Stroke School at Kyrgyzstan, NIHSS training
On the 5th July, 2018 the important step in promoting the activity of the ESO-EAST community in Kyrgyzstan was attempted: the first NIHSS training made by WHO expert, Dr.Francesca Pezzella was organised. This day was also very significant for neurologists in Kyrgyzstan: more than 20 doctors underwent an intensive training about using NIHSS scale in acute stroke and now they are pioneers of NIHSS implementation in acute stroke departments.
The training was organized by the WHO Regional Office in Kyrgyzstan with the invitation of an international WHO stroke expert Dr. Francesca Romana Pezzella. The training involved neurologists from four clinics of Kyrgyzstan: City Clinical Hospital 1, National Hospital (Neurology 2), Osh Interregional Joint Clinical Hospital, Naryn Regional United Hospital. Three of invited departments already are participating in the registry of quality of stroke RES-Q, which is supported by European Stroke organization ESO. The NIHSS scale is an important component of this registry. According to Dr.Pezzella, more than 500,000 doctors around the world have been certified to use the NIHSS scale, using the web platform. To use this scale, trainings and special education is needed, and this is where the regional center of WHO in Kyrgyzstan is helping during several years. WHO regional office at Kyrgyzstan invites experts from Europe to develop clinical protocols such as “The RoadMap for Stroke and Acute coronary syndrome” and much more. The NIHSS scale has been used during last three years by ESO-EAST participants at City Clinic Hospital №1. Due to insistive initiative of ESO-EAST Coordinator in Kyrgyzstan, Dr.Lutsenko Inna and Chief Neurologist of Bishkek, Dr. Abdusalim Artykbayev, the NIHSS scale is being adopted and has been actively used by at the Bishkek City Civil Clinic 1, angioneurological department by doctors, residents, and students since 2015. Doctors Titarenko Denis, Zhumakeeva Salamat and Shapovalova Anna were pioneers of the use NIHSS at this department. Now, the NIHSS is being implemented in the practice of doctors at the angioneurological departments of the City Clinical Hospital 1, the Chuy Joint Regional Hospital, the Osh Interregional Joint Clinical Hospital, the Naryn Regional United Hospital. Filling out the scale with an existing experience takes not more than five minutes, the benefit from it is invaluable and consists of the ability of monitoring patient’s status and adjustment of the treatment according the scale’s score.
The process of certification and the training of the personnel in the use of the NIHSS was conducted in English. During the seminar, Dr. Francesca Pezzella mentioned that the translation of this process into Russian for doctors from the CIS and Central Asia countries is being discussed. According to the WHO expert, “…Time ago, even in Europe attitude of doctors towards stroke was nihilistic and the assessment of the patient’s condition after stroke was subjective without using the standardized stroke severity scales.” Dr. Pezzella, together with other colleagues, studied and proved the effectiveness of using the NIHSS, and they succeeded. Thus, the expert encouraged the conference participants to work with evidence-based medicine. Dr. Pezzella listed the main reasons for usage of the scales such as 1) the validity of scales, because their application is based on clinical trials, 2) improving the diagnostic accuracy, 3) the selection of appropriate treatment methods, 4) the monitoring of neurological disorders, 5) the predicting the outcome. Dr. Pezzella also shared her experience of implementing the scale in her home country – Italy. Some participants of the conference asked the questions they were interested in regarding the NIHSS. During the seminar, the questions about thrombolytic and anticoagulant therapy in patients with stroke in Kyrgyzstan were discussed. Expert Francesca Pezzella summed up, that the special devices for the monitoring of anticoagulation efficacy and safety should be installed in the departments for the treatment of acute stroke and it is necessary to identify the risk factors of the complications using the mRs, CHADS2 and others scales. Regarding the diet in the acute period of stroke Dr. Pezzella also added that in Italy there are three types of diet for patients with dysphagia. She also affected the high probability of deaths from the possibility of choking, improper feeding of patients and the inattention of relatives.
The participants made suggestions for assessing aphasia in the Kyrgyz language and the need to implement the FeSS protocol in acute stroke departments to monitor dysphagia. Most neurologists are interested in using the NIHSS in their activities because of the short time, spent on the scale, high level of validity, more objective data and the ability to predict and measure stroke outcomes. The usage of the NIHSS is planned to be implemented in all hospitals in Kyrgyzstan, where patients with acute stroke are treated to reduce the subjective approach of neurologist in assessment of patient’s condition and to reach the next level in the diagnostics and stroke management in Kyrgyzstan. Students and residents of Kyrgyz State Medical Academy were also actively participating in discussions, what made foreign experts happy. This fact confirmed the high motivation of young people in changes at the stroke management system in Kyrgyzstan. We want to thank the regional center of WHO in Kyrgyzstan and Dr. Francesca Romana Pezzella for this high quality training and hope that the ESO-EAST initiative in Kyrgyzstan together with WHO will be able to change the statistics and epidemiological situation of strokes in the country.
From behalf of ESO-EAST team,
Lutsenko Inna, Sultanova Aishoola, Nazhmudinova Dayana, Ismailova Aziza, Orunbaeva Akmaral.