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Bassa B, Hahner F, Braun S, Meyding-Lamadé U. [Telemedicine and international projects: from Asia to Africa: chances for the future?]. DER NERVENARZT 2024; 95:236-241. [PMID: 38240820 DOI: 10.1007/s00115-023-01605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/06/2024]
Abstract
Although the morbidity and mortality of neurological diseases in many Asian and African countries is high and are predicted to increase even further in the coming decades, in many areas there is a shortage of medical personnel and high-quality treatment options. This shortage, together with a frequently insufficient healthcare infrastructure, limits the access of many patients to medical treatment. The possibilities of telemedicine are multifarious. It provides new, so far unused possibilities in the diagnostics and treatment of neurological diseases, totally independent of geographical boundaries. In the future it could also be used for the education and training of physicians and medical personnel and to close the existing gaps in healthcare, especially in developing countries.
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Affiliation(s)
- B Bassa
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland.
| | - F Hahner
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland
| | - S Braun
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Sambia
| | - U Meyding-Lamadé
- Klinik für Neurologie, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Deutschland
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Muacevic A, Adler JR, Faheem F, Bhatti D, Kalia JS. Medical Education 4.0: A Neurology Perspective. Cureus 2022; 14:e31668. [PMID: 36545165 PMCID: PMC9762427 DOI: 10.7759/cureus.31668] [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] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Medical education faces a difficult challenge today; an exponential increase in knowledge and the rise and rise of disruptive technologies are making traditional education obsolete. As the world nears the era of Industry and Healthcare 4.0, the medical community needs to keep up and prepare physicians for a hyper-connected digital world. Virtual neurological care is poised to be at the forefront of care delivery claims, yet the virtual communication of neurological knowledge is still in its infancy. This increasing digitalization of care and education is both an opportunity and a challenge. With this paper, the authors aim to bridge the gap between technology and neurological education. After a thorough review of recent literature and assessing current trends, the authors propose that contemporary medical education must adhere to the following tenets: Hybrid, Mobile, Mixed-reality, Open Access, Collaborative, Peer-reviewed, Intelligent, Game-based, and Global. We identify and align education objectives with the needs of future digital neurologists. The authors also discuss real-world advances that are aligned to serve the next generation of patients and providers.
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3
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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: 1] [Impact Index Per Article: 0.5] [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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Heemskerk JL, Domingo RA, Tawk RG, Vivas-Buitrago TG, Huang JF, Rogers A, Quinones-Hinojosa A, Abode-Iyamah K, Freeman WD. Time Is Brain: Prehospital Emergency Medical Services Response Times for Suspected Stroke and Effects of Prehospital Interventions. Mayo Clin Proc 2021; 96:1446-1457. [PMID: 33714603 DOI: 10.1016/j.mayocp.2020.08.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time. PATIENTS AND METHODS A retrospective analysis was performed using data from Florida's Emergency Medical Services Tracking and Reporting System database. All patients with suspected stroke transported to a treatment center from January 1, 2018, through December 31, 2018, were analyzed. Time intervals from 911 call to hospital arrival were evaluated and compared with ASA benchmarks. RESULTS In 2018, 11,577 patients with suspected stroke were transported to a hospital (mean age, 71.5±15.7 years; 51.5% women). The median alarm-to-hospital time was 33.98 minutes (27.8 to 41.4), with a total emergency medical services (EMS) time of 32.30 minutes (26.5 to 39.478). The on-scene time was the largest time interval with a median of 13.28 minutes (10.0 to 17.4). Emergency medical services encounters met the ASA benchmarks for time in 58% to 62% of the EMS encounters in Florida (recommended 90%; P<.001). The total EMS time was reduced when a stroke notification was reported by the dispatch center (32.00 minutes vs 32.62 minutes; P=.006) or when a stroke assessment scale was used by the EMS personnel (31.88 minutes vs 32.96 minutes; P=.005). CONCLUSION This study reveals a substantial opportunity for improvement in stroke care in Florida. Two prehospital EMS stroke interventions seem to reduce prehospital time for patients with suspected stroke. Adoption of these interventions might improve the stroke systems of care.
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Affiliation(s)
| | | | - Rabih G Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL
| | | | | | - Ashley Rogers
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | | | | | - William D Freeman
- Department of Neurological Surgery, Neurology, and Critical Care Medicine, Mayo Clinic, Jacksonville, FL.
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Guzik AK, Martin-Schild S, Tadi P, Chapman SN, Al Kasab S, Martini SR, Meyer BC, Demaerschalk BM, Wozniak MA, Southerland AM. Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2021; 30:105802. [PMID: 33866272 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105802] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 12/22/2022] Open
Abstract
While use of telemedicine to guide emergent treatment of ischemic stroke is well established, the COVID-19 pandemic motivated the rapid expansion of care via telemedicine to provide consistent care while reducing patient and provider exposure and preserving personal protective equipment. Temporary changes in re-imbursement, inclusion of home office and patient home environments, and increased access to telehealth technologies by patients, health care staff and health care facilities were key to provide an environment for creative and consistent high-quality stroke care. The continuum of care via telestroke has broadened to include prehospital, inter-facility and intra-facility hospital-based services, stroke telerehabilitation, and ambulatory telestroke. However, disparities in technology access remain a challenge. Preservation of reimbursement and the reduction of regulatory burden that was initiated during the public health emergency will be necessary to maintain expanded patient access to the full complement of telestroke services. Here we outline many of these initiatives and discuss potential opportunities for optimal use of technology in stroke care through and beyond the pandemic.
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Affiliation(s)
- Amy K Guzik
- Department of Neurology, Wake Forest University, Winston-Salem, NC, USA.
| | - Sheryl Martin-Schild
- Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA
| | - Prasanna Tadi
- Department of Neurology, Creighton University, Omaha, NE, USA
| | - Sherita N Chapman
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Sharyl R Martini
- Department of Neurology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Brett C Meyer
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Bart M Demaerschalk
- Department of Neurology, Center for Connected Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew M Southerland
- Department of Neurology, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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De Biase G, Freeman WD, Bydon M, Smith N, Jerreld D, Pascual J, Casler J, Hasse C, Quiñones-Hinojosa A, Abode-Iyamah K. Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future? Mayo Clin Proc Innov Qual Outcomes 2020; 4:736-744. [PMID: 33324948 PMCID: PMC7728424 DOI: 10.1016/j.mayocpiqo.2020.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To describe telemedicine utilization in neurosurgery at a single tertiary institution to provide outpatient care during the coronavirus disease 2019 (COVID-19) pandemic, with 315 telemedicine visits performed by the neurosurgery department. PATIENTS AND METHODS In response to the COVID-19 pandemic national stay-at-home orders and postponed elective surgeries, we converted upcoming clinic visits into telemedicine visits and rescheduled other patients thought not to be markedly affected by surgical postponement. We reviewed the charts of all patients who had telehealth visits from April 1 through April 30, 2020, and collected demographic information, diagnosis, type of visit, and whether they received surgery; a satisfaction questionnaire was also administered. RESULTS In March 2020, 94% (644 of 685) of the neurosurgery clinic visits were face-to-face, whereas in April 2020, 55% (315 of 573) of the visits were telemedicine (P<.001). In April, of the 315 telemedicine visits, 172 (55%) were phone consults and 143 (45%) video consults; 101 (32%) were new consults, 195 (62%) return visits, and 18 (6%) postoperative follow-up. New consults were more likely to be video with audio than return visits and postoperative follow-up (P<.001). Only 39 patients (12%) required surgery. Ninety-one percent of the questionnaire respondents were very likely to recommend telemedicine. CONCLUSION Rapid implementation of telemedicine to evaluate neurosurgery patients became an effective tool for preoperative consultation, postoperative and follow-up visits during the COVID-19 pandemic, and decreased risks of exposure to severe acute respiratory syndrome coronavirus 2 to patients and health care staff. Future larger studies should investigate the cost-effectiveness of telemedicine used to triage surgical from nonsurgical patients, potential cost-savings from reducing travel burdens and lost work time, improved access, reduced wait times, and impact on patient satisfaction.
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Affiliation(s)
| | - William D. Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
- Department of Neurocritical Care, Mayo Clinic, Jacksonville, FL
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Nathan Smith
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | - Daniel Jerreld
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | - Jorge Pascual
- Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - John Casler
- Department of Otolaryngology, Mayo Clinic, Jacksonville, FL
| | - Chris Hasse
- Department of Surgery, Mayo Clinic, Jacksonville, FL
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Zha AM, Chung LS, Song SS, Majersik JJ, Jagolino-Cole AL. Training in Neurology: Adoption of resident teleneurology training in the wake of COVID-19: Telemedicine crash course. Neurology 2020; 95:404-407. [PMID: 32554768 DOI: 10.1212/wnl.0000000000010029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The coronavirus disease 2019 pandemic has changed the way we engage patient care, with a move toward telemedicine-based health care encounters. Teleneurology is now being rapidly embraced by neurologists in clinics and hospitals nationwide but for many, this paradigm of care is unfamiliar. Exposure to telemedicine in neurology training programs is scarce despite previous calls to expand teleneurology education. Programs that provide a teleneurology curriculum have demonstrated increased proficiency, accuracy, and post-training utilization among their trainees. With the current changes in health care, broad incorporation of teleneurology education in resident and fellow training after this pandemic dissipates will only serve to improve trainee preparedness for independent practice.
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Affiliation(s)
- Alicia M Zha
- From the Department of Neurology (A.M.Z., A.L.J.-C.), Institute of Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston; Department of Neurology (L.S.C., J.J.M.), University of Utah, Salt Lake City; and Department of Neurology (S.S.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lee S Chung
- From the Department of Neurology (A.M.Z., A.L.J.-C.), Institute of Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston; Department of Neurology (L.S.C., J.J.M.), University of Utah, Salt Lake City; and Department of Neurology (S.S.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlee S Song
- From the Department of Neurology (A.M.Z., A.L.J.-C.), Institute of Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston; Department of Neurology (L.S.C., J.J.M.), University of Utah, Salt Lake City; and Department of Neurology (S.S.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer J Majersik
- From the Department of Neurology (A.M.Z., A.L.J.-C.), Institute of Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston; Department of Neurology (L.S.C., J.J.M.), University of Utah, Salt Lake City; and Department of Neurology (S.S.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Amanda L Jagolino-Cole
- From the Department of Neurology (A.M.Z., A.L.J.-C.), Institute of Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston; Department of Neurology (L.S.C., J.J.M.), University of Utah, Salt Lake City; and Department of Neurology (S.S.S.), Cedars-Sinai Medical Center, Los Angeles, CA.
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Kwon YS, Tabakin AL, Patel HV, Backstrand JR, Jang TL, Kim IY, Singer EA. Adapting Urology Residency Training in the COVID-19 Era. Urology 2020; 141:15-19. [PMID: 32339555 PMCID: PMC7194676 DOI: 10.1016/j.urology.2020.04.065] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Young Suk Kwon
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Thomas L Jang
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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