Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center.

Background: No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag.

Materials And Methods: A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers.

Is telemedicine an answer to reducing 30-day readmission rates post-acute myocardial infarction?

Background: Patients hospitalized for an acute myocardial infarction (AMI) are at risk for early readmission. Readmission rates in the community reportedly reach approximately 20%, and 30-day readmission rates have become a quality-of-care marker. Telemedicine is one strategy for improving clinical outcomes by offering real-time biometrics tracking and rapid intervention.

New real-time loop recorder diagnosis of symptomatic arrhythmia via telemedicine.

Background: One disadvantage of current loop recorders is the long interval between recording an electrocardiogram (ECG), establishing a diagnosis, and taking appropriate medical measures. The Cardio R loop recorder transmits cardiac recordings by cellular communication at the push of a button. Users can concomitantly relay symptoms, thereby providing a symptom/cardio-rhythm correlation.

Telemedicine for diagnosing and managing paroxysmal atrial fibrillation in outpatients. The phone in the pocket.

Background: Individuals who experience paroxysmal atrial fibrillation (PAF) are at risk of serious sequelae, including stroke. PAF episodes usually occur in out-of-hospital settings, and patients seek emergency services for differential diagnosis and treatment.

Methods: Medical records of all subscribers to a telemedical system ('SHL'-Telemedicine) who had one or more episodes of recurrent PAF managed by the call center between 2/2002 and 8/2009 were retrieved.

Telemedicine for post-myocardial infarction patients: an observational study.

"SHL" Telemedicine (established 1987 in Israel) provides professional care to subscribers who use cardiobeepers and contact its medical call center via telecommunication networks. The extended 6-month Acute Coronary Syndrome Israel Survey (ACSIS) 2004 involved all 26 intensive cardiac care units in Israeli hospitals. We compared the 1-year survival rates of the "SHL" Telemedicine subscribers and ACSIS participants who survived hospitalization after sustaining an acute myocardial infarction.

Vigilance, awareness and a phone line: 20 years of expediting CPR for enhancing survival after out-of-hospital cardiac arrest. The 'SHL'-Telemedicine experience in Israel.

Objectives: The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. We report the 1987-2007 experience of resuscitation of out-of-hospital cardiac arrest victims who were 'SHL'-Telemedicine subscribers and who underwent CPR by SHL-Telemedicine mobile intensive care units (MICUs) personnel or under their instructions.

Methods: 'SHL's records of MICU reports and specifics of CPR maneuvers and outcome of resuscitated patients, as recorded by its MICU physicians, were analyzed to determine whether the system enhanced survival.

Teleconsultation for cardiac patients: a comparison between nurses and physicians: the SHL experience in Israel.

The absence of randomized studies on sufficiently large patient cohorts precludes the drawing of any firm conclusions on the comparative performance between nurses and physicians in transtelephonic triage and consultations and in diagnostic and management decision-making. We conducted such a comparative study at the SHL telemedicine facility. This facility also provides face-to-face medical management for its subscribers by means of mobile intensive care units (MICUs) staffed by physicians.

Intravenous chlorpromazine for the emergency treatment of uncontrolled symptomatic hypertension in the pre-hospital setting: data from 500 consecutive cases.

Background: Chlorpromazine is a dopamine-receptor antagonist antipsychotic agent. Because of its strong alpha-blocking and sedative actions, it has also been used as emergency therapy for extreme arterial hypertension. Published reports to date have included very small numbers of patients (i.

[Surgical treatment of the diabetic septic foot].

An opening and a major stage of the diabetic septic foot surgical treatment is the primary surgical processing that is usually combined with amputation of separate fingers or with various types of transmetatarsal amputations. Out of the total of 379 operated patients 35.7% underwent amputation of separate fingers, combined with resection of the metatarsal bone head.

Sexual activity cardiological survey on members of the Israel Heart Society.

A nationwide telephone survey conducted under the auspices of the Israeli Heart Society examined cardiologists' knowledge of and attitudes towards sexual activity among cardiac patients with concomitant sexual dysfunction. The items covered demography, understanding of relevant mechanisms, drug effects and cardiovascular physiology during sexual activity, suitable interventions and sources of the cardiologists' knowledge. Compliance was excellent (364/379 [96%] responders).

The "SHAHAL" experience in Israel for improving diagnosis of acute coronary syndromes in the prehospital setting.

The diagnosis of acute coronary syndromes is frequently missed, and many high-risk patients fail to be admitted to hospital. The aim of this study was to assess the value of cardiac markers in ruling out acute ischemic events in patients with symptoms of possible cardiac origin and nondiagnostic electrocardiograms. The data collected between May 1999 and April 2000 for this prospective cohort study were retrieved from the records of 777 consecutive prehospital patients (mean age 70 years, 62.

Potential reduction of costs and hospital emergency department visits resulting from prehospital transtelephonic triage--the Shahal experience in Israel.

Background: The rising cost of services provided by hospital emergency departments is of major concern. Attempts to reduce the costs of emergency cardiac care have thus far focused primarily on medical and administrative management in the hospital. The role of the patient in appropriate prehospital decision-making has been generally ignored.

Medical history of hypercholesterolaemia adversely affects the outcome of out-of-hospital cardiopulmonary resuscitation; the 'Shahal' experience in Israel.

Aims: To evaluate the impact selected risk factors for cardiac death may have on the success rate in a large cohort of subscribers to 'SHAHAL' who were resuscitated from out-of-hospital cardiac arrest.

Methods And Results: In this medical facility currently serving 50 000 subscribers, data were prospectively gathered from between 1987-1998. The information retrieved from the patients' medical records included a medical history of hypertension, diabetes, hypercholesterolaemia (>220.

Circadian variation of symptomatic paroxysmal atrial fibrillation. Data from almost 10 000 episodes.

Aims: To determine the circadian rhythm of paroxysmal atrial fibrillation in a very large outpatient population.

Methods And Results: We reviewed all emergency telephone calls received in Shahal (a medical service covering 44 000 subscribers), from 1987 to 1997. Patients were included if new-onset atrial fibrillation was recorded.

Assessment of a creatine kinase-MB/myoglobin kit in the prehospital setting in patients presenting with acute nontraumatic chest pain: the "Shahal" experience.

Objectives: To evaluate the usefulness of a novel qualitative, rapid, bedside immunoassay device for the detection of elevated creatine kinase MBmass (CK-MB) and myoglobin as a supportive tool for decision-making by the physician who is evaluating patients who present with chest pain.

Design: Prospective study.

Setting: Prehospital (mobile intensive care units).

The "telepress" system for self-measurement and monitoring of blood pressure (the "SHAHAL" experience in Israel).

No "white coat" effect contaminated the validity of measurements in 30 participants in a "Telepress" program, in which subscribers to a telecardiologic facility transtelephonically transmit their self-measured blood pressure values.

Usefulness of self-administration of intramuscular lidocaine in the prehospital setting for ventricular tachyarrhythmias unassociated with acute myocardial infarction (the "Shahal" experience in Israel).

We report on the experience accumulated by the subscribers of SHAHAL cardiac services who self-injected intramuscular lidocaine (using an automatic injector "LidoPen") for documented ventricular tachyarrhythmias which were not associated with an acute myocardial infarction. SHAHAL provides professional care to its subscribers who telephone a monitor center and describe their symptoms, whereupon therapeutic measures are decided upon. Patient data are stored in a central computer, and the center can dispatch mobile intensive care units.