Abstract
Once the array of articles is assembled for each edition of our Journal, a nice theme emerges and February is no exception. This edition I was particularly attracted by the work of Kepplinger et al. describing the emergency transfer of acute stroke patients within the East Saxony Telemedicine Stroke Network. Telemedicine has been building a presence as an integral part of stroke management in some countries for a number of years and has been shown to improve times for thrombolysis and hence outcomes. Telemedicine would seem to be of particular value in countries with sparse populations with vast areas of land. It is pleasing to know that telemedicine is being rolled out in parts of the United States, Canada, India, and Australia; the protocol for this timely activity is presented in our Protocols section authored by Christopher Bladin. Telemedicine emphasizes that the time is brain concept, usually in a hub and spoke model. Indeed, the concept of ‘time is brain’ and the translation of this into clinical practice is addressed in a review by Fassbender et al.
The theme continues with the clinical trial protocols, two of which we have selected for this edition are from the FAST-MAG stable. The first is the general methodology for the phase 3 trial and the second for the prehospital study methods. The latter approach is going to become increasingly important as stroke clinicians push for even earlier stroke assessment using mobile ambulance-based imaging technology, similar to those found in Germany, where thrombolysis and potentially other therapies may be administered on site and en route to the hospital.
The FAST-MAG trial has been a long-time coming, and we should see the final results presented during 2014. The investigators must be congratulated on persisting under difficult circumstances to bring the trial to fruition. The FAST-MAG journey does demonstrate the difficulties many of us face in conducting investigator-driven trials, often requiring long recruitment times due to the relatively low funding levels and competition from other trials. The conduct of clinical trials in Western countries has also become increasingly cumbersome, with multiple layers of bureaucracy and increasing competition from developing countries; the former issue is being addressed at a number of levels in countries such as the United Kingdom where they have successfully increased the participation rate in clinical trials and improved bureaucratic efficiencies at many levels. There is a need to simplify study protocols and trial bureaucracy, while maintaining the highest ethical standards. This should be possible. At the same time, we need to create a culture of an expectation of consent to participate in clinical trials in major publicly funded hospitals and community environments to benefit the community at large.
This publication will coincide with the International Stroke Conference where the results of many important trials will be presented. What could be more important than creating an environment to nurture the seeds of ideas to conduct even more important trials that will advance health globally?
As per usual, we compliment our print issue with online audio and video; you can download podcast interviews with various authors from this edition and video from our Word Stroke Organization YouTube channel. Our reviewer thank you is now online at our Int J Stroke blog, which also has an assortment of stroke news from around the world via stroke practitioners and stroke support organizations; again it is a busy year. Enjoy!