Response to letter regarding article, "Art of expertise in stroke telemedicine: imaging and the collaterome".
Response to letter regarding article, "Art of expertise in stroke telemedicine: imaging and the collaterome".
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对有关文章“中风远程医疗专业知识的艺术：成像和collaterome”的信件的回复。
DOI：
10.1161/strokeaha.115.009327
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发表时间：
2015
期刊：
影响因子：
8.3
通讯作者：
Liebeskind,DavidS
中科院分区：
文献类型：
--
作者：
Liebeskind,DavidS
Uchino等人对最近一篇关于中风远程医疗的社论的褒贬评论表明，中风应急移动（STEMO）方法被错误地描述了。1-3他们认为，尽管使用了远程放射学和与高级中风专家进行进一步的远程神经学咨询，以促进复杂的决策，但在救护车上出现神经科医生违反了中风远程医疗的定义。他们在信中描述了柏林首创的移动中风单元方法的进一步迭代，以推进远程医疗和克利夫兰中风患者的简化分类。我强烈支持他们为促进缺血性和出血性中风患者的护理所做的努力，但我认为他们的模式既不是中风远程医疗的第一个，也不是最终的改进。中风远程医疗可以通过不断发展的各种技术创新来定义和实施，主要是利用和强调特定中风护理提供者的专业知识，而不是在医学专业之间创建人工定义和可能存在争议的划分。克利夫兰对远程医疗和远程放射学的定义不必要地造成了分歧，就像最近被誉为中风手术成功的血管内治疗试验的标签一样。急性中风患者的专家神经影像学评估越来越多地由血管神经科医生实时执行，而不是远程放射学。院前卒中远程医疗之前是由创新的电信模式推动的，该模式由注册的卒中治疗镁领域管理局（FAST-MAG）医生带头，在全球范围内对中风患者进行症状发作后几分钟内的评估。在FAST-MAG时代，随着互联网功能的加速，技术从翻盖手机到智能手机再到可视电话都得到了发展。5同样，移动计算机断层扫描（CT）设备在各个国家和城市不断增加，多模态CT血管造影和灌注成像已经成为现实。智能手表的创新和便携式设备无疑将通过研究合作使院前中风远程医疗现代化，这些研究合作使用了知情同意的新方法、紧凑的医疗和成像记录、生物传感器等。应该使用移动CT等技术，但不要崇拜。目前，移动脑卒中单元的快速非对比CT提供了排除出血以外的边缘信息。只有精明的影像专家才能辨别出最细微的和潜在影响的发现。因此，卒中远程医疗最好由评估、治疗和分类所有类型的卒中患者的护理提供者来培养，而不是仅仅关注特定的子集，如那些有大血管闭塞的个体。血管内治疗试验的最新进展从根本上改变了中风远程医疗的格局，强调了神经血管成像和中风医学专业知识的基本价值。最近血管内试验的成功是基于各种神经成像方法来识别大血管闭塞和有利的侧支剖面，在非对比CT、CT血管造影、CT灌注和类似的磁共振成像技术上的定义不同。由于这些理想的血管内候选者只占所有中风患者的一小部分，因此对临床和神经血管成像技能的专业知识的需求将是压倒性的，这可能依赖于远程医疗来有效地定制特定地理区域内所有中风患者的分布。这样的需求可能……
The complimentary comments by Uchino et al1–3 on the recent editorial about stroke telemedicine suggest that the Stroke Emergency Mobile (STEMO) methodology was erroneously described. 1–3 They contend that the presence of a neurologist in the ambulance defies the definition of stroke telemedicine despite the use of both teleradiology and further teleneurology consultation with a senior stroke expert to facilitate complex decision making. Their letter describes a further iteration of the mobile stroke unit methods pioneered in Berlin to advance telemedicine and the streamlined triage of patients with stroke in Cleveland. I strongly endorse their efforts to advance the care of patients with both ischemic and hemorrhagic stroke but suggest that their model is not the first nor ultimate refinement of stroke telemedicine. Stroke telemedicine may be defined and implemented with a variety of technological innovations that continue to evolve, principally leveraging and underscoring the expertise of specific stroke care providers rather than creating artificial definitions and potentially contentious divisions across medical specialties. The Cleveland definition of telemedicine versus teleradiology unnecessarily creates division much like the recent labeling of endovascular therapy trials hailed as the success of stroke surgery. Expert neuroimaging evaluation of the patient with acute stroke is increasingly performed in real time by vascular neurologists, not by teleradiology. Prehospital stroke telemedicine was previously catapulted by the innovative telecommunications paradigm spearheaded by the enrolling Field Administration of Stroke Therapy-Magnesium (FAST-MAG) physicians to evaluate patients with stroke within minutes of symptom onset, from across the globe. 4 During the FAST-MAG years, technology advanced from flip phones to smartphones to videophones as internet capabilities accelerated. 5 Similarly, mobile computed tomographic (CT) units continue to proliferate in various countries and cities, with multimodal CT angiography and perfusion imaging already reality. Smartwatch innovations and portable devices will undoubtedly modernize prehospital stroke telemedicine through research collaborations that use novel methods for informed consent, compact medical and imaging records, biosensors, and more. Technology such as mobile CT, should be used, but not worshiped. At present, the rapid noncontrast CT in the mobile stroke unit provides marginal information beyond the exclusion of hemorrhage. Only the astute imaging expert may discern the most subtle and potentially influential findings. Stroke telemedicine is therefore best cultivated by care providers that evaluate, treat, and triage all types of patients with stroke rather than solely focusing on a particular subset such as those individuals with large vessel occlusions. The recent advances of endovascular therapy trials radically alter the landscape of stroke telemedicine, underscoring the essential value of expertise in neurovascular imaging and stroke medicine. The success of recent endovascular trials was predicated on a variety of neuroimaging approaches to identify large vessel occlusion and a favorable collateral profile, defined differently on noncontrast CT, CT angiography, CT perfusion, and analogous magnetic resonance imaging techniques. As such ideal endovascular candidates constitute a minority of all patients with stroke, there will be an overwhelming demand for expertise in clinical and neurovascular imaging skills that will likely depend on telemedicine to efficiently tailor the distribution of all patients with stroke across a particular geographical region. Such demand may …
Uchino 等人关于文章“中风远程医疗专业知识的艺术：成像和collaterome”的信函。
影响因子：
8.3
作者：
K. Uchino;P. Rasmussen;M. Hussain
通讯作者：
M. Hussain