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Wiestler H, Zickler P, Erdur H, Abu-Mugheisib M, Kallmünzer B, Klingner C, Müller-Barna P, Hubert G, Gumbinger C, Worthmann H. Recommendations for the organization of the teleconsultation service in a telestroke network. Neurol Res Pract 2024; 6:24. [PMID: 38659040 PMCID: PMC11044278 DOI: 10.1186/s42466-024-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
Telestroke networks aim to improve acute stroke care within their catchment area. Through a teleconsultation service, the network centers provide support to network hospitals that lack continuous neurological expertise for acute stroke management decisions. Although the importance of telemedical treatment in stroke care is steadily increasing, so far no standards exist for the organization of the teleconsultation service in networks.To ensure a high-level of quality for all processes and measures concerning telemedical stroke treatment, the commission for telemedical stroke care of the German Stroke Society (Deutsche Schlaganfall-Gesellschaft, DSG) created the following recommendations on how to organize a teleconsultation service within a telestroke network. The recommendations are the result of an adjustment process between the authors and include guidance on requirements, qualifications, processes and quality management within the teleconsultation service.
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Affiliation(s)
- Hanni Wiestler
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany.
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Augsburg, Augsburg, Germany
| | - Hebun Erdur
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | - Mazen Abu-Mugheisib
- Department of Neurology, Municipal Hospital Braunschweig, Braunschweig, Germany
| | - Bernd Kallmünzer
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany
| | | | - Peter Müller-Barna
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Gordian Hubert
- Department of Neurology, Academic Teaching hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Hubert GJ, Hubert ND, Maegerlein C, Kraus F, Wiestler H, Müller-Barna P, Gerdsmeier-Petz W, Degenhart C, Hohenbichler K, Dietrich D, Witton-Davies T, Regler A, Paternoster L, Leitner M, Zeman F, Koller M, Linker RA, Bath PM, Audebert HJ, Haberl RL. Association Between Use of a Flying Intervention Team vs Patient Interhospital Transfer and Time to Endovascular Thrombectomy Among Patients With Acute Ischemic Stroke in Nonurban Germany. JAMA 2022; 327:1795-1805. [PMID: 35510389 PMCID: PMC9092197 DOI: 10.1001/jama.2022.5948] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE The benefit of endovascular thrombectomy (EVT) for acute ischemic stroke is highly time-dependent, and it is challenging to expedite treatment for patients in remote areas. OBJECTIVE To determine whether deployment of a flying intervention team, compared with patient interhospital transfer, is associated with a shorter time to endovascular thrombectomy and improved clinical outcomes for patients with acute ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS This was a nonrandomized controlled intervention study comparing 2 systems of care in alternating weeks. The study was conducted in a nonurban region in Germany including 13 primary telemedicine-assisted stroke centers within a telestroke network. A total of 157 patients with acute ischemic stroke for whom decision to pursue thrombectomy had been made and deployment of flying intervention team or patient interhospital transfer was initiated were enrolled between February 1, 2018, and October 24, 2019. The date of final follow-up was January 31, 2020. EXPOSURES Deployment of a flying intervention team for EVT in a primary stroke center vs patient interhospital transfer for EVT to a referral center. MAIN OUTCOMES AND MEASURES The primary outcome was time delay from decision to pursue thrombectomy to start of the procedure in minutes. Secondary outcomes included functional outcome after 3 months, determined by the distribution of the modified Rankin Scale score (a disability score ranging from 0 [no deficit] to 6 [death]). RESULTS Among the 157 patients included (median [IQR] age, 75 [66-80] y; 80 [51%] women), 72 received flying team care and 85 were transferred. EVT was performed in 60 patients (83%) in the flying team group vs 57 (67%) in the transfer group. Median (IQR) time from decision to pursue EVT to start of the procedure was 58 (51-71) minutes in the flying team group and 148 (124-177) minutes in the transfer group (difference, 90 minutes [95% CI, 75-103]; P < .001). There was no significant difference in modified Rankin Scale score after 3 months between patients in the flying team (n = 59) and transfer (n = 57) groups who received EVT (median [IQR] score, 3 [2-6] vs 3 [2-5]; adjusted common odds ratio for less disability, 1.91 [95% CI, 0.96-3.88]; P = .07). CONCLUSIONS AND RELEVANCE In a nonurban stroke network in Germany, deployment of a flying intervention team to local stroke centers, compared with patient interhospital transfer to referral centers, was significantly associated with shorter time to EVT for patients with acute ischemic stroke. The findings may support consideration of a flying intervention team for some stroke systems of care, although further research is needed to confirm long-term clinical outcomes and to understand applicability to other geographic settings.
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Affiliation(s)
- Gordian J. Hubert
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Nikolai D. Hubert
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Frank Kraus
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Hanni Wiestler
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Peter Müller-Barna
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | | | - Christoph Degenhart
- Department of Diagnostic and Interventional Radiology, München Klinik, Munich, Germany
| | - Katharina Hohenbichler
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Dennis Dietrich
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Witton-Davies
- Department of Diagnostic and Interventional Radiology, München Klinik, Munich, Germany
| | - Angelika Regler
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laura Paternoster
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Miriam Leitner
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Philip M. Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Heinrich J. Audebert
- Department of Neurology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Roman L. Haberl
- TEMPiS telestroke center, Department of Neurology, München Klinik, Academic Teaching hospital of the Ludwig-Maximilians-University, Munich, Germany
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Müller-Barna P, Leinweber C, Pfaffenrath J, Schütt-Becker N, von Martial R, Greck S, Hubert N, Rambold H, Haberl R, Hubert GJ. Identification of Stroke and TIA in Patients With Acute Dizziness, Vertigo or Imbalance in Emergency Departments of Primary Care Hospitals: Early Experiences With a Network-Based Telemedical Approach. Front Neurol 2022; 13:766685. [PMID: 35309564 PMCID: PMC8924543 DOI: 10.3389/fneur.2022.766685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAcute dizziness, vertigo, and imbalance are frequent and difficult to interpret symptoms in the emergency department (ED). Primary care hospitals often lack the expertise to identify stroke or TIA as underlying causes. A telemedical approach based on telestroke networks may offer adequate diagnostics and treatment.AimThe aim of this study is to evaluate the accuracy of a novel ED algorithm in differentiating between peripheral and central vestibular causes.MethodsWithin the Telemedical Project for Integrative Stroke Care (TEMPiS), a telemedical application including a videooculography (VOG) system was introduced in 2018 in 19 primary care spoke hospitals. An ED triage algorithm was established for all patients with acute dizziness, vertigo, or imbalance of unknown cause (ADVIUC) as a leading complaint. In three predefined months, all ADVIUC cases were prospectively registered and discharge letters analyzed. Accuracy of the ED triage algorithm in differentiation between central and peripheral vestibular cases was analyzed by comparison of ED diagnoses to final discharge diagnoses. The rate of missed strokes was calculated in relation to all cases with a suitable brain imaging. Acceptance of teleconsultants and physicians in spoke hospitals was assessed by surveys.ResultsA total number of 388 ADVIUC cases were collected, with a median of 12 cases per months and hospital (IQR 8–14.5). The most frequent hospital discharge diagnoses are vestibular neuritis (22%), stroke/TIA (18%), benign paroxysmal positioning vertigo (18%), and dizziness due to internal medicine causes (15%). Detection of a central vestibular cause by the ED triage algorithm has a high sensitivity (98.6%), albeit poor specificity (45.9%). One stroke out of 32 verified by brain scan was missed (3.1%). User satisfaction, helpfulness of the project, improvement of care, personal competence, and satisfaction about handling of the VOG systems were rated consistently positive.DiscussionThe concept shows good acceptance for a telemedical and network-based approach to manage ADVIUC cases in the ED of primary care hospitals. Identification of stroke cases is accurate, while specificity needs further improvement. The concept could be a major step toward a broadly available state of the art diagnostics and therapy for patients with ADVIUC in primary care hospitals.
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Affiliation(s)
- Peter Müller-Barna
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
- *Correspondence: Peter Müller-Barna
| | - Christina Leinweber
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Julia Pfaffenrath
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Nina Schütt-Becker
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Rascha von Martial
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Greck
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Nikolai Hubert
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Holger Rambold
- Department of Neurology, InnKlinikum Altötting, Altötting, Germany
- Department of Neurology, University of Regensburg, Regensburg, Germany
- MVZ Kliniken Mühldorf, Mühldorf am Inn, Germany
| | - Roman Haberl
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telestroke Center, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, Munich, Germany
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von Martial R, Leinweber C, Hubert N, Rambold H, Haberl RL, Hubert GJ, Müller-Barna P. Feasibility of Telemedical HINTS (Head Impulse-Nystagmus-Test of Skew) Evaluation in Patients With Acute Dizziness or Vertigo in the Emergency Department of Primary Care Hospitals. Front Neurol 2022; 12:768460. [PMID: 35222226 PMCID: PMC8873087 DOI: 10.3389/fneur.2021.768460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Acute dizziness, vertigo and imbalance are common symptoms in emergency departments. Stroke needs to be distinguished from vestibular diseases. A battery of three clinical bedside tests (HINTS: Head Impulse Test, Nystagmus, Test of Skew) has been shown to detect stroke as underlying cause with high reliability, but implementation is challenging in primary care hospitals. Aim of this study is to prove the feasibility of a telemedical HINTS examination via a remotely controlled videooculography (VOG) system. Methods The existing video system of our telestroke network TEMPiS (Telemedic Project for Integrative Stroke Care) was expanded through a VOG system. This feature enables the remote teleneurologist to assess a telemedical HINTS examination based on inspection of eye movements and quantitative video head impulse test (vHIT) evaluation. ED doctors in 11 spoke hospitals were trained in performing vHIT, nystagmus detection and alternating cover test. Patients with first time acute dizziness, vertigo or imbalance, whether ongoing or resolved, presented to the teleneurologist were included in the analysis, as long as no focal neurological deficit according to the standard teleneurological examination or obvious internal medicine cause was present and a fully trained team was available. Primary outcome was defined as the feasibility of the telemedical HINTS examination. Results From 01.06.2019 to 31.03.2020, 81 consecutive patients were included. In 72 (88.9%) cases the telemedical HINTS examination was performed. The complete telemedical HINTS examination was feasible in 46 cases (63.9%), nystagmus detection in all cases (100%) and alternating covert test in 70 cases (97.2%). The vHIT was recorded and interpretable in 47 cases (65.3%). Results of the examination with the VOG system yielded clear results in 21 cases (45.7%) with 14 central and 7 peripheral lesions. The main reason for incomplete examination was the insufficient generation of head impulses. Conclusion In our analysis the telemedical HINTS examination within a telestroke network was feasible in two thirds of the patients. This offers the opportunity to improve specific diagnostics and therapy for patients with acute dizziness and vertigo even in primary care hospitals. Improved training for spoke hospital staff is needed to further increase the feasibility of vHIT.
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Affiliation(s)
- Rascha von Martial
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Christina Leinweber
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Nikolai Hubert
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Holger Rambold
- Department of Neurology, InnKlinikum gKU Altötting und Mühldorf, InnKlinikum Altötting, Altötting, Germany
- Department of Neurology, University of Regensburg, Regensburg, Germany
- Department of Neurology, MVZ Kliniken Mühldorf, Mühldorf am Inn, Germany
| | - Roman Ludwig Haberl
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
| | - Peter Müller-Barna
- Department of Neurology, TEMPiS Telestroke Center, Academic Teaching Hospital of the Ludwig-Maximilians-University, München Klinik, Munich, Germany
- *Correspondence: Peter Müller-Barna
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Müller-Barna P, Hubert ND, Bergner C, Schütt-Becker N, Rambold H, Haberl RL, Hubert GJ. TeleVertigo: Diagnosing Stroke in Acute Dizziness: A Telemedicine-Supported Approach. Stroke 2019; 50:3293-3298. [PMID: 31607244 DOI: 10.1161/strokeaha.119.026505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Müller-Barna
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Nikolai Dominik Hubert
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Christina Bergner
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Nina Schütt-Becker
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Holger Rambold
- Department of Neurology, County Hospitals of Altötting and Burghausen, Germany (H.R.)
- Department of Neurology, University of Regensburg, Germany (H.R.)
- MVZ Kliniken Mühldorf, Mühldorf am Inn, Germany (H.R.)
| | - Roman Ludwig Haberl
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Gordian Jan Hubert
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
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Ezzat N, Müller-Barna P, Krüger C, Randzio O. [Prescription of Psychotropic Drugs with Potentially Restraining Effect: An Analysis of Care Need Assessment Data by MDK Bayern]. Gesundheitswesen 2018; 81:1029-1036. [PMID: 29895053 DOI: 10.1055/a-0631-1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Physical restraints in home care and residential care settings in the form of restraining devices have been reduced in the last years. Now psychotropic drugs with sedating and thus potentially restraining effect are of increasing interest. The objective of this study was to describe prescription of psychotropic drugs for insurants in need of care and factors influencing such prescription. METHODS On the "Annual Word Elder Abuse Awareness Day", the Medical Service of the Statutory Health Insurance undertook a reference day analysis. During the regular assessment of care needs, distribution of psychotropic drugs according to relevant aspects of care were analyzed. Additionally, prescribed drugs were rated with respect to inappropriateness for elder people according to the Priscus list. RESULTS Data on 706 insured people were analyzed; 43% of them received at least one psychotropic drug as a regular medication, 22% of them at least one potentially sedating drug. According to the Priscus list, 16% of prescribed drugs were identified as potentially inappropriate for elder people. Significant correlation was shown between prescription of psychotropic drugs and location of assessment, care need, diagnosis and the degree of limitation in daily living skills. CONCLUSION This paper supports results in literature and emphasizes the discrepancy between restraint in the prescription of psychotropic drugs as advised by experts and distribution of these drugs in reality. Further studies analyzing the quality of prescriptions taking into consideration the individual circumstances of patients are desirable.
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Affiliation(s)
- Nadja Ezzat
- MDK Bayern, Ressort Analyse, Konzept, Consulting, München
| | - Peter Müller-Barna
- Städtisches Klinikum Harlaching, Abteilung für Neurologie und neurologische Intensivmedizin, München
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Abstract
ZusammenfassungDie Zuverlässigkeit der neurologischen Fernuntersuchung mittels Videokonferenz bei akuten Schlaganfallpatienten ist gut belegt. Hiervon ausgehend sind international telemedizinische Netzwerke zur Schlaganfallversorgung entstanden, die auf sehr unterschiedlichen Ansätzen basieren. In Deutschland hat sich das Konzept regionaler und integrierter Netzwerke durchgesetzt, das heißt, dass in den telemedizinisch vernetzten Kliniken Schlaganfalleinheiten mit hohen Qualitätsstandards und ein netzwerkübergreifendes Schulungskonzept und Qualitätsmanagement etabliert wurden. Aus dem TEMPiS-Projekt in Süd-Ost-Bayern mit jährlich über 3 000 Telekonsilen und zuletzt ca. 400 Lysebehandlungen in 15 Kooperationskliniken liegen überzeugende Studienergebnisse zum klinischen Nutzen derart konzipierter Netzwerke vor. Dieser Artikel soll einen Einblick in den Aufbau, die technischen Grundlagen und die Evaluationsergebnisse von telemedizinischen Schlaganfallnetzwerken geben und ihre Zukunftsperspektive beschreiben.
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Hubert GJ, Meretoja A, Audebert HJ, Tatlisumak T, Zeman F, Boy S, Haberl RL, Kaste M, Müller-Barna P. Stroke Thrombolysis in a Centralized and a Decentralized System (Helsinki and Telemedical Project for Integrative Stroke Care Network). Stroke 2016; 47:2999-3004. [PMID: 27834751 DOI: 10.1161/strokeaha.116.014258] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/14/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. METHODS We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1.56 million inhabitants, 9096 km2) and the decentralized TeleStroke Unit network in a predominantly rural area (Telemedical Project for Integrative Stroke Care [TEMPiS], South-East Bavaria, Germany, 1.94 million inhabitants, 14 992 km2). All consecutive tPA treatments were prospectively registered. We compared tPA rates per total ischemic stroke admissions in the Helsinki and TEMPiS catchment areas. For delay comparisons, we excluded patients with basilar artery occlusions, in-hospital strokes, and those being treated after 270 minutes. RESULTS From January 1, 2011, to December 31, 2013, 912 patients received tPA in Helsinki University Central Hospital and 1779 in TEMPiS hospitals. Area-based tPA rates were equal (13.0% of 7017 ischemic strokes in the Helsinki University Central Hospital area versus 13.3% of 14 637 ischemic strokes in the TEMPiS area; P=0.078). Median prehospital delays were longer (88; interquartile range, 60-135 versus 65; 48-101 minutes; P<0.001) but in-hospital delays were shorter (18; interquartile range, 13-30 versus 39; 26-56 minutes; P<0.001) in Helsinki University Central Hospital compared with TEMPiS with no difference in overall delays (117; interquartile range, 81-168 versus 115; 87-155 minutes; P=0.45). CONCLUSIONS A decentralized telestroke thrombolysis service can achieve similar treatment rates and time delays for a rural population as a centralized system can achieve for an urban population.
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Affiliation(s)
- Gordian J Hubert
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.).
| | - Atte Meretoja
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Heinrich J Audebert
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Turgut Tatlisumak
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Florian Zeman
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Sandra Boy
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Roman L Haberl
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Markku Kaste
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
| | - Peter Müller-Barna
- From the Department of Neurology, TEMPiS, Städtisches Klinikum München, Germany (G.J.H., R.L.H.); Department of Neurology, Helsinki University Central Hospital, Finland (A.M., T.T., M.K.); Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (A.M.); Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia (A.M.); Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (H.J.A.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Center for Clinical Studies, University Hospital Regensburg, Germany (F.Z.); Department of Neurology, Asklepios Stadtklinik Bad Tölz, Germany (S.B.); and Department of Analysis, Concept and Consulting, Medical Services of Compulsory Health Insurance Funds, Munich, Germany (P.M.-B.)
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Lehmann K, Vlcek A, Rößlein R, Hagemann M, Jobst R, Fabian M, Schmidt A, Müller-Barna P. Erste Erfahrungen mit einem Fehlermeldesystem in Pflegeeinrichtungen. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Müller-Barna P, Hubert GJ, Boy S, Bogdahn U, Wiedmann S, Heuschmann PU, Audebert HJ. TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care. Stroke 2014; 45:2739-44. [PMID: 25147327 DOI: 10.1161/strokeaha.114.006141] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke Unit care improves stroke prognosis and is recommended for all patients with stroke. In rural areas, population-wide implementation of Stroke Units is challenging. Therefore, the TeleMedical Project for integrative Stroke Care (TEMPiS) was established in 2003 as a TeleStroke Unit network to overcome this barrier in Southeast Bavaria/Germany. Evaluation of its implementation between 2003 and 2005 had revealed improved process quality and clinical outcomes compared with matched hospitals without TeleStroke Units. Data on sustainability of these effects are lacking. METHODS Effects on the stroke care of the local population were analyzed by using data from official hospital reports. Prospective registries from 2003 to 2012 describe processes and outcomes of consecutive patients with stroke and transient ischemic attack treated in TEMPiS hospitals. Quality indicators assess diagnostics, treatment, and outcome. Rates and timeliness of intravenous thrombolysis as well as data on teleconsultations and secondary interhospital transfers were reported over time. RESULTS Within the covered area, network implementation increased the number of patients with stroke and transient ischemic attack treated in hospitals with (Tele-)Stroke Units substantially from 19% to 78%. Between February 2003 and December 2012, 54 804 strokes and transient ischemic attacks were treated in 15 regional hospitals, and 31 864 teleconsultations were performed. Intravenous thrombolysis was applied 3331 stroke cases with proportions increasing from 2.6% to 15.5% of all patients with ischemic stroke. Median onset-to-treatment times decreased from 150 (interquartile range, 127-163) to 120 minutes (interquartile range, 90-160) and door-to-needle times from 80 (interquartile range, 68-101) to 40 minutes (interquartile range, 29-59). CONCLUSIONS TeleStroke Units can provide sustained high-quality stroke care in rural areas.
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Affiliation(s)
- Peter Müller-Barna
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Gordian J Hubert
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Boy
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Bogdahn
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Wiedmann
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter U Heuschmann
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hubert GJ, Müller-Barna P, Audebert HJ. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries. Int J Stroke 2014; 9:968-73. [PMID: 25381687 DOI: 10.1111/ijs.12394] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/08/2014] [Indexed: 01/23/2023]
Abstract
TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries.
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Affiliation(s)
- Gordian J Hubert
- Gordian Hubert, Städtisches Klinikum München GmbH, Klinikum Harlaching, Neurology - TEMPiS, Munich, Germany
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Eyding J, Kitzrow M, Krogias C, Müller-Barna P, Weber R, Bartig D. 78% der Schlaganfälle werden auf 534 Stroke Units behandelt – (noch?) eine Fiktion! Fortschr Neurol Psychiatr 2014; 82:54-5. [DOI: 10.1055/s-0033-1356392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Eyding
- Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum
| | - M. Kitzrow
- Klinik für Neurologie, Universitätsklinikum Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum
| | - C. Krogias
- Klinik für Neurologie, Universitätsklinikum St. Josef-Hospital Bochum
| | - P. Müller-Barna
- Klinik für Neurologie und Neurologische Intensivmedizin, Klinikum Harlaching, Städtisches Klinikum München
| | - R. Weber
- Klinik für Neurologie, Alfried Krupp Krankenhaus Essen
| | - D. Bartig
- drg market, Marktanalysen, Osnabrück
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Kitzrow M, Bartig D, Krogias C, Müller-Barna P, Postert T, Sorgenfrei HU, Weber R, Eyding J. [Quality parameters in the treatment of acute stroke: comparison of various regional treatment concepts]. Nervenarzt 2013; 84:1486-96. [PMID: 24253483 DOI: 10.1007/s00115-013-3930-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The long-term prognosis of stroke patients is still dependent in particular on the timing of a correct diagnosis, immediate initiation of a suitable specific therapy and competent treatment in a stroke unit. Therefore, nationwide attempts are being made to establish a comprehensive coverage of the necessary specific competence and infrastructural requirements. Divergent regional circumstances and economic viewpoints determine the characteristics of the various healthcare concepts and the interplay between participating cooperation partners. This article compares the development with respect to three qualitative treatment parameters exemplified by four regional healthcare models during the time period 2008-2011. METHODS The hospitalization rates for patients with transitory ischemic attacks, ischemic and hemorrhagic stroke, the case numbers for stoke unit treatment and the rates of systemic thrombolysis and mechanical thrombectomy in the regions of Berlin, the Ruhr Area, Ostwestfalen-Lippe and southeast Bayern (TEMPiS) are presented based on the data from the DRG statistical reports for the years 2008 and 2011. RESULTS The average hospitalization rates for ischemic stroke patients (brain infarct ICD 163) in the time period from 2008 to 2011 were 294 per 100,000 inhabitants for the Ruhr Area, 257 per 100,000 inhabitants for Ostwestfalen-Lippe and 265 per 100,000 inhabitants each for Berlin and southeast Bayern. The complex stroke treatment quota for southeast Bayern in 2008 was 31 % and 47 % in 2011 and the respective quotas for the other regions studied were 42-44 % and 58-59 %. The rate of systemic thrombolysis in 2008 ranged between 4.2 % and 7.4 % and in 2011 the increase in the range for the 4 regions studied was between 41 % and 145 %. In 2011 the thrombectomy quota of 2 % in the Ruhr Area was the only one which was above the national average of 1.3 % of all brain infarcts. DISCUSSION Stroke is a common disease in the four regions studied. For the established forms of therapy, complex treatment of stroke and systemic thrombolysis, the positive effect of structurally improved approaches in the four different regional treatment concepts could be confirmed during the course of the observational time period selected. Mechanical thrombectomy which is currently still considered to be an individual healing attempt, was used significantly more often in the Ruhr Area in 2011 than in the other three regions studied. A standardized referral procedure had previously been established in the metropolitan regions.
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Affiliation(s)
- M Kitzrow
- Neurologische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Deutschland,
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14
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Müller-Barna P, Haberl R. Hirnblutung: Ist eine schnelle, intensive Blutdrucksenkung effektiv? - Die schnelle, intensive Blutdrucksenkung ist nicht gefährlich und möglicherweise nützlich. Dtsch Med Wochenschr 2013; 138:1702. [DOI: 10.1055/s-0032-1329056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Struppler A, Jakob C, Müller-Barna P, Schmid M, Lorenzen HW, Paulig M, Prosiegel M. Eine neue Methode zur Frührehabilitation zentralbedingter Lähmungen von Arm und Hand mittels Magnetstimulation. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Struppler A, Havel P, Müller-Barna P. Facilitation of skilled finger movements by repetitive peripheral magnetic stimulation (RPMS) - a new approach in central paresis. NeuroRehabilitation 2003; 18:69-82. [PMID: 12719622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A new therapeutic method for the rehabilitation of central paresis of the upper extremity, especially of fine skilled finger movements, is presented. The therapeutic concept is the activation of reorganization processes in the CNS. These processes are elicited by the induction of proprioceptive input to the CNS which corresponds physiologically to the lost input during active movements. The input is generated by repetitive peripheral magnetic stimulation (RPMS) at the innervation zone of the paretic muscles. The stimulation leads to a motion of the activated muscles. The proprioceptive input is generated by two mechanisms: adequately by activation of mechanoreceptors of the stimulated muscles during the induced contractions and relaxations and inadequately by direct activation of the involved sensorimotor afferents. The method has been applied to 52 patients suffering from spastic paresis of the upper extremity. A simple clinical quantification using the Ashworth scale revealed that spasticity could be remarkably (1-2 points) reduced already by one session of RPMS lasting 15 minutes. In order to get an objective insight into the improvement of active motor performances, a neurophysiological investigation of active finger extensions was performed in eight patients suffering from a central hemiparesis. Following RPMS of the paretic finger extensors, the patients could perform rapid finger extensions with larger displacement and velocity at diminished amounts of EMG activity.
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Affiliation(s)
- A Struppler
- Sensorimotor Integration Research Group, Department of Psychiatry, Technical University of Munich, Germany.
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Struppler A, Havel P, Müller-Barna P. Facilitation of skilled finger movements by repetitive peripheral magnetic stimulation (RPMS) – a new approach in central paresis. NeuroRehabilitation 2003. [DOI: 10.3233/nre-2003-18108] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Struppler
- Sensorimotor Integration Research Group, Department of Psychiatry, Technical University of Munich, Germany
| | - P. Havel
- Sensorimotor Integration Research Group, Department of Psychiatry, Technical University of Munich, Germany
| | - P. Müller-Barna
- Department of Neurology, Städtisches Krankenhaus München-Harlaching, Germany
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