title: Stroke: working toward a prioritized world agenda.
abstract: OBJECTIVE
  The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke.
  
  
  METHODS
  Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium.
  
  
  RESULTS
  Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent "silo" mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a "Brain Health" concept that enables promotion of preventive measures.
  
  
  CONCLUSIONS
  To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
authors.affiliation: University of Western Ontario, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5, USA. Vladimir.Hachinski@lhsc.on.ca
authors.forename: Vladimir
authors.initials: V
authors.lastname: Hachinski
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cramer
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Marc
authors.initials: M
authors.lastname: Fisher
authors.forename: Michael
authors.initials: M
authors.lastname: Brainin
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Buchan
authors.forename: Eng H
authors.initials: EH
authors.lastname: Lo
authors.forename: Brett E
authors.initials: BE
authors.lastname: Skolnick
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Miia
authors.initials: M
authors.lastname: Kivipelto
authors.forename: John
authors.initials: J
authors.lastname: Morris
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Yulun
authors.initials: Y
authors.lastname: Wang
authors.forename: Alan
authors.initials: A
authors.lastname: Bryer
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.forename: Costantino
authors.initials: C
authors.lastname: Iadecola
authors.forename: Sheila C O
authors.initials: SC
authors.lastname: Martins
authors.forename: Jeff
authors.initials: J
authors.lastname: Saver
authors.forename: Veronika
authors.initials: V
authors.lastname: Skvortsova
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Martin M
authors.initials: MM
authors.lastname: Bednar
authors.forename: Pamela
authors.initials: P
authors.lastname: Duncan
authors.forename: Lori
authors.initials: L
authors.lastname: Enney
authors.forename: Seth
authors.initials: S
authors.lastname: Finklestein
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Jones
authors.forename: Lalit
authors.initials: L
authors.lastname: Kalra
authors.forename: Jeff
authors.initials: J
authors.lastname: Kleim
authors.forename: Ralph
authors.initials: R
authors.lastname: Nitkin
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
authors.forename: Bhupat
authors.initials: B
authors.lastname: Desai
authors.forename: Mark P
authors.initials: MP
authors.lastname: Goldberg
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Heiss
authors.forename: Osmo
authors.initials: O
authors.lastname: Saarelma
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Yukito
authors.initials: Y
authors.lastname: Shinohara
authors.forename: Bhargava
authors.initials: B
authors.lastname: Trivedi
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.forename: Lawrence K
authors.initials: LK
authors.lastname: Wong
authors.forename: Antoine
authors.initials: A
authors.lastname: Hakim
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Stephen
authors.initials: S
authors.lastname: Prudhomme
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D000818:Animals; D035843:Biomedical Research; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D006801:Humans; D010353:Patient Education as Topic; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D000071939:Stroke Rehabilitation