In this touching second chapter, Francesca and Roberto take us through the ideas and actions that followed the first TED talk. How it changed and is still impacting not only their lives but also the people who are experiencing the same challange. Be parents of a child who had a prenatal stroke.

Francesca, Roberto and Mario ( their son) were first on the TED Global stage in 2013. From then on their life changed a lot and a lot of projects took life. On our stage they share their experience and achievements. From Inspiring to activate.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at



As the first European Stroke Organisation Conference has drawn to a close, I want to thank all faculty members and delegates for their intellectual and practical support to the preparation and delivery of what has I believe been an outstanding success. When the overwhelming wish of our association was expressed just 11 months ago that we should establish a new conference, we barely dared to hope for 800-1,000 delegates in our first year. The reality was that 84 countries were represented in Glasgow, and that delegate numbers were close to 2,700. To accompany the presentations to a packed auditorium in our first plenary session alone there were two simultaneous online publications in the New England Journal of Medicine and one in Lancet, and we had new results presented from two additional fresh NEJM publications and an Annals of Neurology paper. In the afternoon, we heard the first multicentre, blinded RCT of an experimental approach in stroke, a stem cell RCT, the complete results of the desmoteplase programme and a further new thrombectomy trial. By the time we retired to the poster session and welcome reception, the exhibition hall was buzzing with excitement. The enthusiasm and cheerfulness were tangible, affecting everyone from the most junior researchers through to old hands. The sun shone on the entire conference, literally. I attribute the success to a huge amount of good fortune, to the efforts of a vast team and to the enthusiasm of every delegate. It would be unfair to single out any one contribution but I am convinced that it was those numerous individual contributions, offered generously and constructively, that allowed us to take advantage of the good fortune. To be present at this inaugural conference was reward enough for anyone working in stroke, because it was a once in a career occasion that we will each remember with great fondness. It was rather like a birth, a christening and a wedding, all rolled into one. Certainly, we have shown what a large and happy family we are in stroke medicine, and that Europe stands not alone but with societies and individuals all across the world. We will build on this success, we will maintain the spirit and principles that informed ESOC 2015, and I promise that by 10-12 May 2016 in Barcelona we will have another outstanding programme. For now, I express my sincere thanks to everyone for their support and hope that each of you left Glasgow with enthusiasm, new friendships and shared optimism for the future, for our patients and our specialty.


Press release


Mechanical thrombectomy improves outcomes in acute ischemic stroke.


Joint statement of the European Stroke Organisation (ESO), the European Society  of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR)


Stroke results from rupture or interruption of blood flow in brain vessels can lead to devastating consequences for patients, their families and society. Steady progress has been achieved in the last 20 years in stroke treatment through better prevention, establishment of stroke care units and the use of clot-busting drugs (intravenous thrombolysis).


Last week, new scientific evidence from four major stroke studies was presented at the International Stroke Conference in Nashville, USA. It proved that rapid mechanical thrombectomy (clot retrieval) improves patient function after acute ischemic stroke. To achieve this benefit, patients were treated by interventional neuroradiologists in stroke centers with multidisciplinary stroke teams. This treatment should be performed as rapidly as possible in conjunction with standard intravenous thrombolysis.


ESO, ESMINT and ESNR acknowledge this significant progress in acute stroke treatment and strongly support its application in appropriately selected patients in well equipped stroke centers by properly trained neurointerventionists. Further randomized trials of thrombectomy and more detailed analysis of the current trials will help to optimize patient selection and treatment algorithms.


Detailed guidelines on mechanical thrombectomy are currently being prepared by the key European societies involved in acute stroke care. Before these detailed guidelines become available, ESO, ESMINT and ESNR have jointly updated and support the consensus statement on thrombectomy by the ESO-Karolinska Stroke Update (see



The European Stroke Organisation (ESO) is a society of stroke physicians, researchers, societies and patient organizations with the goal of optimizing  and harmonizing  the management of stroke in Europe by supporting medical education and stroke projects.

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The European Society of  Minimally Invasive Neurological Therapy (ESMINT) is a multidisciplinary society of individuals and groups working or training in the field of minimally invasive neurological therapy in geographical Europe. It has been established in order to promote the benefits of minimally invasive neurological therapies through education, training and support for high quality scientific research. 

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The European Society of Neuroradiology / ESNR Diagnostic and Interventional is a professional society organising European neuroradiologists. The Society organises Annual Scientific meetings – ESNR Congress, common European Training courses in neuroradiology – European Course of Neuroradiology (ECNR) and is a forum for professional development of European Neuroradiology.

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SITS endorses the ESOC – the European Stroke Organisation Conference in Glasgow 17-19 April 2015 – according to an announcement by SITS Chairman professor Nils Wahlgren today.

SITS usually arranges meetings for National Coordinators, SITS participants, workgroups and  regional committees at large conferences and ESOC will be the conference for our meetings in Europe next year, Nils Wahlgren declared.

Nils Wahlgren concluded: We hope to see as many SITS members as possible in Glasgow, since it facilitates networking between those who use SITS.


The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00-3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed.

TICH-2 trial – Tranexamic acid for IntraCerebral Haemorrhage 2

investigator meeting italy , Mantova 19 Nov 2014 hosting Alfonso Ciccone

  • The trial is funded by the NIHR HTA
  • The trial opened in March 2013 and will run until February 2017
  • The University of Nottingham is acting as trial sponsor
  • The trial is live and recruitment is ongoing, with 682 participants so far
  • Start up phase — March 2013
  • Main phase — April 2014
  • New sites welcome in the UK and internationally

For further information please contact us.

Trial Manager: Hayley Foster <>
Chief Investigator: Dr Nikola Sprigg <>
Nottingham Stroke Trials Office:

IST-3 Bibliography: published full papers in peer-reviewed journals

  1.  Innes K. Thrombolysis for acute ischaemic stroke: core nursing requirements. British Journal of Nursing 2003;12(7):416-24
  2. Kane I, Lindley R, Lewis S, Sandercock P. Impact of stroke syndrome and stroke severity on the process of consent in the Third International Stroke Trial. Cerebrovascular Diseases 2006;21:348-52

  1. Whiteley W, Lindley R, Wardlaw J, Sandercock P. Third International Stroke Trial. Int J Stroke. 2006;1:172-6.

  1. Sandercock P, Lindley R, Wardlaw J, Protocol 06PRT/1269: Third International Stroke Trial (IST-3). Lancet

  1. Wardlaw JM, Bath P, Sandercock P, Perry D, Palmer J, Watson G, Lloyd S, Geddes J, Farrall A. The NeuroGrid stroke exemplar clinical trial protocol. Int J Stroke. 2007;2:63-9
  2. The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials 2008;9(1):37.
  3. SCOPE (Stroke Complications and Outcomes Prediction Engine) Collaborations and IST. Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3). JNNP 2008;79:397-400

  1. EPITHET-where next? Sandercock P, Wardlaw J, Dennis M, Lindley R, Hankey G, Matz K, Peeters A, Phillips S, Gubitz G, Prasad K, Ricci S, Celani MG, Righetti E, Cantisani T, Arauz A, Berge E, Slot KB, Kobayashi A, Czlonkowska A, Correia M, Murray V, Lyrer P, Venables G; IST-3 Collaborative Group. Lancet Neurology 2008;7(7):570-1.

  1. Oxfordshire community stroke project clinical stroke syndrome and appearances of tissue and vascular lesions on pre-treatment CT in hyper-acute ischemic stroke among the first 510 patients in the Third International Stroke Trial (IST-3). Kobayashi A, Wardlaw J, Lindley R, Lewis S, Sandercock P, Czlonkowska A; IST-3 Collaborative Group.Stroke 2009;40(3):743-8.

  1. Should more patients with acute ischaemic stroke receive thrombolytic treatment? Wardlaw J, Murray V, Sandercock P,BMJ 2009; 339.
  2. The Third International Stroke Trial: Thrombolysis (IST-3) in Poland: are we recruiting the right patients? Czlonkowska A, Kobayashi A, Lewis S, Sandercock P, Lindley R, Baranska-Gieruszczak M on behalf of the IST-3 collaborative group. Polish Journal of Neurology and Neurosurgery. 2009; 43, 3:228-235.,15,12742,0,1.html

  1. Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials2011, 12:252

  1. How many patients might receive thrombolytic therapy in the light of the ECASS-3 and IST-3 data? Jan Bembenek, Adam Kobayashi, Peter Sandercock, Anna Czlonkowska. Int J Stroke 2010; 5:428–431.

  1. ‘Where are we now with intravenous thrombolysis for acute ischaemic stroke’? Peter Sandercock, Joanna Wardlaw, and Richard Lindley. Int J Stroke 2010; 5: 381–382:
  2. Statistical analysis plan for the third International Stroke Trial (IST-3); part of a ‘thread’ of reports of the trial. Int J Stroke 2012; 7: 186–18.
  3. The IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379(9834):2352-2363.

  1. Wardlaw J M, Murray V, Berge E, del Z G, Sandercock P, Lindley R L et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379(9834):2364-2372.
  2. IST-3 Collaborative Group. Effect of thrombolysis with alteplase within 6h of acute ischaemic stroke on long-term outcomes (the third international stroke trial [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurology 2013;12:768-76. doi:10.1016/S1474-4422(13)70130-3.

  1. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, Sandercock P. Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome. An analysis of the Third International Stroke trial. Stroke 2014;45:1000-6:
  2. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J et al. Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial). Stroke Published online before print November 4, 2014,
  3. Mair G, von Kummer R, Adami A, White PM, Adams ME, Yan B et al. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial. Neuroradiology 2014 October 7.
  4. Impact of treatment delay, age and stroke severity of the effects of intravenous thrombolysis with alteplase in acute ischaemic stroke: an individual participant data meta-analysis of randomised trials Emberson J and the Stroke Thrombolysis Trialists Collaboration Lancet. 2014 Aug 5. pii: S0140-6736(14)60584-5. .
  5. Mair G, Boyd EV, Chappell FM, von Kummer R, Lindley RI, Sandercock P, Wardlaw JM IST-3 Collaborative Group. Sensitivity and specificity of the Hyperdense Artery Sign for arterial obstruction in acute ischemic stroke Stroke (in press)
  6. Lindley RI, Wardlaw JM, Whiteley W, Cohen G, Blackwell B, Murray G, Sandercock P & the IST-3 Collaborative Group. Alteplase for acute ischemic stroke: outcomes by clinically important subgroups in the Third International Stroke Trial Stroke (submitted for publication)

Link to video of public lecture on stroke and thrombolysis by Peter Sandercock

Editorials and commentaries on IST-3 since 2012


  1. Lyden PD. In anticipation of International Stroke Trial-3 (IST-3). Stroke 2012;43:1691-4
  2. Leys L, Cordonnier C. rt-PA for ischaemic stroke: what will the next question be?. Lancet 2012;379:2320-1
  3. Donnan GA, Davis SM. IST-3: a major contribution to thrombolysis research. International Journal of Stroke 2012;7:566-7
  4. Furlan AJ. IST-3: no pragmatic answers. International Journal of Stroke 2012;7:568-9
  5. Hoffman JR, Cooper RJ. How is more negative evidence being used to support claims of benefit: the curious case of the international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:473-6
  6. Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:477-9
  7. Kleinig TJ, Churilov L, Parsch CS, Dewey HM, Barber PA. Stroke thrombolysis and the third international stroke trial: examining “the totality of the evidence”. Emergency Medicine Australasia 2012;25:107-9
  8. Hughes S. IST-3: tPA benefits sustained out to 18 months. Medscape. 2013. Article ID 806690. []
  9. Anderson C. Thrombolysis with alteplase after stroke: extending outcomes. Lancet Neurology 2013;12:731-2
  10. Evidence and doubt in the translation of research into care. Lancet 2014;384:638

Correspondence since 2012


  1. Fatovich DM, MacDonald SP, Brown SG, Smith B, Newman DH, Shreves AE, Barer D, Durtis D, Sandercock P, Wardlaw J, Dennis M, Murray G, Lindley R. Thrombolysis in acute ischaemic stroke. Lancet 2012;380:1053-5
  2. Shinton R, Sandercock P, Wardlaw JM, Hudson I. Questions about authorisation of alteplase for ischaemic stroke. Lancet 2014;384:659-63
  3. Dai Q, Sun W, Liu X,Whiteley WN, Thompson D, Sandercock P. Letter by Dai et al regarding article “Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial”. Stroke 2014;45:e132-3


Abstracts published since trial results made public in 2012

  1. Sandercock P, Wardlaw JM, Lindley RI, Dennis MS, Cohen G. The third international stroke trial (IST-3) main results part I: primary and secondary outcomes among 3035 patients randomised. Cerebrovascular Diseases 2012;33 Suppl 2:16
  2. Lindley RI, Sandercock P, Wardlaw JW, Dennis MS, Cohen G. The third international stroke trial (IST-3) of thrombolysis main results III. Effect of iv thrombolysis with iv t-PA on death or dependency in the 3035 patients randomized: subgroup analysis. Cerebrovascular Diseases 2012;33(suppl 2):79 (Abst.1) [Ref 19448]
  3. Roots A, Birns J, Bhalla A, Rudd A. Nurse-led telemedicine-directed hyper-acute stroke trial randomisation and management of post-thrombolysis anaphylaxis. Cerebrovascular Diseases 2012;33(suppl 2):477-8 (Abst.2022) [Ref 19403]
  4. Farrall A, Wardlaw J, Sandercock P, Lindley R, Cohen G, von Kummer R, et al. The third international stroke trial (IST-3) of intravenous thrombolysis with rt-PA: baseline imaging features among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:61-2 (Abst.142)
  5. Sandercock P; IST-3 Collaborative Group. The Third International Stroke Trial (IST-3) of thrombolysis. Main results & implications for clinical practice. Cerebrovascular Diseases 2012;34 Suppl 1:6-7 (Abst.S5-1)
  6. Sandercock PAG, Wardlaw JM, Lindley RI, Cohen G; IST3 collaborative group. The third international stroke trial (IST-3) of intravenous rt-PA: effect of age and time on treatment effect among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:6
  7. Lindley RI, Sandercock PA, Wardlaw JM, Dennis MS, Cohen G, IST-3 Collaborative Group. Third international stroke trial (IST-3): subgroup effects of iv rt-PA < 6 hrs in acute ischemic stroke on symptomatic intracranial haemorrhage and outcome at 6 months. Stroke 2013;44 (Abst.TMP23)
  8. Sandercock PA, Wardlaw JM, Lindley RI, Dennis MS, IST-3 Collaborative Group. Third international stroke trial (IST-3): effect of iv rt-pa < 6 hours in acute ischaemic stroke on living circumstances and health related quality of life at six months. Stroke 2013;44 (Abst.WMP22)]
  9. Wardlaw J, Carpenter T, von Kummer R, Cohen G, Lindley R, Sandercock P. Perfusion imaging in patients randomised to rt-PA or control in the third international stroke trial (IST-3): baseline characteristics and association with outcome. Stroke 2013;44 (Abst.A10)
  10. Wardlaw J, von Kummer R, Farrall A, Cala L, von Heijne A, Peeters A, etal. The impact of ischemic and structural brain tissue changes on response to rt-PA: an analysis of imaging from 3035 patients in the third international stroke trial. Stroke 2013;44 (Abst.A104)
  11. Sandercock P, Wardlaw J, Dennis M, Cohen G, Whiteley W, Lindley, et al. Impact of thrombolysis on important aspects of daily life at 18 months in the third International Stroke Trial (IST-3). International Journal of Stroke 2013;8 Suppl 3:4
  12. Whiteley WN, Cohen G, Wardlaw J, Lindley R, Sandercock PAG. IST-3 trial: impact of rt-PA on survival to 18 months post ischaemic stroke. Cerebrovascular Diseases 2013;35(Suppl 3):19 (Abst.6)
  13. Sandercock PAG, Lindley RI, Wardlaw JM, Dennis MS, Cohen G. The third international stroke trial (IST-3): benefits of iv thrombolysis on functional outcome and health-related quality of life (HRQoL) persist to 18 months after treatment. Cerebrovascular Diseases 2013;35(Suppl 3):34 (Abst.4)
  14. Wardlaw JM, Carpenter T, Cohen G, von Kimmer R, Lindley R, Sandercock P. Does perfusion imaging lesion size or mismatch influence six month outcomes after rt-PA given up to six hours after acute ischaemic stroke? The third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):111 (Abst.12)
  15. Whiteley WN, Thompson D, Cohen G, Lindley R, Wardlaw JM, Sandercock PAG. Predictions of intracranial haemorrhage and the risks and benefits of rtPA in acute ischaemic stroke: an analysis of the IST-3 trial. Cerebrovascular Diseases 2013;35(Suppl 3):169 (Abst.4)
  16. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R. Combining CT angiography with non-contrast CT to predict infarct on follow up CT in acute ischaemic stroke. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):237 (Abst.15)
  17. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R, Farrall AJ. Association of non-contrast CT and CT angiography with baseline clinical deficit and functional outcome. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):405 (Abst.226)
  18. Sakka E, Perry D, Buchanan D, Innes K, Sandercock P, Lindley RI, Wardlaw JM. Medical image management for multicentre trials. Experience from the Third International Stroke Trial (IST-3) with 6576 scans. Cerebrovascular Diseases 2013;35(Suppl 3):562 (Abst.24)
  19. Mair G, Wardlaw JM, von Kummer R, Sandercock PA. Response to thrombolysis treatment in ischemic stroke patients with and without arterial occlusion on computed tomographic angiography: the Third International Stroke Trial. Stroke 2014;45(Suppl 1) (Abst.A6)
  20. Khatri P, Tayama D, Cohen G, Lindley RI, Wardlaw JM, Yeatts SD, et al. Effect of IV rtPA in mild strokes in the third international stroke trial (IST3): a post hoc analysis. Stroke 2014;45(Suppl 1) (Abst.ATMP21)




For the World Stroke Day this year, the World Stroke Organization has decided to dedicate it to the woman, Often she is the victim of this disease and needs thereby special attention. ARS Umbria has produced this short spot to help the public to know- understand and better prevent stroke in women. Directed by Marzia Raspa

The WHO atlas addresses the global epidemic of heart disease and stroke in a clear and accessible format.

Cardiovascular disease now ranks as the world s top causeof death, causing one third of all deaths globally. Heartdisease can no longer be seen as the problem ofoverworked, overweight middle-aged men in developed countries. In todays world, women and children too are atrisk. Already, 75% of all CVD deaths occur in the poorer regions of the world, and this is likely to increase in the future. Following on from the success of WHO s Tobacco Atlas , the Atlas of Heart Disease and Stroke  addresses this most
urgent health issue in a ground-breaking, clear and accessible format, designed to inform UN agencies,
government officials, politicians, and other decision makers, the media, researchers, and the general public, as well as provide an essential tool for the health professional.
Topics include:

* Risk factors: high blood pressure, tobacco use,
inactivity, obesity, lipids, diabetes
* Women, childhood and youth
* The global burden of CVD, including the economic
* Research
* Prevention
* Policies and legislation
* Treatment
* Predictions


data from the ministery of health for central italy

So far it was a secret given to word of mouth among health professionals. The new Guide to Health Focus, now in its third edition with the most current data, it also recognizes the right of patients to know which are the most reliable centers to turn to be taken care of in the best way.Of course, hard to choose when you have a heart attack or a stroke: it relies on the ETS and it is hoped that in their region and in their local health healthcare is efficient.

April 2018
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