CT interpretation in a telestroke network: agreement among a spoke radiologist, hub vascular neurologist, and hub neuroradiologist.

Background And Purpose: The American Stroke Association guidelines emphasized the need for further high-quality studies that assess agreement by radiologists and nonradiologists engaged in emergency telestroke assessments and decision-making. Therefore, the objective of this study was to determine the level of agreement of baseline brain CT scan interpretations of patients with acute stroke presenting to telestroke spoke hospitals between central reading committee neuroradiologists and each of 2 groups, spoke hospital radiologists and hub hospital vascular neurologists (telestrokologists).

Methods: The Stroke Team Remote Evaluation Using a Digital Observation Camera Arizona trial was a prospective, urban single-hub, rural 2-spoke, randomized, blinded, controlled trial of a 2-way, site-independent, audiovisual telemedicine and teleradiology system designed for remote evaluation of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis.

Smartphone teleradiology application is successfully incorporated into a telestroke network environment.

Background And Purpose: ResolutionMD mobile application runs on a Smartphone and affords vascular neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators.

Sleep apnea and white matter disease in hypertensive patients: a case series.

Obstructive sleep apnea (OSA) is associated with hypertension (HTN) and cardiovascular disease. Transient episodes of hypoxia, hypercapnia, and blood pressure elevation during OSA may lead to neural damage and subsequently white matter disease (WMD). As WMD is usually the result of chronic small vessel ischemia, a relationship between OSA and cerebrovascular disease may exist.

Vascular neurology nurse practitioner provision of telemedicine consultations.

Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods.

Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial.

Background And Purpose: Telemedicine techniques can be used to address the rural-metropolitan disparity in acute stroke care. The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trial reported more accurate decision making for telemedicine consultations compared with telephone-only and that the California-based research network facilitated a high rate of thrombolysis use, improved data collection, low risk of complications, low technical complications, and favorable assessment times. The main objective of the STRokE DOC Arizona TIME (The Initial Mayo Clinic Experience) trial was to determine the feasibility of establishing, de novo, a single-hub, multirural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol.

Nursing Roles within a Stroke Telemedicine Network.

Time sensitive acute stroke treatments and the growing shortage of vascular neurologists compound to create a gap in the delivery of care to meet the American Stroke Association guidelines in underserviced regions. Audio/video consultation (telemedicine), which has been evolving since the late 1990's, is a putative solution. While telemedicine can serve as a valuable facilitative tool, the telestroke consultation is only one piece of a complex collaboration between hub and spoke environments and clinical personnel.

The state of emergency stroke resources and care in rural Arizona: a platform for telemedicine.

A rural-urban disparity exists in acute stroke management practices in Arizona. A proposed solution is a statewide acute stroke care plan centered on stroke telemedicine. Our purpose was to evaluate the emergency stroke resources available at and care provided by remote Arizona hospitals and to formulate a 5-year stroke telemedicine plan for Arizona rural residents.

Stroke telemedicine.

Stroke telemedicine is a consultative modality that facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers. The design and implementation of a hub-and-spoke telestroke network are complex. This review describes the technology that makes stroke telemedicine possible, the members that should be included in a telestroke team, the hub-and-spoke characteristics of a telestroke network, and the format of a typical consultation.