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Edited by C Wolfe, C McKevitt, A Rudd. Oxford: Radcliffe Medical Press, 2002, £24.95, pp 160 (paperback). ISBN 1 85775 455 7
Stroke remains a major cause of death and disability throughout the world. In the UK and elsewhere, care for people with stroke has been shown to vary dramatically in relation to how that care is organised and delivered, and what it achieves. The greatest strength of this book is therefore not so much that it identifies variability across Europe, but that it contains eloquent and practical discussion about the difficulties in carrying out such research and interpreting the findings. The authors also discuss potential advances we need to make in research into stroke and other chronic conditions, across geographical and cultural boundaries.
The majority of chapters follow a similar pattern, first highlighting a particular issue arising in multinational research such as disease registers, economic evaluation, and identifying and defining outcomes that are important to patients. The authors then draw upon the BIOMED-I and BIOMED-II stroke research programmes (both widely reported in the literature) as illustrative case studies. Once this pattern is grasped by the reader it works well, not least because a number of the authors have contributed to multiple chapters thereby keeping a reasonable thematic thread for an edited text. The fact that this book explicitly tackles some of the very important, but sometimes overlooked, issues in both country specific and international epidemiological studies is exciting and valuable.
While we may be part of the way towards identifying and measuring what constitutes “good quality care” and the reasons for variation, this book argues that we have further to go. A strength of the writing is that it helps the reader take a step outside nation specific assumptions and preconceptions about what “could” and “should” be done. Although reconsideration of our basic assumptions can make for uncomfortable and unsettling reading, it is clearly necessary from time to time if we are truly interested in developing continuous improvement in quality care. The book finishes by arguing that, despite the clear difficulties in doing such research and the resultant need for caution in interpreting findings, international collaborations are possible and can reveal new findings and promote new questions. It is not merely philosophical rhetoric, as many of the experiences outlined in the book provide a useful way forward for others considering such studies or simply trying to make sense of them.