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Tunkl C, Agarwal A, Ramage E, Velez FS, Roushdy T, Ullberg T, Li L, Carbonera LA, Yusof Khan AHK, Ciopleias B, Law ZK, Katsanos AH, Heldner MR, Khan M, Matuja S, Alet MJ, Lagos-Servellón J, Minhas JS, Zuurbier SM, Mosconi MG, Lotlikar R, Elkady A, Gerner ST, Shreyan S, Krauss A, Gumbinger C, Srivastava P, Kiper P, Ohannessian R, Berberich A, Sampaio Silva G, Ranta A. Telemedicine networks for acute stroke: An analysis of global coverage, gaps, and opportunities. Int J Stroke 2025; 20:297-309. [PMID: 39460528 PMCID: PMC11874588 DOI: 10.1177/17474930241298450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 10/22/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND Despite the proven efficacy of telestroke in improving clinical outcomes by providing access to specialized expertise and allowing rapid expert hyperacute stroke management and decision-making, detailed operational evidence is scarce, especially for less developed or lower income regions. AIM We aimed to map the global telestroke landscape and characterize existing networks. METHODS We employed a four-tiered approach to comprehensively identify telestroke networks, primarily involving engagement with national stroke experts, stroke societies, and international stroke authorities. A carefully designed questionnaire was then distributed to the leaders of all identified networks to assess these networks' structures, processes, and outcomes. RESULTS We identified 254 telestroke networks distributed across 67 countries. High-income countries (HICs) concentrated 175 (69%) of the networks. No evidence of telestroke services was found in 58 (30%) countries. From the identified networks, 88 (34%) completed the survey, being 61 (71%) located in HICs. Network setup was highly heterogeneous, ranging from 17 (22%) networks with more than 20 affiliated hospitals, providing thousands of annual consultations using purpose-built highly specialized technology, to 11 (13%) networks with fewer than 120 consultations annually using generic videoconferencing equipment. Real-time video and image transfer was employed in 64 (75%) networks, while 62 (74%) conducting quality monitoring. Most networks established in the past 3 years were located in low- and middle-income countries (LMICs). CONCLUSION This comprehensive global survey of telestroke networks found significant variation in network coverage, setup, and technology use. Most services are in HICs, and a few services are in LMICs, although an emerging trend of new networks in these regions marks a pivotal moment in global telestroke care. The wide variation in quality monitoring practices across networks, with many failing to report key performance metrics, underscores the urgent need for standardized, resource-appropriate, quality assurance measures that can be adapted to diverse settings.
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Affiliation(s)
- Christine Tunkl
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Emily Ramage
- The Florey Institute of Neuroscience and Mental Health, and Western Health, Parkville, VIC, Australia
| | - Faddi Saleh Velez
- Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamer Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Teresa Ullberg
- Department of Neurology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Leonardo A Carbonera
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Bogdan Ciopleias
- Department of Neurology, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - Zhe Kang Law
- Department of Medicine, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Aristeidis H Katsanos
- Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Mohammed Bin Rashid University of Medical and Health Sciences, Dubai, UAE
| | - Sarah Matuja
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Matias J Alet
- Department of Neurology, Comprehensive Stroke Center, Fleni, Ciudad de Buenos Aires, Argentina
| | | | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM), Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Maria Giulia Mosconi
- Internal Vascular and Emergency Medicine—Stroke Unit, University of Perugia, Perugia, Italy
| | - Radhika Lotlikar
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | | | - Stefan T Gerner
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | | | - Alexandra Krauss
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Pawel Kiper
- Healthcare Innovation Technology Lab, San Camillo IRCCS, Venice, Italy
| | | | - Anne Berberich
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Gisele Sampaio Silva
- Albert Einstein Hospital, Sao Paulo, Brazil
- Departamento de Neurologia da Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
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Barragán-Prieto A, Pérez-Sánchez S, Castellanos M, González A, Montaner J. The current situation of Telestroke in Spain. Neurologia 2025; 40:182-190. [PMID: 39947286 DOI: 10.1016/j.nrleng.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/07/2023] [Indexed: 02/19/2025] Open
Abstract
INTRODUCTION In recent years, telestroke programmes have been established as a fundamental tool for extending acute stroke care to hospitals that lack an on-call neurology service. The main objective of this study is to describe the existence and functioning of the different telestroke systems and networks (TS) in Spain. METHODS We conducted a cross-sectional study to analyse the current situation of TS in Spain using a structured survey distributed among the members of the Stroke Study Group of the Spanish Society of Neurology. RESULTS Responses were received from 12 of the 17 Spanish autonomous communities, of which 10 had implemented TS. In addition, a literature search revealed that 2 other systems were in operation. Twelve of the 17 regions in the country have TS, achieving coverage of at least 20% of the Spanish population. Of these 10 TS, organisation was regional in 7, provincial in 2, and hospital-based in one. Most TS (9) included at least simple CT and angio-CT studies; 4 also included perfusion imaging. Nine TS operated with professional videoconferencing equipment. However, the suboptimal quality of examination via videoconferencing scan was the main problem identified in 50% of TS. Other problems detected are difficulty obtaining data from registries and the transfer of images between hospitals. CONCLUSION In recent years, a significant expansion of telestroke programmes has taken place in Spain, which has improved the accessibility of specialised care in patients with symptoms of acute stroke. This study allows us to describe the different types of TS in Spain and to detect areas for improvement and expansion, and could contribute to defining regional telestroke implementation strategies to offer quality care to the whole population.
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Affiliation(s)
- A Barragán-Prieto
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - S Pérez-Sánchez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña, La Coruña, Spain
| | - A González
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
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Guzik AK, Jagolino-Cole AL, Mijalski Sells C, Southerland AM, Dumitrascu OM, Sreekrishnan A, Martini SR, Meyer BC. Telestroke Training: Considerations for Expansion of Vascular Neurology Program Requirements. Stroke 2025; 56:209-218. [PMID: 39355905 DOI: 10.1161/strokeaha.124.047826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/12/2024] [Accepted: 08/28/2024] [Indexed: 10/03/2024]
Abstract
Telemedicine for stroke (Telestroke) has been a key component to efficient, widespread acute stroke care for many years. The expansion of reimbursement through the Furthering Access to Stroke Telemedicine Act and rapid deployment of telemedicine resources during the COVID-19 public health emergency have further expanded remote care, with practitioners of varying educational backgrounds, and experience providing acute stroke care via telemedicine (Telestroke). Some Telestroke practitioners have not had fellowship-level vascular neurology training and many are without training specific to virtual modalities. While many vascular neurology fellowship programs incorporate Telestroke training into the curriculum, components of this curriculum are not consistent, extent of involvement is variable, and not all fellows receive hands-on training in remote care. Furthermore, the extent of training and evaluation of Telestroke in American Board of Psychiatry and Neurology training requirements and Accreditation Council for Graduate Medical Education assessments for vascular neurology fellowship are not standardized. We suggest that Telestroke be formally incorporated into vascular neurology fellowship curricula and provide considerations for key components of this training and metrics for evaluation.
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Affiliation(s)
- Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC (A.K.G.)
| | - Amanda L Jagolino-Cole
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston (A.L.J.-C.)
| | | | - Andrew M Southerland
- Department of Neurology and Public Health University of Virginia School of Medicine, Charlottesville (A.M.S.)
| | - Oana M Dumitrascu
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ (O.M.D.)
| | | | - Sharyl R Martini
- National Neurology Program, Veterans Health Administration (S.R.M.)
- Department of Neurology, Baylor College of Medicine, Houston, TX (S.R.M.)
| | - Brett C Meyer
- Department of Neurosciences, University of California San Diego (B.C.M.)
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Luengo Gómez D, Salmerón Ruiz Á, Romero Manjón MI, Medina Benítez A, Láinez Ramos-Bossini AJ. Telerobotic Versus Standard Ultrasound in the Assessment of the Abdomen and Pelvis: A Real-World Prospective Study. Int J Telemed Appl 2024; 2024:1482326. [PMID: 39713775 PMCID: PMC11663047 DOI: 10.1155/ijta/1482326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 09/18/2024] [Accepted: 11/28/2024] [Indexed: 12/24/2024] Open
Abstract
Introduction: Telerobotic ultrasound has emerged as a promising technology in medicine, especially in settings with limited medical access or a lack of specialized personnel. However, there are very few studies evaluating its usefulness in real-world clinical practice. Objective: This study evaluates the usefulness of abdominopelvic telerobotic ultrasound in a real-world practice setting. Methods: A prospective study was performed in a cohort of adult patients who underwent abdominal ultrasound in a remote secondary hospital for suspected abdominal or pelvic pathology. Examinations were performed by an on-site technician and a remote abdominal radiologist. Satisfaction of patients and explorers, scan times, quality of visualization of anatomical structures, and ultrasound findings were measured and compared with standard ultrasound examinations performed by an on-site radiologist blinded to telerobotic ultrasound findings. Multivariate analyses were performed to predict variables related to the visualization quality of abdominopelvic organs. Results: The sample included 40 patients (60% women; mean age, 51.2 ± 16.1 years; 35% overweight and 17.5% obese). Significant differences in ultrasound duration were observed between telerobotic ultrasound and standard ultrasound (27.4 ± 8.3 and 12.7 ± 3.1 min, respectively; p < 0.001). The mean satisfaction of radiologists, technicians, and patients with telerobotic ultrasound was high (7.35 ± 1.14 for radiologists, 7.93 ± 0.83 for technicians, and 8.43 ± 1.38 for patients). Visualization of anatomical structures was acceptable for most organs on telerobotic ultrasound but significantly worse than conventional ultrasound when "excellent visualization" was the reference standard. In addition, telerobotic ultrasound did not identify potentially relevant findings in a significant (70%) proportion of patients. Conclusions: Telerobotic ultrasound offers acceptable results in the assessment of abdominopelvic organs and can help provide adequate healthcare to patients in locations with limited access to radiology specialists. However, there are significant limitations compared to standard ultrasound for their optimal evaluation.
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Affiliation(s)
- David Luengo Gómez
- Abdominal Radiology Unit, Department of Radiology, Hospital Universitario Virgen de las Nieves 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe-22), Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA) 18012, Granada, Spain
| | - Ángela Salmerón Ruiz
- Abdominal Radiology Unit, Department of Radiology, Hospital Universitario Virgen de las Nieves 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe-22), Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA) 18012, Granada, Spain
| | - María Isabel Romero Manjón
- Abdominal Radiology Unit, Department of Radiology, Hospital Universitario Virgen de las Nieves 18014, Granada, Spain
| | - Antonio Medina Benítez
- Abdominal Radiology Unit, Department of Radiology, Hospital Universitario Virgen de las Nieves 18014, Granada, Spain
| | - Antonio Jesús Láinez Ramos-Bossini
- Abdominal Radiology Unit, Department of Radiology, Hospital Universitario Virgen de las Nieves 18014, Granada, Spain
- Advanced Medical Imaging Group (TeCe-22), Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA) 18012, Granada, Spain
- Department of Human Anatomy and Embryology, School of Medicine, University of Granada 18071, Granada, Spain
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Kolangarakath A, Chalil Madathil K, Hegde S, Agrawal S, Bian M, Simmons L, Molloseau G, Holmstedt C, LeBlanc D, Harvey J, McGeorge T, Spampinato M, Roberts D. Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care. ERGONOMICS 2024; 67:1938-1957. [PMID: 38916114 DOI: 10.1080/00140139.2024.2367157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.
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Affiliation(s)
- Arvind Kolangarakath
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Kapil Chalil Madathil
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Sudeep Hegde
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Shubham Agrawal
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Mary Bian
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Lauren Simmons
- Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina, USA
| | - Gabby Molloseau
- College of Medicine, Medical University of South Carolina, Clemson, South Carolina, USA
| | - Christine Holmstedt
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dustin LeBlanc
- Department of Emergency Medicine, Medical University of South Carolina,Charleston, South Carolina, USA
| | - Jillian Harvey
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Todd McGeorge
- Charleston County Emergency Medical Services, Charleston, South Carolina, USA
| | - Maria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donna Roberts
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
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Anandakumar J, Ja Mai H, Bv Riblet N, Waseem H. Telehealth interventions for stroke management and rehabilitation in low- and middle-income countries: A scoping review. J Clin Neurosci 2024; 130:110906. [PMID: 39541653 DOI: 10.1016/j.jocn.2024.110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 10/07/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION The burden of stroke is higher in low- and middle-income countries (LMICs) than in high-income countries due to the lack of stroke care centers, stroke specialist, and rehabilitation access. One way to increase access to stroke care in LMICs is through the use of telehealth. MATERIAL & METHOD We performed a scoping review to summarize the evidence on telehealth in LMICs. We searched Medline, SCOPUS, and Web of Science through February 18th, 2022. Reviewers screened for studies reporting on health outcomes following telehealth interventions (imaging, thrombolysis, and rehabilitation) in LMICs. We included all study designs. RESULTS Out of 259 studies, 10 studies met the eligibility criteria. Nine reported on functional or disability measures, 6 reported on cerebral infarction or intracerebral hemorrhage, 5 reported on door-to-needle time to thrombolysis, and 6 reported on mortality rate. Out of 9 studies, 8 reported that the use of telehealth for stroke management and rehabilitation in LMICs has led to a decrease in the degree of post-stroke disability. However, the comparison group may have received no rehabilitation treatment at all in LMICs. All 5 studies that measured administration of thrombolytic therapy in respective telehealth interventions were within the recommended 3-hour time window. Studies with a comparison arm found that there was no significant difference in mortality and cerebral infarction/intracerebral hemorrhage rates between telehealth and control. CONCLUSION Evidence from this review suggests that telehealth may improve post-stroke disability and facilitate the timely administration of thrombolytics therapy within the 3-hour window by allowing remote access to distant tertiary stroke care center in situations where it would otherwise be delayed in LMICs due to logistical barriers such as an extended travel time. Further research using randomized and quasi-experimental studies are needed in LMICs to determine the overall effectiveness of telehealth intervention for stroke management and rehabilitation.
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Affiliation(s)
- Jeya Anandakumar
- The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA.
| | - Htun Ja Mai
- The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA.
| | - Natalie Bv Riblet
- The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA; Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Hanover, NH, USA.
| | - Hena Waseem
- The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA.
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Nag DS, Swain A, Sahu S, Sen B, Vatsala, Parween S. Stroke: Evolution of newer treatment modalities for acute ischemic stroke. World J Clin Cases 2024; 12:6137-6147. [PMID: 39371560 PMCID: PMC11362888 DOI: 10.12998/wjcc.v12.i28.6137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/08/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
Acute ischemic stroke is one of the leading causes of morbidity and mortality worldwide. Restoration of cerebral blood flow to affected ischemic areas has been the cornerstone of therapy for patients for eligible patients as early diagnosis and treatment have shown improved outcomes. However, there has been a paradigm shift in the management approach over the last decade, and with the emphasis currently directed toward including newer modalities such as neuroprotection, stem cell treatment, magnetic stimulation, anti-apoptotic drugs, delayed recanalization, and utilization of artificial intelligence for early diagnosis and suggesting algorithm-based management protocols.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
| | - Amlan Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Biswajit Sen
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
| | - Vatsala
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
| | - Sadiya Parween
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
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Niu S, Hong W, Ma Y. How Expectations and Trust in Telemedicine Contribute to Older Adults' Sense of Control: An Empirical Study. Healthcare (Basel) 2024; 12:1685. [PMID: 39273710 PMCID: PMC11394832 DOI: 10.3390/healthcare12171685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
As numerous nations transition into digital and aging societies, the digital divide has emerged as a significant impediment to older adults' autonomous engagement in the digital society. Enhancing the well-being of elderly individuals through remote medical technology represents a prevailing and prospective trend. Nevertheless, remote medical technology extends beyond the realm of healthcare, offering promise for narrowing the digital divide through the deployment of digital devices and provision of intergenerational support. Therefore, this study investigates the role of trust and expectations in the use of telemedicine, indicating potential pathways for how these products can improve older adults' daily living abilities. Through the construction of a theoretical model, we collected the relevant data of 661 elderly people who use telemedicine technology in China and analyzed the data with SmartPLS4 to obtain the research results. The study discovered that, among older people using telemedicine technology, (1) healthcare expectations promote the breadth of telemedicine product use; (2) trust in product safety increases the depth of telemedicine product use; (3) trust in the service provider promotes the breadth of telemedicine product use; and (4) when compared to the depth of product use, the breadth of telemedicine product use increases older adults' sense of control over their digital lives. The findings provide new empirical data to support growing beliefs about how expectations and trust can increase a sense of control over one's life. They also provide practical contributions on how to boost older adults' usage of telemedicine products, promote their digital literacy and competency, and enhance their sense of control over their digital lives.
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Affiliation(s)
- Siyu Niu
- School of Health Management, Anhui Medical University, Hefei 230032, China
| | - Wenjia Hong
- School of Management, Hefei University of Technology, Hefei 230009, China
| | - Yiming Ma
- School of Management Science and Engineering, Anhui University of Finance and Economics, Bengbu 233030, China
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Alrashed FA, Ahmad T, Almurdi MM, Alderaa AA, Alhammad SA, Serajuddin M, Alsubiheen AM. Incorporating Technology Adoption in Medical Education: A Qualitative Study of Medical Students' Perspectives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:615-625. [PMID: 38975614 PMCID: PMC11227328 DOI: 10.2147/amep.s464555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
Introduction The integration of technology into medical education has witnessed significant growth in recent years, with tools such as virtual reality, artificial intelligence, and telemedicine gaining prominence. These tool in medical education, offering immersive, experiential learning experiences. Methods We approached medical students currently enrolled in medical education programs and who are familiar with and actively use AI in medical education. Initially, we invited 21 random students to participate in the study; however, only 13 agreed to interviews. Some students cited their busy exam schedules as the reason for not participating. The participants were informed of the objective of the study before the commencement of the recorded interviews. Semi-structured interviews were used to guide the record interviews. Audio recordings were transcribed and analyzed using Atlas.ti, a qualitative data analysis software. Results Participants exhibited a diverse range of perceptions and levels of awareness regarding VR, AI, and telemedicine technologies. Learning with virtual reality was considered to be fun, memorable, inclusive, and engaging by participants. The use of virtual reality technology is seen as complementing current teaching and learning approaches, helping to build learners' confidence, as well as providing medical students with a safe environment for problem-solving and trial-and-error learning. The students reported that AI was seen as a potential game-changer in the healthcare sector. Participants hoped that telemedicine would provide healthcare services to remote and underserved populations. Conclusion The study conducted focus group discussions with medical students and residents in Saudi Arabia to explore their views on integrating VR, AI, and telemedicine in medical education and practice. Their insights highlight the need for informed decision-making and strategic development to optimize the benefits and address challenges like initial investments, technical issues, ethics, and regulations. These considerations are crucial for fully realizing the potential benefits of technology in medical education globally.
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Affiliation(s)
- Fahad Abdulaziz Alrashed
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muneera M Almurdi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Asma A Alderaa
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saad A Alhammad
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Abdulrahman M Alsubiheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Rothlisberger PN. AI-Powered Patient-Centered Care: A Call to Action for Innovation. J Healthc Manag 2024; 69:255-266. [PMID: 38976786 DOI: 10.1097/jhm-d-24-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
SUMMARY The influential report Crossing the Quality Chasm: A New Health System for the 21st Century established six core objectives to enhance healthcare quality. It highlighted the necessity for healthcare to encompass safety, effectiveness, a patient-centered approach, timeliness, efficiency, and equity. This essay focuses on one of these six core objectives: a patient-centered approach. Healthcare leaders actively seek solutions to improve and ensure the delivery of high-quality care. The imperative to provide quality healthcare underscores the need for artificial intelligence (AI) to become an essential component in a patient-centered approach rather than merely an optional advantage. Despite the expansion of AI, there is a lack of understanding of how AI can improve patient-centered care. This essay examines the fundamental aspects of patient-centered care, as outlined by the Picker Institute, while also exploring the prospective role of AI in advancing the core principles of patient-centered care and proposing frameworks for applying AI in healthcare.
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Affiliation(s)
- Paige N Rothlisberger
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, Ohio
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11
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Qurat Ul Ain H, Junaid Tahir M, Abbasher Hussien Mohamed Ahmed K, Ahmed F, Mohamed Ibrahim Ali M, Hassan Salih Elhaj E, Mustafa GE, Ahsan A, Yousaf Z. Tele-stroke: a strategy to improve acute stroke care in low- and middle-income countries. Ann Med Surg (Lond) 2024; 86:3808-3811. [PMID: 38989217 PMCID: PMC11230807 DOI: 10.1097/ms9.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
| | | | | | | | | | | | | | - Areeba Ahsan
- Foundation University School of Health Sciences, Islamabad, Pakistan
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12
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Srinivasan M, Scott A, Soo J, Sreedhara M, Popat S, Beasley KL, Jackson TN, Abbas A, Keaton WA, Holmstedt C, Harvey J, Kruis R, McLeod S, Ahn R. The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina. J Stroke Cerebrovasc Dis 2024; 33:107702. [PMID: 38556068 PMCID: PMC11088489 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.
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Affiliation(s)
- Mithuna Srinivasan
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States.
| | - Amber Scott
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Jackie Soo
- NORC at the University of Chicago, Chicago, IL, United States
| | - Meera Sreedhara
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Cherokee Nation Operational Solutions, Tulsa, OK, United States
| | - Shena Popat
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States
| | - Kincaid Lowe Beasley
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States
| | - Tiara N Jackson
- Decision Information Resources, Inc., Houston, TX, United States
| | - Amena Abbas
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; ASRT, Inc., Atlanta, GA, United States
| | - W Alexander Keaton
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | | | - Jillian Harvey
- Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Kruis
- Medical University of South Carolina, Charleston, SC, United States
| | - Shay McLeod
- Medical University of South Carolina, Charleston, SC, United States
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, IL, United States
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Duren JV, Puttgen HA, Martinez J, Murray NM. Poisson Modeling Predicts Acute Telestroke Patient Call Volume. Telemed J E Health 2024; 30:1866-1873. [PMID: 38603583 DOI: 10.1089/tmj.2023.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Predicting the frequency of calls for telestroke and emergency teleneurology consultation is essential to prepare staffing for the immediate management of time-sensitive strokes. In this study, we evaluate Poisson distribution count data using a generalized linear model that predicts the volume of hourly telestroke calls over a 24-h period. Methods: We performed an Institutional Review Board approved retrospective cohort review of patients (January 2019-December 2022) from an institutional telestroke database at a large nonprofit multihospital system in the United States. All patients ≥18 years with a telestroke activation were included. Telestroke calls were quantified in frequency per day and analyzed by multiple time and date intervals. Poisson probability mass function (PMF) and cumulative distribution function (CDF) were used to predict call probabilities. A univariable Poisson regression model was fit to predict call volumes. Results: A total of 8,499 patients at 21 hospitals met inclusion criteria, the mean calls/day were 5.82 ± 2.54, and mean calls/day within each hour increment ranged from a minimum of 0.07 from 5 a.m. to 6 a.m. to a maximum of 0.45 from 7 p.m. to 8 p.m. The Poisson distribution was the most appropriate parametric probability model for these data, confirmed by the fit of the data to the expected distributions corresponding to the calculated means. The predicted probabilities of call frequencies by hour were calculated using the Poisson PMF and CDF; the probability of two or fewer calls/day by hour ranged from 98.9% to 99.9%. Univariable Poisson regression modeled an increase of future calls/day from 6.7 calls/day in July 2023 to 7.6 calls/day in October 2025. Conclusion: Poisson modeling closely fits telestroke call volumes, predicts the future volumes, and can be applied to any health system in which the mean call volume is known, which may inform the number of physicians needed to cover calls in real-time.
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Affiliation(s)
- Joe Van Duren
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - H Adrian Puttgen
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Julie Martinez
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Nick M Murray
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
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Murray NM, Johnson P, McKasson M, Martinez J, Chatwin S, Püttgen A. Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience. Neurohospitalist 2024; 14:170-173. [PMID: 38666267 PMCID: PMC11040611 DOI: 10.1177/19418744231211968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background and Purpose Telestroke evaluation of patients with acute ischemic stroke is supported by American Heart and Stroke Association Guidelines. However, there is no data on outcomes or safety of administering IV thrombolytic stroke therapy using extended window criteria (>4.5 h since onset of symptoms with a hyperacute MRI diffusion T2/FLAIR mismatch) via telestroke. Here, we report adverse events and outcomes of extended-window thrombolysis by telestroke vs in-person care. Methods We performed a retrospective cohort review from 2020 to 2022 of prospectively collected multinstitutional databases from a large, not-for-profit health system with both in-person stroke and telestroke care. The primary outcome was frequency of symptomatic intracranial hemorrhage (sICH). Secondary outcomes were favorable functional outcome at hospital discharge (modified Rankin Scale, mRS, 0-3) and discharge disposition. Results A total of 33 patients were treated with extended-window thrombolysis (n = 20 in-person, n = 13 telestroke). The median NIH stroke scale was 6, and time since last known normal was similar (median [95% CI]: in-person 13 h [11-15 h] vs telestroke 12 h [9-16 h], P = .33). The sICH frequency was low and occurred in one patient (4.8% in-person vs 0% by telestroke). Favorable outcome at discharge was not different between in-person and telestroke care (median mRS [95% CI]: 2 [1-3] vs 1 [0-2], OR .0 [.0-1.8], P = .27), and discharge deposition was also similar. Conclusions In patients eligible for extended window acute stroke treatment with thrombolytics, there was no difference in adverse events between telestroke and in-person care.
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Affiliation(s)
- Nick M. Murray
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
| | - Paul Johnson
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
| | - Marilyn McKasson
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
| | - Julie Martinez
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
| | - Stephen Chatwin
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
| | - Adrian Püttgen
- Department of Neurology, Intermountain Medical Center, Murray, UT, USA
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15
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Alhajala H, Hendricks-Jones M, Shawver J, Amllay A, Chen JT, Hajjar M, Robbins S, Dwyer T, Sedlak E, Crayne C, Miller B, Kung V, Burgess R, Jumaa M, Zaidi SF. Expansion of Telestroke Coverage in Community Hospitals: Unifying Stroke Care and Reducing Transfer Rate. Ann Neurol 2024; 95:576-582. [PMID: 38038962 DOI: 10.1002/ana.26839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Telestroke (TS) service has been shown to improve stroke diagnosis timing and accuracy, facilitate treatment decisions, and decrease interfacility transfers. Expanding TS service to inpatient units at the community hospital provides an opportunity to follow up on stroke patients and optimize medical management. This study examines the outcome of expanding TS coverage from acute emergency room triage to incorporate inpatient consultation. METHODS We studied the effect of expanding TS to inpatient consultation service at 19 regional hospitals affiliated with Promedica Stroke Network. We analyzed data pre- and post-TS expansion. We reviewed changes in TS utilization, admission rate, thrombolytic therapy, patient transfer rate, and diagnosis accuracy. RESULTS Between January 2018 and June 2022, a total of 9,756 patients were evaluated in our stroke network (4,705 in pre- and 5,051 in the post-TS expansion). In the post-TS expansion period, stroke patients' admission at the spoke hospital increased from 18/month to 40/month, and for TIA from 11/month to 16/month. TS cart use increased from 12% to 35.2%. Patient transfers to hub hospital decreased by 31%. TS service expansion did not affect intravenous thrombolytic therapy rate or door-to-needle time. There was no difference in length of stay or readmission rate, and the patients at the spoke hospitals had a higher rate of home discharge 57.38% compared with 52.58% at hub hospital. INTERPRETATION Telestroke service expansion to inpatient units helped decrease transfers and retain patients in their communities, increased stroke and TIA diagnosis accuracy, and did not compromise patients' hospitalization or outcome. ANN NEUROL 2024;95:576-582.
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Affiliation(s)
- Hisham Alhajala
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | | | - Julie Shawver
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | | | - John Tuhao Chen
- Department of Statistics, Bowling Green State University, Bowling Green, OH, USA
| | - Monica Hajjar
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Sarah Robbins
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Trisha Dwyer
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Emily Sedlak
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | | | - Brian Miller
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Vieh Kung
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Richard Burgess
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA
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16
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Bagot KL, Bladin CF, Vu M, Bernard S, Smith K, Hocking G, Coupland T, Hutton D, Badcock D, Budge M, Nadurata V, Pearce W, Hall H, Kelly B, Spencer A, Chapman P, Oqueli E, Sahathevan R, Kraemer T, Hair C, Dion S, McGuinness C, Cadilhac DA. Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care. J Eval Clin Pract 2024; 30:184-198. [PMID: 37721181 DOI: 10.1111/jep.13923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
RATIONALE Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. AIMS To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. METHODS We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). RESULTS Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. CONCLUSION Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.
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Affiliation(s)
- Kathleen L Bagot
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Chris F Bladin
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Michelle Vu
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Bernard
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Silverchain Group, Melbourne, Victoria, Australia
| | | | | | - Debra Hutton
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Marc Budge
- Bendigo Health, Bendigo, Victoria, Australia
| | | | - Wayne Pearce
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Howard Hall
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ben Kelly
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Angie Spencer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | | | - Ernesto Oqueli
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Department of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Ramesh Sahathevan
- Grampians Health Ballarat, Ballarat, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Ballarat Clinical School, School of Medicine, Deakin University, Ballarat, Australia
| | - Thomas Kraemer
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Casey Hair
- Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Stub Dion
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Connor McGuinness
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Dominique A Cadilhac
- Public Health and Health Services Research, Stroke theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Ramos MB, Rech MM, Telles JPM, Moraes WM, Teixeira MJ, Figueiredo EG. Repercussions of the Emergency neurological life support on scientific literature: a bibliometric study. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-10. [PMID: 38272043 PMCID: PMC10810700 DOI: 10.1055/s-0043-1777110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND In 2012, the Neurocritical Care Society launched a compilation of protocols regarding the core issues that should be addressed within the first hours of neurological emergencies - the Emergency neurological life support (ENLS). OBJECTIVE We aim to evaluate this repercussion through a bibliometric analysis. METHODS We searched Scopus on October 2022 for articles mentioning ENLS. The following variables were obtained: number of citations; number of citations per year; number of publications per year; year of publication; research type; research subtype; country of corresponding author and its income category and world region; journal of publication and its 5-year impact factor (IF); and section where ENLS appeared. RESULTS After applying eligibility criteria, we retrieved 421 articles, published from 2012 to 2022. The mean number of citations per article was 17.46 (95% Confidence Interval (CI) = 8.20-26.72), while the mean number of citations per year per article was 4.05 (95% CI = 2.50-5.61). The mean destiny journal 5-year IF was 5.141 (95% CI = 4.189-6.093). The majority of articles were secondary research (57.48%; n = 242/421) of which most were narrative reviews (71.90%; n = 174/242). High-Income countries were the most prominent (80.05%; n = 337/421 articles). There were no papers from low-income countries. There were no trials or systematic reviews from middle-income countries. CONCLUSION Although still low, the number of publications mentioning ENLS is increasing. Articles were mainly published in journals of intensive care medicine, neurology, neurosurgery, and emergency medicine. Most articles were published by authors from high-income countries. The majority of papers were secondary research, with narrative review as the most frequent subtype.
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Affiliation(s)
- Miguel Bertelli Ramos
- Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurocirurgia, São Paulo SP, Brazil.
| | - Matheus Machado Rech
- Universidade de Caxias do Sul, Faculdade de Medicina, Departamento de Neurocirurgia, Caxias do Sul RS, Brazil.
| | - João Paulo Mota Telles
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Willian Medeiros Moraes
- Hospital Nossa Senhora da Conceição, Departamento de Medicina Interna, Porto Alegre RS, Brazil.
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
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Zeng N, Liu MC, Zhong XY, Wang SG, Xia QD. Knowledge mapping of telemedicine in urology in the past 20 years: A bibliometric analysis (2004-2024). Digit Health 2024; 10:20552076241287460. [PMID: 39421308 PMCID: PMC11483830 DOI: 10.1177/20552076241287460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/10/2024] [Indexed: 10/19/2024] Open
Abstract
Telemedicine refers to the process of utilizing communication technologies to exchange disease information, perform surgery and educate care providers remotely, breaking through the distance limit and promoting the health of individuals and communities. The fifth-generation (5G) technology and the COVID-19 pandemic have greatly boosted studies on the application of telemedicine in urology. In this study, we conduct a comprehensive overview of the knowledge structure and research hotspots of telemedicine in urology through bibliometrics. We searched publications related to telemedicine in urology from 2004 to 2024 on the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace and R package "bibliometrix" were employed in this bibliometric analysis. A total of 1,357 articles from 97 countries and 2,628 institutions were included. The number of annual publications on telemedicine in urology witnessed a steady increase in the last two decades. Duke University was the top research institution. Urology was the most popular journal, and Journal of Medical Internet Research was the most co-cited journal. Clarissa Diamantidis and Chad Ellimoottil published the most papers, and Boyd Viers was co-cited most frequently. Effectiveness evaluation of telemonitoring, cost-benefit analysis of teleconsultation and exploration of telesurgery are three main research hotspots. As the first bibliometric analysis of research on telemedicine in urology, this study reviews research progress and highlights frontiers and trending topics, offering valuable insights for future studies.
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Affiliation(s)
- Na Zeng
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei-Cheng Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-Yu Zhong
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-Gang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi-Dong Xia
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chhabra N, English SW, Miller M, Hanus AE, Basharath R, Butterfield RJ, Zhang N, Demaerschalk BM. Demonstration of High Diagnostic Accuracy for Cerebral Ischemia in a Large Academic Hub-and -Spoke Telestroke Network. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2023; 1:490-497. [PMID: 40206305 PMCID: PMC11975710 DOI: 10.1016/j.mcpdig.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Objective To determine the diagnostic accuracy of the initial telestroke consultation in a large academic hub-and-spoke telemedicine network. Patients and Methods This retrospective study includes all patients evaluated for cerebral ischemia through video telestroke consultation in a large academic hub-and-spoke telemedicine network from January 1, 2019 to December 31, 2020. A detailed chart review was conducted to identify the initial suspected diagnosis and final diagnosis. Cerebral ischemia was defined as acute ischemic stroke and transient ischemic attack. All other diagnoses were defined as stroke mimics. Data were organized into continuous and categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve (AUC), and likelihood ratio (LR+) for the telestroke-consultation diagnosis were calculated while using the final diagnosis as the gold standard diagnosis. Results A total of 1043 patients met the inclusion criteria. The final diagnosis of cerebral ischemia was made in 63.5% of all patients (539 of the 1043 with acute ischemic stroke,123 of the 1043 with transient ischemic attack). Stroke mimic was diagnosed in 36.5% patients (381 of the 1043). The sensitivity and specificity of telestroke evaluation for diagnosis of cerebral ischemia were 97.1% and 81.4%, respectively. Positive predictive value was 90.1%, and negative predictive value was 94.2%. Overall diagnostic accuracy was 91.4%, with an LR+ of 5.21 and AUC of 0.89. Conclusion This study highlights the high diagnostic accuracy of telestroke providers in diagnosing cerebral ischemia. Further research exploring the application of teleneurology in the nonstroke setting and other medical subspecialties is warranted.
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Affiliation(s)
- Nikita Chhabra
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ
| | - Stephen W. English
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Monet Miller
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ
| | - Abigail E. Hanus
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Rida Basharath
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ
| | - Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ
- Center for Digital Health, Mayo Clinic, Rochester, MN
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Arumuganathan P, Adcock AK, Espinosa C, Findley S. Analysis of Telestroke Usage in Rural Critical Access Emergency Departments. Telemed J E Health 2023; 29:1828-1833. [PMID: 37205846 PMCID: PMC10714255 DOI: 10.1089/tmj.2022.0408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/30/2022] [Accepted: 01/04/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction: Telestroke is an effective strategy to increase appropriate stroke treatments among patients in resource-limited environments. Despite the well-documented benefits of telestroke, there is limited literature regarding its utilization. The purposes of this study are: (1) determine the percentage of potential stroke patients who generate a telestroke consult in rural critical access hospitals (CAHs) and (2) validate an electronic medical record (EMR)-derived report as a stroke screen. Methods: This retrospective chart review analyzed patients presenting between September 1, 2020 and February 1, 2021 to three CAHs. Visits with triage complaints suggesting acute ischemic stroke (AIS)/transient ischemic attack (TIA) were pooled for analysis using an EMR-derived report. Patients with confirmed AIS/TIA at discharge over this period were used to validate the EMR tool. Results: The EMR report pooled 252 possible AIS/TIA visits out of 12,685 emergency department visits for analysis. It had a specificity of 98.78% and sensitivity of 58.06%. Of the 252 visits, 12.7% met telestroke criteria and 38.89% received telestroke evaluation. Among these, a definite diagnosis of AIS/TIA was made in 92.86%. Of the remaining population who met criteria but didn't undergo consultation, 61.11% were diagnosed with AIS/TIA at discharge. Conclusion: This study provides novel characterization of stroke presentations and telestroke in rural CAHs. The EMR-derived report is a reasonable tool to concentrate potential AIS/TIA cases for review and resource allocation but is not sensitive enough to detect stroke as a stand-alone tool. The majority (56%) of eligible patients did not undergo telestroke consultation. Future studies are critical to further understand reasons contributing to this.
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Affiliation(s)
- Priya Arumuganathan
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Amelia K. Adcock
- Department of Neurology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Cristal Espinosa
- Department of Pediatric Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Scott Findley
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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Hendrickx L, Kuznia C, Maneval L. Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms. Crit Care Nurse 2023; 43:49-56. [PMID: 37777248 DOI: 10.4037/ccn2023505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
BACKGROUND Cerebrovascular accident, or stroke, is a common cause of death or disability. Timely diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke. For patients with ischemic stroke, thrombolytic drugs and endovascular intervention are time-sensitive treatment options. LOCAL PROBLEM Patients living in rural areas often do not have access to rapid consultation with specialized neurologic teams for diagnosis and treatment of stroke. The use of telemedicine in the form of a telestroke consultation can improve timely diagnosis and treatment for rural patients exhibiting stroke symptoms. METHODS A telestroke program was implemented in the upper Midwest. A team of 4 interventional neurologists provided telestroke consultation to a comprehensive stroke center and 5 other acute stroke-ready rural hospitals. RESULTS A tiered stroke alert algorithm and telestroke workflow chart were developed to help health care professionals at rural sites determine eligibility for telestroke consultation. A teleneurologist connected with the originating site, and the National Institutes of Health Stroke Scale could be completed remotely with assistance from the originating site. Telestroke has increased the percentage of patients receiving thrombolytics in less than 60 minutes, and door-to-needle time has decreased. CONCLUSION Rural patients with stroke symptoms may experience a delay in care or stroke diagnosis due to distance to specialized neurologic services. Telestroke consultation is a successful method for timely diagnosis of stroke and recommendation for treatment.
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Affiliation(s)
- Lori Hendrickx
- Lori Hendrickx is a professor at South Dakota State University College of Nursing, Brookings, South Dakota, and a staff nurse at St. Mary's Essentia Health, Detroit Lakes, Minnesota
| | - Chelsey Kuznia
- Chelsey Kuznia is the stroke program manager for the Comprehensive Stroke Center, Essentia Health, Fargo, North Dakota
| | - Lindsey Maneval
- Lindsey Maneval is an emergency department supervisor and stroke coordinator, St. Mary's Essentia Health, Detroit Lakes
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22
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Sharma S, Rawal R, Shah D. Addressing the challenges of AI-based telemedicine: Best practices and lessons learned. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:338. [PMID: 38023098 PMCID: PMC10671014 DOI: 10.4103/jehp.jehp_402_23] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 12/01/2023]
Abstract
Telemedicine is the use of technology to provide healthcare services and information remotely, without requiring physical proximity between patients and healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has accelerated the rapid growth of telemedicine worldwide. Integrating artificial intelligence (AI) into telemedicine has the potential to enhance and expand its capabilities in addressing various healthcare needs, such as patient monitoring, healthcare information technology (IT), intelligent diagnosis, and assistance. Despite the potential benefits, implementing AI in telemedicine presents challenges that can be overcome with physician-guided implementation. AI can assist physicians in decision-making, improve healthcare delivery, and automate administrative tasks. To ensure optimal effectiveness, AI-powered telemedicine should comply with existing clinical practices and adhere to a framework adaptable to various technologies. It should also consider technical and scientific factors, including trustworthiness, reproducibility, usability, availability, and cost. Education and training are crucial for the appropriate use of new healthcare technologies such as AI-enabled telemedicine. This article examines the benefits and limitations of AI-based telemedicine in various medical domains and underscores the importance of physician-guided implementation, compliance with existing clinical practices, and appropriate education and training for healthcare providers.
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Affiliation(s)
- Sachin Sharma
- Department of Computer Science and Engineering, Indrashil University, Mehsana, Gujarat, India
| | - Raj Rawal
- Department of Critical Care, Gujarat Pulmonary and Critical Care Medicine, Ahmedabad, Gujarat, India
| | - Dharmesh Shah
- Department of ICT, Indrashil University, Mehsana, Gujarat, India
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23
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Lebioda LA, Pedroso B, dos Santos MEC, Pinto GMC, Welling LC. Neurological telerehabilitation in the COVID-19 era - current perspectives through a bibliometric analysis. Front Neurol 2023; 14:1227846. [PMID: 37794878 PMCID: PMC10546771 DOI: 10.3389/fneur.2023.1227846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023] Open
Abstract
Objective To identify bibliometric parameters and research trends regarding to telerehabilitation of patients with stroke in the COVID-19 era. Methodology This is an integrative review carried out in the Scopus database, from June to July 2021, through the Biblioshiny graphical interface, provided by the Bibliometrix program. The search terms used were "Stroke," "COVID-19" and "Telerehabilitation." Results were filtered by publication date from 2019 onwards. No language restrictions were imposed. Results Twenty two articles were included in the study and the results were presented in the form of figures demonstrating that the journal Frontiers in Neurology was the one with the most relevant studies and the author with the highest number of citations. The Brazilian Academy of Neurology was the institution with the greatest number of studies and China ranked first as the country with the greatest scientific production. The authors used recent references in their work. A thematic map showed the centrality and density of the words presented and, finally, a three-field graph showed a strong intimacy between countries, keywords and authors. Conclusion A greater interest in the subject was observed in China with greater relevance of journals and institutions focused on neurology. However, despite telerehabilitation being an effective alternative in the context of the pandemic, few studies have explored this modality.
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Han CY, Zhang J, Ye XM, Lu JP, Jin HY, Xu WW, Wang P, Zhang M. Telemedicine-assisted structured self-monitoring of blood glucose in management of T2DM results of a randomized clinical trial. BMC Med Inform Decis Mak 2023; 23:182. [PMID: 37710226 PMCID: PMC10500819 DOI: 10.1186/s12911-023-02283-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/02/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND This prospective study aimed to compare telemedicine-assisted structured self-monitoring of blood glucose(SMBG) with a traditional blood glucose meter (BGM) in adults of type 2 diabetes mellitus (T2DM). METHODS Adult participants with T2DM were assigned to an intervention group or a control group. The patients in the intervention group received a connected BGM with real-time data submission as well as individual needs-based tele-coaching to address and improve motivation and daily diabetes self-management. The patients in the control group received a traditional BGM. Changes in glycated hemoglobin(HbA1c), low blood glucose index(LBGI), and diabetes self-management behaviors were analyzed. RESULTS The study demonstrated the superiority of the telemedicine-assisted structured SMBG versus the traditional BGM for improving HbA1c. Additionally, the telemedicine-assisted SMBG reduced the risk of hypoglycemia and enhanced diabetes self-management behaviors, as differences in the LBGI and the Diabetes Self-Management Questionnaire(DSMQ) results between the groups after 6 months were found to be significant. CONCLUSIONS Telemedicine-assisted structured SMBG helps physicians and patients to achieve a specific level of glycemic control and reduce hypoglycemia. The use of coaching applications and telemedicine-assisted SMBG indicated beneficial effects for T2DM self-management, which may help limit disease progression. TRIAL REGISTRATION Chinese Clinical Trail Registry No: ChiCTR2300072356 on 12/06/2023. Retrospectively registered.
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Affiliation(s)
- Chen-Yu Han
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Jian Zhang
- Department of Pharmacology, Medical College of Shaoxing University, Shaoxing, 312000, China
| | - Xiao-Mei Ye
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Jia-Ping Lu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Hai-Ying Jin
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Wei-Wei Xu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Ping Wang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China
| | - Min Zhang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, No.1158 of Gongyuan Road, Qingpu District, Shanghai, 201700, China.
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O'Sullivan S, Schneider H. Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial). Sci Rep 2023; 13:13332. [PMID: 37587222 PMCID: PMC10432512 DOI: 10.1038/s41598-023-40501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023] Open
Abstract
Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.
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Affiliation(s)
- Seán O'Sullivan
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany.
| | - Henning Schneider
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Gießen, Germany
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Jun-O’Connell AH, Sivakumar S, Henninger N, Silver B, Trivedi M, Ghasemi M, Lalla RR, Kobayashi KJ. Outcomes of Telestroke Inter-Hospital Transfers Among Intervention and Non-Intervention Patients. J Clin Med Res 2023; 15:292-299. [PMID: 37434777 PMCID: PMC10332878 DOI: 10.14740/jocmr4945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Background Telestroke is an established telemedicine method of delivering emergency stroke care. However, not all neurological patients utilizing telestroke service require emergency interventions or transfer to a comprehensive stroke center. To develop an understanding of the appropriateness of inter-hospital neurological transfers utilizing the telemedicine, our study aimed to assess the differences in outcomes of inter-hospital transfers utilizing the service in relation to the need for neurological interventions. Methods The pragmatic, retrospective analysis included 181 consecutive patients, who were emergently transferred from telestroke-affiliated regional medical centers between October 3, 2021, and May 3, 2022. In this exploratory study investigating the outcomes of telestroke-referred patients, patients receiving interventions were compared to those that did not following transfer to our tertiary center. Neurological interventions included mechanical thrombectomy (MT) and/or tissue plasminogen activator (tPA), craniectomy, electroencephalography (EEG), or external ventricular drain (EVD). Transfer mortality rate, discharge functional status defined by modified Rankin scale (mRS), neurological status defined by National Institutes of Health Stroke Scale (NIHSS), 30-day unpreventable readmission rate, 90-day clinical major adverse cardiovascular events (MACE), and 90-day mRS, and NIHSS were studied. We used χ2 or Fisher exact tests to evaluate the association between the intervention and categorical or dichotomous variables. Continuous or ordinal measures were compared using Wilcoxon rank-sum tests. All tests of statistical significance were considered to be significant at P < 0.05. Results Among the 181 transferred patients, 114 (63%) received neuro-intervention and 67 (37%) did not. The death rate during the index admission was not statistically significant between the intervention and non-intervention groups (P = 0.196). The discharge NIHSS and mRS were worse in the intervention compared to the non-intervention (P < 0.05 each, respectively). The 90-day mortality and cardiovascular event rates were similar between intervention and non-intervention groups (P > 0.05 each, respectively). The 30-day readmission rates were also similar between the two groups (14% intervention vs. 13.4% non-intervention, P = 0.910). The 90-day mRS were not significantly different between intervention and non-intervention groups (median 3 (IQR: 1 - 6) vs. 2 (IQR: 0 - 6), P = 0.109). However, 90-day NIHSS was worse in the intervention compared to non-intervention group (median 2 (IQR: 0 - 11) vs. 0 (IQR: 0 - 3), P = 0.004). Conclusions Telestroke is a valuable resource that expedites emergent neurological care via referral to a stroke center. However, not all transferred patients benefit from the transfer process. Future multicenter studies are warranted to study the effects or appropriateness of telestroke networks, and to better understand the patient characteristics, resources allocation, and transferring institutions to improve telestroke care.
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Affiliation(s)
- Adalia H. Jun-O’Connell
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Shravan Sivakumar
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Brian Silver
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Meghna Trivedi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Rakhee R. Lalla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Kimiyoshi J. Kobayashi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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Current Use and Future Considerations for Concussion Telemedicine Healthcare in Canada. Can J Neurol Sci 2023; 50:257-261. [PMID: 35272736 DOI: 10.1017/cjn.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the use of telemedicine among Canadian concussion providers and clinics before and after the COVID-19 pandemic onset and identify barriers and facilitators for future use. METHODS Ninety-nine concussion clinics and healthcare providers across Canada that offered one or more clinical concussion-related service were identified using standardized online searches and approached to complete a cross-sectional online survey. RESULTS Thirty clinics or providers completed the survey and two completed subsections of the survey (response rate of 32.3%). Only 28.1% of respondents indicated that they used telemedicine to provide care prior to the COVID-19 pandemic. Providers most commonly using telemedicine prior to the pandemic were occupational therapists and physicians, while the most commonly used services were in-person videoconferencing and eConsultation. Most respondents (87%) indicated their clinic's use of telemedicine changed following the onset of the COVID-19 pandemic including new use of in-person video-conferencing, telephone calls, and eConsultation. Ninety-three percent indicated that they would consider using telemedicine to provide care to their concussion patients once the pandemic was over. Barriers needed to be overcome to facilitate use or greater use of telemedicine-based services were the inability to conduct a complete physical examination, lack of appropriate reimbursement, lack of start-up, and maintenance funding and medico-legal risk. CONCLUSION Telemedicine was used by a minority of Canadian concussion clinics and providers prior to the COVID-19 pandemic but was rapidly adopted by many facilities. This study provides important insight into the factors that must be considered to optimize use of telemedicine in concussion care in the future.
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Anvari S, Neumark S, Jangra R, Sandre A, Pasumarthi K, Xenodemetropoulos T. Best Practices for the Provision of Virtual Care: A Systematic Review of Current Guidelines. Telemed J E Health 2023; 29:3-22. [PMID: 35532969 DOI: 10.1089/tmj.2022.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. Results: A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. Discussion: General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.
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Affiliation(s)
- Sama Anvari
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rhea Jangra
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony Sandre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Keerthana Pasumarthi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ted Xenodemetropoulos
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Shea CM, Turner K, Weinstein J, Tabriz AA, Babu N, Reeve JL, North S. Telestroke Infrastructure, Processes, and Support Needs: A Survey of Hospitals in Five States. Telemed J E Health 2022; 28:1823-1834. [PMID: 35420460 DOI: 10.1089/tmj.2022.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Telestroke has been shown to be a cost-effective approach to promoting use and timeliness of evidence-based treatment. However, adoption of telestroke has been relatively low. Several barriers to telestroke implementation have been previously identified in the literature. These barriers, and the strategies needed to overcome them, may vary across hospitals. Our study aimed to examine telestroke programs to identify opportunities for future research and efforts to promote effective implementation and sustainment of telestroke services. Methods: We surveyed hospitals in five states to capture information about the current status of the hospital's telestroke program; the model(s) of delivery being used (e.g., hub-and-spoke and third-party vendor); and telestroke infrastructure, processes, and implementation strategies. The survey included both closed-ended and open-ended response options. Descriptive results are presented, complemented with illustrative examples of open-ended responses. Results: We received 89 responses, each representing a different hospital. Approximately one-third of telestroke programs in our sample began between 2018 and 2020. More than two-thirds reported participating in a collaboration with other organizations to improve telestroke services. The most commonly reported, high-priority topics for additional guidance involved monitoring process measures, using performance indicators for improvement, and sharing data from measures with physicians. Discussion: Results complement prior studies, specifically about impacts of COVID-19 on telestroke programs and capabilities that hospitals most need assistance with. Challenges faced and guidance needed differ across hospitals, suggesting a need for a tailored support. The results also suggest more work is needed to understand factors that threaten sustainability of telestroke programs.
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Affiliation(s)
- Christopher M Shea
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Josh Weinstein
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Nimmy Babu
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Steve North
- Center for Rural Health Innovations, Spruce Pine, North Carolina, USA
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Zeiler SR, Abshire Saylor M, Chao A, Bahouth M. Telemedicine Services for the Delivery of Specialty Home-Based Neurological Care. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Steven R. Zeiler
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Alyssa Chao
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mona Bahouth
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Harahsheh E, English SW, Hrdlicka CM, Demaerschalk B. Telestroke’s Role Through the COVID-19 Pandemic and Beyond. Curr Treat Options Neurol 2022; 24:589-603. [PMID: 35999901 PMCID: PMC9388966 DOI: 10.1007/s11940-022-00737-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
Purpose of review The goal of this paper is to discuss the role and utilization of telestroke services through the COVID-19 pandemic and to suggest future directions to sustain and increase patients’ access to stroke expertise. Recent findings Telestroke is an innovative and effective tool that has been shown to improve access, quality of care, and outcomes of patients with acute stroke syndromes in resource-limited areas for the last two decades. The COVID-19 pandemic posed a significant challenge and strained healthcare systems worldwide, but it created novel and unique opportunities to expand and increase the utilization of telehealth and telestroke services to deliver personalized healthcare across the continuum of stroke care outside of traditional settings. This rapid and widespread increase in telestroke use was facilitated by the removal of many legislative and regulatory barriers which have limited patients’ access to stroke expertise for many years. Summary As the public health emergency ends, there exists a unique opportunity to optimize and expand upon the pandemic-related rapid growth of telestroke care. Optimal utilization of telehealth and telestroke services will depend on maintaining and improving required infrastructure, laws, and regulations, particularly those governing reimbursement and licensing.
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Affiliation(s)
- Ehab Harahsheh
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
| | | | - Courtney M. Hrdlicka
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
| | - Bart Demaerschalk
- Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259 USA
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Maki Y, Ishibashi R, Yasuda T, Tokumasu H, Yamamoto Y, Goda A, Yamashita H, Morita T, Ikeda H, Chin M, Yamagata S. Correlation of Scoring Systems with the Requirement of an External Ventricular Drain in Intraventricular Hemorrhage. World Neurosurg 2022; 163:e532-e538. [PMID: 35405320 DOI: 10.1016/j.wneu.2022.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND External ventricular drainage (EVD) is required to resolve acute hydrocephalus associated with intraventricular hemorrhage (IVH). The correlation of scoring systems of IVH with indications for EVD for acute hydrocephalus related to IVH is currently unknown. METHODS We identified 213 hypertensive patients with IVH and divided them into 2 groups according to treatment method: 187 patients receiving blood pressure control alone and 26 patients undergoing EVD. The following patients were excluded: pediatric patients, patients undergoing intracranial hematoma removal, patients with fetal status, and patients without sufficient clinical data. We compared the Glasgow Coma Scale score, Graeb score, LeRoux score, Evans index, and bicaudate index values between the 2 groups and determined the prognostication accuracy of each scoring system. RESULTS There were significant differences in all 4 scoring systems between the 2 groups (P < 0.001). The cutoff values (sensitivity and specificity) of each scoring system were as follows: Glasgow Coma Scale, 8 (65.4%, 87.7%); Graeb score, 6 (80.8%, 75.4%); LeRoux score, 9 (80.8%, 76.5%); Evans index, 0.245 (80.8%, 67.9%); and bicaudate index, 0.186 (76.9%, 76.5%). The value of the area under the curve of each scoring system (95% confidence interval) was as follows: Glasgow Coma Scale, 0.806 (0.705-0.907); Graeb score, 0.852 (0.779-0.925); LeRoux score, 0.875 (0.812-0.937); Evans index, 0.788 (0.702-0.875); and bicaudate index, 0.778 (0.673-0.883). CONCLUSIONS The LeRoux score is better for identifying patients with IVH who are more likely to have EVD.
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Affiliation(s)
- Yoshinori Maki
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takaya Yasuda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hironobu Tokumasu
- The Clinical Research Institute, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Yamamoto
- The Clinical Research Institute, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akio Goda
- Faculty of Health Sciences, Department of Physical Therapy, Kyoto Tachibana University, Kyoto, Japan
| | - Hokuto Yamashita
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takumi Morita
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan
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English S, Barrett KM, Freeman WD, Demaerschalk BM, Dumitrascu O. Improving the Telemedicine Evaluation of Patients With Acute Vision Loss: A Call to Eyes. Neurology 2022; 99:381-386. [PMID: 35764399 DOI: 10.1212/wnl.0000000000200969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Acute vision loss related to cerebral or retinal ischemia is a time-sensitive emergency with potential treatment options including intravenous or intraarterial thrombolysis and mechanical thrombectomy. However, patients either present in delayed fashion or present to an emergency department that lacks the subspecialty expertise to recognize and treat these conditions in a timely fashion. Moreover, healthcare systems in the United States are becoming increasingly reliant on telestroke and teleneurology services for acute neurologic care, making accurate diagnosis of acute vision loss even more challenging due to critical limitations to the remote video evaluation, including the inability to perform routine ophthalmoscopy. The COVID-19 pandemic has led to a greater reliance on telemedicine services and helped to accelerate the development of novel tools and care pathways to improve remote ophthalmologic evaluation, but these tools have yet to be adapted for use in the remote evaluation of acute vision loss. Permanent vision loss can be disabling for patients and efforts must be made to increase and improve early diagnosis and management. Herein, the authors outline the importance of improving acute ophthalmologic diagnosis, outline key limitations and barriers to the current video-based teleneurology assessments, highlight opportunities to leverage new tools to enhance the remote assessment of vision loss, and propose new avenues to improve access to emergent ophthalmology subspeciality.
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Affiliation(s)
- Stephen English
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Kevin M Barrett
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - William D Freeman
- Departments of Neurology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Bart M Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Oana Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
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Turner AC, Etherton MR. Utilization of Telestroke Prior to and Following the COVID-19 Pandemic. Semin Neurol 2022; 42:3-11. [PMID: 35576926 DOI: 10.1055/s-0041-1742181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. A successful telestroke system should include adequate protocols and training, equipment, documentation system, and tracking of quality metrics. Upfront costs of needed technology and devices, credentialing hurdles, and limited reimbursement are all reported barriers to the utilization of telestroke. Emphasis on safety measures during the COVID-19 pandemic resulted in the dramatic upscaling of telehealth utilization, although overall stroke volumes declined in many areas in the early phases of the pandemic. Going forward, continued reduction in cost of required devices and broadband connections, increased use of automated and advanced analytical software, and a universal licensing and credentialing system are needed to continue the expansion of telestroke use.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Matiello M, Cohen AB. Telehealth for Comprehensive Care of Acute Neurologic Disorders. Semin Neurol 2022; 42:12-17. [PMID: 35576927 DOI: 10.1055/s-0041-1742195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A teleneurology hospitalist model aims to address the demand for high-quality neurologic acute care and the shortage of neurologists. Here, we review concepts and models of teleneurology services to address access and care gaps in neurology beyond telestroke models. The goal of these emergent teleservices is to empower community hospitals to deliver the highest quality care, while also reducing unnecessary patient transfers to tertiary care hospitals. We highlight the clinical models, patient populations, and innovative approaches of different tele-neurohospitalist services. This includes challenges related to clinical limitations, legal issues, and reimbursement. We highlight specific areas of research that can further clarify and refine the appropriate use, cost-effectiveness, and clinical outcomes of these telemedicine-based care models.
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Affiliation(s)
- Marcelo Matiello
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam B Cohen
- Department of Neurology, Yale New Haven Health System, Yale Medical School, New Haven, Connecticut.,National Health Mission Area, The Johns Hopkins Applied Physics Lab, Laurel, Maryland
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"Beyond Just a Supplement": Administrators' Visions for the Future of Virtual Primary Care Services. J Am Board Fam Med 2022; 35:527-536. [PMID: 35641035 PMCID: PMC9726205 DOI: 10.3122/jabfm.2022.03.210479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The COVID-19 pandemic resulted in unprecedented adoption and implementation of virtual primary care services, and little is known about whether and how virtual care services will be provided after the pandemic ends. We aim to identify how administrators at health care organizations perceive the future of virtual primary care services. METHODS In March-April of 2021, we conducted semistructured qualitative phone interviews with administrators at 17 health care organizations that ranged from multi-state nonfederal delivery systems to single-site primary care practices. Organizations differed in size, structure, ownership, and geography. We explore how health care administrators anticipate their organization will offer virtual primary care services after the COVID-19 pandemic subsides. RESULTS All interviewed administrators expected virtual primary care services to persist after the pandemic. We categorize expected impact of future virtual services as limited (n = 4); targeted to a narrow set of clinical encounters (n = 5); and a major shift in primary care delivery (n = 8). The underlying motivation expressed by administrators for providing virtual care services was to remain financially stable and competitive. This motivation can be seen in the 3 main goals described for their anticipated use of virtual services: (1) optimizing medical services; (2) enhancing the patient experience; and (3) increasing loyalty among patients. CONCLUSIONS Health care organizations are considering how virtual primary care services can be used to improve patient outcomes, access to care, and convenience of care. To implement and sustain virtual primary care services, health care organizations will need long-term support from regulators and payers.
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Oermann EK, Riina HA. Editorial. The future of stroke care is remote and now. J Neurosurg 2022; 136:990-991. [PMID: 34560649 DOI: 10.3171/2021.1.jns21227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Howard A Riina
- Departments of1Neurosurgery
- 3Neurology, New York University, New York, New York
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Demaerschalk BM, Aguilar MI, Ingall TJ, Dodick DW, Vargas BB, Channer DD, Boyd EL, Kiernan TE, Fitz-Patrick DG, Collins JG, Hentz JG, Noble BN, Wu Q, Brazdys K, Bobrow BJ. Stroke Telemedicine for Arizona Rural Residents, the Legacy Telestroke Study. TELEMEDICINE REPORTS 2022; 3:67-78. [PMID: 35720454 PMCID: PMC9052207 DOI: 10.1089/tmr.2022.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Efficacy of telemedicine for stroke was first established by the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trials in California and Arizona. Following these randomized controlled trials, the Stroke Telemedicine for Arizona Rural Residents (STARR) network was the first telestroke network to be established in Arizona. It consisted of a 7 spoke 1 hub telestroke system, and it was designed to serve rural, remote, or neurologically underserved communities. OBJECTIVE The objective of STARR was to establish a multicenter state-wide telestroke research network to determine the feasibility of prospective collection, recording, and regularly analysis of telestroke patient consultations and care data for the purposes of establishing quality measures, improvement, and benchmarking against other national and international telestroke programs. METHODS The STARR trial was open to enrollment for 29 months from 2008 to 2011. Mayo Clinic Hospital, Phoenix, Arizona served as the hub primary stroke center and its vascular neurologists provided emergency telestroke consultations to seven participating rural, remote, or underserved spoke community hospitals in Arizona. Eligibility criteria for activation of a telestroke alert and study enrollment were established. Consecutive patients exhibiting symptoms and signs of acute stroke within a 12 h window were enrolled, assessed, and treated by telemedicine. The state government sponsor, Arizona Department of Health Services' research grant covered the cost of acquisition, maintenance, and service of the selected telemedicine equipment as well as the professional telestroke services provided. The study deployed multiple telemedicine video cart systems, picture archive and communications systems software, and call management solutions. The STARR protocol was reviewed and approved by Mayo Clinic IRB, which served as the central IRB of record for all the participating hospitals, and the trial was registered at ClinicalTrials.gov. RESULTS The telestroke hotline was activated 537 times, and ultimately 443 subjects met criteria and consented to participate. The STARR successfully established a multicenter state-wide telestroke research network. The STARR developed a feasible and pragmatic approach to the prospective collection, storage, and analysis of telestroke patient consultations and care data for the purposes of establishing quality measures and tracking improvement. STARR benchmarked well against other national and international telestroke programs. STARR helped set the foundation for multiple regional and state telestroke networks and ultimately evolved into a national telestroke network. CONCLUSIONS Multiple small and rurally located community hospitals and health systems can successfully collaborate with a more centrally located larger hospital center through telemedicine technologies to develop a coordinated approach to the assessment, diagnosis, and emergency treatment of patients manifesting symptoms and signs of an acute stroke syndrome. This model may serve well the needs of patients presenting with other time-sensitive medical emergencies.Clinical Trial Registration number: NCT00829361.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
- Center for Connected Care, Mayo Clinic and Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria I. Aguilar
- Neuro Hospitalist and Stroke Program, Penrose/St Francis, Centura Health, Colroado Springs, Colorado, USA
| | - Timothy J. Ingall
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Bert B. Vargas
- Department of Neurology and Neurotherapeutics at University of Texas Southwestern, Dallas, Texas, USA
| | - Dwight D. Channer
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
- Center for Connected Care, Mayo Clinic and Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica L. Boyd
- Department of Research, Mayo Clinic, Phoenix, Arizona, USA
| | - Terri E.J. Kiernan
- Comprehensive Stroke Program, St. Anthony's Hospital, Lakewood, Colorado, USA
| | | | - J. Gregory Collins
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Joseph G. Hentz
- Department of Biostatistics, Mayo Clinic, Phoenix, Arizona, USA
| | - Brie N. Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, Oregon, USA
| | - Qing Wu
- School of Public Health and Nevada Institute of Personalized Medicine at the University of Nevada, Las Vegas, Nevada, USA
| | - Karina Brazdys
- Clinical Research Practice, Los Angeles, California, USA
| | - Bentley J. Bobrow
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
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39
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Patra DP, Demaerschalk BM, Chong BW, Krishna C, Bendok BR. A Renaissance in Modern and Future Endovascular Stroke Care. Neurosurg Clin N Am 2022; 33:169-183. [DOI: 10.1016/j.nec.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prust M, Saylor D, Zimba S, Sarfo FS, Shrestha GS, Berkowitz A, Vora N. Inpatient Management of Acute Stroke of Unknown Type in Resource-Limited Settings. Stroke 2022; 53:e108-e117. [PMID: 35045720 PMCID: PMC8885836 DOI: 10.1161/strokeaha.121.037297] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is the second leading cause of death and disability worldwide, with a disproportionate burden on low- and middle-income countries. Critical elements of guideline-based stroke care developed in high-income countries are not applicable to resource-limited settings, where lack of access to neuroimaging prevents clinicians from distinguishing between ischemic stroke and intracranial hemorrhage, requiring challenging clinical decision-making, particularly in the acute setting. We discuss strategies for acute inpatient management of stroke of unknown type with a focus on blood pressure management and antiplatelet therapy when neuroimaging is unavailable, and review some of the challenges and strategies for successfully implementing stroke unit care in resource-limited health care settings.
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Affiliation(s)
| | - Deanna Saylor
- Johns Hopkins University Hospital, Baltimore, MD, USA,University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Aaron Berkowitz
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Nirali Vora
- Stanford University Medical Center, Stanford, CA, USA
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Firmawati E, Setyopanoto I, Pangastuti HS. Mobile Health Application to Support Family Caregivers in Recurrent Stroke Prevention: Scoping Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2021.7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND OF THE STUDY: Caregivers play a vital role in continuum care for stroke patients. Involvement of caregivers in stroke care was important. With the advancement of information technology and the rapid growth worldwide in cell-phone use and internet connectivity, additional evidence may be needed in the use of mobile applications to support caregivers in stroke care.
AIM OF THE STUDY: The aims of this review was to identify existing mobile application designed to support family caregivers of people with stroke disease.
METHODOLOGY: A scoping review study framework was carried out in this study, using the EBSCO, Cochrane, PubMed, ProQuest, and Science Direct databases using search keywords: ‘family caregiver’, ‘mobile health application’, and ‘recurrent stroke or secondary stroke prevention’. This review examined studies published between January 2011 and December 2020. Of a total of 728 papers found, 9 journals were selected. RESULTS: The results founded three categories and their attendant sub-categories. The categories was caregivers support, involvement caregivers in stroke care, and barriers. The majority of mobile application was used to provide video education for caregivers. Caregivers involved in stroke care including emotional care, nutrition, exercise, and recurrent stroke prevention. Poor connection was the most barrier in using mobile application.
CONCLUSION: Mobile application can support caregivers in stroke care. Healthcare providers are expected to utilize mobile applications in helping caregivers in post-stroke care.
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Anjum MR, Chalmers J, Hamid R, Rajoriya N. COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future. World J Gastroenterol 2021; 27:7625-7648. [PMID: 34908803 PMCID: PMC8641058 DOI: 10.3748/wjg.v27.i44.7625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus 'coronavirus disease 2019 (COVID-19)'. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all 'non-urgent' services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care.
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Affiliation(s)
- Muhammad Raheel Anjum
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton WV100QP, United Kingdom
| | - Jodie Chalmers
- Department of Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
| | - Rizwana Hamid
- Department of Gastroenterology, Royal Alexandria Hospital, Paisley PA2 9PJ, Scotland, United Kingdom
| | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, United Kingdom
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Tumma A, Berzou S, Jaques K, Shah D, Smith AC, Thomas EE. Considerations for the Implementation of a Telestroke Network: A Systematic Review. J Stroke Cerebrovasc Dis 2021; 31:106171. [PMID: 34735902 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106171] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/14/2021] [Accepted: 10/10/2021] [Indexed: 12/18/2022] Open
Abstract
The application of telestroke has matured considerably since its inception in 1999. The use of telestroke is now recommended in several published guidelines. Consequently, jurisdictions without a telestroke service are seeking practical information on the best approach to implement telestroke. French et al. (2013) reviewed the challenges of implementing a telestroke network including studies between 2000 and 2010. At the time, telestroke networks were largely limited to the UK, USA, Canada and Europe and only one process evaluation had been conducted. Given the prolific expansion of telestroke services since 2010, we conducted a systematic review to determine factors associated with successful establishment, management, and sustainability of a contemporary telestroke services. A comprehensive search of telestroke studies was conducted in July 2021. Empirical studies published between 2010 and 2021 were included if they contained descriptive, evaluation or operational data on the implementation of a telestroke network. Studies were subsequently evaluated using the Consolidated Framework for Implementation Research (CFIR). The initial literature search revealed a total of 7415 potential studies; 38 of which met the inclusion criteria. The past decade of process evaluation studies has enabled a more nuanced investigations into how to implement and sustain a telestroke network. Pre-implementation planning is crucial to ensure clear telestroke processes, governance structures and stakeholder engagement. Sustainability of networks relies on securing long-term investment, providing adequate resources, and maintaining staff motivation and willingness. Recommendations are provided to overcome commonly identified barriers related to technology, staffing, planning and standardisation of processes, evaluation, and sustainability and scale-up. Further research needs to explore how new advancements in stroke care such as endovascular clot retrieval (EVT) and advanced brain imaging can be considered and planned for during the implementation of a new telestroke service.
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Affiliation(s)
- Abishek Tumma
- Department of Medicine, Queensland Health, Logan Hospital, Brisbane, Australia
| | - Souad Berzou
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Katherine Jaques
- Queensland Health, Clinical Excellence Queensland, Brisbane Australia
| | - Darshan Shah
- Department of Neurology, Queensland Health, Gold Coast University Hospital, Gold Coast, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia; Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
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Davoodi NM, Chen K, Zou M, Li M, Jiménez F, Wetle TF, Goldberg EM. Emergency physician perspectives on using telehealth with older adults during COVID-19: A qualitative study. J Am Coll Emerg Physicians Open 2021; 2:e12577. [PMID: 34693401 PMCID: PMC8516338 DOI: 10.1002/emp2.12577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Emergency medicine physicians have played a pivotal role throughout the coronavirus disease 19 (COVID-19) pandemic through in-person and remote management and treatment. Our primary objectives were to understand emergency medicine physicians' experiences using telehealth throughout the pandemic, any facilitators/barriers to successful usage, lessons learned during implementation, and successful/abandoned strategies used to engage with older adults. METHODS Using a semi-structured interview guide, we conducted 30-min interviews. We used purposeful sampling to recruit emergency medicine physicians from all United States regions, rural-urban settings, and academic and community practices, who reported caring for patients 65 years or older in-person or virtually during the pandemic. Interviews were audio-recorded, transcribed, double-coded, and analyzed for emergent themes using framework analysis. RESULTS A total of 15 in-depth interviews were completed from September to November 2020. Physicians had a median age of 37 years, 7 were women, and 9 had experience with telehealth before the pandemic. We identified several themes: (1) there were various motivations for telehealth use; (2) telehealth was used primarily to supplement, not replace in-person care; (3) most platforms were easy to use; (4) patients and caregivers had high acceptability of telemedicine; and (5) older adults with sensory and cognitive impairments often relied on caregivers. Emergency medicine physicians played a critical role during primary care office closures during the first wave-dispelling misinformation about COVID-19, triaging patients to testing and treatment, and providing care that would otherwise have been deferred. CONCLUSIONS Our data show that telemedicine gained acceptability among emergency medicine physicians and provided options to patients who may have otherwise deferred care. These findings can inform future healthcare delivery for acute care needs or pandemic responses.
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Affiliation(s)
| | - Kevin Chen
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Maria Zou
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Melinda Li
- The Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Frances Jiménez
- School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Terrie Fox Wetle
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Center for Gerontology and Healthcare ResearchBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Elizabeth M. Goldberg
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Department of Emergency MedicineThe Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Almubark BM, Majrashi N, Alghusun N, Alhammad M, Alhthifi F, Alyahya RSW. Telehealth Clinical Practice Guide for Occupational Therapy, Physical Therapy, and Speech and Language Pathology: A Saudi and Middle Eastern Guide. Telemed J E Health 2021; 28:636-642. [PMID: 34529497 DOI: 10.1089/tmj.2021.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Telehealth refers to the application of telecommunications technology to deliver clinical services at a distance by linking clinician to patient, caregiver, or any person(s) involved in client care for assessment, intervention, consultation, and supervision. Telehealth for occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP) have produced service delivery venues that are of great benefit during the coronavirus disease 2019 pandemic. The concept of telehealth for rehabilitation services is relatively new in the Middle East, and no specialty-specific clinical practice standards or guidelines are published to guide the rehabilitation practitioners. Therefore, a specialty-specific telehealth practice guide for rehabilitation practitioners has been developed by an expert panel in the field of rehabilitation. This guide is documented in this article. Such a guide will be beneficial when providing tele-evaluation, teleintervention/telerehabilitation, teleconsultation, and telemonitoring through communication technologies. The purpose of this guide is to enable understanding of core telehealth clinical principles and aid the provision of OT, PT, and SLP telehealth services in Saudi Arabia. Also, the guide can potentially be implemented in other Middle Eastern countries. The guide is based on key telehealth guidelines involving the American Occupational Therapy Association telehealth resources, American Physical Therapy Association, American Speech and Hearing Association, telemedicine policies in Saudi Arabia by the national health information center at the Saudi Health Council, and a blueprint for telerehabilitation guidelines that are based on the American Telemedicine Association's Core Standards for Telemedicine Operations.
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Affiliation(s)
- Bazah M Almubark
- Occupational Therapy Unit, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Norah Alghusun
- Department of Communication and Swallowing Disorders, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Faisal Alhthifi
- Rehabilitation Services, Al Qassim University, Qassim, Saudi Arabia
| | - Reem S W Alyahya
- Department of Communication and Swallowing Disorders, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, Alfaisal University, Saudi Arabia
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Choi J, Petrone A, Adcock A. A Case for the Non-Neurologist Telestroke Provider. Front Neurol 2021; 12:651519. [PMID: 34421782 PMCID: PMC8377720 DOI: 10.3389/fneur.2021.651519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. We hypothesize that rates of tPA recommendation, sensitivity of final diagnosis, and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations. Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center over 1 year. Statistical analysis: Chi squared test. Results: Three hundred and three consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non-stroke-trained neurologists, and 59% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine-trained, stroke neurology-trained and other neurology- trained provider groups, respectively (p = 0.427). Sensitivity of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group. Discussion/Conclusion: Our results did not illustrate any statistically significant difference between care provided by an emergency medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore, may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.
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Affiliation(s)
- Justin Choi
- School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Ashley Petrone
- Department of Neurology, West Virginia University Hospitals, Morgantown, WV, United States
| | - Amelia Adcock
- Department of Neurology, West Virginia University Hospitals, Morgantown, WV, United States.,Department of Neurology, Mayo Clinic, Phoenix, AZ, United States
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Carlin R, Zhang N, Demaerschalk BM. Validation of the Telestroke Mimic Score in Mayo Clinic population. J Stroke Cerebrovasc Dis 2021; 30:106021. [PMID: 34388405 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/03/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Telestroke consultations enable hospital providers to administer intravenous (IV) alteplase to patients who would otherwise not receive it due to lack of an in-hospital stroke team. However, up to 30% of acute stroke patient evaluations are deemed to be stroke mimics. Mimics present a challenge with the limitations of a virtual neurological exam. The administration of IV alteplase in these patients is not without risk. With the cost and risk associated with IV alteplase, there are both ethical and practical incentives to avoid administering alteplase to a patient manifesting a stroke-mimic. Recently a retrospective analysis validated a TeleStroke Mimic Score (TM-Score) to help detect stroke mimics. We retrospectively applied this tool to Mayo Clinic Stroke Telemedicine for Arizona Rural Residents (STARR) telestroke database to provide external validation in an independent study population. MATERIALS AND METHODS We analyzed 339 patients in the STARR database for validation of the TM-Score, which was applied retrospectively to determine whether it predicted stroke-mimic, using data available during each patient's telestroke consult. We assessed the TM-Score's performance with a receiver-operating characteristic (ROC) curve. A scatter plot of the data was assembled to demonstrate the relationship between the TM-Score and the likelihood of having a stroke mimic, and was compared to the nomogram in the original TM-Score study. RESULTS When the TM-Score was applied to Mayo Clinic STARR validation cohort, the area under the ROC curve was 0.78, larger than that of the derivation cohort in the original study (0.75). Further analysis suggested that a TM-Score > 25 or < 10 provided a greater degree of confidence that the patient had presented with stroke or stroke mimic, respectively. In STARR cohort, additional variables were significantly different between stroke and stroke mimic populations, including a history of sleep apnea and diabetes. CONCLUSIONS We determined that the original TM-Score was valid when applied to Mayo Clinic STARR telestroke population.
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Affiliation(s)
- Rachel Carlin
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, US.
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic College of Medicine and Science, Phoenix, AZ, US.
| | - Bart M Demaerschalk
- Department of Neurology, Center for Connected Care, Center for Digital Health, Rochester, MN, US; Mayo Clinic College of Medicine and Science, Phoenix, AZ, US.
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Sikka V, Somma SD, Galwankar SC, Sinha S, Garg N, Talwalkar N, Garg S, Mahajan P, Chauhan V, Moreno-Walton L, Dubhashi S, Dutta V, Saddikuti V, B. Nanayakkara PW, Grover J, Paranjape K, Singh S, Sharma P, Bhoi S, Sinha T, Stawicki SP, Garg M, Sardesai I. The World Health Organization Collaborating Center for Emergency and Trauma (WHO-CCET) in South East Asia, The World Academic Council of Emergency Medicine (WACEM), and The American College of Academic International Medicine (ACAIM) 2021 Framework for using Telemedicine Technology at Healthcare Institutions. J Emerg Trauma Shock 2021; 14:173-179. [PMID: 34759635 PMCID: PMC8527056 DOI: 10.4103/jets.jets_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 crisis has forced the world to integrate telemedicine into health delivery systems in an unprecedented way. To deliver essential care, lawmakers, physicians, patients, payers, and health systems have all adopted telemedicine and redesigned delivery processes with accelerated speed and coordination in a fragmented way without a long-term vision or uniformed standards. There is an opportunity to learn from the experiences gained by this pandemic to help shape a better health-care system that standardizes telemedicine to optimize the overall efficiency of remote health-care delivery. This collaboration focuses on four pillars of telemedicine that will serve as a framework to enable a uniformed, standardized process that allows for remote data capture and quality, aiming to improve ongoing management outside the hospital. In this collaboration, we recommend learning from this experience by proposing a telemedicine framework built on the following four pillars-patient safety and confidentiality; metrics, analytics, and reform; recording of audio-visual data as a health record; and reimbursement and accountability.
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Affiliation(s)
- Veronica Sikka
- Clinical Contact Center, VA Sunshine Healthcare Network 8, St. Petersburg, Florida, USA
| | - Salvatore Di Somma
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Sagar C. Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, Florida, USA
| | - Sagar Sinha
- Department of Emergency Medicine and Critical Care, MGM Medical College and Hospital, MGMIHS, Mumbai, India
| | - Nidhi Garg
- Director of Emergency Medicine Research, South Shore University Hospital/Northwell Health; Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Bay Shore, New York, USA
| | - Neilesh Talwalkar
- Bombay Hospital and Medical Research Center, Breach Candy Hospital, Mumbai, India
| | - Sona Garg
- Chief Medical Officer,S Holistic Family Medicine, US
| | - Prashant Mahajan
- Department of Emergency Medicine, CS Mott Children's Hospital of Michigan, Ann Arbor, Michigan, USA
| | - Vivek Chauhan
- Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
| | - Lisa Moreno-Walton
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Siddharth Dubhashi
- Department of Surgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vibha Dutta
- Department of Director and CEO, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Prabath W. B. Nanayakkara
- Location VU University Medical Center, General Internal Medicine, Acute Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joydeep Grover
- Department of Emergency Medicine, Southmead Hospital, Bristol, England, United Kingdom
| | - Ketan Paranjape
- Location VU University Medical Center, General Internal Medicine, Acute Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sarman Singh
- Director, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pushpa Sharma
- Department of Anaesthesiology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, WHO Collaborating Center for Emergency and Trauma, AIIMS, New Delhi, India
| | - Tejprakash Sinha
- Department of Emergency Medicine, JPN Apex Trauma Center, WHO Collaborating Center for Emergency and Trauma AIIMS, New Delhi, India
| | - Stanislaw P. Stawicki
- Department of Research an Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Manish Garg
- Departments of Emergency Medicine, New York Presbyterian, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Indrani Sardesai
- Department of Emergency Medicine, Queen Elizabeth Hospital, Gateshead, England, United Kingdom
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Quality and safety of Telemedicine in acute ischemic stroke: Early experience in Taiwan. J Formos Med Assoc 2021; 121:314-318. [PMID: 33994236 DOI: 10.1016/j.jfma.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Telemedicine helps to provide the safe management of stroke patients in the emergency department (ED) and has been used worldwide. However, we had limited experience of telestroke in Taiwan. We aimed to identify the quality of telestroke and compare it with the original face-to-face consultation model. METHODS Among 178 consecutive acute ischemic stroke patients treated with intravenous tissue plasminogen activator (IVtPA) from January 1, 2018, to December 31, 2019, we compared two different consultation methods: face-to-face consultation and telestroke consultation. We collected data on demographics, the National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS) scores, time measurements (onset-to-arrival time, onset-to-telestroke activation time, and time of IVtPA administration (Door-to-Needle; DTN)). RESULTS The mean age to receive a telestroke consultation was 66.6 years, 36% were female, and the median NIHSS score was 9. The median time from patient arrival to telestroke consult activation was 40 min, and the median DTN time was 11 min longer than for face-to-face consults (62 min versus 51 min, p = .01). Telestroke consultation, similar to a face-to-face consultation, resulted in safe IVtPA eligibility assessments and administration with post-thrombolysis ICH in 4% overall (4% telestroke, 3% face-to-face consultation; p = .851). The 90-day outcomes were not different for mRS score, dichotomized 0-2 (60% telestroke 59% face-to-face consultation; p = .961), or for mortality (16% telestroke, 9% face-to-face consultation; p = .292). CONCLUSION In the ED, consultation via the telestroke program provides equal quality to the original face-to-face consultation model to manage ischemic stroke.
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Shah ND, Krupinski EA, Bernard J, Moyer MF. The evolution and utilization of telehealth in ambulatory nutrition practice. Nutr Clin Pract 2021; 36:739-749. [PMID: 33734469 DOI: 10.1002/ncp.10641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The term telehealth is often used interchangeably with telemedicine. Telemedicine involves the electronic exchange of medical information between two remote sites for the optimization of patient care, whereas telehealth is the application of all electronic communication and delivery systems in the provision of healthcare. Telehealth gives patients an opportunity to communicate with their healthcare providers and, overall, access ambulatory care that otherwise is not available in their area of residence. Several telehealth delivery systems are available for electronic communication. Telehealth and other communications technologies used in the delivery of healthcare services are regulated at both the federal and state levels. Coverage and payment policies vary among the different insurers (e.g., Medicare, Medicaid, and private plans), and policies may further be defined by state telehealth parity laws. Telenutrition involves the use of digital technology to provide nutrition care to patients and caregivers and shows potential to optimize nutrition care and outcomes. The coronavirus disease 2019 pandemic has contributed to sweeping legislative and regulatory changes that allowed the temporary expansion of telehealth delivery and reimbursement to maintain continuity of care for patients who were not able to come in for an in-person office visit with their healthcare provider. The purpose of this review is to introduce key concepts of telehealth delivery systems including policy, legal, and regulatory considerations for ambulatory care as well as the role of telenutrition in nutrition care, and highlight the evolving role of telehealth in optimizing patient and nutrition care during a pandemic and beyond.
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Affiliation(s)
- Neha D Shah
- Department of Nutrition and Food Services, University of San Francisco, San Francisco, California, USA.,Neha Shah Nutrition, San Francisco, California, USA
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | | | - Meagan F Moyer
- Department of Clinical Nutrition Services, Stanford Health Care, Stanford, California, USA
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