1
|
Gutiérrez-Zúñiga R, Uclés J, Sánchez-Manso JC, Fuentes B, de Celis E, Ruiz-Ares G, Rodríguez-Pardo J, Rigual R, Casado L, Alonso E, Fernández-Prieto A, Navia P, Álvarez-Muelas A, Marín B, Díez Tejedor E, Alonso de Leciñana M. The use of a smartphone application to improve stroke code workflow metrics: A pilot study in a comprehensive stroke centre. Digit Health 2022; 8:20552076221137252. [PMID: 36406153 PMCID: PMC9669691 DOI: 10.1177/20552076221137252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Timely coordination between stroke team members is of relevance for stroke
code management. We explore the feasibility and potential utility of a
smartphone application for clinical and neuroimaging data sharing for
improving workflow metrics of stroke code pathways, and professionals’
opinions about its use. Methods We performed an observational pilot study including stroke code activations
at La Paz University Hospital in Madrid, from June 2019 to March 2020.
Patients were classified according to the activation or not of the JOIN app
by the attending physician. Clinical data and time-to-procedures were
retrieved from the app or from the hospital records and the Madrid regional
stroke registry as appropriate and compared between both groups. An
anonymous survey collected professionals’ opinions about the app and its
use. Results A total of 282 stroke code activations were registered. The JOIN app was
activated in 111 (39%) cases. They had a significant reduction in
imaging-to-thrombolysis (31 vs 20 min, p = .026) and in door-to-thrombolysis
times (51 vs 36 min, p = .004), with more patients achieving a
door-to-needle time below 45 min (68.8% vs 37.8%, p = .016). About 50% of
the users found the app useful for facilitating the diagnosis and
decision-making; interoperability with clinical files was considered an
opportunity for improvement. Conclusions This pilot study suggests that JOIN helps improve and document workflow
metrics in acute stroke management in a comprehensive stroke centre. These
results support testing JOIN in a prospective randomised study to confirm
its usefulness and the general applicability of the results.
Collapse
Affiliation(s)
- Raquel Gutiérrez-Zúñiga
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Uclés
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Carlos Sánchez-Manso
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena de Celis
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Rigual
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Casado
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elisa Alonso
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andrés Fernández-Prieto
- Section of Neuroradiology, Department of Radiology, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pedro Navia
- Section of Neuroradiology, Department of Radiology, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Álvarez-Muelas
- Section of Neuroradiology, Department of Radiology, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Begoña Marín
- Section of Neuroradiology, Department of Radiology, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez Tejedor
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Centre, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
2
|
Saban M, Myers V, Ben-Shetrit S, Wilf-Miron R. Socioeconomic gradient in COVID-19 vaccination: evidence from Israel. Int J Equity Health 2021; 20:242. [PMID: 34749718 PMCID: PMC8574141 DOI: 10.1186/s12939-021-01566-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Low socioeconomic status (SES) groups have been disproportionately affected by the COVID-19 pandemic. We aimed to examine COVID-19 vaccination rate by neighborhood SES and ethnicity in Israel, a country which has achieved high vaccination rates. Methods Data on vaccinations were obtained from the Israeli Ministry of Health’s open COVID-19 database, for December 20, 2020 to August 31, 2021. Correlation between vaccination rate and neighborhood SES was analyzed. Difference in vaccination rate between the first and second vaccine dose was analyzed by neighborhood SES and ethnicity. Findings A clear socioeconomic gradient was demonstrated, with higher vaccination rates in the higher SES categories (first dose: r = 0.66; second dose: r = 0.74; third dose: r = 0.92). Vaccination uptake was lower in the lower SES groups and in the Arab population, with the largest difference in uptake between Jewish and Arab localities for people younger than 60, and with the gap widening between first and third doses. Conclusions Low SES groups and the Arab ethnic minority demonstrated disparities in vaccine uptake, which were greater for the second and third, compared with the first vaccine dose. Strategies to address vaccination inequity will need to identify barriers, provide targeted information, and include trust-building in disadvantaged communities.
Collapse
Affiliation(s)
- Mor Saban
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Emek Dotan 1, 5262100, Ramat Gan, Israel.
| | - Vicki Myers
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Emek Dotan 1, 5262100, Ramat Gan, Israel
| | | | - Rachel Wilf-Miron
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Emek Dotan 1, 5262100, Ramat Gan, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Komatsu T, Sakai K, Iguchi Y, Takao H, Ishibashi T, Murayama Y. Using a Smartphone Application for the Accurate and Rapid Diagnosis of Acute Anterior Intracranial Arterial Occlusion: Usability Study. J Med Internet Res 2021; 23:e28192. [PMID: 34448716 PMCID: PMC8433940 DOI: 10.2196/28192] [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: 02/24/2021] [Revised: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Telestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy. Objective To investigate whether vascular neurologists can diagnose intracranial large vessel occlusion (LVO) as quickly and accurately using a smartphone application compared to a hospital-based desktop PC monitor. Methods We retrospectively enrolled 108 consecutive patients with acute ischemic stroke in the middle cerebral artery territory who underwent magnetic resonance imaging (MRI) within 24 hours of their stroke onset. Two vascular neurologists, blinded to all clinical information, independently evaluated magnetic resonance angiography and fluid-attenuated inversion recovery images for the presence or absence of LVO in the internal carotid artery and middle cerebral artery (M1, M2, or M3) on both a smartphone application (Smartphone-LVO) and a hospital-based desktop PC monitor (PC-LVO). To evaluate the accuracy of an arterial occlusion diagnosis, interdevice variability between Smartphone-LVO and PC-LVO was analyzed using κ statistics, and image interpretation time was compared between Smartphone-LVO and PC-LVO. Results There was broad agreement between Smartphone-LVO and PC-LVO evaluations regarding the presence or absence of arterial occlusion (Reader 1: κ=0.94; P<.001 vs Reader 2: κ=0.89; P<.001), and interpretation times were similar between Smartphone-LVO and PC-LVO. Conclusions The results indicate the evaluation of neuroimages using a smartphone application can provide an accurate and timely diagnosis of anterior intracranial arterial occlusion that can be shared immediately with members of the stroke team to support the management of patients with hyperacute ischemic stroke.
Collapse
Affiliation(s)
- Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Cewe P, Burström G, Drnasin I, Ohlsson M, Skulason H, Vucica S, Elmi-Terander A, Edström E. Evaluation of a Novel Teleradiology Technology for Image-Based Distant Consultations: Applications in Neurosurgery. Diagnostics (Basel) 2021; 11:diagnostics11081413. [PMID: 34441347 PMCID: PMC8391712 DOI: 10.3390/diagnostics11081413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
In emergency settings, fast access to medical imaging for diagnostic is pivotal for clinical decision making. Hence, a need has emerged for solutions that allow rapid access to images on small mobile devices (SMD) without local data storage. Our objective was to evaluate access times to full quality anonymized DICOM datasets, comparing standard access through an authorized hospital computer (AHC) to a zero-footprint teleradiology technology (ZTT) used on a personal computer (PC) or SMD using national and international networks at a regional neurosurgical center. Image datasets were sent to a senior neurosurgeon, outside the hospital network using either an AHC and a VPN connection or a ZTT (Image Over Globe (IOG)), on a PC or an SMD. Time to access DICOM images was measured using both solutions. The mean time using AHC and VPN was 250 ± 10 s (median 249 s (233–274)) while the same procedure using IOG took 50 ± 8 s (median 49 s (42–60)) on a PC and 47 ± 20 s (median 39 (33–88)) on a SMD. Similarly, an international consultation was performed requiring 23 ± 5 s (median 21 (16–33)) and 27 ± 1 s (median 27 (25–29)) for PC and SMD respectively. IOG is a secure, rapid and easy to use telemedicine technology facilitating efficient clinical decision making and remote consultations.
Collapse
Affiliation(s)
- Paulina Cewe
- Department of Trauma and Musculoskeletal Radiology, Karolinska University Hospital, 171 64 Stockholm, Sweden;
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.O.); (A.E.-T.); (E.E.)
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.O.); (A.E.-T.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
- Correspondence:
| | - Ivan Drnasin
- Image Over Globe, 21000 Split, Croatia; (I.D.); (S.V.)
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.O.); (A.E.-T.); (E.E.)
- Department of Neuroradiology, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Halldor Skulason
- Department of Neurosurgery, Landspitali University Hospital, 101 Reykjavik, Iceland;
| | | | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.O.); (A.E.-T.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.O.); (A.E.-T.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| |
Collapse
|
5
|
Fasen BACM, Borghans RAP, Heijboer RJJ, Hulsmans FJH, Kwee RM. Reliability and accuracy of 3-mm and 2-mm maximum intensity projection CT angiography to detect intracranial large vessel occlusion in patients with acute anterior cerebral circulation stroke. Neuroradiology 2021; 63:1611-1616. [PMID: 33533946 DOI: 10.1007/s00234-021-02659-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the reliability and accuracy of thick maximum intensity projection (MIP) CTA images to detect large-vessel occlusion (LVO) in the anterior circulation in patients with acute stroke. METHODS A total of 140 acute stroke patients (41 with and 99 without LVO) were evaluated by two neuroradiologists for LVO using axial 3-mm and 2-mm MIPs. RESULTS Interobserver agreement was substantial using 3-mm MIPs (ĸ = 0.67) and almost perfect using 2-mm MIPs (ĸ = 0.82). Using 3-mm MIPs, sensitivities were 80.5% and 68.3%, with specificities of 98.0% and 96.0%. Using 2-mm MIPs, sensitivities were 82.9% and 73.2%, with specificities of 98.0% and 99.0%. Sensitivity and specificity of 3 mm and 2 mm MIPs were not statistically significantly different (P ≥ 0.375). The majority of LVOs in the distal intracranial carotid artery, and/or M1-segment were correctly identified: 96.0% (observer 1, 3-mm MIPs), 88.0% (observer 2, 3-mm MIPs), 96.0% (observer 1, 2-mm MIPs), and 96.0% (observer 2, 2 mm MIPs). Using 3-mm MIP images, observers 1 and 2 missed 7/15 (46.7%) and 9/15 (60.0%) of isolated M2-segment occlusions, respectively. Using 2-mm MIP images, observers 1 and 2 missed 5/15 (33.3%) and 6/15 (40.0%) of isolated M2-segment occlusions, respectively. CONCLUSION Thick (2-3 mm) axial MIPs are not useful to detect proximal LVO in the anterior circulation.
Collapse
Affiliation(s)
- Bram A C M Fasen
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Rob A P Borghans
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Roeland J J Heijboer
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Frans-Jan H Hulsmans
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands.
| |
Collapse
|
6
|
A Lightweight Internet Sharing Scheme for Sectional Medical Images according to Existing Hospital Network Facilities and Basic Information Security Rules. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8838390. [PMID: 33354310 PMCID: PMC7737442 DOI: 10.1155/2020/8838390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
Background With the outbreak of COVID-19, large-scale telemedicine applications can play an important role in the epidemic areas or less developed areas. However, the transmission of hundreds of megabytes of Sectional Medical Images (SMIs) from hospital's Intranet to the Internet has the problems of efficiency, cost, and security. This article proposes a novel lightweight sharing scheme for permitting Internet users to quickly and safely access the SMIs from a hospital using an Internet computer anywhere but without relying on a virtual private network or another complex deployment. Methods A four-level endpoint network penetration scheme based on the existing hospital network facilities and information security rules was proposed to realize the secure and lightweight sharing of SMIs over the Internet. A "Master-Slave" interaction to the interactive characteristics of multiplanar reconstruction and maximum/minimum/average intensity projection was designed to enhance the user experience. Finally, a prototype system was established. Results When accessing SMIs with a data size ranging from 251.6 to 307.04 MB with 200 kBps client bandwidth (extreme test), the network response time to each interactive request remained at approximately 1 s, the original SMIs were kept in the hospital, and the deployment did not require a complex process; the imaging quality and interactive experience were recognized by radiologists. Conclusions This solution could serve Internet medicine at a low cost and may promote the diversified development of mobile medical technology. Under the current COVID-19 epidemic situation, we expect that it could play a low-cost and high-efficiency role in remote emergency support.
Collapse
|
7
|
Fasen BACM, Heijboer RJJ, Hulsmans FJH, Kwee RM. Diagnostic performance of single-phase CT angiography in detecting large vessel occlusion in ischemic stroke: A systematic review. Eur J Radiol 2020; 134:109458. [PMID: 33302028 DOI: 10.1016/j.ejrad.2020.109458] [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: 06/13/2020] [Revised: 09/24/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To systematically review the diagnostic performance of single-phase CT angiography (CTA) in detecting intracranial large vessel occlusion (LVO). METHOD MEDLINE and Embase were searched for studies investigating the diagnostic performance of single-phase CTA in detecting LVO. Study quality was assessed. Sensitivity and specificity were calculated and meta-analyzed with a bivariate random-effects model. Heterogeneity was assessed with a chi-squared test. RESULTS Eleven studies were included. High risk of bias with regard to "patient selection", "reference standard", and "flow and timing" was present in 4, 1, and 2 studies, respectively. In 7 studies, it was unclear whether reference tests were interpreted blinded to CTA readings. There was variability in types of vessel segments analyzed, resulting in heterogeneous sensitivity and specificity (P < 0.05). Two studies provided data for the proximal anterior circulation (distal intracranial carotid artery, A1-, A2-, M1- and M2-segments), with pooled sensitivity of 88.4 % (95 % CI: 62.2-97.2 %) and pooled specificity of 98.5 % (95 % CI: 33.2-100 %). One study suggested that multiphase CTA improved agreement between nonexperts and an expert in detecting A1-, A2-, M1-, M2-, and M3-segment occlusions compared to single-phase CTA (ĸ = 0.72-0.76 vs. ĸ = 0.32-0.45). No other included study reported added value of advanced CTA (CT perfusion, 4D-CTA, or multiphase CTA) compared to single-phase CTA in detecting proximal anterior circulation LVO. CONCLUSION There is lack of high-quality studies on the diagnostic performance of single-phase CTA for LVO detection in the proximal anterior circulation. The added value of advanced CTA techniques in detecting proximal anterior circulation LVO is not completely clear yet.
Collapse
Affiliation(s)
- Bram A C M Fasen
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands
| | - Roeland J J Heijboer
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands
| | - Frans-Jan H Hulsmans
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands
| | - Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.
| |
Collapse
|
8
|
Smartphone evaluation of postero-anterior chest x-rays: An inter-observer study. Am J Emerg Med 2020; 46:515-519. [PMID: 33172746 DOI: 10.1016/j.ajem.2020.10.069] [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: 09/11/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Posterior-anterior chest x-ray (PA-CXR) is among the most commonly used imaging methods in the diagnosis both in the emergency departments (ED) and the other clinics. The aim of the present study was to evaluate the diagnostic reliability of PA-CXRs sent via a smartphone. METHODS This study was conducted as an inter-observer study. PA-CXRs were photographed with a smartphone and they were sent to two separate participants (emergency medicine specialists one with 4 years experience and another with 3) via the WhatsApp application. And the participants evaluated to these images on their mobile phone. RESULTS A poor concordance was determined in a ratio of 3/8 and good concordance was detected in a ratio of 3/8 between the two participants (p < 0.05). It was observed that only the mediastinum assessments could be an alternative to the gold standard (p < 0.01). CONCLUSION We may conclude that the assessments done via a smartphone (photographing and sharing) may not be reliable.
Collapse
|
9
|
Sanchez S, Campos Y, Cadena A, Habib S, Deprince M, Chalouhi N, Vibbert M, Urtecho J, Athar MK, Tzeng D, Sheehan L, Bell R, Tjoumakaris S, Jabbour P, Rosenwasser R, Rincon F. Intravenous thrombolysis in the elderly is facilitated by a tele-stroke network: A cross-sectional study. Clin Neurol Neurosurg 2020; 197:106177. [PMID: 32861925 DOI: 10.1016/j.clineuro.2020.106177] [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: 03/21/2019] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Data suggest that elderly patients have less favorable outcomes after ischemic stroke. OBJECTIVE To study the outcomes after intravenous tissue plasminogen activator (tPA) administration in elderly patients with acute ischemic stroke. METHODS Cross-sectional study using prospective collected patient data maintained via our "tele-stroke" network, which provides acute care in 29 community hospitals within our region from 2013-2015. Exposure of interest was age divided into >80 years (octogenarian) or younger. Outcomes of interest were rate of intravenous tPA administration, hemorrhagic transformation (ICH), in-hospital neurological deterioration, and poor outcome defined as a composite of hospital discharge to long-term care facility or death. RESULTS Mean age 67 ± 16 years, 57 % (743/1317) were women, and median (Md) NIHSS was 4 (Interquartile Range [IQR] 8). The rate of tPA was 20 % (267/1317). Compared to reported rates of tPA administration in the nation, our tPA rate exceeded the one from the literature (20 % v 3%, z = 2.83, SE = 0.04, p = .005). There were no differences in ICH or neurological deterioration. The octogenarian group had a higher proportion of poor-outcome (61 % vs. 23 %, p < 0.001) than the younger group but similar in-hospital case-fatality (25 % v 14 %, p = 0.09). Predictors of poor-outcome were age >80 (OR 4.9; CI, 2.0-12, p < .001) and α-NIHSS>9. (OR 8.7; CI, 3.5-20, p < .001). CONCLUSION Our data suggest that in our "tele-stroke" network, rates of tPA administration are higher than those reported in the literature and that this rate was not different in octogenarians compared to younger patients. Octogenarians were not at risk for ICH or neurological deterioration after tPA administration. However, octogenarians had a higher risk of poor outcome.
Collapse
Affiliation(s)
- Sebastian Sanchez
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Yesica Campos
- Department of Neurology, University of Alabama, United States
| | - Angel Cadena
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Sara Habib
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Matthew Vibbert
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - M Kamran Athar
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Diana Tzeng
- Department of Neurology, Thomas Jefferson University, United States
| | - Lori Sheehan
- Department of Neurology, Thomas Jefferson University, United States
| | - Rodney Bell
- Department of Neurology, Thomas Jefferson University, United States
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Fred Rincon
- Department of Neurosurgery, Thomas Jefferson University, United States; Department of Neurology, Thomas Jefferson University, United States.
| |
Collapse
|
10
|
Sakai K, Komatsu T, Iguchi Y, Takao H, Ishibashi T, Murayama Y. Reliability of Smartphone for Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study. J Med Internet Res 2020; 22:e15893. [PMID: 32515744 PMCID: PMC7312257 DOI: 10.2196/15893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background High-quality neuroimages can be viewed using a medical app installed on a smartphone. Although interdevice agreement between smartphone and desktop PC monitor was found to be favorable for evaluating computed tomography images, there are no interdevice agreement data for diffusion-weighted imaging (DWI). Objective The aim of our study was to compare DWI interpretation using the Join smartphone app with that using a desktop PC monitor, in terms of interdevice and interrater agreement and elapsed interpretation time. Methods The ischemic change in the DWI of consecutive patients with acute stroke in the middle cerebral artery territory was graded by 2 vascular neurologists using the Join smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) ≥7 or DWI-ASPECTS <7 according to the Japanese Society for Neuroendovascular Therapy. We analyzed interdevice agreement and interrater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by the Join smartphone app and a desktop PC monitor. Results We analyzed the images of 111 patients (66% male; median age=69 years; median National Institutes of Health Stroke Scale score on admission=4). Interdevice agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable (vascular neurologist 1: κ=0.777, P<.001, vascular neurologist 2: κ=0.787, P<.001). Interrater agreement was also satisfactory for the smartphone (κ=0.710, P<.001) and the desktop PC monitor (κ=0.663, P<.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1: 1.7 min vs 1.6 min; P=.64); vascular neurologist 2: 2.4 min vs 2.0 min; P=.14). Conclusions The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The Join medical smartphone app shows great promise in the management of acute stroke.
Collapse
Affiliation(s)
- Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Yaeger KA, Shoirah H, Kellner CP, Fifi J, Mocco J. Emerging Technologies in Optimizing Pre-Intervention Workflow for Acute Stroke. Neurosurgery 2020; 85:S9-S17. [PMID: 31197335 DOI: 10.1093/neuros/nyz058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Over the last several years, thrombectomy for large vessel occlusions (LVOs) has emerged as a standard of care for acute stroke patients. Furthermore, the time to reperfusion has been identified as a predictor of overall patient outcomes, and much effort has been made to identify potential areas to target in enhancing preintervention workflow. As medical technology and stroke devices improve, nearly all time points can be affected, from field stroke triage to automated imaging interpretation to mass mobile stroke code communications. In this article, we review the preintervention stroke workflow with specific regard to emerging technologies in improving time to reperfusion and overall patient outcomes.
Collapse
Affiliation(s)
- Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Hazem Shoirah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Johanna Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| |
Collapse
|
12
|
Salazar AJ, Useche N, Granja M, Bermúdez S, Morillo AJ, Torres O, Rueda N, Ropero B. Reliability and accuracy of individual Alberta Stroke Program Early CT Score regions using a medical and a smartphone reading system in a telestroke network. J Telemed Telecare 2019; 27:436-443. [PMID: 31635531 PMCID: PMC8366140 DOI: 10.1177/1357633x19881863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction The aim of this study was to assess individual regions of the Alberta Stroke Program Early CT Score in noncontrast head computed tomography interpretations using a smartphone in a telestroke network, by comparison to a medical monitor. Methods The review board of our institution approved this retrospective study. A factorial design with 188 patients, four radiologists and two reading systems was used. Accuracy and reliability were evaluated. Results Very good interobserver agreements were observed on the total Alberta Stroke Program Early CT Score for both the medical and smartphone reading systems, with intraclass correlation coefficients of 0.91 and 0.84 respectively. Interobserver agreements were moderate to very good for the medical reading system (all intraclass correlation coefficients >0.74), whereas they were fair to very good for the smartphone (intraclass correlation coefficients ranged from 0.31–0.81). All intraobserver agreements were good (intraclass correlation coefficient >0.64), except for internal capsule (0.48) and M2 (0.55) regions. The areas under the receiver-operating curve ranged from 0.69–0.89 for the medical system, while for the smartphone ranged from 0.44–0.86. No statistical differences were observed between medical and smartphone reading systems for each region (all p > 0.05). Discussion If radiologists are better trained in the evaluation of the lesions in the insula, the internal capsule and the M2 regions, the total and the dichotomised Alberta Stroke Program Early CT Score will be more precise. Hence, ruling out contraindications to thrombolysis administration will be improved, allowing assessment of head computed tomography in a telestroke network using a smartphone to be a common practice.
Collapse
Affiliation(s)
- Antonio J Salazar
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Colombia
| | - Nicolás Useche
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | | | - Sonia Bermúdez
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Aníbal J Morillo
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Oscar Torres
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia
| | - Natalia Rueda
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Brenda Ropero
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Colombia.,Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia
| |
Collapse
|
13
|
Hong G, Rui G, Zhang D, Lian M, Yang Y, Chen P, Yang H, Guan Z, Chen W, Wang Y. A smartphone-assisted pressure-measuring-based diagnosis system for acute myocardial infarction diagnosis. Int J Nanomedicine 2019; 14:2451-2464. [PMID: 31040668 PMCID: PMC6459154 DOI: 10.2147/ijn.s197541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Acute myocardial infarction (AMI), usually caused by atherosclerosis of coronary artery, is the most severe manifestation of coronary artery disease which results in a large amount of death annually. A new diagnosis approach with high accuracy, reliability and low measuring-time-consuming is essential for AMI quick diagnosis. Purpose The objective of this study was to develop a new point-of-care testing system with high accuracy and reliability for AMI quick diagnosis. Patients and methods 50 plasma samples of acute myocardial infarction patients were analyzed by developed Smartphone-Assisted Pressure-Measuring-Based Diagnosis System (SPDS). The concentration of substrate was firstly optimized. The effect of antibody labeling and matrix solution on measuring result were then evaluated. And standard curves for cTnI, CK-MB and Myo were built for clinical sample analysis. The measuring results of 50 clinical samples were finally evaluated by comparing with the measuring result obtained by CLIA. Results The concentration of substrate H2O2 was firstly optimized as 30% to increase measuring signal. A commercial serum matrix was chosen as the matrix solution to dilute biomarkers for standard curve building to minimize matrix effect on the accuracy of clinical plasma sample measuring. The standard curves for cTnI, CK-MB and Myo were built, with measuring dynamic range of 0–25 ng/mL, 0–33 ng/mL and 0–250 ng/mL, and limit of detection of 0.014 ng/mL, 0.16 ng/mL and 0.85 ng/mL respectively. The measuring results obtained by the developed system of 50 clinical plasma samples for three biomarkers matched well with the results obtained by chemiluminescent immunoassay. Conclusion Due to its small device size, high sensitivity and accuracy, SPDS showed a bright potential for point-of-care testing (POCT) applications.
Collapse
Affiliation(s)
- Guolin Hong
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Gang Rui
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Dongdong Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Mingjian Lian
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Yuanyuan Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Ping Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen 361005, People's Republic of China
| | - Huijing Yang
- Department of Clinical Medicine, Fujian Medical University, Fuzhou 350108, People's Republic of China
| | - Zhichao Guan
- Department of Research and development, Xiamen Passtech Co.,Ltd., Xiamen 361101, People's Republic of China
| | - Wei Chen
- Higher Educational Key Laboratory for Nano Biomedical Technology of Fujian Province, Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou 350004, People's Republic of China,
| | - Yan Wang
- Department of Cardiology, the Affiliated Cardiovascular Hospital of Xiamen University, Medical College of Xiamen University, Xiamen 361004, People's Republic of China,
| |
Collapse
|
14
|
Expansion of Telemedicine Services: Telepharmacy, Telestroke, Teledialysis, Tele-Emergency Medicine. Crit Care Clin 2019; 35:519-533. [PMID: 31076051 DOI: 10.1016/j.ccc.2019.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele-emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best practices and resultant outcomes for these subsets of telemedicine models.
Collapse
|
15
|
Hidlay DT, McTaggart RA, Baird G, Yaghi S, Hemendinger M, Tung EL, Dibiasio EL, Haas RA, Jayaraman MV. Accuracy of smartphone-based evaluation of Emergent Large Vessel Occlusion on CTA. Clin Neurol Neurosurg 2018; 171:135-138. [PMID: 29909185 DOI: 10.1016/j.clineuro.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Mechanical thrombectomy is the standard of care for stroke caused by an emergent large vessel occlusion in the anterior circulation, and the ability to rapidly review CTA is one hurdle in minimizing the time from diagnosis to intervention. We evaluated the diagnostic accuracy and confidence in review of stroke CTA for ELVO via a smartphone-based application as compared to PACS workstation. PATIENTS AND METHODS Seventy-six head and neck CTA studies performed for stroke from one comprehensive and seven primary stroke centers were independently reviewed remotely on smartphone by two blinded interventional neuroradiologists in actual-use circumstances. The presence and location of large vessel occlusion(s), diagnostic quality, and confidence in interpretation were recorded. Comparison was made to blinded PACS workstation review performed at a delayed interval. Weighted Kappa and Kendall's Tau statistics were calculated to evaluate intra- and inter-observer reliability. RESULTS Of the 76 studies, 20 (26%) had a large vessel occlusion. 14 M1 segment occlusions (18%); 2 ICA terminus (3%); 2 tandem carotid and M1 (3%); and 2 basilar artery (3%). There was 100% diagnostic accuracy by both PACS workstation and smartphone review (p = .9999) with high inter- and intra-rater reliability for assessments of both image quality and diagnostic confidence. CONCLUSION In actual-use circumstances, experienced neuroradiologists can diagnose ELVOs on CTA using a smartphone application as accurately as on PACS workstation without degradation of confidence. These findings support the use of mobile electronic devices by stroke centers to rapidly triage patients for mechanical thrombectomy.
Collapse
Affiliation(s)
- Douglas T Hidlay
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States
| | - Ryan A McTaggart
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States; Department of Neurology, Warren Alpert School of Medicine at Brown University, United States; Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, United States; Norman Prince Neuroscience Institute, Rhode Island Hospital, United States
| | - Grayson Baird
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States; Lifespan Biostatistics Core, Rhode Island Hospital, United States
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert School of Medicine at Brown University, United States; Norman Prince Neuroscience Institute, Rhode Island Hospital, United States
| | - Morgan Hemendinger
- Department of Neurology, Warren Alpert School of Medicine at Brown University, United States
| | - Eric L Tung
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States
| | - Eleanor L Dibiasio
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States
| | - Richard A Haas
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States; Department of Neurology, Warren Alpert School of Medicine at Brown University, United States; Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, United States; Norman Prince Neuroscience Institute, Rhode Island Hospital, United States
| | - Mahesh V Jayaraman
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, United States; Department of Neurology, Warren Alpert School of Medicine at Brown University, United States; Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, United States; Norman Prince Neuroscience Institute, Rhode Island Hospital, United States.
| |
Collapse
|
16
|
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110. [PMID: 29367334 DOI: 10.1161/str.0000000000000158] [Citation(s) in RCA: 3485] [Impact Index Per Article: 580.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. RESULTS These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. CONCLUSIONS These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
Collapse
|
17
|
|
18
|
An HTML5-Based Pure Website Solution for Rapidly Viewing and Processing Large-Scale 3D Medical Volume Reconstruction on Mobile Internet. Int J Telemed Appl 2017. [PMID: 28638406 PMCID: PMC5468779 DOI: 10.1155/2017/4074137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed to propose a pure web-based solution to serve users to access large-scale 3D medical volume anywhere with good user experience and complete details. A novel solution of the Master-Slave interaction mode was proposed, which absorbed advantages of remote volume rendering and surface rendering. On server side, we designed a message-responding mechanism to listen to interactive requests from clients (Slave model) and to guide Master volume rendering. On client side, we used HTML5 to normalize user-interactive behaviors on Slave model and enhance the accuracy of behavior request and user-friendly experience. The results showed that more than four independent tasks (each with a data size of 249.4 MB) could be simultaneously carried out with a 100-KBps client bandwidth (extreme test); the first loading time was <12 s, and the response time of each behavior request for final high quality image remained at approximately 1 s, while the peak value of bandwidth was <50-KBps. Meanwhile, the FPS value for each client was ≥40. This solution could serve the users by rapidly accessing the application via one URL hyperlink without special software and hardware requirement in a diversified network environment and could be easily integrated into other telemedical systems seamlessly.
Collapse
|
19
|
Shkirkova K, Akam EY, Huang J, Sheth SA, Nour M, Liang CW, McManus M, Trinh V, Duckwiler G, Tarpley J, Vinuela F, Saver JL. Feasibility and utility of an integrated medical imaging and informatics smartphone system for management of acute stroke. Int J Stroke 2017; 12:953-960. [DOI: 10.1177/1747493017694386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care. Aim To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system. Methods We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6–18) times by a median of 3 (interquartile range 2–4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0–1, range 0–13) users per case and viewed by median 1 (interquartile range 0–3, range 0–44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5–69.5) and median door-to-groin 94.5 min (interquartile range 85.5–121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%–99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%–78%). Conclusion The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.
Collapse
Affiliation(s)
- Kristina Shkirkova
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | | | - Josephine Huang
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil A Sheth
- Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - May Nour
- Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Conrad W Liang
- Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Michael McManus
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Van Trinh
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Jason Tarpley
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Fernando Vinuela
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | | |
Collapse
|
20
|
Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, Hess DC, Majersik JJ, Nystrom KV, Reeves MJ, Rosamond WD, Switzer JA. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 48:e3-e25. [PMID: 27811332 DOI: 10.1161/str.0000000000000114] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. METHODS A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. RESULTS Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation.
Collapse
|
21
|
Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
Collapse
Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
| |
Collapse
|
22
|
Rumsfeld JS, Brooks SC, Aufderheide TP, Leary M, Bradley SM, Nkonde-Price C, Schwamm LH, Jessup M, Ferrer JME, Merchant RM. Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care. Circulation 2016; 134:e87-e108. [DOI: 10.1161/cir.0000000000000428] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
23
|
Kim C, Kang B, Choi HJ, Park JB. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone. J Digit Imaging 2016; 28:399-406. [PMID: 25700617 DOI: 10.1007/s10278-015-9775-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.
Collapse
Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro(st), Guri-si, Gyeonggi-do, 471-701, Republic of Korea
| | | | | | | |
Collapse
|
24
|
Randhawa PA, Morrish W, Lysack JT, Hu W, Goyal M, Hill MD. Neuroradiology Using Secure Mobile Device Review. Can J Neurol Sci 2016; 43:1-4. [PMID: 27045605 DOI: 10.1017/cjn.2016.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Image review on computer-based workstations has made film-based review outdated. Despite advances in technology, the lack of portability of digital workstations creates an inherent disadvantage. As such, we sought to determine if the quality of image review on a handheld device is adequate for routine clinical use. METHODS Six CT/CTA cases and six MR/MRA cases were independently reviewed by three neuroradiologists in varying environments: high and low ambient light using a handheld device and on a traditional imaging workstation in ideal conditions. On first review (using a handheld device in high ambient light), a preliminary diagnosis for each case was made. Upon changes in review conditions, neuroradiologists were asked if any additional features were seen that changed their initial diagnoses. Reviewers were also asked to comment on overall clinical quality and if the handheld display was of acceptable quality for image review. RESULTS After the initial CT review in high ambient light, additional findings were reported in 2 of 18 instances on subsequent reviews. Similarly, additional findings were identified in 4 of 18 instances after the initial MR review in high ambient lighting. Only one of these six additional findings contributed to the diagnosis made on the initial preliminary review. CONCLUSIONS Use of a handheld device for image review is of adequate diagnostic quality based on image contrast, sharpness of structures, visible artefacts and overall display quality. Although reviewers were comfortable with using this technology, a handheld device with a larger screen may be diagnostically superior.
Collapse
Affiliation(s)
- Privia A Randhawa
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - William Morrish
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - John T Lysack
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - William Hu
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Mayank Goyal
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Michael D Hill
- 1Calgary Stroke Program,Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| |
Collapse
|
25
|
Ludwig CA, Callaway NF, Park JH, Leng T. Mobile Health in the Retinal Clinic Population: Access to and Interest in Self-Tracking. Ophthalmic Surg Lasers Imaging Retina 2016; 47:252-7. [PMID: 26985799 DOI: 10.3928/23258160-20160229-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/07/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Implementation of mobile health-tracking programs for retinal pathology requires both access to mobile devices and patient motivation to participate in self-tracking. The authors' study aimed to evaluate the prevalence of smartphone and tablet ownership and patient interest in self-tracking among a retinal clinic population. PATIENTS AND METHODS This is an institutional, prospective, cross-sectional survey of 103 retinal clinic outpatients. Consenting patients underwent a one-on-one interview conducted in the examination room during their waiting period by one researcher. RESULTS Overall, 75 of 103 participants (72.2%) reported either owning a smartphone and/or tablet or having access at their household to a device that could be used to track eye health. The majority of participants (69 of 103 participants; 67%) reported interest in using a mobile application (smartphone or tablet) to track their eye health. CONCLUSION These data suggest strong patient interest in the use of mobile devices to track eye health.
Collapse
|
26
|
Yuan ZW, Liu ZR, Wei D, Shi M, Wang BJ, Liu YH, Wang WZ, Zhao G. Mobile Stroke: An Experience of Intravenous Thrombolysis Guided by Teleconsultation Based on Google Glass. CNS Neurosci Ther 2016; 21:607-9. [PMID: 26096048 DOI: 10.1111/cns.12413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/07/2015] [Accepted: 05/04/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Zi-Wen Yuan
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi`an, China
| | - Zhi-Rong Liu
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi`an, China
| | - Dong Wei
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi`an, China
| | - Ming Shi
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi`an, China
| | - Bing-Ju Wang
- Department of Neurology, Xianyang Hospital, Xianyang, China
| | - Yong-Hong Liu
- Department of Neurology, Xianyang Hospital, Xianyang, China
| | - Wen-Zhe Wang
- Department of Neurology, Xianyang Hospital, Xianyang, China
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi`an, China
| |
Collapse
|
27
|
Matar R, Renapurkar R, Obuchowski N, Menon V, Piraino D, Schoenhagen P. Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network. J Cardiovasc Comput Tomogr 2015; 9:524-33. [PMID: 26277273 DOI: 10.1016/j.jcct.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prompt diagnosis and early referral to specialized centers is critical for patients presenting with cardiovascular emergencies, including acute aortic syndromes (AAS). Prior data has suggested that mobile access to imaging studies with hand-held devices can accelerate diagnosis and management. OBJECTIVE We conducted a study to determine the diagnostic accuracy of a hand-held device compared to conventional dedicated work-stations for diagnosing a spectrum of cardiovascular emergencies, predominantly acute aortic pathology. METHODS This study included 104 cases who underwent computed tomography (CT)-scan during "on-call'' hours between January, 2013 and August, 2014 for suspected AAS. Assessment was performed on a hand-held device independently by two readers using an iPhone5 connected via secure connection to web-based PACS servers. The subsequent interpretation from a dedicated workstation coupled with the diagnosis at the time of discharge was used as the reference standard for determining the presence or absence of an acute abnormality. Sensitivity and Specificity were calculated on a per patient basis. RESULTS Readers' sensitivity and specificity using the hand-held device to diagnose acute chest pathology were calculated. Hand-held device evaluation was determined to have a sensitivity of 85.2% and a specificity of 98.6% by reader A and a sensitivity of 96.3% and specificity of 100% by reader B. Of 103 cases interpreted by both readers, the readers agreed about the diagnosis in 98 cases (95.1%). CONCLUSION This study demonstrates that hand-held devices can be a potential useful tool to assist in diagnosis and triage of patients presenting with cardiovascular emergencies. Further studies are needed to assess the impact of screen size and resolution.
Collapse
Affiliation(s)
- Ralph Matar
- Internal Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Rahul Renapurkar
- Imaging Institute and Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - David Piraino
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Paul Schoenhagen
- Imaging Institute and Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
28
|
Zwart CM, He M, Wu T, Demaerschalk BM, Mitchell JR, Hara AK. Selection and pilot implementation of a mobile image viewer: a case study. JMIR Mhealth Uhealth 2015; 3:e45. [PMID: 26018587 PMCID: PMC4463772 DOI: 10.2196/mhealth.4271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022] Open
Abstract
Background For health care providers, mobile image viewing increases image accessibility, which could lead to faster interpretation/consultations and improved patient outcomes. Objective We explored the technical requirements and challenges associated with implementing a commercial mobile image viewer and conducted a small study testing the hypothesis that the mobile image viewer would provide faster image access. Methods A total of 19 clinicians (9 radiologists, 3 surgeons, 4 neurologists, and 3 physician assistants) evaluated (1) a desktop commercial picture archiving and communication system (PACS) viewer, (2) a desktop viewer developed internally over 20 years and deployed throughout the enterprise (ENTERPRISE viewer) and (3) a commercial Food and Drug Administration class II-cleared mobile viewer compatible with Web browsers, tablets, and mobile phones. Data were collected during two separate 7-day periods, before and after mobile image viewer deployment. Data included image viewer chosen, time to view first image, technical issues, diagnostic confidence, and ease of use. Results For 565 image-viewing events, ease of use was identical for PACS and mobile viewers (mean 3.6 for all scores of a possible 4.0), and significantly worse for the enterprise viewer (mean 2.9, P=.001). Technical issues were highest with the enterprise viewer (26%, 56/215) compared with the mobile (7%,19/259, P=.001) and PACS (8%, 7/91, P=.003) viewers. Mean time to first image for the mobile viewer (2.4 minutes) was significantly faster than PACS (12.5 minutes, P=.001) and the enterprise viewer (4.5 minutes, P=.001). Diagnostic confidence was similar for PACS and mobile viewers and worst for enterprise viewer. Mobile image viewing increased by sixfold, from 14% (37/269, before the deployment) to 88.9% (263/296, after the deployment). Conclusions A mobile viewer provided faster time to first image, improved technical performance, ease of use, and diagnostic confidence, compared with desktop image viewers.
Collapse
Affiliation(s)
- Christine Marie Zwart
- Medical Imaging Informatics, Department of Radiology, Mayo Clinic, Scottsdale, AZ, United States.
| | | | | | | | | | | |
Collapse
|
29
|
Yuan Z, Wang B, Li F, Wang J, Zhi J, Luo E, Liu Z, Zhao G. Intravenous thrombolysis guided by a telemedicine consultation system for acute ischaemic stroke patients in China: the protocol of a multicentre historically controlled study. BMJ Open 2015; 5:e006704. [PMID: 25979867 PMCID: PMC4442242 DOI: 10.1136/bmjopen-2014-006704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rate of intravenous thrombolysis with tissue-type plasminogen activator or urokinase for stroke patients is extremely low in China. It has been demonstrated that a telestroke service may help to increase the rate of intravenous thrombolysis and improve stroke care quality in local hospitals. The aim of this study, also called the Acute Stroke Advancing Program, is to evaluate the effectiveness and safety of decision-making concerning intravenous thrombolysis via a telemedicine consultation system for acute ischaemic stroke patients in China. METHODS AND ANALYSIS This is a multicentre historically controlled study with a planned enrolment of 300 participants in each of two groups. The telestroke network consists of one hub hospital and 14 spoke hospitals in underserved regions of China. The usual stroke care quality in the spoke hospitals without guidance from the hub hospital will be used as the historical control. The telemedicine consultation system is an interactive, two-way, wireless, audiovisual system accessed on portable devices. The primary outcome is the percentage of patients treated with intravenous thrombolysis within 4.5 h of stroke onset. ETHICS AND DISSEMINATION The project has been approved by the Institutional Review Board of Xijing Hospital. The results will be published in scientific journals and presented to local government and relevant institutes. TRIAL REGISTRATION NUMBER NCT02088346 (12 March 2014).
Collapse
Affiliation(s)
- Ziwen Yuan
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xìan, China
| | - Bo Wang
- Department of Epidemiology, The Fourth Military Medical University, Xìan, China
| | - Feijiang Li
- School of Biomedical Engineering, The Fourth Military Medical University, Xìan, China
| | - Jing Wang
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xìan, China
| | - Jin Zhi
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xìan, China
| | - Erping Luo
- School of Biomedical Engineering, The Fourth Military Medical University, Xìan, China
| | - Zhirong Liu
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xìan, China
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University, Xìan, China
| |
Collapse
|
30
|
Kammerer FJ, Hammon M, Schlechtweg PM, Uder M, Schwab SA. A web based cross-platform application for teleconsultation in radiology. J Telemed Telecare 2015; 21:355-63. [PMID: 25962651 DOI: 10.1177/1357633x15575237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 11/17/2022]
Abstract
The growing complexity of radiologic examinations and interventional procedures requires frequent exchange of knowledge. Consequently a simple way to share and discuss patient images between radiology experts and with colleagues from other medical disciplines is needed. Aims of this work were the development and initial performance evaluation of a fast and user friendly, platform independent teleconsultation system for medical imaging. A local back end system receives DICOM images and generates anonymized JPEG files that are uploaded to an internet webserver. The front end running on that webserver comprises an image viewer with a specially developed pointer element for indicating findings to collaborative partners. The front end that uses only standard web technologies works on a variety of different platforms, mobile devices and desktop computers. Images can be accessed by simply calling up a special internet address in a web browser that may be exchanged between users (e.g. via email). A speed evaluation of the system showed good results: For example the preparation and upload of a standard head CT took less than 21 seconds. The data volume of the same series and the viewer application could be transferred to a mobile phone in less than 42 seconds via a UMTS network or in less than 3 seconds via a HSPA network. The presented system with its minimal hard- and software requirements, its simplicity and platform independence might be a promising tool in the increasingly important area of teleconsultation.
Collapse
Affiliation(s)
| | - Matthias Hammon
- Department of Radiology, University hospital Erlangen, Germany
| | | | - Michael Uder
- Department of Radiology, University hospital Erlangen, Germany
| | | |
Collapse
|
31
|
Merchán-Baeza JA, Gonzalez-Sanchez M, Cuesta-Vargas A. Clinical effect size of an educational intervention in the home and compliance with mobile phone-based reminders for people who suffer from stroke: protocol of a randomized controlled trial. JMIR Res Protoc 2015; 4:e33. [PMID: 25757808 PMCID: PMC4376126 DOI: 10.2196/resprot.4034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 11/15/2022] Open
Abstract
Background Stroke is the third-leading cause of death and the leading cause of long-term neurological disability in the world. Cognitive, communication, and physical weakness combined with environmental changes frequently cause changes in the roles, routines, and daily occupations of stroke sufferers. Educational intervention combines didactic and interactive intervention, which combines the best choices for teaching new behaviors since it involves the active participation of the patient in learning. Nowadays, there are many types of interventions or means to increase adherence to treatment. Objective The aim of this study is to enable patients who have suffered stroke and been discharged to their homes to improve the performance of the activities of daily living (ADL) in their home environment, based on advice given by the therapist. A secondary aim is that these patients continue the treatment through a reminder app installed on their mobile phones. Methods This study is a clinical randomized controlled trial. The total sample will consist of 80 adults who have suffered a stroke with moderate severity and who have been discharged to their homes in the 3 months prior to recruitment to the study. The following tests and scales will be used to measure the outcome variables: Barthel Index, the Functional Independence Measure, the Mini-Mental State Examination, the Canadian Neurological Scale, the Stroke Impact Scale-16, the Trunk Control Test, the Modified Rankin Scale, the Multidimensional Scale of Perceived Social Support, the Quality of Life Scale for Stroke, the Functional Reach Test, the Romberg Test, the Time Up and Go test, the Timed-Stands Test, a portable dynamometer, and a sociodemographic questionnaire. Descriptive analyses will include mean, standard deviation, and 95% confidence intervals of the values for each variable. The Kolmogov-Smirnov (KS) test and a 2x2 mixed-model analysis of variance (ANOVA) will be used. Intergroup effect sizes will be calculated (Cohen’s d). Results Currently, the study is in the recruitment phase and implementation of the intervention has begun. The authors anticipate that during 2015 the following processes should be completed: recruitment, intervention, and data collection. It is expected that the analysis of all data and the first results should be available in early-to-mid 2016. Conclusions An educational intervention based on therapeutic home advice and a reminder app has been developed by the authors with the intention that patients who have suffered stroke perform the ADL more easily and use their affected limbs more actively in the ADL. The use of reminders via mobile phone is proposed as an innovative tool to increase treatment adherence in this population. Trial Registration ClinicalTrials.gov NCT01980641; https://clinicaltrials.gov/ct2/show/NCT01980641 (Archived by WebCite at http://www.webcitation.org/6WRWFmY6U).
Collapse
|
32
|
Cui X, Baker JM, Liu N, Reiss AL. Sensitivity of fNIRS measurement to head motion: an applied use of smartphones in the lab. J Neurosci Methods 2015; 245:37-43. [PMID: 25687634 DOI: 10.1016/j.jneumeth.2015.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Powerful computing capabilities in small, easy to use hand-held devices have made smart technologies such as smartphones and tablets ubiquitous in today's society. The capabilities of these devices provide scientists with many tools that can be used to improve the scientific method. METHOD Here, we demonstrate how smartphones may be used to quantify the sensitivity of functional near-infrared spectroscopy (fNIRS) signal to head motion. By attaching a smartphone to participants' heads during the fNIRS scan, we were able to capture data describing the degree of head motion. RESULTS Our results demonstrate that data recorded from an off-the-shelf smartphone accelerometer may be used to identify correlations between head-movement and fNIRS signal change. Furthermore, our results identify correlations between the magnitudes of head-movement and signal artifact, as well as a relationship between the direction of head movement and the location of the resulting signal noise. CONCLUSIONS These data provide a valuable proof-of-concept for the use of off-the-shelf smart technologies in neuroimaging applications.
Collapse
Affiliation(s)
- Xu Cui
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Joseph M Baker
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Ning Liu
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
- Department of Radiology, Stanford University School of Medicine
| |
Collapse
|
33
|
He L, Xu L, Ming X, Liu Q. A web service system supporting three-dimensional post-processing of medical images based on WADO protocol. J Med Syst 2015; 39:6. [PMID: 25628160 DOI: 10.1007/s10916-015-0196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
Three-dimensional post-processing operations on the volume data generated by a series of CT or MR images had important significance on image reading and diagnosis. As a part of the DIOCM standard, WADO service defined how to access DICOM objects on the Web, but it didn't involve three-dimensional post-processing operations on the series images. This paper analyzed the technical features of three-dimensional post-processing operations on the volume data, and then designed and implemented a web service system for three-dimensional post-processing operations of medical images based on the WADO protocol. In order to improve the scalability of the proposed system, the business tasks and calculation operations were separated into two modules. As results, it was proved that the proposed system could support three-dimensional post-processing service of medical images for multiple clients at the same moment, which met the demand of accessing three-dimensional post-processing operations on the volume data on the web.
Collapse
Affiliation(s)
- Longjun He
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | | | | | | |
Collapse
|
34
|
Hubert GJ, Müller-Barna P, Audebert HJ. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries. Int J Stroke 2014; 9:968-73. [PMID: 25381687 DOI: 10.1111/ijs.12394] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/08/2014] [Indexed: 01/23/2023]
Abstract
TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries.
Collapse
Affiliation(s)
- Gordian J Hubert
- Gordian Hubert, Städtisches Klinikum München GmbH, Klinikum Harlaching, Neurology - TEMPiS, Munich, Germany
| | | | | |
Collapse
|
35
|
Azzazy HME, Elbehery AHA. Clinical laboratory data: acquire, analyze, communicate, liberate. Clin Chim Acta 2014; 438:186-94. [PMID: 25172035 DOI: 10.1016/j.cca.2014.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 01/07/2023]
Abstract
The availability of portable healthcare devices, which can acquire and transmit medical data to remote experts would dramatically affect healthcare in areas with poor infrastructure. Smartphones, which feature touchscreen computer capabilities and sophisticated cameras, have become widely available with over billion units shipped in 2013. In the clinical laboratory, smartphones have recently brought the capabilities of key instruments such as spectrophotometers, fluorescence analyzers and microscopes into the palm of the hand. Several research groups have developed sensitive and low-cost smartphone-based diagnostic assay prototypes for testing cholesterol, albumin, vitamin D, tumor markers, and the detection of infectious agents. This review covers the use of smartphones to acquire, analyze, communicate, and liberate clinical laboratory data. Smartphones promise to dramatically improve the quality and quantity of healthcare offered in resource-limited areas.
Collapse
Affiliation(s)
- Hassan M E Azzazy
- Novel Diagnostics and Therapeutics, Yousef Jameel Science & Technology Research Centre, and Department of Chemistry, School of Sciences & Engineering, The American University in Cairo, New Cairo, Egypt.
| | - Ali H A Elbehery
- Graduate Program of Biotechnology, School of Sciences and Engineering, The American University in Cairo, New Cairo, Egypt
| |
Collapse
|
36
|
Off-site smartphone reading of CT images for patients with inconclusive diagnoses of appendicitis from on-call radiologists. AJR Am J Roentgenol 2014; 203:3-9. [PMID: 24951190 DOI: 10.2214/ajr.13.11787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to simulate a mobile consultation in patients with inconclusive diagnosis of appendicitis made by on-call radiologists, as well as to measure the diagnostic confidence and performance of the mobile consultation. MATERIALS AND METHODS Two off-site abdominal radiologists interpreted the CT images from 68 patients (including 29 patients with confirmed appendicitis) on a smart-phone for whom the preliminary CT reports by 25 in-house on-call radiologists were inconclusive. The smartphone readings were compared with the preliminary reports by on-call radiologists and with the original final reports by in-house abdominal radiologists. Heat maps, kappa statistics, Wilcoxon signed-rank tests, and ROC curves were used for data analysis. RESULTS The heat maps and kappa statistics showed that the smartphone readings were more similar to the final reports than to the preliminary reports. In diagnosing or ruling out appendicitis, the smartphone readings were more confident than the preliminary reports (p ≤ 0.01) and did not significantly differ in diagnostic confidence from the final reports (p ≥ 0.19). The AUCs of the smartphone readings (0.91 and 0.92) did not differ significantly from those of the preliminary (0.85) or final (0.97) reports (p ≥ 0.09). CONCLUSION With the given study sample, the diagnostic performance of the off-site smartphone readings did not differ significantly from that of the in-house preliminary reports. However, the smartphone readings provided higher diagnostic confidence than the preliminary reports.
Collapse
|
37
|
He L, Ming X, Liu Q. A medical application integrating remote 3D visualization tools to access picture archiving and communication system on mobile devices. J Med Syst 2014; 38:44. [PMID: 24705800 DOI: 10.1007/s10916-014-0044-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
With computing capability and display size growing, the mobile device has been used as a tool to help clinicians view patient information and medical images anywhere and anytime. However, for direct interactive 3D visualization, which plays an important role in radiological diagnosis, the mobile device cannot provide a satisfactory quality of experience for radiologists. This paper developed a medical system that can get medical images from the picture archiving and communication system on the mobile device over the wireless network. In the proposed application, the mobile device got patient information and medical images through a proxy server connecting to the PACS server. Meanwhile, the proxy server integrated a range of 3D visualization techniques, including maximum intensity projection, multi-planar reconstruction and direct volume rendering, to providing shape, brightness, depth and location information generated from the original sectional images for radiologists. Furthermore, an algorithm that changes remote render parameters automatically to adapt to the network status was employed to improve the quality of experience. Finally, performance issues regarding the remote 3D visualization of the medical images over the wireless network of the proposed application were also discussed. The results demonstrated that this proposed medical application could provide a smooth interactive experience in the WLAN and 3G networks.
Collapse
Affiliation(s)
- Longjun He
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | | |
Collapse
|
38
|
Krupinski EA. Telemedicine Workplace Environments: Designing for Success. Healthcare (Basel) 2014; 2:115-22. [PMID: 27429263 PMCID: PMC4934497 DOI: 10.3390/healthcare2010115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/16/2022] Open
Abstract
When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation—where the patient is and where the consultant is. On the patient side, the first thing to realize is that most telemedicine clinics are not going to be newly designed and built. In all likelihood they will be existing rooms converted to telemedicine clinic rooms. Quite often the former room will not even have been used for clinical purposes, but may have simply been a storage area cleared out for telemedicine use. Therefore, design is often a challenge but there are a few basic principles that can be followed to create a workable clinical space. This paper will review some of the basic human factors principles to take into account when designing a working telemedicine environment.
Collapse
Affiliation(s)
- Elizabeth A Krupinski
- Department of Medical Imaging & Arizona Telemedicine Program, University of Arizona, 1609 N Warren Bldg 211, Tucson, AZ 85724, USA.
| |
Collapse
|
39
|
Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform 2014; 5:229. [PMID: 24683442 PMCID: PMC3959919 DOI: 10.5210/ojphi.v5i3.4814] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This paper examines the state of the art in mobile clinical and health-related apps. A 2012
estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals
and consumers continue to express concerns about the quality of many apps, calling for some form of
app regulatory control or certification to be put in place. We describe the range of apps on offer
as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps
that have been conducted to date, covering a range of clinical disciplines and topics. Our survey
includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps.
We discuss the concept of ‘apps as a medical device’ and the relevant regulatory
controls that apply in USA and Europe, offering examples of apps that have been formally approved
using these mechanisms. We describe the online Health Apps Library run by the National Health
Service in England and the calls for a vetted medical and health app store. We discuss the
ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical
device’. These ingredients cover app content quality, usability, the need to match apps to
consumers’ general and health literacy levels, device connectivity standards (for apps that
connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy.
‘Happtique Health App Certification Program’ (HACP), a voluntary app certification
scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the
US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many
“similar” quality benchmarking tools and codes of conduct for information publishers
were proposed to appraise and rate online medical and health information. It is probably impossible
to rate and police every app on offer today, much like in those early days of the Web, when people
quickly realised the same regarding informational Web pages. The best first line of defence was, is,
and will always be to educate consumers regarding the potentially harmful content of (some)
apps.
Collapse
|
40
|
Pimmer C, Mateescu M, Zahn C, Genewein U. Smartphones as multimodal communication devices to facilitate clinical knowledge processes: randomized controlled trial. J Med Internet Res 2013; 15:e263. [PMID: 24284080 PMCID: PMC3868983 DOI: 10.2196/jmir.2758] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/17/2013] [Accepted: 10/07/2013] [Indexed: 12/04/2022] Open
Abstract
Background Despite the widespread use and advancements of mobile technology that facilitate rich communication modes, there is little evidence demonstrating the value of smartphones for effective interclinician communication and knowledge processes. Objective The objective of this study was to determine the effects of different synchronous smartphone-based modes of communication, such as (1) speech only, (2) speech and images, and (3) speech, images, and image annotation (guided noticing) on the recall and transfer of visually and verbally represented medical knowledge. Methods The experiment was conducted from November 2011 to May 2012 at the University Hospital Basel (Switzerland) with 42 medical students in a master’s program. All participants analyzed a standardized case (a patient with a subcapital fracture of the fifth metacarpal bone) based on a radiological image, photographs of the hand, and textual descriptions, and were asked to consult a remote surgical specialist via a smartphone. Participants were randomly assigned to 3 experimental conditions/groups. In group 1, the specialist provided verbal explanations (speech only). In group 2, the specialist provided verbal explanations and displayed the radiological image and the photographs to the participants (speech and images). In group 3, the specialist provided verbal explanations, displayed the radiological image and the photographs, and annotated the radiological image by drawing structures/angle elements (speech, images, and image annotation). To assess knowledge recall, participants were asked to write brief summaries of the case (verbally represented knowledge) after the consultation and to re-analyze the diagnostic images (visually represented knowledge). To assess knowledge transfer, participants analyzed a similar case without specialist support. Results Data analysis by ANOVA found that participants in groups 2 and 3 (images used) evaluated the support provided by the specialist as significantly more positive than group 1, the speech-only group (group 1: mean 4.08, SD 0.90; group 2: mean 4.73, SD 0.59; group 3: mean 4.93, SD 0.25; F2,39=6.76, P=.003; partial η2=0.26, 1–β=.90). However, significant positive effects on the recall and transfer of visually represented medical knowledge were only observed when the smartphone-based communication involved the combination of speech, images, and image annotation (group 3). There were no significant positive effects on the recall and transfer of visually represented knowledge between group 1 (speech only) and group 2 (speech and images). No significant differences were observed between the groups regarding verbally represented medical knowledge. Conclusions The results show (1) the value of annotation functions for digital and mobile technology for interclinician communication and medical informatics, and (2) the use of guided noticing (the integration of speech, images, and image annotation) leads to significantly improved knowledge gains for visually represented knowledge. This is particularly valuable in situations involving complex visual subject matters, typical in clinical practice.
Collapse
Affiliation(s)
- Christoph Pimmer
- Institute for Information Systems, School of Business, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Basel, Switzerland.
| | | | | | | |
Collapse
|
41
|
Nam HS, Park E, Heo JH. Facilitating Stroke Management using Modern Information Technology. J Stroke 2013; 15:135-43. [PMID: 24396807 PMCID: PMC3859007 DOI: 10.5853/jos.2013.15.3.135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/08/2013] [Accepted: 09/09/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management. SUMMARY OF ISSUES Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals. CONCLUSIONS Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.
Collapse
Affiliation(s)
- Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjeong Park
- Wireless Health Institute, University of California Los Angeles (UCLA), Los Angeles, United States. ; Embedded Software Research Center, Ewha Woman's University, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Carey E, Payne KFB, Ahmed N, Goodson A. The Benefit of the Smartphone in Oral and Maxillofacial Surgery: Smartphone Use Among Maxillofacial Surgery Trainees and iPhone Apps for the Maxillofacial Surgeon. J Maxillofac Oral Surg 2013; 14:131-7. [PMID: 26028826 DOI: 10.1007/s12663-013-0550-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/29/2013] [Indexed: 11/30/2022] Open
Abstract
The use of smartphones has soared among healthcare professionals in recent years, with estimated figures reporting that the majority of clinicians own and use smartphones in the workplace. Smartphones allow the clinician to carry textbooks in their pocket, write documents on the move and use email and internet to enhance productivity and clinical decision making. These advances in smartphone technology have enabled access to healthcare information for the clinician and transfer of data between team members, giving rise to the phenomenon of telemedicine. With the ability to instantly transfer clinical data to the off-site surgeon, combined with purpose-built medical apps, the smartphone is rapidly becoming an invaluable tool for the modern surgeon. Many studies have linked the benefits of smartphones and apps in other surgical specialities, but no article to date has highlighted the merits and full scope of this technology to the Oral and Maxillofacial Surgeon. We report that 94 % of British maxillofacial surgery trainees own a smartphone, with 61 % owning an iPhone. 89 % of trainees questioned had downloaded medical apps and used them regularly during clinical activities. We discuss the clinical application of the smartphone in the field of oral and maxillofacial surgery and review a list of useful and relevant apps for the modern maxillofacial surgeon using the iPhone as an example platform.
Collapse
Affiliation(s)
- Elinor Carey
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London, UK
| | | | - Nabeela Ahmed
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London, UK
| | - Alexander Goodson
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London, UK
| |
Collapse
|
43
|
Panughpath SG, Kumar S, Kalyanpur A. Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage. Indian J Radiol Imaging 2013; 23:4-7. [PMID: 23986611 PMCID: PMC3737617 DOI: 10.4103/0971-3026.113610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: To evaluate the utility of a mobile device to detect and assess intracranial hemorrhage (ICH) on head computed tomographys (CT) performed in the emergency setting. Materials and Methods: 100 head CT scans were randomly selected from our emergency radiology database and anonymized for patient demographics and clinical history. The studies were independently interpreted by two experienced radiologists in a blinded manner, initially on a mobile device (iPad, Apple computers) and subsequently, at an interval of one week, on a regular desktop workstation. Evaluation was directed towards detection, localization and characterization of hemorrhage. The results were assessed for accuracy, sensitivity, specificity and positive predictive value. Statistical significance was ascertained using Fisher's exact test. Results: 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used. Conclusion: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT.
Collapse
Affiliation(s)
- Sridhar G Panughpath
- Department of Emergency Radiology, Teleradiology Sollutions Pvt Ltd., Bangalore, Karnataka, India
| | | | | |
Collapse
|
44
|
Channer DC, Demaerschalk BM. Response to letter regarding article, “smartphone teleradiology application is successfully incorporated into a telestroke network environment”. Stroke 2013; 44:e12. [PMID: 23451349 DOI: 10.1161/strokeaha.112.681296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
45
|
The iPad tablet computer for mobile on-call radiology diagnosis? Auditing discrepancy in CT and MRI reporting. J Digit Imaging 2013; 25:628-34. [PMID: 22562174 DOI: 10.1007/s10278-012-9485-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Tablet computers such as the iPad, which have a large format, improved graphic display resolution and a touch screen interface, may have an advantage compared to existing mobile devices such as smartphones and laptops for viewing radiological images. We assessed their potential for emergency radiology teleconsultation by reviewing multi-image CT and MRI studies on iPad tablet computers compared to Picture Archival and Communication Systems (PACS) workstations. Annonymised DICOM images of 79 CT and nine MRI studies comprising a range of common on-call conditions, reported on full-featured diagnostic PACS workstation by one Reporting Radiologist, were transferred from PACS to three iPad tablet computers running OsiriX HD v 2.02 DICOM software and viewed independently by three reviewing radiologists. Structured documentation was made of major findings (primary diagnosis or other clinically important findings), minor findings (incidental findings), and user feedback. Two hundred and sixty four readings (88 studies read by three reviewing radiologists) were compared, with 3.4 % (nine of 264) major discrepancies and 5.6 % (15 of 264) minor discrepancies. All reviewing radiologists reported favorable user experience but noted issues with software stability and limitations of image manipulation tools. Our results suggest that emergency conditions commonly encountered on CT and MRI can be diagnosed using tablet computers with good agreement with dedicated PACS workstations. Shortcomings in software and application design should be addressed if the potential of tablet computers for mobile teleradiology is to be fully realized.
Collapse
|
46
|
Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3207] [Impact Index Per Article: 291.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
Collapse
|
47
|
Bhatia A, Patel S, Pantol G, Wu YY, Plitnikas M, Hancock C. Intra and Inter-Observer Reliability of Mobile Tablet PACS Viewer System vs. Standard PACS Viewing Station-Diagnosis of Acute Central Nervous System Events. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.32014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
48
|
Al-Hasani H, Abboudi H, Ninan T, Shaygi B, Roobottom C. Smartphone Applications for the Radiologist. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.34037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Demaerschalk BM, Vegunta S, Vargas BB, Wu Q, Channer DD, Hentz JG. Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients. Stroke 2012; 43:3271-7. [PMID: 23160878 DOI: 10.1161/strokeaha.112.669150] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Telestroke reduces acute stroke care disparities between urban stroke centers and rural hospitals. Current technologies used to conduct remote patient assessments have high start-up costs, yet they cannot consistently establish quality timely connections. Smartphones can be used for high-quality video teleconferencing. They are inexpensive and ubiquitous among health care providers. We aimed to study the reliability of high-quality video teleconferencing using smartphones for conducting the National Institutes of Health Stroke Scale (NIHSS). METHODS Two vascular neurologists assessed 100 stroke patients with the NIHSS. The remote vascular neurologist assessed subjects using smartphone videoconferencing with the assistance of a bedside medical aide. The bedside vascular neurologist scored patients contemporaneously. Each vascular neurologist was blinded to the other's NIHSS scores. We tested the inter-method agreement and physician satisfaction with the device. RESULTS We demonstrated high total NIHSS score correlation between the methods (r=0.949; P<0.001). The mean total NIHSS scores for bedside and remote assessments were 7.93±8.10 and 7.28±7.85, with ranges, of 0 to 35 and 0 to 37, respectively. Eight categories had high agreement: level of consciousness (questions), level of consciousness (commands), visual fields, motor left and right (arm and leg), and best language. Six categories had moderate agreement: level of consciousness (consciousness), best gaze, facial palsy, sensory, dysarthria, and extinction/inattention. Ataxia had poor agreement. There was high physician satisfaction with the smartphone. CONCLUSIONS Smartphone high-quality video teleconferencing is reliable, easy to use, affordable for telestroke NIHSS administration, and has high physician satisfaction.
Collapse
Affiliation(s)
- Bart M Demaerschalk
- Department of Neurology, Mayo Clinic, University of Arizona College of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
The use of mobile devices is revolutionizing the way we communicate, interact, are entertained, and organize our lives. With healthcare in general and radiology in particular becoming increasingly digital, the use of such devices in radiologic practice is inevitable. This article reviews the current status of the use of mobile devices in the clinical practice of radiology, namely in emergency teleradiology. Technical parameters such as luminance and resolution are discussed. The article also discusses the benefits of such mobility vis-à-vis the current limitations of the technologies available.
Collapse
Affiliation(s)
- Sridhar G Panughpath
- Department of Radiology, Teleradiology Solutions Private Limited, Whitefield, Bangalore, Karnataka, India
| | - Arjun Kalyanpur
- Department of Radiology, Teleradiology Solutions Private Limited, Whitefield, Bangalore, Karnataka, India
| |
Collapse
|