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Stroke Management in Low-Resource Settings

Course Description | Faculty | Accreditation | General Information

Course Description

This activity aims to educate health care professionals on the appropriate management of stroke in low-resource settings. Stroke is the cause of significant morbidity and mortality worldwide, constituting 4.1% of disability-adjusted life years (DALYs) lost worldwide, making it the 3rd highest cause of DALYs lost (Murray, 2012). Data on the impact of stroke within Haiti itself are limited by poor public health infrastructure, but the latest figures from the Pan-American Health Organization put stroke as the 3rd highest cause of death within the country, behind AIDS and diarrheal diseases (PAHO). There exist comprehensive guidelines in stroke management (AHA/ASA guidelines), however these guidelines assume ready access to advanced diagnostics (notable CT scanners) and the ability for intensive monitoring (such as frequent nursing checks and arterial lines).

Original Release: 4/1/2014
Most Recent Update: 4/1/2014
Termination Date: 4/1/2017

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

COST: COST: $25.00

OVERALL LEARNING OBJECTIVES:
Upon completion of this activity, participants will be able to:

  1. Provide resource-appropriate management for strokes of unclear etiology (as most stroke patients in Haiti will not have a CT scan performed)
  2. Counsel patients effectively on primary and secondary stroke prophylaxis
  3. Identify the most important modifiable risk factors for primary and secondary stroke
  4. Identify public health and public policy measures that have been employed in middle income countries to reduce the risk of stroke

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Faculty
JAMES HUDSPETH, MD
Course Director
Dr Hudspeth has been active in global health since his medical school training at Washington University School of Medicine, both locally and nationally with organizations such as AMSA and PHR. He performed a Fogarty Fellowship during medical school in South Africa researching HIV/TB coinfections, and subsequently did clinical rotations in South Africa and Rwanda during his internal medicine residency at the Brigham and Women's Hospital.

Since 2011 he has been a hospitalist at Boston Medical Center, with an interest in medical education (both in the US and abroad) and global health, serving as the coordinator for global health for the BMC internal medicine residency. He is also a founding member, a board member, and the chair of curriculum development for the NGO Physicians for Haiti, which works on improving access for medical education for Haitian clinicians.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ZADOK SACKS, MD
Course Director
Dr. Sacks currently practices hospitalist medicine at Faulkner and Brigham and Women's Hospitals and serves as Co-Chair and Founding Director of Physicians for Haiti. He is a graduate of the Harvard Brigham and Women's/Boston Children's Hospital Medicine-Pediatrics Residency Program, and served as Chief Resident for the program in his final year of residency, during which he was awarded a Harvard Medical School Resident Teaching Award by the graduating class of students.

During his residency, he also co-founded Physicians for Haiti, an organization dedicated to providing Haitian health care professionals with medical educational and leadership training opportunities

DISCLOSURE:
Disclosure information not received.



ERNEST BARTHÉLEMY, MD, MA
Course Contributor
Dr. Ernest Barthélemy is a resident in neurosurgery at the Icahn School of Medicine at Mount Sinai in New York City, where he also completed his medical degree. Prior to medical school, he completed a Masters degree in Motor Control and Applied Physiology at Teachers College, Columbia University, where his interest in clinical neuroscience first began. In medical school, Dr. Barthélemy was the first recipient of the Medical Student Neurosurgery Scholarship Award, which funded his research year focusing on neurological and neurosurgical disease patterns in Haiti. The results of his research were subsequently accepted for publication in the journal World Neurosurgery, and he was honored with his medical school's Distinction in Research award for publishing this work. Dr. Barthélemy's research on Haitian neuroepidemiology has also been presented at scientific meetings of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the 2014 AHA/ASA International Stroke Conference. Dr. Barthélemy is also a co-founder and board member of the non-profit organization Medical Students for Haiti, Inc., a student-run global health enterprise that aims to improve Haitian health care through peer teaching projects, academic twinning and cross-cultural exchange.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



AARON BERKOWITZ, MD, PhD
Course Contributor
Aaron Berkowitz, MD, PhD is an associate neurologist and the Director of the Global Neurology Program at Brigham and Women’s Hospital, and an instructor in neurology at Harvard Medical School. He works closely with NGOs Partners in Health and Physicians for Haiti on the development of education and training materials for neurologic diseases in resource-limited settings for non-neurologists. He has been actively involved in on-site and online clinical education for faculty, residents, and medical students in Haiti (St. Marc, Mirebalais, Cange, and Fond-des-Blancs) and Malawi (Neno, Lilongwe, and Blantyre). His current work includes collaborating with Partners in Health/Zanmi Lasante on a community-based epilepsy care pathway and training program for community health workers, psychologists, nurses, social workers, and physicians in Haiti's Central Plateau; creating a series of CME modules on neurologic practice in resource-constrained settings with Physicians for Haiti; and use of decision analysis modeling to develop decision aids for stroke care where CT scans are not available. He completed medical school at Johns Hopkins, his PhD at Harvard University, and his residency in neurology at Brigham and Women's Hospital/Massachusetts General Hospital, where he served as chief resident. his His articles have been published in Neurology, International Journal of Stroke, Journal of Clinical Neuroscience, Practical Neurology, Neurohospitalist, and NeuroImage.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



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Reviewers
SHERRY CHOU, MD
Reviewer
Sherry H-Y. Chou is a neurologist in the division of Critical Care Neurology and division of Stroke at Brigham and Women’s Hospital and an Assistant Professor of Neurology at Harvard Medical School. Dr. Chou completed residency in neurology and fellowships in vascular neurology and in critical care neurology at Massachusetts General Hospital and Brigham and Women’s Hospital. Clinically, Dr. Chou specializes in management of acute stroke and of critically-ill patients with acute brain injuries. Dr. Chou is committed to advancing therapeutic options and improving outcome and quality of life of patients with severe brain injury. Following completion of clinical training, Dr. Chou completed a Masters of Medical Science program dedicated to translational research at Harvard Medical School and a Physician Leadership Program through Harvard Business School. Dr. Chou devotes her research efforts in developing a patient-oriented translational research program to facilitate further research in critically-ill patients with acute brain injuries. One of Dr. Chou’s main research focu is on using tissue biomarkers to understand the mechanisms of secondary brain injury and predicting outcome following aneurysmal subarachnoid hemorrhage. Her research is funded by the American Heart Association and the National Institute of Health/National Institute of Neurological Disorders and Stroke. Dr. Chou has received numerous awards and citations for her work, including the Neuroscience Section award from the Society of Critical Care Medicine and Scholar Award from the American Federation of Medical Research. Nationally, Dr. Chou was recently elected to the board of directors of the Neurocritical Care Society, where she continues her efforts to promote scientific advancement, education, diversity, and advocate for patients with severe brain injuries. In addition to clinical and research responsibilities, Dr. Chou is dedicated to education and training of the next generation. She serves as faculty mentor and “Uber mentor” for neurology residents in the Partners Neurology Residency program, has mentored numerous pre-med, medical, graduate students, as well as residents and fellows, and was recently awarded the Junior Faculty Mentoring Award from Brigham and Women’s Hospital. Dr. Chou leads the educational seminar in the Division of Cerebrovascular Diseases and Critical Care Neurology at Brigham and Women’s Hospital, and teaches in multiple CME courses through Harvard Medical School and the American Academy of Neurology.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



FARRAH MATEEN, MD
Reviewer
Dr. Farrah Mateen is an assistant professor at the Massachusetts General Hospital Department of Neurology. She is completing a PhD in International Health at Johns Hopkins Bloomberg School of Public Health which is focused on emerging risk factors for stroke in low-income populations. She is the author of more than 80 peer-reviewed manuscripts and has consulted for several non-governmental organizations and United Nations agencies on neurological disorders in low- and middle-income countries and performed original research and advocacy-based work on this topic.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



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Course Planners
SANJIV CHOPRA, MD
Planner
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



CHRISTOPHER DRURY, MA
Planner
Mr. Drury is founder of The Quill Consulting, LLC, a privately-owned medical writing and editing company. With graduate degrees in both English and biology, Chris has written and edited professionally for over a decade in areas that span medicine, pharmaceuticals, marketing, outcomes research, health devices, and several others. He has also worked extensively in CME by planning and building CME programs; reviewing, writing, and editing proposals and CME content; moderating programs; and following through on outcomes deliverables. Chris currently operates out of his home in Mount Pleasant, South Carolina.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



ANDI LONG, EdM
Planner
Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities.



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Accreditation

NUMBER OF CREDITS: 1 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate


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General Information

HARDWARE/SOFTWARE REQUIREMENTS

Computers
Any computer running Windows, Mac OS, or Unix machines are supported.


Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Browsers
Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Plugins
Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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