One recommendation was to use population-based surveillance to assess achievement of evidence-based guidelines.878 Alliances with the federal government through the National Institute of Neurological Disease and Stroke, Centers for Disease Control and Prevention, nonprofit organiza- tions such as the AHA/ASA, and medical specialty groups such as the American Academy of Neurology and the Brain Attack Coalition are needed to coor- dinate, develop, and optimize implementation of evi- dence-based stroke prevention recommendations.9 3. The AHRQ Universal Precautions Toolkit for Health is a publicly available document that includes a 21-step approach to ensuring that writ- ten and oral instructions to patients are clear, under- standable, and sensitive to health literacy. Healthcare providers who listen, speak slowly, use nonmedical language, encourage questions, apply teach-back methods, address language differences, are culturally competent, and incorporate graphics in their teach- ing promote a culture sensitive to health literacy.880 4. Several RCTs have tested secondary stroke pre- vention interventions in predominantly Black, Hispanic, and/or low-socioeconomic-status pop- In all trials, primary outcomes improved in the intervention and control groups without significant differences between the 2 arms. A few of the trials showed improvement in second- ary outcomes or subpopulations. 