound, CT MRI 2017; 38 (04) 384-398
  • 20 Chesnut RM, Temkin N, Carney N. et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
  • 21 Frija G, Blažić I, Frush DP. et al. How to improve access to medical imaging in low- and middle-income countries?. EClinicalMedicine 2021; 38: 101034
  • 22 Global atlas of medical devices. WHO Medical device technical series. Geneva: World Health Organization; 2017: 480
  • 23 Mohammadshahi M, Alipouri Sakha M, Esfandiari A, Shirvani M, Akbari Sari A. Cost effectiveness of mobile versus fixed computed tomography and magnetic resonance imaging: a systematic review. Iran J Public Health 2019; 48 (08) 1418-1427
  • 24 Huang Z, Zhao S, Leng Q, Hu S, Li Z, Song B. Container CT scanner: a solution for modular emergency radiology department during the COVID-19 pandemic. Diagn Interv Radiol 2021; 27 (03) 350-353
  • 25 Yansouni CP, Bottieau E, Lutumba P. et al. Rapid diagnostic tests for neurological infections in central Africa. Lancet Infect Dis 2013; 13 (06) 546-558
  • 26 Anazodo UC, Ng JJ, Ehiogu B. et al. A framework for advancing sustainable MRI access in Africa. medRxiv 2022:2022.05.02. 22274588 Accessed November 18, 2023 at: http://medrxiv.org/content/early/2022/05/05/2022.05.02.22274588.abstract
  • 27 Saadi A, Mendizabal A, Mejia NI. Teleneurology and health disparities. Semin Neurol 2022; 42 (01) 60-66
  • 28 Yadav JK, Nepal G, Shing YK, Banerji RR, Gajurel BP. An opportunity to improve acute ischemic stroke care in the South Asian region through telestroke services. Ann Med Surg (Lond) 2021; 72: 103115
  • 29 Sarfo FS, Adamu S, Awuah D, Ovbiagele B. Tele-neurology in sub-Saharan Africa: a systematic review of the literature. J Neurol Sci 2017; 380: 196-199
  • 30 Pagaling GT, Espiritu AI, Dellosa MAA, Leochico CFD, Pasco PMD. The practice of teleneurology in the Philippines during the COVID-19 pandemic. Neurol Sci 2022; 43 (02) 811-819
  • 31 Dorsey ER, Glidden AM, Holloway MR, Birbeck GL, Schwamm LH. Teleneurology and mobile technologies: the future of neurological care. Nat Rev Neurol 2018; 14 (05) 285-297
  • 32 Mishra VN, Pathak A, Chaurasia RN, Kumar A, Joshi D, Singh VK. Observations in a virtual telephone and WhatsApp video-enabled neurology clinic during lockdown in Varanasi, India - a preliminary report. Neurol India 2021; 69 (05) 1234-1240
  • 33 McGinley MP, Ontaneda D, Wang Z. et al. Teleneurology as a solution for outpatient care during the COVID-19 pandemic. Telemed J E Health 2020; 26 (12) 1537-1539
  • 34 Sharma S, Padma MV, Bhardwaj A, Sharma A, Sawal N, Thakur S. Telestroke in resource-poor developing country model. Neurol India 2016; 64 (05) 934-940
  • 35 Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet 2000; 356 (9233): 894-899
  • 36 Evans A, Harraf F, Donaldson N, Kalra L. Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes. Stroke 2002; 33 (02) 449-455
  • 37 Pham X, Ray J, Neto AS. et al. Association of neurocritical care services with mortality and functional outcomes for adults with brain injury: a systematic review and meta-analysis. JAMA Neurol 2022; 79 (10) 1049-1058
  • 38 Prust ML, Mbonde A, Rubinos C. et al. Providing neurocritical care in resource-limited settings: challenges and opportunities. Neurocrit Care 2022; 37 (02) 583-592
  • 39 Shrestha GS, Goffi A, Aryal D. Delivering neurocritical care in resource-challenged environments. Curr Opin Crit Care 2016; 22 (02) 100-105
  • 40 Silva GS, Rocha E. Developing Systems of Care for Stroke in Resource-limited Settings. Semin Neurol 2024; 44: 119-129
  • 41 Langhorne P, de Villiers L, Pandian JD. Applicability of stroke-unit care to low-income and middle-income countries. Lancet Neurol 2012; 11 (04) 341-348
  • 42 Nepal G, Yadav JK, Bhandari S, Gautam J, Gajurel BP. Low-cost alternatives for the management of acute ischemic stroke in low and middle-income countries. Ann Med Surg (Lond) 2021; 72: 102969
  • 43 John L, William A, Dawar D. et al. Implementation of a physician-based stroke unit in a remote hospital of North-East India - Tezpur model. J Neurosci Rural Pract 2021; 12 (02) 356-361
  • 44 Cisse FA, Damien C, Bah AK. et al. Minimal setting stroke unit in a sub-Saharan African public hospital. Front Neurol 2019; 10 (Jul): 856
  • 45 Rubinos C, San-Juan D, Alva-Diaz C. et al Epilepsy Care in Latin America and the Caribbean: Overcoming Challenges and Embracing Opportunities. Semin Neurol 2024; 44: 130-146
  • 46 Espinosa-Jovel C, Toledano R, Aledo-Serrano Á, García-Morales I, Gil-Nagel A. Epidemiological profile of epilepsy in low income populations. Seizure 2018; 56: 67-72
  • 47 White Jr AC. Calcifications and the global burden of neurocysticercosis: not just rocks in your head. Clin Infect Dis 2021; 73 (09) e2604-e2606
  • 48 Lee B. Asian Status Epilepticus Survey Group. Treatment gap for convulsive status epilepticus in resource-poor countries. Epilepsia 2018; 59 (Suppl. 02) 135-139
  • 49 Fong S-L, Thuy Le M-A, Lim K-S. et al. Affordability of newer antiseizure medications in Asian resource-limited countries. Epilepsia 2023; 64 (08) 2116-2125
  • 50 Niyongere J, Welty TE, Bell MW. et al. Barriers to generic antiseizure medication use: results of a global survey by the International League Against Epilepsy Generic Substitution Task Force. Epilepsia Open 2022; 7 (02) 260-270
  • 51 WHO Model List of Essential Medicines. WHO; 2023
  • 52 National Guideline Alliance (UK). Effectiveness of a nurse specialist in the management of epilepsy: Epilepsies in children, young people and adults: Evidence review O [Internet]. London: National Institute for Health and Care Excellence (NICE); 2022. Accessed November 22, 2023 at : https://www.ncbi.nlm.nih.gov/books/NBK581161/
  • 53 Kengne AP, Fezeu LL, Awah PK, Sobngwi E, Dongmo S, Mbanya JC. Nurse-led care for epilepsy at primary level in a rural health district in Cameroon. Epilepsia 2008; 49 (09) 1639-1642
  • 54 Coates S, Clarke A, Davison G, Patterson V. Tele-EEG in the UK: a report of over 1,000 patients. J Telemed Telecare 2012; 18 (05) 243-246
  • 55 Murphey DK, Anderson ER. The past, present, and future of tele-EEG. Semin Neurol 2022; 42 (01) 31-38
  • 56 McKenzie ED, Lim ASP, Leung ECW. et al. Validation of a smartphone-based EEG among people with epilepsy: a prospective study. Sci Rep 2017; 7: 45567
  • 57 Chesnut RM, Temkin N, Videtta W. et al. Consensus-Based Management Protocol (CREVICE Protocol) for the treatment of severe traumatic brain injury based on imaging and clinical examination for use when intracranial pressure monitoring is not employed. J Neurotrauma 2020; 37 (11) 1291-1299
  • 58 Rubiano AM, Vera DS, Montenegro JH. et al. Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: a stratified protocol [BOOTStraP]). J Neurosci Rural Pract 2020; 11 (01) 7-22
  • 59 de Moraes FM, Rocha E, Barros FCD. et al. Waveform morphology as a surrogate for ICP monitoring: a comparison between an invasive and a noninvasive method. Neurocrit Care 2022; 37 (01) 219-227
  • 60 Chang T, Li L, Yang Y, Li M, Qu Y, Gao L. Transcranial Doppler ultrasonography for the management of severe traumatic brain injury after decompressive craniectomy. World Neurosurg 2019; 126: e116-e124
  • 61 CRASH-3 Trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394 (10210): 1713-1723
  • 62 Leonhard SE, Mandarakas MR, Gondim FAA. et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15 (11) 671-683
  • 63 Shang P, Feng J, Wu W, Zhang H-L. Intensive care and treatment of severe Guillain-Barré syndrome. Front Pharmacol 2021; 12: 608130
  • 64 Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021; 397 (10280): 1214-1228
  • 65 Dishnica N, Vuong A, Xiong L. et al. Single count breath test for the evaluation of respiratory function in myasthenia gravis: a systematic review. J Clin Neurosci 2023; 112: 58-63
  • 66 Walgaard C, Lingsma HF, Ruts L. et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol 2010; 67 (06) 781-787
  • 67 Bekele B, Masresha Z, Alemayehu M, Seyoum B, Wassie L, Abebe M. Intravenous immunoglobulin G (IVIG) need assessment survey toward local manufacturing of IVIG using a mini-pool plasma fractionation technique. Health Serv Insights 2023;16:11786329231157467
  • 68 El-Ekiaby M, Vargas M, Sayed M. et al. Minipool caprylic acid fractionation of plasma using disposable equipment: a practical method to enhance immunoglobulin supply in developing countries. PLoS Negl Trop Dis 2015; 9 (02) e0003501
  • 69 El-Ekiaby M, Radosevich M, Goubran H, El Sayed M, Burnouf T. New methods of plasma fractionation – a presentation of the ‘mini-pool’ fractionation procedure developed in Egypt. ISBT Sci Ser 2009; 4 (01) 99-106
  • 70 Nepal G, Shrestha GS, Shing YK, Yadav JK, Coghlan MA, Ojha R. Low-cost alternatives for the management of Guillain-Barré syndrome in low- and middle-income countries. World Medical & Health Policy 2021; 13 (04) 749-757
  • 71 Islam B, Islam Z, Rahman S. et al. Small volume plasma exchange for Guillain-Barré syndrome in resource-limited settings: a phase II safety and feasibility study. BMJ Open 2018; 8 (08) e022862
  • 72 van Doorn PA, Van den Bergh PYK, Hadden RDM. et al. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol 2023; 30 (12) 3646-3674
  • 73 Walsh MG, Pattanaik A, Vyas N. et al. High-risk landscapes of Japanese encephalitis virus outbreaks in India converge on wetlands, rain-fed agriculture, wild Ardeidae, and domestic pigs and chickens. Int J Epidemiol 2022; 51 (05) 1408-1418
  • 74 Wang H, Zhao S, Wang S. et al. Global magnitude of encephalitis burden and its evolving pattern over the past 30 years. J Infect 2022; 84 (06) 777-787
  • 75 WHO. Why Encephalitis Matters? WHO; 2023
  • 76 Montano SM, Mori N, Nelson CA. et al; Meningoencephalitis Working Group. Herpes simplex virus encephalitis in Peru: a multicentre prospective study. Epidemiol Infect 2016; 144 (08) 1673-1678
  • 77 Bell DJ, Suckling R, Rothburn MM. et al. Management of suspected herpes simplex virus encephalitis in adults in a U.K. teaching hospital. Clin Med (Lond) 2009; 9 (03) 231-235
  • 78 Nath P, Kabir MA, Doust SK, Ray A. Diagnosis of herpes simplex virus: laboratory and point-of-care techniques. Infect Dis Rep 2021; 13 (02) 518-539
  • 79 Thakur KT, Mateyo K, Hachaambwa L. et al. Lumbar puncture refusal in sub-Saharan Africa: a call for further understanding and intervention. Neurology 2015; 84 (19) 1988-1990
  • 80 Solomon T, Michael BD, Smith PE. et al; National Encephalitis Guidelines Development and Stakeholder Groups. Management of suspected viral encephalitis in adults–Association of British Neurologists and British Infection Association National Guidelines. J Infect 2012; 64 (04) 347-373
  • 81 Matthews E, Beckham JD, Piquet AL, Tyler KL, Chauhan L, Pastula DM. Herpesvirus-associated encephalitis: an update. Curr Trop Med Rep 2022; 9 (03) 92-100
  • 82 Stahl JP, Mailles A. Herpes simplex virus encephalitis update. Curr Opin Infect Dis 2019; 32 (03) 239-243
  • 83 Pouplin T, Pouplin JN, Van Toi P. et al. Valacyclovir for herpes simplex encephalitis. Antimicrob Agents Chemother 2011; 55 (07) 3624-3626
  • 84 Bodilsen J, Nielsen H, Whitley RJ. Valaciclovir therapy for herpes encephalitis: caution advised. J Antimicrob Chemother 2019; 74 (06) 1467-1468
  • 85 McLaughlin MM, Sutton SH, Jensen AO, Esterly JS. Use of high-dose oral valacyclovir during an intravenous acyclovir shortage: a retrospective analysis of tolerability and drug shortage management. Infect Dis Ther 2017; 6 (02) 259-264
  • 86 Block N, Naucler P, Wagner P, Morfeldt E, Henriques-Normark B. Bacterial meningitis: aetiology, risk factors, disease trends and severe sequelae during 50 years in Sweden. J Intern Med 2022; 292 (02) 350-364
  • 87 Gouveia EL, Reis JN, Flannery B. et al. Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study. BMC Infect Dis 2011; 11 (01) 323
  • 88 Gelaw LY, Bitew AA, Gashey EM, Ademe MN. Ceftriaxone resistance among patients at GAMBY teaching general hospital. Sci Rep 2022; 12 (01) 12000
  • 89 Scarborough M, Thwaites GE. The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol 2008; 7 (07) 637-648
  • 90 Gundamraj S, Hasbun R. The use of adjunctive steroids in central nervous infections. Front Cell Infect Microbiol 2020; 10: 592017
  • 91 Thwaites GE, Nguyen DB, Nguyen HD. et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351 (17) 1741-1751
  • 92 Jarvis JN, Lawrence DS, Meya DB. et al; Ambition Study Group. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis. N Engl J Med 2022; 386 (12) 1109-1120
  • 93 Lawrence DS, Muthoga C, Meya DB. et al; AMBITION Study Group. Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial. Lancet Glob Health 2022; 10 (12) e1845-e1854
  • 94 Cikla U, Sahin B, Hanalioglu S, Ahmed AS, Niemann D, Baskaya MK. A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery. J Neurosurg 2018; (May): 1-9
  • 95 Narayanan KMD, Balasubramanian D. An affordable neurosurgical training system for neurosurgical residents; the Indian perspective. Neurol India 2020; 68 (06) 1418-1422
  • 96 Warf BC. The impact of combined endoscopic third ventriculostomy and choroid plexus cauterization on the management of pediatric hydrocephalus in developing countries. World Neurosurg 2013; 79 (2, suppl): 23.e13-23.e15
  • 97 Morales-Gómez JA, Garcia-Estrada E, Leos-Bortoni JE. et al. Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer. J Neurosurg 2018; (Jun): 1-7
  • 98 Maricevich JPBR, Cezar-Junior AB, de Oliveira-Junior EX. et al. Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: a prospective study. Surg Neurol Int 2019; 10: 1
  • 99 Ibrahim GM, Bernstein M. Models of neurosurgery international aid and their potential ethical pitfalls. Virtual Mentor 2015; 17 (01) 49-55
  • 100 Peixoto Brito ML, Reis Macedo LF, de Siqueira Coelho Lisboa KW, Dos Santos Sales V, de Lima Pinto S, Felix Silva DS. Neurocritical patients: review of the scope of nursing diagnoses and care in the intensive care unit. SAGE Open Nurs 2023;9:23779608231158978
  • 101 Imam A, Obiesie S, Aluvaala J, Maina JM, Gathara D, English M. Identifying gaps in global evidence for nurse staffing and patient care outcomes research in low/middle-income countries: an umbrella review. BMJ Open 2022; 12 (10) e064050
  • 102 Azad A, Min J-G, Syed S, Anderson S. Continued nursing education in low-income and middle-income countries: a narrative synthesis. BMJ Glob Health 2020; 5 (02) e001981
  • 103 Mauro V, Biggeri M, Deepak S, Trani J-F. The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial. J Epidemiol Community Health 2014; 68 (11) 1102-1108
  • 104 Sivakumar T, James JW, Basavarajappa C, Parthasarathy R, Naveen Kumar C, Thirthalli J. Impact of community-based rehabilitation for mental illness on ‘out of pocket’ expenditure in rural South India. Asian J Psychiatr 2019; 44: 138-142
  • 105 Greaves CJ, Campbell JL. Supporting self-care in general practice. Br J Gen Pract 2007; 57 (543): 814-821
  • 106 de Mello Monteiro CB, Dawes H, Mayo N, Collett J, Magalhães FH. Assistive Technology Innovations in Neurological Conditions. Vol. 2021. BioMed Research International; United States: 2021: 6846120
  • 107 MacNeil M, Hirslund E, Baiocco-Romano L, Kuspinar A, Stolee P. A scoping review of the use of intelligent assistive technologies in rehabilitation practice with older adults. Disabil Rehabil Assist Technol 2023; 1-32
  • 108 Bergen DC, Good D. Neurology training programs worldwide: a world federation of neurology survey. J Neurol Sci 2006; 246 (1-2): 59-64
  • 109 Steck A, Struhal W, Sergay SM, Grisold W. Education Committee World Federation of Neurology. The global perspective on neurology training: the World Federation of Neurology survey. J Neurol Sci 2013; 334 (1-2): 30-47
  • 110 Saluja S, Rudolfson N, Massenburg BB, Meara JG, Shrime MG. The impact of physician migration on mortality in low and middle-income countries: an economic modelling study. BMJ Glob Health 2020; 5 (01) e001535
  • 111 Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353 (17) 1810-1818
  • 112 Bankole NDA, Ouahabi AEL. Towards a collaborative-integrative model of education and training in neurosurgery in low and middle-income countries. Clin Neurol Neurosurg 2022; 220: 107376
  • 113 Rutkove SB, Poduri A, Holloway RG, Pomeroy SL, McArthur JC. Global neurology: it's time to take notice. Ann Clin Transl Neurol 2023; 10 (05) 842-845
  • 114 Medina MT, Munsat T, Portera-Sánchez A, Durón RM, Becker CA, Holden KR. WFN Education Committee. Developing a neurology training program in Honduras: a joint project of neurologists in Honduras and the World Federation of Neurology. J Neurol Sci 2007; 253 (1-2): 7-17
  • 115 Israel K, Strander SM, Pierre S, Martineau L, Morse ME, Berkowitz AL. Development of a neurology training program in Haiti. Neurology 2019; 92 (08) 391-394
  • 116 Akinyemi RO, Owolabi MO, Adebayo PB. et al. Task-shifting training improves stroke knowledge among Nigerian non-neurologist health workers. J Neurol Sci 2015; 359 (1-2): 112-116
  • 117 Robertson FC, Esene IN, Kolias AG. et al; Collaborative Working Group. Task-shifting and task-sharing in neurosurgery: an international survey of current practices in low- and middle-income countries. World Neurosurg X 2019; 6: 100059
  • 118 Joshi R, Alim M, Kengne AP. et al. Task shifting for non-communicable disease management in low and middle income countries – a systematic review. PLoS One 2014; 9 (08) e103754
  • 119 McDonald SB, Privitera M, Kakacek J, Owens S, Shafer P, Kobau R. Developing epilepsy training capacity for primary care providers using the project ECHO telementoring model. Epilepsy Behav 2021; 116: 107789
  • 120 Understanding the Role of the Emergency Neurologic Life Support (ENLS) Course in Resource-Limited Settings. A Needs Assessment and Live Training Event for African Health Care Workers - Neurology Blogs [cited 2023 Sep 12]. Accessed November 28, 2023 at: https://blogs.neurology.org/global/understanding-the-role-of-the-emergency-neurologic-life-support-enls-course-in-resource-limited-settings-a-needs-assessment-and-live-training-event-for-african-health-care-workers/
  • 121 McCredie VA, Shrestha GS, Acharya S. et al. Evaluating the effectiveness of the Emergency Neurological Life Support educational framework in low-income countries. Int Health 2018; 10 (02) 116-124
  • 122 Barkley AS, Medina-Beckwith J, Sothea S, Pak S, Durfy SJ, Lele AV. Teaching the emergency neurologic life support course at two major hospitals in Phnom Penh, Cambodia. World Neurosurg 2020; 141: e686-e690
  • 123 Mikulík R, Caso V, Bornstein NM. et al. Enhancing and accelerating stroke treatment in Eastern European region: methods and achievement of the ESO EAST program. Eur Stroke J 2020; 5 (02) 204-212
  • 124 Thango N, Baticulon RE, Lippa L. The role of registries in neurotrauma research: Translating data into health policy that enhances patient care comment on “Neurotrauma surveillance in national registries of low- and middle-income countries: A scoping review and comparative analysis of data dictionaries”. Int J Health Policy Manag 2023; 12: 7521
  • 125 Truelsen T, Heuschmann PU, Bonita R. et al. Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol 2007; 6 (02) 134-139
  • 126 Vishnu VY, Bhatia R, Khurana D. et al. Smartphone-based Telestroke vs “Stroke Physician” led Acute Stroke Management (SMART INDIA): a protocol for a cluster-randomized trial. Ann Indian Acad Neurol 2022; 25 (03) 422-427
  • 127 Narsinh KH, Paez R, Mueller K. et al. Robotics for neuroendovascular intervention: Background and primer. Neuroradiol J 2022; 35 (01) 25-35
  • 128 Posadzki P, Mastellos N, Ryan R. et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12 (12) CD009921
  • 129 Nieuwlaat R, Wilczynski N, Navarro T. et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014; 2014 (11) CD000011
  • 130 Carvalho VSJ, Picanço MR, Volschan A, Bezerra DC. Impact of simulation training on a telestroke network. Int J stroke 2019; 14 (05) 500-507
  • 131 Wu N, Gong E, Wang B. et al. A smart and multifaceted mobile health system for delivering evidence-based secondary prevention of stroke in rural China: design, development, and feasibility study. JMIR Mhealth Uhealth 2019; 7 (07) e13503
  • 132 Saposnik G, Galanos LC, Guerrero R, Casagrande F, Adhamidhis E, Gao MMY. et al The World Stroke Academy: A world stroke organization global pathway to improve knowledge in stroke care. Int J stroke 2022; 17 (08) 829-834