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Editorial
Stroke care in Spain. What do we have? What do we need?
Situación asistencial del ictus en España. ¿Qué tenemos? ¿Qué nos falta?
E. Díez-Tejedor
Corresponding author
ediezt@meditex.es

Corresponding author.
, B. Fuentes
Servicio de Neurología y Centro de Ictus, Área de Neurociencias, Instituto de Investigación IdIPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For many years&#44; caring for stroke has been suffering from a major therapeutic nihilism&#44; with patients being entrusted&#44; at best&#44; to the natural course of their condition&#46; Fortunately&#44; since the 1980s&#44; studies have begun to be published showing that specialist attention in <span class="elsevierStyleItalic">ictus</span> has an impact on patients&#8217; progress&#44; leading the World Health Organization and the European Stroke Council to issue in 1995 what has become known as the Helsinborg Declaration&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> ratified in 2006&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> when the target set was to achieve&#44; for all patients with an acute stroke&#44; early specialist assessment and treatment in a stroke unit &#40;SU&#41;&#46; In addition&#44; however&#44; over and above the scientific evidence&#44; specialized neurological care for stroke patients is a clear demand of modern society&#46; Thus&#44; the associations of neurology patients and the Spanish Neurology Society &#40;SEN&#41; drafted back in 2000 the so-called Madrid Declaration&#44; setting out the &#8220;right of all citizens to be seen when necessary by an expert with specific competencies in the various neurological pathologies&#44; with access to the most up-to-date diagnostic and therapeutic techniques&#44; and to be able to be cared for in specific interdisciplinary units where they can obtain all assistance necessary for their health problem&#44; with assurances that this care will be of the highest quality possible&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In his report on subsequent brain damage&#44; Spain&#39;s Ombudsman included a recommendation for the Regional Health Authorities&#58; stress should be placed on the early specialized care of stroke patients through the creation of specific stroke units or specialist stroke teams so as to cover the entire population&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since the results of the first randomized studies demonstrating the efficacy of SU were published in the 1980s&#44; these units have become the cornerstone for the treatment of acute stroke&#46; Subsequently&#44; in the 1990s&#44; the efficacy of intravenous fibrinolytic treatment was demonstrated in selected cases of acute cerebral infarction and we are currently seeing major advances in the development of reperfusion therapies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Stroke units have been shown to be clearly effective in reducing mortality and better functional recovery&#44; with an evidence level of I &#40;grade A recommendation&#41; based on randomized studies and meta-analyses&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> They also represent a cost-effective measure&#44; as they shorten the mean duration of patient stays and increase their survival without this implying a larger number of institutionalizations&#44; with a higher number of independent patients&#46; Their benefits extend to all types of ictus and are independent of age and severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> In addition&#44; in comparison with thrombolysis&#44; they have a larger potential target population as it has been estimated that 83&#37; of patients would be candidates for specialist management at an SU&#44; versus 10&#37; who could be treated with intravenous thrombolysis in the first 3<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Nonetheless&#44; the high degree of scientific evidence underlying the recommendations on care for acute stroke patients at these stroke units does not correspond to the degree of their implementation in Spain&#44; nor even in the whole of the European Union&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this sense&#44; the SEN&#39;s Cerebrovascular Diseases Study Group &#40;GEECV&#41; has taken the initiative and assumed the responsibility for drawing up a snapshot of the situation of stroke care in Spain at the end of 2008&#44; and this issue of <span class="elsevierStyleItalic">Neurolog&#237;a</span> presents the results of the &#8220;National Stroke Care Survey&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> which helps to show what it was like just before the Ministry of Health approves the National Stroke Strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As is well known&#44; in recent years there has been considerable rapprochement between the Health Authorities and the scientific societies&#44; which has culminated in the preparation of stroke care plans at both regional and national levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;15</span></a> It should be pointed out that these documents have arisen thanks to the drive given by the SEN&#39;s GEECV through the publication and dissemination of the Stroke Health Care Plan &#40;PASI&#41;&#44; published in 2006&#44; which established the levels of care to be provided for this condition and the importance of the Stroke Code&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> recently revised<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41;&#44; as well as to groups of stroke experts in a number of regions that have&#44; together with their respective Regional Governments&#44; initiated care plans for acute stroke&#46; These documents have set out the bases for implementing the Stroke Code both inside and outside the hospital context&#44; as well as improvements in the levels of care through an increase in the number of hospitals with an SU&#44; stroke teams&#44; and the emergence of stroke reference centres&#44; together with the creation of stroke care networks interconnecting these levels of care&#44; in addition to the adaptation of specific rehabilitation programmes&#46; IN parallel&#44; the Ministry of Health and Social Policy has picked up the baton and has drafted the stroke strategy within the National Health System &#40;SNS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This was published in November&#44; 2008&#44; with the participation&#44; in addition to the technical committee of stroke experts responsible for its wording&#44; of an institutional committee with representatives of the Regional Governments and the Ministry of Health and Consumer Affairs&#44; as it was then&#46; The strategy aims to homogenize stroke care&#44; committing the Regional Governments&#8217; Health Departments to develop and implement these care plans&#44; reflecting the basic strategic lines &#40;primary and secondary prevention of stroke&#44; care in the acute phase&#44; rehabilitation and return to normal life&#44; as well as training and research&#41; and the necessary indicators for their assessment &#40;these indicators can be extracted from the SNS data system and are combined with specific information compiled using questionnaires agreed within the strategy&#39;s monitoring committee&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although the signing of the National Stroke Strategy by the Inter-Territorial Health Council and&#44; therefore&#44; all the Health Departments of the 17 Regional Governments has implied a major achievement that tends to stimulate the development of specific plans helping to standardize and improve stroke care throughout Spain and accelerate its application in the regions&#44; there is still a lot of work to do in order to achieve the targets set&#46; It is certainly necessary to understand the situation we started from 2008 so as to assess correctly the effects of the implementation of this strategy&#44; which&#44; in addition&#44; proposed an assessment using indicators that can be extracted from the SNS on one hand and&#44; on the other&#44; obtaining specific information through a questionnaire undertaken by this strategy&#39;s monitoring committee&#44; with the participation of all the Regions&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the survey presented here&#44; it is concluded that&#44; in the first half of 2009&#44; there were 39 SUs&#44; albeit unevenly distributed across the country&#46; Thus&#44; it is possible to observe a large concentration of SUs in Madrid and Barcelona&#44; which coincide in being the most active with regard to the number of thrombolytic treatments administered and&#44; also&#44; in having regional stroke care plans in place with the use of &#8220;stroke codes&#8221; before the approval of the national strategy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although this kind of survey of the status of stroke care in Spain is very important and welcome&#44; it is necessary to make certain considerations in connection with the one published here&#46; First of all&#44; the publication of the data prior to the implementation of the SNS stroke strategy at this stage is a little tardy and there is no analysis of the changes that may have already occurred&#44; whether or not due to its implementation&#46; The data may therefore be considered to be outdated and&#44; to a certain extent&#44; redundant as&#44; when the strategy was drawn up&#44; an analysis was made of the situation in the different regions to reflect the number that had protocols&#44; clinical practice guidelines&#44; clinical routes&#44; stroke codes&#44; protocols for intravenous fibrinolysis&#44; SUs&#44; as well as neurosonology resources&#44; diffusion&#47;perfusion magnetic resonance and neurovascular interventionism&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Secondly&#44; although the goal proposed in this survey is to study the situation of stroke care in Spain at the moment the Stroke Strategy was approved &#40;November&#44; 2008&#41;&#44; the analysis of the two main variables &#40;SUs and number of patients treated with intravenous thrombolysis&#41; was considered for different periods&#46; Thus&#44; the intravenous thrombolysis data refer to 2008 &#40;prior to the publication of the national strategy&#41;&#44; but the analysis of the SUs refers to the first half of 2009&#44; when it might be possible to find a new incorporation&#44; possibly decided prior to the signing of the said strategy&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Also&#44; the analysis of the ratio of stroke unit beds per inhabitant&#44; without taking into account population density and territorial dispersion&#44; is an aspect that may lead to mistaken evaluations as no consideration is given to the fact that some stroke patients may not really be referred to hospitals with an SU&#44; such as when there is no stroke unit available in all the provinces in the region&#44; or when it is located quite far from where the patient has suffered the stroke&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The analysis of thrombolytic dispersion may be influenced by this fact&#44; so it would be useful to reflect not only the absolute figures for treatments performed in a year&#44; which are surprisingly low in some regions&#44; but also the percentage of treatments applied among all the patients with ischaemic stroke arriving at the emergency room&#46; For this reason&#44; the indicator of the number of intravenous thrombolysis performed should be adjusted for the total number of patients with ischaemic stroke arriving at hospitals&#46; In this way&#44; applying this analysis in the Region of Madrid&#44; for example&#44; it has been seen that the implementation of the stroke care plan has managed to increase the percentage of treatments with intravenous fibrinolysis performed at SUs&#44; which was 6&#46;9&#37; in 2008 and 23&#46;3&#37; in 2009&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> clearly reflecting an increase related to the better operation of the stroke code&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is also necessary to consider the possible biases entailed by conducting a survey of this kind&#44; mainly informational biases as the data provided by different people surveyed might be subject to a certain degree of subjectivity&#44; or to errors of perception or interpretation&#44; and they do not seem to have been sufficiently verified&#46; In this sense&#44; it would be more practical to use records that include all resources available for stroke care and the patients seen&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Another interesting aspect of the survey is that it also collects data on the hospitals performing neurovascular interventionism&#44; an aspect not contemplated among the original goals and recommendations of the National Health System&#39;s National Stroke Strategy and due to be included among the new indicators&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; this initiative by the SEN&#39;s GEECV&#44; which provides us a &#8220;snapshot&#8221; of the situation of stroke care in Spain as of December&#44; 2008&#44; is a source of satisfaction&#44; even though this situation is not very satisfactory and has brought to light some achievements and a lot of shortcomings&#44; with huge territorial inequalities&#44; which means that we have to continue improving&#46; But it is essential for us to perfect our data collection process to achieve a true &#8220;magnetic resonance&#8221; image of the stroke care situation in Spain&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nonetheless&#44; even with all these limitations&#44; this survey is a very good contribution that allows us to understand better the starting point at the end of 2008 so as to be able to analyze the progress made over the last 2 years&#44; so we invite the GEECV to conduct a second study assessing the impact of this National Stroke Strategy and so serve as a stimulus to achieve its more widespread implementation and substantial continuous improvement of the situation with regard to stroke care in Spain&#44; so as to come closer to the recommendations contained in the new PASI document recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span>"
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          "clase" => "keyword"
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            0 => "Stroke units"
            1 => "Stroke care"
            2 => "National Stroke Strategy"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The high level of scientific evidence which supports the recommendations for the care of acute stroke in stroke units &#40;SUs&#41; with a good health care network&#44; does not correspond to the level of introduction in Spain&#46; In this regard&#44; the Cerebrovascular Diseases Study Group &#40;GEECV&#41; of the Spanish Society of Neurology has taken the initiative to conduct the &#8220;National Survey of Stroke Care&#8221; that will help to determine the real situation in acute stroke management in Spain just before the approval of the National Stroke Strategy &#40;NSS&#41; by the Ministry of Health and concludes that in the first semester of 2009 there were 39 SUs&#44; unevenly distributed with higher concentration in Madrid and Barcelona&#46; Although the approval of the NSS was a major achievement&#44; much remains to be done to meet the objectives&#46; We thank the GEECV&#39;s initiative&#44; which gives us an &#8220;X-ray&#8221; of the&#44; not very satisfactory&#44; state of stroke care in Spain in December 2008&#44; highlighting some achievements and the many shortcomings&#46; Therefore&#44; we must continue to improve&#44; refine our data collection with records that include all available resources and all the stroke patients attended&#46; We invite GEECV to carry out a second study to evaluate the impact of NSS and to serve as a stimulus to achieve a substantial improvement in stroke care in Spain&#44; closer to the recommendations of the new PASI document&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El alto grado de evidencia cient&#237;fica en el que se sustentan las recomendaciones sobre la asistencia de los pacientes con ictus agudo en unidades de ictus &#40;UI&#41; con una buena red asistencial no se corresponde con el grado de implantaci&#243;n de las mismas en Espa&#241;a&#46; En este sentido&#44; el Grupo de Estudio de Enfermedades Cerebrovasculares &#40;GEECV&#41; de la SEN ha tomado la iniciativa de elaborar la &#171;Encuesta nacional de la asistencia del ictus&#187; que ayuda a conocer c&#243;mo era &#233;sta justo antes de aprobarse la Estrategia Nacional del Ictus &#40;ENI&#41; por el Ministerio de Sanidad y concluye que en el primer semestre del a&#241;o 2009 exist&#237;an 39 UI&#44; distribuidas de forma desigual con mayor concentraci&#243;n en Madrid y Barcelona&#46; Aunque la firma de la ENI ha supuesto un importante logro&#44; todav&#237;a queda mucho por hacer para cumplir los objetivos planteados&#46; Es motivo de satisfacci&#243;n esta iniciativa del GEECV&#44; que nos aporta una &#171;radiograf&#237;a&#187; de la situaci&#243;n de la atenci&#243;n del ictus en Espa&#241;a a diciembre de 2008&#44; que no es muy satisfactoria y que alumbra alg&#250;n logro y muchas carencias&#44; por lo que hemos de continuar mejorando&#44; perfeccionando nuestra recogida de datos mediante registros que incluyan todos los recursos disponibles en la atenci&#243;n del ictus y los pacientes atendidos&#46; Invitamos al GEECV a realizar un segundo trabajo que eval&#250;e el impacto de esta ENI y que sirva de est&#237;mulo para conseguir una mejora continua y sustancial de la situaci&#243;n en Espa&#241;a&#44; y aproximarnos a las recomendaciones del nuevo documento Plan de atenci&#243;n sanitaria del ictus&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; D&#237;ez-Tejedor E&#44; Fuentes B&#46; Situaci&#243;n asistencial del ictus en Espa&#241;a&#46; &#191;Qu&#233; tenemos&#63; &#191;Qu&#233; nos falta&#63; Neurolog&#237;a&#46; 2011&#59;26&#58;445&#8211;8&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Strategies for Early Intervention in Stroke&#46; A report of an ad hoc consensus group meeting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The European ad Hoc Consensus Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "1996"
                        "volumen" => "6"
                        "paginaInicial" => "315"
                        "paginaFinal" => "324"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Helsingborg Declaration 2006 on European stroke strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Kjellstrom"
                            1 => "B&#46; Norrving"
                            2 => "A&#46; Shatchkute"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000097646"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2007"
                        "volumen" => "23"
                        "paginaInicial" => "231"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17139166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Declaraci&#243;n de Madrid&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.sen.es/pdf/declaracion_madrid.pdf">WWW&#46;sen&#46;es&#47;pdf&#47;declaracion&#95;madrid&#46;pdf</a>"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Defensor del Pueblo&#46; Da&#241;o cerebral sobrevenido en Espa&#241;a&#46; Un acercamiento epidemiol&#243;gico y sociosanitario&#59; 2005&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.defensordelpueblo.es/documentacion/informesmonograficos/INFORMEDANIO.zip">www&#46;defensordelpueblo&#46;es&#47;documentacion&#47;informesmonograficos&#47;INFORMEDANIO&#46;zip</a>"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organised inpatient &#40;stroke unit&#41; care for stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Stroke Unit Trialists&#8217; Collaboration"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD000197.pub2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "4"
                        "paginaInicial" => "CD000197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17943737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke unit&#58; a cost-effective care need"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Fuentes"
                            1 => "E&#46; Diez Tejedor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologia"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "456"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17853964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke units&#58; many questions&#44; some answers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Fuentes"
                            1 => "E&#46; Diez-Tejedor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1747-4949.2009.00244.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Stroke"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "28"
                        "paginaFinal" => "37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19236495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke units&#44; tissue plasminogen activator&#44; aspirin and neuroprotection&#58; which stroke intervention could provide the greatest community benefit&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;K&#46; Gilligan"
                            1 => "A&#46;G&#46; Thrift"
                            2 => "J&#46;W&#46; Sturm"
                            3 => "H&#46;M&#46; Dewey"
                            4 => "R&#46;A&#46; Macdonell"
                            5 => "G&#46;A&#46; Donnan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000087705"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2005"
                        "volumen" => "20"
                        "paginaInicial" => "239"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16123543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "An&#225;lisis de la asistencia al ictus en Espa&#241;a&#58; Resultados de la Encuesta nacional Ictus del Grupo de Estudio de Enfermedades Cerebrovasculares&#46; Neurolog&#237;a&#46; 2011&#59;26&#58;449&#8211;54&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Sanidad y Pol&#237;tica Social&#46; Estrategia en ictus del SNS&#59; 2008&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.msc.es/organizacion/sns/planCalidadSNS/docs/EstrategiaIctusSNS.pdf">http&#58;&#47;&#47;www&#46;msc&#46;es&#47;organizacion&#47;sns&#47;planCalidadSNS&#47;docs&#47;EstrategiaIctusSNS&#46;pdf</a>"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plan de asistencia sanitaria al ictus II 2010&#46; Documento de consenso elaborado por un Comit&#233; ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares &#40;GEECV&#41; de la Sociedad Espa&#241;ola de Neurolog&#237;a &#40;SEN&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Masjuan"
                            1 => "J&#46; &#193;lvarez-Sab&#237;n"
                            2 => "J&#46; Arenillas"
                            3 => "S&#46; Calleja"
                            4 => "J&#46; Castillo"
                            5 => "A&#46; D&#225;valos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nrl.2010.05.008"
                      "Revista" => array:2 [
                        "tituloSerie" => "Neurolog&#237;a"
                        "fecha" => "2010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relevance of stroke code&#44; stroke unit and stroke networks in organization of acute stroke care&#8212;the Madrid acute stroke care program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; De Lecinana-Cases"
                            1 => "A&#46; Gil-Nunez"
                            2 => "E&#46; Diez-Tejedor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000200452"
                      "Revista" => array:7 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "140"
                        "paginaFinal" => "147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19342844"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plan for stroke healthcare delivery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Alvarez Sabin"
                            1 => "M&#46; Alonso de Lecinana"
                            2 => "J&#46; Gallego"
                            3 => "A&#46; Gil-Peralta"
                            4 => "I&#46; Casado"
                            5 => "J&#46; Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologia"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "717"
                        "paginaFinal" => "726"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17106825"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Asociaci&#243;n Madrile&#241;a de Neurolog&#237;a y Servicio Madrile&#241;o de Salud&#46; Atenci&#243;n a los pacientes con ictus en la Comunidad de Madrid&#46; Consejer&#237;a de Sanidad&#59; 2009&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.madrid.org/cs/Satellite%3Fc=CM_Publicaciones_FA%26cid=1142553237007%26idConsejeria=1109266187266%26idListConsj=1109265444710%26language=es%26pagename=ComunidadMadrid%252FEstructura%26pid=1109265444699%26sm=1109265844004">http&#58;&#47;&#47;www&#46;madrid&#46;org&#47;cs&#47;Satellite&#63;c&#61;CM&#95;Publicaciones&#95;FA&#38;cid&#61;1142553237007&#38;idConsejeria&#61;1109266187266&#38;idListConsj&#61;1109265444710&#10216;uage&#61;es&#38;pagename&#61;ComunidadMadrid&#37;2FEstructura&#960;d&#61;1109265444699&#38;sm&#61;1109265844004</a>"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The stroke programme of Catalonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Gallofre"
                            1 => "S&#46; Abilleira"
                            2 => "R&#46; Tresserras"
                            3 => "M&#46;L&#46; De la Puente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
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Article information
ISSN: 21735808
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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