Telemedicine Core

远程医疗核心

• 批准号: 9320366
• 负责人: WHIT HALL
• 金额: $ 37.45万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9320366
• 关键词: Academic Medical Centers; Academy; Accident and Emergency department; Acute; Address; American; Area; Arkansas; Awareness; Birth; Breathing; Cardiovascular system; Caring; Childhood; Clinic; Communication; Communities; Complex; Computer software; Computers; Consensus; Consultations; Core Facility; Country; Development; Diagnosis; Disasters; Disease; Education; Emergency Department Physician; Emergency medical service; Emergency research; Funding; Germany; Goals; Guidelines; Healthcare; Hospitals; Incidence; India; Infant Mortality; Internet; Intubation; Learning; Link; Location; Lung; Neonatal Intensive Care; Nurseries; Outcome; Participant; Patients; Pattern; Pediatrics; Persons; Physicians; Physicians' Offices; Premature Infant; Provider; Puerto Rico; Questionnaires; Readiness; Rehabilitation Outcome; Research; Research Project Grants; Resolution; Resources; Role; Rural; Rural Hospitals; Scanning; Site; Source; Specialist; Speed; Stroke; Structure; Telemedicine; Time; Training; Translating; Translational Research; Trauma; Urban Hospitals; Very Low Birth Weight Infant; Zambia; community based participatory research; computer monitor; design; family support; health care delivery; improved; innovation; intraventricular hemorrhage; mortality; neonatal care; neonate; new technology; outreach program; programs; satisfaction; skills; stroke treatment; success; surfactant; symposium; translational neuroscience; trauma centers; web site

The Telemedicine Core Facility is designed to carry out community-based research. The greatest needs that this community faced were education and consultation. The first network we developed was an educational program called Pediatric Physician Learning and Collaborative Education (Peds PLACE). We began with an effort to speed translational research in pediatrics from the academic bedside to the community. The Core includes 25 telemedicine units (high resolution monitor, computer, camera, scanning capacity, etc.) linked by T1 lines capable of carrying two simultaneous real-time conferences that connect hospitals statewide. The network is controlled by a media site that switches all video to the person who is speaking at a site, managing real-time interaction and allowing for educational videos to be reviewed at a later date by community providers. Each session addresses the diagnosis and treatment of a common disorder, and 10 consensus guidelines are developed annually by the participants. We typically have ~20 sites tuning into each conference, which can now be accessed via website utilizing Jabber software on private computers directly from physicians' offices with real-time conversation for web viewers. Community providers can submit questions which can be addressed during the session either directly using the software or online. Some presenters are located remotely and our programs are now viewed from as far away as Puerto Rico, Germany and India. With this program in place, we began the research component, "Tele-nursery", initially to address regionalization of neonatal intensive care. Although regionalization is associated with lower mortality, implementation has been difficult, especially in rural states like Arkansas. The CTN Telemedicine Core has been used to modify patterns of delivery in an established state network with great success. The sickest babies, in consultation with the Core, are now transferred to those sites most able to address the complex needs of Very Low Birth Weight (VLBW, <1500 grams) neonates, but those that can be cared for locally remain, maintaining closer family and support structures. This has resulted in widespread satisfaction (assessed in questionnaires) among staff and patients. More importantly, infant mortality was lowered from 8.5/1000 births to 7/1000, closer to the U.S. level of ~6/1000. In addition to these innovations, other programs in this Core include the development of a telelaryngoscope for intubating babies under remote video control from our hospital. Intubation is a critical skill because of the need to establish an ainway in preterm neonates with surfactant deficient lungs. Unfortunately, current training is often inadequate as 1/3 of pediatric residents at the end of their training cannot intubate a VLBW neonate after 3 tries, and skills deteriorate even more after training. The inability to intubate likely is a key factor in the increased incidence of intraventricular hemorrhage in neonates who inadvertently deliver in smaller community nurseries without neonatologists. We now have four of these units around the state, making them available to each region of the state. Another outreach program is the implementation of the "Helping Babies Breathe" program in partnership with the American Academy of Pediatrics, which we took to Zambia, and carried out training and provided supplies for three delivery sites (the CTN provided logistical support). The Core Facility also developed a network of sites at emergency departments (EDs) around the state. Since rural hospitals admit patients through the EDs rather than clinics as in large urban hospitals, the ED is an ideal location for research in rural and underserved communities. We thus developed the Emergency Department Physician Learning and Collaborative Education (EDs PLACE) program as an educational and consultation platform, and will soon begin the research program; Six units were placed at sites not already covered by the stroke program that has 9 locations, for a total of 19 units in EDs in AR. Additional units have been placed at other EDs by separate funding. In addition to eariy diagnosis and treatment of stroke, topics targeted trauma since our hospital recently became a Level 1 Trauma Center, and expanded to a range of topics including emergency medical services, acute cardiovascular care, disaster preparedness, rehabilitation and outcomes.

远程医疗核心设施旨在开展社区研究。最伟大的需要是 这个社区面临的是教育和咨询。我们开发的第一个网络是一个教育网络， 儿科医生学习和协作教育（Peds Place）。我们从一个 努力加速儿科学的转化研究从学术床边到社区。核心 包括25个远程医疗单元（高分辨率监视器、计算机、摄像机、扫描能力等）相连 T1线路能够同时进行两个实时会议，连接全州的医院。的 网络由媒体站点控制，该媒体站点将所有视频切换到在站点发言的人，管理 实时互动，并允许教育视频在以后的日期由社区提供商审查。 每一次会议都涉及一种常见疾病的诊断和治疗，10个共识指南是 每年由参与者制定。我们通常有~20个站点调谐到每个会议，这可以 现在可以通过网站使用Jabber软件在私人电脑上直接从医生的办公室访问 为网络观众提供实时对话。社区提供者可以提交问题， 在会议期间直接使用软件或在线解决。一些主持人位于 我们的节目现在远至波多黎各、德国和印度都能收看。与此 计划到位后，我们开始了研究部分，“远程托儿所”，最初是为了解决区域化的问题。 新生儿重症监护虽然区域化与较低的死亡率有关，但执行情况一直不佳。 这很困难，尤其是在像阿肯色州这样的乡村州。CTN远程医疗核心已被用于修改 在一个已建立的国家网络中的交付模式取得了巨大成功。最多的婴儿，在咨询 核心，现在转移到那些最有能力解决极低出生体重的复杂需求的网站 (VLBW，<1 500克）的新生儿，但那些可以在当地得到照顾的新生儿仍然留在当地，维持更密切的家庭关系， 支持结构。这导致工作人员普遍感到满意（通过问卷进行评估）， 患者更重要的是，婴儿死亡率从8.5/1000下降到7/1000，接近美国的水平 约6/1000。除了这些创新，本核心的其他项目还包括远程喉镜的开发 在我们医院的远程视频控制下给婴儿插管插管是一项关键技能 因为需要在肺表面活性物质缺乏的早产新生儿中建立气道。不幸的是， 目前的培训往往是不够的，因为1/3的儿科住院医师在培训结束时不能插管， VLBW新生儿在3次尝试后，训练后技能恶化更严重。无法插管可能是 意外分娩的新生儿脑室内出血发生率增加的关键因素 小型社区托儿所，没有托儿所学家。我们现在在全州有四个这样的单位， 使其适用于国家的每个地区。另一个外展计划是实施 “帮助婴儿呼吸”计划与美国儿科学会合作，我们采取了 赞比亚，并为三个交货地点进行了培训和提供了用品（CTN提供了后勤支助）。 支持）。核心设施还在 状态由于农村医院通过急诊室而不是像大城市医院那样通过诊所收治病人， 艾德是在农村和服务不足的社区进行研究的理想场所。因此，我们制定了紧急情况 部门医生学习和协作教育（EDs PLACE）计划作为一个教育和 咨询平台，并将很快开始研究计划;六个单位被放置在网站还没有 卒中计划涵盖9个地点，AR急诊室共19个单位。其他单位有 由其他基金资助。除了中风的早期诊断和治疗， 有针对性的创伤，因为我们的医院最近成为一级创伤中心，并扩大到一系列的 主题包括紧急医疗服务，急性心血管护理，灾难准备，康复 和结果。