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Maya Madhavan, Steven Karceski
No abstract text is available yet for this article.
September 27, 2016: Neurology
Adrià Arboix, María José Sánchez
No abstract text is available yet for this article.
September 2016: Neurology India
Sudhir Sharma, M V Padma, Amit Bhardwaj, Ashish Sharma, Nishit Sawal, Suresh Thakur
CONTEXT: Telemedicine is a major effort to tackle the uneven availability of facilities for thrombolysis in acute ischemic stroke. We present a telestroke model introduced in a small hilly state of Himachal Pradesh in India. AIMS: To provide acute ischemic stroke treatment with tissue plasminogen activator in all district hospitals of Himachal Pradesh with computerized axial tomographic scan facility through Telemedicine. SETTINGS AND DESIGN: Smartphone-based hub and spoke telestroke model was used with two tertiary care hospitals (with neurologists) as hub and 17 district hospitals (without onsite neurologists) as spokes...
September 2016: Neurology India
Kunal Agrawal, Rema Raman, Karin Ernstrom, Robert Joseph Claycomb, Dawn Matherne Meyer, Thomas Martin Hemmen, Royya Fatima Modir, Pranav Kachhi, Brett Cowan Meyer
OBJECTIVES: The objective of the study is to assess the accuracy of final diagnosis in telestroke-guided tissue plasminogen activator (rt-PA) patients compared with bedside evaluation using computed tomography (CT) or magnetic resonance imaging (MRI) as a surrogate for final stroke diagnosis. The overall goal was to determine if telestroke had similar diagnostic accuracy as bedside evaluations in diagnosing rt-PA-treated patients. MATERIALS AND METHODS: We analyzed all acute stroke code calls who received intravenous rt-PA at our center from October 2013 to June 2015...
September 2, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jessica Kepplinger, Kristian Barlinn, Stefanie Deckert, Madlen Scheibe, Ulf Bodechtel, Jochen Schmitt
OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of IV thrombolysis (IVT) with tissue plasminogen activator (tPA) delivered through telestroke networks in patients with acute ischemic stroke. METHODS: We conducted a systematic review and meta-analysis according to PRISMA guidelines. Literature searches on MEDLINE, Embase, and CENTRAL databases covered prospective randomized controlled and nonrandomized studies comparing telemedicine-guided IVT to IVT administered at stroke centers and were published from the earliest date available until April 1, 2015...
September 27, 2016: Neurology
Bart M Demaerschalk, Steven R Levine
No abstract text is available yet for this article.
September 27, 2016: Neurology
Gary H Belt, Robert A Felberg, Jane Rubin, John J Halperin
BACKGROUND AND PURPOSE: Time to treatment is critically important in ischemic stroke. We compared the efficacy and cost of teleneurology evaluation during patient transport with that of mobile stroke transport units. METHODS: Using cellular-connected telemedicine devices, we assessed 89 presumptive stroke patients in ambulances in transit. Paramedics assisted remote teleneurologists in obtaining a simplified history and examination, then coordinating care with the receiving emergency department...
September 2016: Stroke; a Journal of Cerebral Circulation
Kori Sauser-Zachrison, Ernest Shen, Navdeep Sangha, Zahra Ajani, William P Neil, Michael K Gould, Dustin Ballard, Adam L Sharp
CONTEXT: There is substantial hospital-level variation in use of tissue plasminogenactivator (tPA) for treatment of acute ischemic stroke. Telestroke services can bringneurologic expertise to hospitals with fewer resources. OBJECTIVE: To determine whether implementation of a telestroke intervention in a large integrated health system would lead to increased tPA utilization and would change rates of hemorrhagic complications. DESIGN: A stepped-wedge cluster randomized trial of 11 community hospitals connected to 2 tertiary care centers via telestroke, implemented at each hospital incrementally during a 1-year period...
July 29, 2016: Permanente Journal
Lee A Birnbaum, Jesse S Rodriguez, Christopher H Topel, Reza Behrouz, Vivek Misra, Santiago Palacio, Michele G Patterson, Deb S Motz, Martin W Goros, John E Cornell, Jean-Louis R Caron
INTRODUCTION: The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom presentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice. METHODS: A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included...
July 28, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Teruyoshi Kageji, Fumiaki Obata, Hirofumi Oka, Yasuhisa Kanematsu, Ryo Tabata, Kenji Tani, Hiroyasu Bando, Shinji Nagahiro
There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists...
June 22, 2016: Neurologia Medico-chirurgica
J Marta Moreno, M Bestué Cardiel, A Giménez Muñoz, M Palacín Larroy
INTRODUCTION: In 2008, stroke mortality, morbidity, and disability rates in Aragon were higher than the average in Spain. These data underscored the need to develop a stroke care programme (PAIA). MATERIAL AND METHODS: We present the dynamics of planning, implementation, evaluation, and improvement developed between 2009 and 2014 as well as the results of the PAIA after that 5-year period. RESULTS: Structure, processes, and outcomes have improved with reference to the key indicators of healthcare (audit: 2008, 2010, 2012) among others: stroke rate in 2013 was 2...
June 14, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Sébastien Richard, Gioia Mione, Claude Varoqui, Arnaud Vezain, Arielle Brunner, Serge Bracard, Marc Debouverie, Marc Braun
Telemedicine contributes to initiating early intravenous recombinant tissue plasminogen activator (rt-PA) treatment for patients with acute cerebral infarction in areas without a stroke unit. However, the experience and skills of the emergency teams in the spokes to prepare patients and administer rt-PA treatment are ill-defined. Improving these skills could vastly improve management of acute stroke by telemedicine. We developed a medical simulation training model for emergency teams to perform intravenous rt-PA treatment in a telestroke system...
June 2016: Medicine (Baltimore)
A M Alasheev, A Yu Andreev, Yu V Gonysheva, M N Lagutenko, G I Lipin, E E Lokteva, O Yu Lutskovich, A V Mamonova, E V Prazdnichkova, A A Belkin
AIM: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to subjectivity of NIHSS administration. Authors aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. MATERIAL AND METHODS: Ninety acute stroke patients within 48 hours of onset were assessed by 6 stroke neurologists grouped in 15 pairs...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Sherita N Chapman Smith, Prasanthi Govindarajan, Matthew M Padrick, Jason M Lippman, Timothy L McMurry, Brian L Resler, Kevin Keenan, Brian S Gunnell, Prachi Mehndiratta, Christina Y Chee, Elizabeth A Cahill, Cameron Dietiker, David C Cattell-Gordon, Wade S Smith, Debra G Perina, Nina J Solenski, Bradford B Worrall, Andrew M Southerland
OBJECTIVES: In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. METHODS: We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission...
July 5, 2016: Neurology
Archit Bhatt, Alexandra Lesko, Lindsay Lucas, Amit Kansara, Elizabeth Baraban
BACKGROUND: The benefits of intravenous tissue-type plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) are time dependent. Because emergency rooms quickly initiate a stroke alert with more severe symptoms, we hypothesized that patients with lower National Institutes of Health Stroke Scale (NIHSS) scores, indicating a less severe stroke, would have longer door-to-needle (DTN) times compared to patients with higher NIHSS scores. METHODS: Data obtained from the 19-hospital Providence Stroke Registry were used to identify AIS patients who received IV-tPA within 4...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
N Legris, M Hervieu-Bègue, B Daubail, A Daumas, B Delpont, G-V Osseby, O Rouaud, M Giroud, Y Béjot
BACKGROUND: In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star-shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients. METHODS: One hundred and thirty-two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012-2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011-2012) were included...
September 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Lucia Nardetto, Claudio Dario, Simone Tonello, Marta Carla Brunelli, Manola Lisiero, Maria Grazia Carraro, Claudio Saccavini, Gianluigi Scannapieco, Bruno Giometto
Over 10 years after European approval, thrombolysis is still limited by a restricted time window and non-optimal territorial coverage. Implementation of telestroke can give a growing number of patients access to treatment. We hereby present the first Italian telemedicine study applied to both the acute and the monitoring phase of stroke care. From January 2011 to December 2013, we tested a web-based, drip, and treat interaction model, connecting the cerebrovascular specialist of one hub center to the Emergency Department of a Spoke center...
May 2016: Neurological Sciences
Amanda L Jagolino, Judy Jia, Kasey Gildersleeve, Christy Ankrom, Chunyan Cai, Mohammad Rahbar, Sean I Savitz, Tzu-Ching Wu
During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted...
May 10, 2016: Neurology
Patricia Commiskey, Arash Afshinnik, Elizabeth Cothren, Toby Gropen, Ifeanyi Iwuchukwu, Bethany Jennings, Harold C McGrade, Julia Mora-Guillot, Vivek Sabharwal, Gabriel A Vidal, Richard M Zweifler, Kenneth Gaines
United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines "drip and ship" and "drip and keep" models with a comprehensive stroke center primary hub at Ochsner Medical Center in New Orleans, advanced stroke-capable regional hubs, and geographically-aligned, "stroke-ready" spokes. The primary hub provides vascular neurology expertise via telemedicine and monitors care for patients remaining at regional hubs and spokes using a multidisciplinary team approach...
March 16, 2016: Journal of Telemedicine and Telecare
F Akbik, J A Hirsch, R V Chandra, D Frei, A B Patel, J D Rabinov, N Rost, L H Schwamm, T M Leslie-Mazwi
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care...
March 16, 2016: Journal of Neurointerventional Surgery
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