Telemedicine and neurosciences in developing countries

Ganapathy, Krishnan

doi:10.1016/s0090-3019(02)00924-2

Cited by 44 publications

(23 citation statements)

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“…This 'zero option' could be compatible with the management of casualties in rural areas of the developing world. 51 Early secondary transfer is defined as the first inter-hospital transfer occurring within 12 hours of hospital presentation. This will therefore include all urgent transfer decisions made after patient stabilisation and investigation, including cases in which logistical constraints may delay immediate transportation.…”

Section: Model Scopementioning

confidence: 99%

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

Lecky

Russell

Fuller

et al. 2016

Health Technol Assess

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BackgroundReconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence – with regard to ‘early neurosurgery’ in this cohort – which we sought to address.MethodsPilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). Primary outcomes: recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. ‘Open-label’ secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions.ResultsOverall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%;p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury.ConclusionsCurrent NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating ‘early neurosurgery through bypass’ and address the challenge of reliable TBI diagnosis at the scene of injury.Trial registrationCurrent Controlled Trials ISRCTN68087745.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.

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Section: Model Scopementioning

confidence: 99%

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

Lecky

Russell

Fuller

et al. 2016

Health Technol Assess

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“…44 As Ganapathy stated elegantly, “what is required is not implementing better technology and getting funds, but changing the mindset of the people involved”. 45 In China there has recently been a proliferation of telemedicine units, that has not been matched by a similar increase in human resources, leaving many such units underutilized. 46 In India, a fully equipped videoconference connection was established between two centers 1500 kilometers apart to help in neurology, a rare specialty in India, in which the whole country has only 750 neurologist.…”

Section: Teleoncology In Low- and Middle-income Countriesmentioning

confidence: 99%

“…India has one of the largest telemedicine operations in the developing world, with participation by both private and public sectors. 3,45,47,48 Other experiences from Cambodia, 49 Solomon Islands, 50 Brazil, 51 and Jordan. 9,16,20 are summarized in Table 3.…”

Section: Teleoncology In Low- and Middle-income Countriesmentioning

confidence: 99%

Teleoncology: current and future applications for improving cancer care globally

Hazin

Qaddoumi

2010

The Lancet Oncology

141

123

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Access to quality cancer care is often unavailable not only in low- and middle-income countries but also in rural or remote areas of high-income countries. Teleoncology (oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines) has the potential to enhance both access to and the quality of clinical cancer care as well as education and training. Its implementation in the developing world requires an approach tailored to priorities, resources, and needs. We believe that teleoncology can best achieve its proposed goals through programmatic, consistent, and long-term application. Here we review teleoncology initiatives that have the potential to decrease cancer care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programs in low- and middle-income countries.

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“…[68] In 1997, the national neurosurgical teleradiology system in Ireland connected six major referring hospitals to the only two neurosurgical departments serving a population of 3.5 million. [69] Of the 750 emergency CT scans transmitted, transmission failures occurred in 6% cases. As CT and MRI scanners were not DICOM compatible, the films were scanned and sent for teleconsultation.…”

Section: Tele-strokementioning

confidence: 99%

Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine

Ganapathy

2015

Neurol India

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Majority of Indians have no access to centres of neurological excellence in the country. A detailed analysis of 3666 members of the Neurological Society of India and the Indian Academy of Neurology revealed that not a single member lived in a geographical area covering 934.8 million people. 30.09% live in the four major metropolitan cities, 29.54% in the state capitals, 30.58% in Tier 2 cities, 7.12% in tier 3 cities and 2.67% in rural areas covering a population of 84.59 million. Building additional neurological centres cannot be the only answer, given the acute shortage of funds and trained personnel. In 1999, the author among others, foresaw that it could be possible, to extend the reach of urban specialists to suburban and rural India, by virtual means. The neurological community has been slow to use Information and Communication Technology (ICT) as an integral part of their health care delivery system. This article analyses the distribution of neurologists and neurosurgeons in India and suggests that providing additional virtual neurological care can be the only answer to offset the lop sided distribution of clinical care givers in neurosciences. In this article, the authors' considerable experience in introducing and developing telehealth in India over the last 15 years is being shared with specific emphasis on its relevance to neurosciences. A review of the global literature on telemedicine and neurosciences will substantiate the plea that telemedicine must be deployed by neurologists and neurosurgeons in India to extend their reach to patients particularly those residing in rural areas.

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Telemedicine and neurosciences in developing countries

Cited by 44 publications

References 0 publications

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

Teleoncology: current and future applications for improving cancer care globally

Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine

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