Telemedicine In Acute Stroke Care

This issue is a dedicated supplement published in addition to the regular issues of 'Cerebrovascular Diseases' focussing on one specific topic. 'Cerebrovascular Diseases' is a well-respected, international peer-reviewed journal in Neurology. Supplement issues are included in the subscription.

Stroke is the third largest cause of death after cardiovascular diseases and cancer and is a major factor of permanent disability in most industrial countries. Disparities exist in access to healthcare services due to geographical barriers and limited resources. Rural locations often lack the resources for adequate stroke management. The idea of telestroke is to transfer knowledge and expertise of acute stroke management into areas with limited neurological services. The first part in this dissertation mainly covers the evidence of telestroke. The second part is an evaluation of a telestroke network in Salzburg, Austria. The aim is to assess the safety and effectiveness of intravenous thrombolysis application via a real time two-way videoconferencing system combined with a teleradiological procedure followed by transfer to a specialised stroke unit.

Background and Aims A team of researchers, with experience in telestroke systems, has worked on research and development project founded by u201cInstituto de Salud Carlos IIIu201d whose objective is to design, develop and validate a flexible, reusable, and scalable technology platform capable of supporting the integrated plan for acute stroke care.Hypothesis: The platform coordinate acute stroke clinical care in all possible scenarios prehospital and hospital care thus creating a network of connected resources. Thereby it is possible to provide an adequate health service offering patient safety, equity in access to the service and optimization of the use of health resources, with a platform easily implementable.Method The methodology used is Agile Software Development with modular architecture using free software. The developed system is been piloted in an area of one million inhabitants. It will extend to the Andalusian network of sanitary resources for 8,5 million inhabitants.Results Services developed:u2022tExchange of valuable information, laboratory tests, CT, MRI, and balanced scorecard.u2022tCommunication interfaces based on technical, syntactic and semantic interoperability standards.u2022tVideoconference allowing the joint exploration.u2022tSupport for clinical decision-making in the field of evidence-based, providing up-to-date clinical, diagnostic and therapeutic recommendations (six automated rules developed). In addition the system is easy, useful and effective.Conclusion This tool has been developed with free software and interoperability standards, thus enabling its use in any healthcare environment. Thereby, the system can be considered portable and easily extended anywhere. This is the most important advantaje over the current situation.

Telestroke helps readers develop a deeper understanding on how to utilize telestroke in clinical practice, a key step in providing optimal treatment and management to those with geographical and social/economic disparities. The book discusses how to provide accurate and fast revascularization for patients with acute ischemic stroke and how to continue remote care of patients. It also reviews underlying stroke etiology, interpretation and assessment of stroke diagnostic tools/teleradiology, complications of care, discusses targeted, secondary preventative therapies and covers telerehabilitation, outpatient follow-up and clinical trial engagement. Includes tactics on how to enact rapid implementation by stroke neurologists Explains recent changes to telehealth coding/reimbursement Reviews the underlying stroke etiology, interpretation and assessment of stroke diagnostic tools/teleradiology, and complications of care Covers targeted, preventative therapies, telerehabilitation, outpatient follow-up, and clinical trial engagement

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

Background: Lack of stroke specialists determines that many European rural areas remain underserved. Use of telemedicine in stroke care has shown to be safe, increase use of evidence-based therapy and enable coverage of large areas of low population density.The ESO Telestroke recommendations described the main rules according to those a Telestroke network may be efficient and sustainable. Italy has large underpopulated areas with wide seasonal population variability not having active stroke care. Three hospital categories are identified to be part of a hub-and-spoke network: (1) the Telemedicine Stroke Centre (an European Stroke Organisation stroke centre or equivalent with specific infrastructure and setup for network and telemedicine support), (2) the telemedicine-assisted stroke Unit (equivalent to an European Stroke Organisation stroke unit but without 24 h onsite stroke expertise) and (3) the telemedicine-assisted stroke ready hospital (only covering hyperacute treatment in the emergency department and transferring all patients for further treatment).Objective: The national Italian coverage for Stroke unit services was demonstrated not homogeneous (Bernetti 2018). A group of Italian experts (ESO Telestroke attendees in Munich on July 2018) selected in 4 Italian regions (Tuscany, Emilia-Romagna, Lazio, and Umbria) specific areas underserved in the local stroke networks. We suggested a coverage of these areas using a Telestroke Units (TSU) network and/or Telethrombolysis units (TTU), Telemedicine assisted stroke ready hospitals (TSRH) according to the ESO recommendations (Hubert 2018).Methods: When choosing the right service for a telestroke network two rules should be applied: (1) the TSU should treat at least 200 stroke patients per year and (2) acute stroke care should be within reach of 45 min for 90% of the population. Minimum size of an area to be covered by a singlestroke unit can be calculated by the Hubert formula. This is the minimum size of an area to be covered by a single stroke unit. Size is inversely related to population density (population/km2) and stroke incidence (number of strokes/ 100.000/year). Transport times were calculated using google maps simulations.Results: In the 4 regions were identified 4 different isolated areas Lunigiana, Valnerina, Reggio Emilia, Latina. The population density was ranging between 69 and 254 people per sq/km with a considered stroke incidence of 0.0016. The area size range was 566-2256 sq/km. One selected area satisfied criteria 1 (Latina county) and 3 others fulfilled criteria 2 (Reggio-Emilia, Lunigiana, Valnerina).Conclusions access to thrombolysis may be further guaranteed by telemedicine coverage with appropriately deployed TSU and/or TTU. Modeling stroke care with telemedicine networks offers to the stakeholders a chance of understanding the most sustainable solutions for increasing access to stroke care.

Telemedicine has evolved to become an important field of medicine and healthcare, involving everything from simple patient care to actual performance of operations at a distance. This groundbreaking volume addresses the complex technical and clinical development in the management of trauma, disaster, and emergency situations using telemedicine. The book explains how telemedicine and related technologies can be used to effectively handle a wide range of scenarios, from a situation as small as a car crash, to major disasters such as an earthquake. Professionals find critical discussions on the practicality, logistics, and safety of telemedicine from recognized experts in the field. From teleteaching and telemonitoring, to teletrauma and telesurgery, this authoritative book covers all the major aspects that practitioners need to understand in order to engage and utilize this burgeoning area of medicine.

Acute Stroke Management in the First 24 hours bridges the clinical application gap by offering a practice-based approach to treating ischemic and hemorrhagic stroke. The comprehensive text, written by international experts in the field of stroke care, covers all aspects of stroke care, including review of stroke systems, clinic features, neuroimaging diagnostic characteristics, and pre-hospital care and challenges. This book is an easy-to-use reference guide ideal for first responders and clinicians working in emergency medicine, neurology, neurosurgery, and critical care.