عنوان مقاله
کاربرد تله نورولوژی برای ارتقاء روند مراقبت از سکته در نواحی روستایی: تله پزشکی در سکته در پروژه(Swabia (TESS
فهرست مطالب
چکیده
مقدمه
افراد و روشها
نتایج
بحث
بخشی از مقاله
سهم های وابسته در مدیریت سکته توسط پزشکان محلی و نورولوژیست ها در کلیه طبقات رتبه بندی گردید. در طبقه کار تشخیصی، رتبه بندی ها از 41 درصد تا 80 درصد ، برای پزشکان محلی و از 37 تا 79 درصد برای نورولوژیست ها متغیر بود. در طبقه ارزیابیCT ، رتبه بندی سهم های وابسته از 21 درصد تا 47 درصد برای پزشکان محلی و از 6 درصد تا 48 درصد برای نورولوژیست ها متغیر بود. برای طبقه تصمیمات درمانی، این نسبت یکسان بود.
کلمات کلیدی:
Teleneurology to Improve Stroke Care in Rural Areas The Telemedicine in Stroke in Swabia (TESS) Project Andreas Wiborg, MD; Bernhard Widder, MD, PhD; for the TESS Study Group Background and Purpose—Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. Methods—Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project). The local physicians are free to present every admitted stroke patient to the Günzburg stroke expert, who can assess the clinical status and CT images, thereafter giving therapeutic recommendations. All teleconsultations are rated concerning transmission quality and relevance of telemedicine for stroke management. Results—A total of 153 stroke patients were examined by teleconsultation. Mean age was 67.5 years. Eighty-seven patients had suffered an ischemic stroke, 9 had an intracerebral hemorrhage, and 17 suffered a transient ischemic attack. Forty patients were revealed to have a diagnosis other than stroke. Duration of teleconsultation was 15 minutes on average. User satisfaction was good concerning imaging and audio quality, and patient satisfaction was very good or good in all cases. Relevant contributions could be made in 75% of the cases concerning diagnostic workup, CT assessment, and therapeutic recommendations. Conclusions—Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances. (Stroke. 2003; 34:2951-2957.) Key Words: stroke, acute stroke assessment stroke management telemedicine During the last decade, the importance of specialized so-called stroke units for acute care and early rehabilitation has been demonstrated. It is especially in rural areas, however, that the implementation of stroke units offering all diagnostic and therapeutic procedures for state-of-the-art stroke management is very costly if the whole population is to gain access to this “maximum” level of stroke care. In regard to this situation, the question arises of whether a telemedicine network connecting general wards in rural community hospitals with a stroke center could improve stroke care significantly by conveying the stroke expertise in the assessment of patients and CT (or MRI) to the emergency physician “on the scene.” First trials with general neurological patients in which a videoconference system was used showed encouraging results.1,2 Even the administration of recombinant tissue plasminogen activator seems possible in a stroke network.3,4 After interrater reliability in assessing both patients and CT scans by teleconsultation was shown to be comparable to the examination on the scene in preliminary studies,5–7 we started a project (Telemedicine in Stroke in Swabia [TESS]) to examine the feasibility, acceptance, and economic conseSee Editorial Comment, page 2957 quences of a telemedicine network including a special stroke training program. Subjects and Methods The 7 cooperating rural community hospitals are all situated in the southern part of Germany in Swabia, where the population outside larger cities is 100 to 150 inhabitants per square kilometer. The first hospital was connected in March 2001 and the last in March 2002 (Table 1). The distance between the hospitals and the stroke unit in Günzburg ranges from 53 to 136 km, with an average transportation time of approximately 80 minutes to reach Günzburg. All hospitals are provided with the possibility of CT scanning and extracranial ultrasound on 24-hour standby, and 3 of them can also offer daytime cerebral MRI. All laboratory examinations (including cerebrospinal fluid analysis), ECG, echocardiography (transthoracic and transesophageal), 24-hour ECG recording, and 24-hour blood pressure recording are available. There is no on-site neurologist available in any of the hospitals. All hospitals were provided with the videoconference system Sony Contact (cost, approximately $8000), consisting of a portable device including a color video camera and microphone that can be connected to a commercial television monitor. Data were transmitted over 3 parallel integrated services digital network (ISDN) lines at
