Journal of telemedicine and telecare
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Review Meta Analysis
Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke: a meta-analysis.
The aim of this study was to assess the benefits of telemedicine in the delivery of thrombolytic therapy for patients with acute ischemic stroke. We performed a meta-analysis using combinations of the following terms: telestroke, telemedicine, tissue plasminogen activator/t-PA, and acute ischemic stroke. The primary outcome was favorable outcome based on the modified Rankin score. ⋯ We found no significant difference in favorable outcome between the telemedicine and control groups, and no significant difference was found between these groups in the rate of symptomatic intracranial hemorrhage or overall mortality. Patients with acute ischemic stroke who were treated with intravenous thrombolysis had similar outcomes regardless of whether telemedicine was used or they were treated in-person at a medical facility. Telemedicine can be used to support hospitals with limited experience in administering thrombolytic therapy for stroke.
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Randomized Controlled Trial Multicenter Study
A randomized controlled trial on Stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care.
We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans from three Veterans Affairs Medical Centers. Participants who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. ⋯ Core concepts identified were: (a) beneficial impact of the trained assistant; (b) exercises helpful; (c) home use of technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional post-stroke rehabilitation.
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E-consultations are being offered within clinic walls as an option for specialist advice without a face-to-face consultation appointment. In a six month time frame, nearly 100% of primary care internists and family medicine providers in a multispecialty practice had used an e-consultation at least once. Specialists also used e-consultations for advice from other specialists. ⋯ Although e-consultations were offered as an alternative to face-to-face specialty consultations, 1,111 of 5,334 e-consultations eventually did receive face-to-face appointments in the same specialty. Within 30 days of the e-consultation 11.5% had a specialty face-to-face visit and 17.7% had seen a specialist face-to-face within 90 days of the e-consultation. The conversions of e-consultations to face-to-face consultations depended on the specialty providing the e-consultation (fewer for gastroenterology and infectious disease), patient distance from the clinic (fewer for international patients and those living greater than 800 kilometers from the clinic), and experience of specialist responding to the e-consultation (lower conversions for specialists providing 15 or more e-consultations).