Telemedicine Core

远程医疗核心设施旨在开展以社区为基础的研究。最大的需求是 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 该计划名为儿科医生学习和合作教育(PEDS Place)。我们从一个 努力加快儿科研究从学术床边到社区的转化。《核心》 包括25个远程医疗单元(高分辨率监视器、计算机、照相机、扫描能力等)链接者 T1线路能够承载连接全州医院的两个同步实时会议。这个 网络由媒体站点控制，该站点将所有视频切换到在站点发言的人，管理 实时互动，并允许教育视频稍后由社区提供商审查。 每一次会议都涉及一种常见疾病的诊断和治疗，10项共识指南是 由参与者每年开发。我们通常有大约20个站点收看每个会议，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 为网络观众提供实时对话功能。社区提供商可以提交问题，这些问题可以 在会议期间直接使用软件或在线解决。一些演讲者位于 我们的节目现在可以从遥远的波多黎各、德国和印度观看。有了这个 计划到位后，我们开始了研究组成部分“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有关，但实施 困难，特别是在像阿肯色州这样的农村州。CTN远程医疗核心已用于修改 在一个成熟的国家网络中的交付模式取得了巨大的成功。病情最严重的婴儿，在与 核心，现在转移到那些最能满足极低出生体重的复杂需求的网站 (VLBW，&lt；1500克)新生儿，但那些可以在当地照顾的人留下来，保持更亲密的家庭和 支撑结构。这在工作人员中产生了广泛的满意度(通过问卷调查进行评估)， 病人。更重要的是，婴儿死亡率从千分之8.5下降到千分之七，更接近美国的水平 约6/1000。除了这些创新之外，这个核心的其他项目还包括开发远程喉镜 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 因为需要为肺表面活性物质缺乏的早产儿建立一条主干道。不幸的是， 目前的培训往往是不够的，因为三分之一的儿科住院医师在培训结束时无法插管 VLBW 3次试训初生，训练后技能更差无法插管很可能是一种 意外分娩的新生儿脑室出血发生率增加的关键因素 没有新生儿医生的较小的社区托儿所。我们现在在全州有四个这样的单位， 使它们可以在该州的每个地区使用。另一项外展方案是实施 “帮助婴儿呼吸”项目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并提供了物资(反恐委员会提供后勤服务 支持)。核心设施还在各地的急诊科建立了一个站点网络 州政府。由于乡村医院通过急诊室而不是像城市大医院那样通过诊所接收病人， ED是在农村和服务不足的社区进行研究的理想地点。因此，我们开发了紧急情况 科室医生学习和协作教育(EDS Place)计划作为一种教育和 会诊平台，即将启动研究计划；六个单位已被安置在尚未到位的地点 由中风计划覆盖，该计划有9个地点，在AR的ED中总共有19个单位。更多的单位 通过单独的资金放在其他急诊室。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，并扩大到一系列 主题包括紧急医疗服务、急性心血管护理、备灾、康复 和结果。

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.