Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site

Fong, Wing-Chi; Ismail, Moamina; Lo, Joyce Wai-Ting; Li, Jessica Tsz-Ching; Wong, Anna Hiu-Yi; Ng, Yee-Wah; Chan, Phillip Yin-Cheung; Chan, Andrew; Chan, Germaine Hiu-Fai; Fong, Ka Wing; Cheung, Nelson Yuk-Fai; Wong, Gordon C K; Ho, Hiu Fai; Chan, Shun Tim; Kwok, Vivian Wai Yan; Yuen, Bernard Man-Kam; Chan, James C.; Li, Patrick Chung-Ki

doi:10.1016/j.jstrokecerebrovasdis.2015.01.022

Cited by 16 publications

(16 citation statements)

References 20 publications

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“…The median DTN time among telestroke patients was 70 minutes and is lower than the 90-97 minutes reported in other jurisdictions. 9,20,21 Studies have shown that prehospital processes are associated with reduced DTN times and, consequently, complications and mortality. [22][23][24] In Ontario's stroke system, pre-hospital protocols include a paramedic screening tool and ED pre-notification.…”

Section: Discussionmentioning

confidence: 99%

“…6 Prior studies have found no difference in mortality between patients who received thrombolysis through telemedicine compared to those who were managed with onsite stroke specialists; however, these did not account for the relative contributions of the severity of stroke, the underlying health of the patient, or process factors at the site where treatment was provided. [7][8][9] The purpose of this study was to determine whether patients receiving telestroke-assisted IV tPA had similar outcomes to patients who received IV tPA without telestroke. Specifically, we estimated the risk of mortality within 7 and 90 days of telestroke-assisted IV tPA compared to IV tPA provided with on-site stroke expertise.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

et al. 2017

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Introduction Since 2002, the Ontario Telestroke Program has provided hospitals in under-served regions of the province the opportunity to offer intravenous thrombolysis with tissue plasminogen activator (IV tPA) to eligible patients. The purpose of this study was to determine whether telestroke-assisted IV tPA patients had similar risks of 7- and 90-day mortality, symptomatic intracerebral haemorrhage (sICH), and poor functional outcome compared to patients who received IV tPA with on-site expertise. Methods Data from two audits of patients with acute ischaemic stroke hospitalized in Ontario, Canada in 2010 and 2012 were analysed. We modelled the risk of all-cause death within 7 and 90 days of receiving IV tPA using proportional hazards adjusting for hospital type, patient characteristics, and whether IV tPA was administered as part of a telestroke consultation. Outcomes of sICH and modified Rankin Scale ≥ 3 at discharge were modelled using generalized estimating equations adjusting for the same variables used in the mortality model. Results There was no difference in 7- or 90-day mortality among those who received IV tPA with telestroke ( n = 214) compared to those without ( n = 1885) (7-day adjusted hazard ratio (aHR) 1.29 (95% confidence interval (CI) 0.68, 2.44); 90-day aHR 1.01 (95% CI 0.67, 1.50)). Complications were similar between groups, with an adjusted odds ratio (aOR) for sICH of 0.71 (95% CI 0.29, 1.71) and an aOR of 0.75 (95% CI 0.46, 1.23) for poor functional ability at discharge. Discussion Patients receiving IV tPA supported by telestroke had similar outcomes to those managed with on-site expertise.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

et al. 2017

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“…Introduction of teleradiology in the island of Ameland, off the coast of the Netherlands resulted in a reduced number of missed fractures and a reduction in unnecessary referrals [8]. Similarly, teleradiologyguided thrombolysis for acute stroke achieved comparable results to 'on-site' treatment decisions [9]. A high degree of correlation was also seen with respect to decisions on coronary angiograms made by transmission of digital images to smartphones via Face Time application compared to conventional on site reporting in the laboratory [10].…”

Section: Applications Of Telemedicinementioning

confidence: 98%

Is there a role for telemedicine in adult allergy services?

Krishna

Knibb

Huissoon

2016

Clin Experimental Allergy

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Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store-and-forward and real-time interactive services.Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomised controlled studies and lack of data relating to costeffectiveness, health related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre-assessment for specialised treatments such as allergen immunotherapy; follow up to assess treatment response and side effects; and education in self-management plan including training updates for self-injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Welldesigned prospective studies are needed to evaluate its role.

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“…Помимо ССЗ, использование телемедицинских технологий было изучено и показало свою эффективность (от p<0,05 до p<0,001) в профилактике самых разнообразных патологий: сахарного диабета (СД), онкологических заболеваний, хронической обструктивной болезни легких, инсультов и др. [11,[13][14][15][16][17]. Трудно назвать область медицины, в которой бы в данное время не шли разработки и исследования применения телемедицинских технологий.…”

Section: медицинский аспектunclassified

Telemedicine consultations in non-communicable disease prevention: Main opportunities and challenges of implementation

Копылова¹

2015

Profil. med.

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Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site

Cited by 16 publications

References 20 publications

Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

Is there a role for telemedicine in adult allergy services?

Telemedicine consultations in non-communicable disease prevention: Main opportunities and challenges of implementation

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Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site

Cited by 16 publications

References 20 publications

Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada

Is there a role for telemedicine in adult allergy services?

Telemedicine consultations in non-communicable disease pre­vention: Main opportunities and challenges of implementation

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Product

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Telemedicine consultations in non-communicable disease prevention: Main opportunities and challenges of implementation