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Elias Atallah, Kimon Bekelis, Hassan Saad, Nohra Chalouhi, Sophia Dang, Jonathan Li, Ayan Kumar, Justin Turpin, Randa Barsoom, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana Labella, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVES: Neurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its proven efficacy, neurovascular surgeons(NS) are playing an increasingly important role in the management and overall care of AIS. We assessed outcomes of AIS patients managed by NS, who have been traditionally managed by neurologists...
February 23, 2018: Clinical Neurology and Neurosurgery
Mark R Etherton, Lee H Schwamm
No abstract text is available yet for this article.
March 6, 2018: Stroke; a Journal of Cerebral Circulation
Ileana M Howard, Marla S Kaufman
Telehealth describes the provision of medical services remotely through technology, and may enhance patient access to specialty care services. Although teleneurology has expanded widely since the introduction of telestroke in 1999, telehealth services for outpatients with neuromuscular or musculoskeletal disorders are less widespread. In this narrative review, we will describe the current technology, applications, outcomes, and limitations of this dynamically growing field. Evidence for telehealth applications related to neuromuscular diseases, palliative care, specialized multidisciplinary services, and musculoskeletal care are reviewed...
March 6, 2018: Muscle & Nerve
Charlotte Zerna, Thomas Jeerakathil, Michael D Hill
Stroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experienced physicians under the guidance of stroke neurology experts...
December 27, 2017: Canadian Journal of Cardiology
Syed F Ali, Gordian J Hubert, Jeffrey A Switzer, Jennifer J Majersik, Roland Backhaus, L Wylie Shepard, Kishore Vedala, Lee H Schwamm
BACKGROUND AND PURPOSE: Up to 30% of acute stroke evaluations are deemed stroke mimics, and these are common in telestroke as well. We recently published a risk prediction score for use during telestroke encounters to differentiate stroke mimics from ischemic cerebrovascular disease derived and validated in the Partners TeleStroke Network. Using data from 3 distinct US and European telestroke networks, we sought to externally validate the TeleStroke Mimic (TM) score in a broader population...
March 2018: Stroke; a Journal of Cerebral Circulation
Sami Al Kasab, Mohamad Y Orabi, Jillian B Harvey, Nancy Turner, Pat Aysse, Ellen Debenham, Christine A Holmstedt
BACKGROUND: Intravenous tissue plasminogen activator (tPA) remains the cornerstone medical treatment for acute ischemic stroke. The establishment of telestroke technology has allowed patients presenting to hospitals that lack expert stroke care to be evaluated and receive tPA. The safety of tPA administered through telestroke has been evaluated only when tPA is given within the 3-h window of last known normal. The purpose of this study is to evaluate the safety of tPA when administered through telestroke within a 4...
January 25, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Alireza Baratloo, Leila Rahimpour, Abdelrahman Ibrahim Abushouk, Saeed Safari, Chung Wing Lee, Ali Abdalvand
OBJECTIVE: Telestroke systems are tools, used to provide an advanced stroke care in regions without sufficient neurologic services. We performed this meta-analysis to assess the effects of telemedicine on treatment times and clinical outcomes of acute stroke care. METHODS: A literature search of PubMed, SCOPUS, and Cochrane CENTRAL was conducted for original studies investigating telemedicine applications in acute stroke care. Dichotomous data on treatment outcomes were pooled as odds ratios (ORs), while continuous data on thrombolysis times were pooled as mean differences (MDs) with 95% confidence interval (CI), using RevMan software (version 5...
January 18, 2018: Prehospital Emergency Care
Antonio J Salazar, Nicolás Useche, Manuel Granja, Aníbal J Morillo, Sonia Bermúdez
Objective: The aim of this study was to evaluate the equivalence of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer, in a telestroke service. Materials and Methods: The ethics committee of our institution approved this retrospective study. A factorial design with 1452 interpretations was used. The assessed variables were the type of stroke classification, the presence of contraindications to the tPA administration, the presence of a hyperdense intracranial artery sign (HMCA), and the Alberta Stroke Program Early CT Score (ASPECTS) score...
2017: International Journal of Telemedicine and Applications
Mai N Nguyen-Huynh, Jeffrey G Klingman, Andrew L Avins, Vivek A Rao, Abigail Eaton, Sunil Bhopale, Anne C Kim, John W Morehouse, Alexander C Flint
BACKGROUND AND PURPOSE: Faster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single standardized version of a modified Helsinki model and (2) have all emergency stroke cases managed by a dedicated telestroke neurologist. We examined the effect of Kaiser Permanente Northern California's Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke program on door-to-needle (DTN) time, alteplase use, and symptomatic intracranial hemorrhage rates...
January 2018: Stroke; a Journal of Cerebral Circulation
Nolwenn Riou-Comte, Gioia Mione, Lisa Humbertjean, Arielle Brunner, Arnaud Vezain, Karine Lavandier, Sophie Marchal, Serge Bracard, Marc Debouverie, Sébastien Richard
Background: Telestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall , France, which includes one expert center (hub) and six spokes. Methods: The model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub...
2017: Frontiers in Neurology
Joonas H Kauppila, Lasse Raatiniemi, Juha-Matti Isokangas, Matti Martikainen, Katja Piironen
Thrombolysis with tissue plasminogen activator is the mainstay in the treatment of acute stroke. Reducing the delay of thrombolysis treatment improves patient prognosis and reduces the incidence of complications. Variable telestroke regimens have improved the availability of stroke thrombolysis, especially in rural settings, where neurologists are not readily available. In the drip-and-ship strategy, stroke thrombolysis is initiated in a peripheral hospital and the patient is then transferred to a tertiary care unit...
2017: Duodecim; Lääketieteellinen Aikakauskirja
Jacquelyn Corley
No abstract text is available yet for this article.
February 2018: Lancet Neurology
Kathleen L Bagot, Dominique A Cadilhac, Christopher F Bladin, Caroline L Watkins, Michelle Vu, Geoffrey A Donnan, Helen M Dewey, Hedley C A Emsley, D Paul Davies, Elaine Day, Gary A Ford, Christopher I Price, Carl R May, Alison S R McLoughlin, Josephine M E Gibson, Catherine E Lightbody
BACKGROUND: Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. METHODS: Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012)...
November 21, 2017: BMC Health Services Research
Robin Ohannessian, Nicola Fortune, Jean-Marie Rodrigues, Thierry Moulin, Laurent Derex, Richard Madden, Anne-Marie Schott
BACKGROUND: and purpose: Acute stroke care is to detect, diagnose, and treat patients in the shortest amount of time. Access to acute stroke care may however be limited in some areas and telemedicine has been thus used to increase its access. Coding acute stroke care as a health intervention had limited attention in the past. METHODS: The International Classification of Health Interventions (ICHI) currently under development was used to identify existing codes relevant for coding acute stroke care interventions, including telestroke...
December 2017: International Journal of Medical Informatics
Gang Zhao, Huan Huang, Fang Yang
Stroke remains the leading cause of death in China. The disparity of distribution in specialists and hospitals affects access to timely stroke care. Telestroke, the use of telemedicine for stroke, may be the solution to access to stroke care. Telestroke can improve the rate of successful intravenous thrombolysis and shorten the time to treatment. Here we review the progress of telestroke in China.
September 2017: Stroke and Vascular Neurology
Ganesh Asaithambi, Amy L Castle, Michael A Sperl, Jayashree Ravichandran, Aditi Gupta, Bridget M Ho, Sandra K Hanson
The administration of intravenous (IV) alteplase to patients with stroke via telestroke (TS) can be safe and effective. It remains unclear how quickly IV alteplase occurs during TS evaluations. We sought to compare door to needle times (DNTs) between patients receiving IV alteplase who present directly to our comprehensive stroke center (CSC) and those presenting to community hospitals in our TS network. Consecutive patients with acute ischemic stroke (AIS) who presented to emergency departments and received IV alteplase between August 2014 and June 2015 were identified at our CSC and TS network...
October 2017: Neurohospitalist
L Breuer, S Schwab
Telemedicine is already widely used in many telestroke networks and ensures stroke treatment close to the patient's home in rural and medically underserved areas. This is particularly effective when telemedicine is integrated into a stroke unit concept. While telemedically based thrombolysis therapy has become routine practice for many years, practical implementation of comprehensive mechanical thrombectomy and the related processes remains challenging. The main tasks for the future further include development of a structured stroke aftercare system in neurologically underserved areas and permanent assurance of high-quality stroke care in telemedically connected sites...
November 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Dong In Sinn, Sami Al Kasab, Chirantan Banerjee, Shelly Ozark
No abstract text is available yet for this article.
September 2017: Journal of Stroke
Fred S Sarfo, Sheila Adamu, Dominic Awuah, Bruce Ovbiagele
BACKGROUND: The rapid advancement in telecommunications on the African continent has opened up avenues for improving medical care to underserved populations. Although the greatest burden of neurological disorders is borne by Low-and-Middle Income Countries (LMICs) including sub-Saharan Africa (SSA), there is a profound paucity of neurologists to serve the population. Telemedicine presents a promising avenue for effective mobilization and utilization of the few neurologists in Africa. OBJECTIVE: To systematically review the published literature on the use of telemedicine for improved care and outcomes for patients with neurological disorders in SSA...
September 15, 2017: Journal of the Neurological Sciences
Amanda L Jagolino-Cole, Shima Bozorgui, Christy M Ankrom, Arvind B Bambhroliya, Tiffany D Cossey, Alyssa D Trevino, Sean I Savitz, Tzu-Ching Wu, Farhaan S Vahidy
BACKGROUND AND PURPOSE: Formal telestroke training for neurovascular fellows (NVFs) is necessary because of growing use of telestroke technologies in the management of acute ischemic stroke; yet, educational approaches and training benchmarks are not formalized. Time between telestroke consultant page and tissue-type plasminogen activator administration (page-to-needle time, PTNT) can provide an objective measure of proficiency. We compared PTNT between NVFs and neurovascular attendings (NVAs) and evaluated changes in PTNT with experience...
September 2017: Stroke; a Journal of Cerebral Circulation
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