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Telemedicine Research

Implementing a stroke program using telemedicine

J Emerg Nurs. 2013 Nov;39(6):613 – 8. doi: 10.1016/j.jen.2012.04.012. Epub 2012 Jun 28.
Cronin T.
This article discusses how telemedicine was used in a 288‐​bed privately owned community hospital — the only hospital in the county — to implement a stroke program and receive Primary Stroke designation within nine months. In the words of the author: “Providing communities with this vital treatment not only saves lives but improves the quality of life for persons who meet the criteria for thrombolytics.” Visit the online journal.


The history and future of telestroke

Nat Rev Neurol. 2013 Jun;9(6):340 – 50. doi: 10.1038/nrneurol.2013.86. Epub 2013 May 7.
Hess DC, Audebert HJ.
This review concerns the use of telemedicine to acute stroke patients from the prehospital setting through hospitalization. The positive attributes and possible limitations of telestroke are outlined throughout both of these settings. Visit the review.


Cost‐​Effectiveness of Hub‐​and‐​Spoke Telestroke Networks for the Management of Acute Ischemic Stroke From the Hospitals’ Perspectives

Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):18 – 26. doi: 10.1161/CIRCOUTCOMES.112.967125. Epub 2012 Dec 4.
Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ.
In this study, a model was developed to compare costs and effectiveness with and without a telestroke network over a 5‐​year timeframe. The study conducted a cost‐​benefit analysis and identified cost‐​savings and a strategy for sharing them between hub and spokes so that each facility could benefit. The results suggest that a telestroke network may increase the number of patients discharged home and reduce the costs borne by the network hospitals. Review the study.


Stroke telepresence — Removing all geographic barriers 

Neurology 2011 Mar 29;76(13):1121 – 3. doi: 10.1212/WNL.0b013e3182166e82. Epub 2011 Mar 2.
Hess DC, Switzer JA.
This article highlights how telemedicine is aiding stroke care by allowing patients to receive consultation at their local hospitals. The “drip and ship” and “drip and keep” scenarios are compared. Visit the online journal.


A Telestroke Network Enhances Recruitment into Acute Stroke Clinical Trials

Stroke. 2010 Mar;41(3):566 – 9. doi: 10.1161/STROKEAHA.109.566844. Epub 2010 Jan 7.
Switzer JA, Hall CE, Close B, Nichols FT, Gross H, Bruno A, Hess DC.
This study looks into whether telemedicine could facilitate enrollment in acute stroke clinical trials. The results concluded that it is possible because the research drug at the remote site could be given under telemedicine guidance. Visit the online journal.


A Web‐​Based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments

J Emerg Med. 2009 Jan;36(1):12 – 8. doi: 10.1016/j.jemermed.2007.06.041. Epub 2008 Feb 1. doi:10.1016/j.jemermed.2007.06.041
Switzer JA, Hall C, Gross H, Waller J, Nichols FT, Wang S, Adams RJ, Hess DC.
This study describes the safety, feasibility, and treatment times of using the REACH telestroke system to administer thrombolytic therapy. The REACH telestroke system is compared to other forms of stroke care delivery systems. The study concludes that the risk of SICH using REACH seems to be in the lower range reported in other studies and that tPA administration can be safely administered using the system. Visit the online journal.


An analysis of business issues in a telestroke project.

J Telemed Telecare. 2007;13(5):257 – 62
Cho S, Khasanshina EV, Mathiassen L, Hess DC, Wang S, Stachura ME
This study concerns internal and external business issues faced by the Georgia Regents University (formerly Medical College of Georgia) REACH telestroke network over its first three years. REACH co‐​founder Dr. David Hess and his colleagues identify a variety of strategies to address these specific challenges. Review the abstract.


Reasons Why Few Patients With Acute Stroke Receive Tissue Plasminogen Activator

Arch Neurol. 2006 May;63(5):661 – 4. doi:10.1001/archneur.63.5.661
Bambauer KZ, Johnston SC, Bambauer DE, Zivin JA.
This study discusses three reasons medical professionals underuse tPA treatment for acute ischemic stroke patients. The reasons studied were poor patient education, physicians’ perception of legal liability, and low reimbursement amounts. Low reimbursement amounts are heavily discussed due to its complex problems and improvements being implemented. Review the study.


Telestroke: extending stroke expertise into underserved areas

Lancet Neurol. 2006 Mar;5(3):275 – 8. doi: 10.1016/S1474-4422(06)70377 – 5
Hess DC, Wang S, Gross H, Nichols FT, Hall CE, Adams RJ.
This study details the benefits of a stroke‐​care delivery system such as REACH. The REACH telestroke system is described as a low‐​cost, web‐​based system that allows patients to be served even if the consultant is at home, work, or traveling. Telestroke has allowed stroke‐​care expertise to patients irrespective of geographic barriers. Visit the online journal.


REACH — Clinical Feasibility of a Rural Telestroke Network

Stroke. 2005 Sep;36(9):2018 – 20. Epub 2005 Jul 28. doi: 10.1161/01.STR.0000177534.02969.e4
Hess DC, Wang S, Hamilton W, Lee S, Pardue C, Waller JL, Gross H, Nichols F, Hall C, Adams RJ.
This study details the importance of bringing a telestroke network to underserved, rural areas. The REACH telestroke tool was developed and analyzed to provide the REACH telestroke network. The study concludes that the telestroke system allowed for safe and rapid use of tPA in community hospitals. Visit the online journal.


Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia.

Stroke. 2004 Jul;35(7):1763 – 8. Epub 2004 May 27
Wang S1, Gross H, Lee SB, Pardue C, Waller J, Nichols FT 3rd, Adams RJ, Hess DC.
This study details the performance of the Georgia Regents University (formerly Medical College of Georgia) REACH telestroke network over its first year of operation. The system was used to evaluate 75 patients during this timeframe, twelve of whom received tPA, all without intracranial hemorrhage complications. The study found that REACH may be used as a rapid consult tool to provide the same quality of stroke care to patients in rural hospitals as is given in tertiary stroke centers. Review the study.


Remote Evaluation of Acute Ischemic Stroke — Reliability of National Institutes of Health Stroke Scale via Telestroke

Stroke. 2003 Oct;34(10):e188-91. Epub 2003 Sep 18.
Wang S, Lee SB, Pardue C, Ramsingh D, Waller J, Gross H, Nichols FT 3rd, Hess DC, Adams RJ.
This study concerns if the National Institutes of Stroke Scale evaluation can be reliably performed using the REACH telestroke system.  The results overwhelmingly show that the system can reliably perform the NIHSS supporting the endeavor to bring expertise in stroke‐​care to rural hospitals. Review the study.

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