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Introduction: In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India. Methods and Analysis: This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases. Discussion: Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.
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An adult female Labrador Retriever dog was presented at referral veterinary polyclinic, IVRI in lateral recumbency with history of anorexia, high fever, severe panting, heavy tick infestation, and not responding to cephalosporins and fluoroquinolones since last 1 week. Clinical examination showed pale conjunctiva, enlarged popliteal lymph node however, electrocardiogram (ECG) report found to be normal. Haematological finding showed marked anaemia and thrombocytopenia. Parasitological examination found it to be positive for Ehrlichia canis and confirmed ticks to be Rhipicephalus sanguineus. Dog was treated with doxycycline @ 10 mg/kg for 28 days in divided dose with supportive therapy. Blood transfusion was done on second day to avoid complication. Dog showed marked recovery after 15 days and re-examination of blood revealed no parasitemia.
