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基于社区的研究。最需要的是 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 名为儿科医师学习和协作教育（Peds PLACE）的计划。我们从一个 努力加快儿科转化研究从学术床边到社区的速度。核心 包括 25 个远程医疗单元（高分辨率监视器、计算机、摄像头、扫描能力等），通过以下方式连接 T1 线路能够同时承载两个连接全州医院的实时会议。这 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上发言的人，管理 实时交互并允许社区提供商稍后审查教育视频。 每场会议都会讨论一种常见疾病的诊断和治疗，并有 10 条共识指南 每年由参与者开发。我们通常有大约 20 个站点收听每个会议，这可以 现在可以直接从医生办公室通过私人计算机上的 Jabber 软件通过网站访问 与网络浏览者进行实时对话。社区提供者可以提交问题，这些问题可以 在会议期间直接使用软件或在线解决。部分主持人位于 现在，远至波多黎各、德国和印度也可以远程观看我们的节目。有了这个 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 新生儿重症监护。尽管区域化与较低的死亡率相关，但实施情况却不尽如人意。 困难，尤其是在阿肯色州这样的农村州。 CTN远程医疗核心已用于修改 已建立的国家网络中的交付模式取得了巨大成功。病情最严重的婴儿，请咨询 核心，现在转移到那些最有能力满足极低出生体重的复杂需求的地点 （VLBW，<1500 克）新生儿，但那些可以在当地照顾的人仍保留，维持更密切的家庭和 支撑结构。这导致工作人员和员工普遍满意（通过问卷评估） 患者。更重要的是，婴儿死亡率从8.5/1000下降到7/1000，接近美国水平 约 6/1000。除了这些创新之外，该核心的其他计划还包括开发远程喉镜 在我们医院的远程视频控制下为婴儿插管。插管是一项关键技能 因为需要为肺表面活性物质缺乏的早产儿建立一条通道。很遗憾， 目前的培训往往不足，因为 1/3 的儿科住院医师在培训结束时无法插管 极低出生体重儿经过 3 次尝试，技能在训练后更加恶化。无法插管可能是 意外分娩新生儿脑室内出血发生率增加的关键因素 没有新生儿科医生的较小社区托儿所。我们现在在全州有四个这样的单位， 使它们可供该州的每个地区使用。另一项外展计划是实施 我们与美国儿科学会合作开展“帮助婴儿呼吸”计划 赞比亚，为三个交付点开展培训并提供物资（CTN提供后勤保障） 支持）。核心设施还开发了一个急诊科 (ED) 站点网络 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， ED 是在农村和服务欠缺社区进行研究的理想场所。因此我们开发了紧急 科室医师学习和协作教育 (EDs PLACE) 计划作为一项教育和 咨询平台，即将启动研究计划；六个单元已放置在尚未放置的地点 卒中计划涵盖 9 个地点，AR 急诊室共有 19 个单位。附加单位有 通过单独的资助被安置在其他急诊室。除了中风的早期诊断和治疗外，主题 自从我们医院最近成为一级创伤中心以来，有针对性的创伤，并扩展到一系列 主题包括紧急医疗服务、急性心血管护理、备灾、康复 和结果。