The Stroke Tower

The skyline of Barcellona offers always many surprises. One of them is directly connected with our interests.

A special tower stands in a southern residential area neighborhood, this is a popular metropolitan area grown for the workers in the bustling automotive industry of the 60s.

This is the tower of the Hospital Universitari de Bellvitge. We had a quick visit to the 9th floor together with Dr. Pere Cardona Portela (see photo).

Next to a “pan-optical” stroke unit at the same level of the Neurosurgery ward a special room hosts the “tele ictus” service.

A service active 24/7 for all partner hospitals of Catalunya. This is one of the Telestroke HUB of Barcelona metropolitan area, the other is the Hospital Universitari Vall d’Hebron.

With safe teleconsult techniques an audio-video streaming (see picture) connects the spoke with the hub. This is of help in the decision making process and facilitates the patient dispatchment avoiding futility.

An efficient regional PACS/RIS system support the clinicians for their decisions. The report written by the stroke expert will reach the spoke hospital in real time minimizing the risk of medical errors.

Also mobile devices ara available to guarantee the service from home by the stroke specialists “on call”. In Bellvitge 1200 patients are admitted each year and thanks to telemedicine 170 patients are centralized for thrombectomy. Every year 350 teleconsults are done with peaks of 3-4 per day.

We leave the “telestroke tower” with a better idea on one of the most exciting challenges for many health care systems: emergency telemedicine.

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Recommendations on telestroke in Europe by ESO

Hubert, G. J., Santo, G., Vanhooren, G., Zvan, B., Campos, S. T., Alasheev, A., … Corea, F. (2018). Recommendations on telestroke in Europe. European Stroke Journal

 

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Lack of stroke specialists determines that many European rural areas remain underserved. Use of telemedicine in stroke care has shown to be safe, increase use of evidence-based therapy and enable coverage of large areas of low population density. The aim of this article is to summarise the following recommendations of the Telestroke Committee of the European Stroke Organisation on the setup of telestroke networks in Europe: Hospitals participating in telestroke networks should be chosen according to criteria that include population density, transportation distance, geographic specifics and in-hospital infrastructure and professional resources. Three hospital categories are identified to be part of a hub-and-spoke network: (1) the Telemedicine Stroke Centre (an European Stroke Organisation stroke centre or equivalent with specific infrastructure and setup for network and telemedicine support), (2) the telemedicine-assisted stroke Unit (equivalent to an European Stroke Organisation stroke unit but without 24 h onsite stroke expertise) and (3) the telemedicine-assisted stroke ready hospital (only covering hyperacute treatment in the emergency department and transferring all patients for further treatment).

ETNA DUS study site open #edoxaban @Foligno stroke

The San Giovanni Battista Hospital of Foligno was opened yesterday after teleconference SIV. Now active and enrolling on the ETNA DUS safety use of edoxaban. First active site in Umbria contacts +39 0742 339 7063 PI & contact francesco.corea@uslumbria2.it

 

World Stroke Day 2018

Le iniziative associate allo WSD si susseguono in queste settimane. Con il motto #upagainafterstroke.

Qui trovate un estratto dell’evento che si è svolto in Umbria a Foligno (Palazzo Trinci sala rossa). Presenti medici di 118, pronto soccorsi e neurologia della USL Umbria 2.

Sometimes the hardest part of having a stroke is the feeling that you are alone.

80 million people in the world have had a stroke, 50 million stroke survivors live with some form of permanent disability. If you have had a stroke, or care for someone who has, one thing is for sure – you are not alone! We are here to help you get #UpAgainAfterStroke

How Telestroke works ?

The first Telestroke workshop organized by the ESO Telestroke Committee took place in Munich, Germany from 5 to 6 July. the workshop was hosted by the Neurology staff of the Klinikum Harlaching chair Prof. Roman Haberl and the Tempis coordinators Gordian Hubert and Peter Muller-Bama.

The meeting was attended by 12 doctors coming from 7 different countries (Croatia, Italy, Macedonia, Philippines, Slovenia, Serbia and Spain).

Speakers from the Tempis staff, Dr. Frank Kraus and the ESO committee members gave a wide overview of the main solution and updates on the most advanced frontiers of telemedicine. Working groups simulated telemedicine models to be set up in each country, focusing on most disadvantaged geographical areas. A simulated call from a stroke centre was presented to the attendees. Also continental reimbursement policies, risk management aspects and technical issues were discussed.

The committee group looks forward producing shortly a recommendation paper and standard of certification for telestroke services.

The Committee members

Gordian Hubert (Chair), Germany
Sonia Abilleira, Spain
Andrey Alasheev, Russia
Jessica Balinn, Germany
Francesco Corea, Italy
Gustavo Santo, Portugal
Silvia Tur Campos, Spain
Geert Vanhooren, Belgium
Bojana Zvan, Slovenia

Meeting Milano “Urgenze Neurologiche”

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  Presentati sommariamente i risultati della survey promossa dal Telestroke committee ESO di questa estate. Indicativa di difficoltà di accesso alle cure nella metà delle 20 reti ictus esaminate. Si riscontra altresì diffusione di sistemi per teleconsulto. Pochi sono dispositivi elettromedicali in uso, più frequenti le soluzioni improvvisate. Il mercato dei dispositivi appare eterogeneo e si patisce un vuoto organizzativo.

• Si concorda invio della survey alla rivista di Thierry Moulin /European Research in Telemedicine.
• Analisi più allargata (Elba, Roma altri eventuali) sarà inviata all’ESOC 2018 entro la deadline del congresso.
• Non vi sono pacchetti formativi in materia di telestroke/teleneurologia.
• ASL di Emilia Romagna, Abruzzo, Umbria e Toscana hanno mosso passi significativi per acquisire strumentazione per cifre maggiori al milione e mezzo di € spesso i medici non sono coinvolti nel processo organizzativo. 
• Si riscontrano carenze contrattuali con mancato riconoscimento anche finanziario in chi pratica telemedicina con particolare criticità nel telelavoro dal domicilio.
• I partecipanti si prodigheranno nel trasmettere alle organizzazioni sindacali ed ordini medici competenti territorialmente tali criticità nella prospettiva del rinnovo del CCNN di primavera e pressione su aziende sanitarie.
• Ci ripromettiamo di proporre a ditte del settore di sponsorizzare eventi specifici anche nelle prossime edizioni delle urgenze neurologiche parlandone con gli organizzatori.
• Concordiamo nel rivederci ove possibile a Göteborg ESOC 2018 e Milano ESOC 2019 per perseguire un significativo progresso in questo ambito di lavoro
• Durante la tavola rotonda I Prof Comi e Micieli, invitavano lo scrivente ad esporre alcune istanze e prefigurano la possibilità di corsi in materia tramite “ANEU”.
• Il Prof Toni raccomanda di segnalare le trombolisi effettuate in telemedicina affinché possano integrarsi con i registri già operativi.Gruppo Telestroke

World Stroke Day 2017 la Giornata Mondiale dell’Ictus

Fare un salto in ospedale con l’auto d’epoca… per ricordarsi che un ictus … sei mesi fa rischiava di portarti via l’autonomia, la memoria e la libertà. Questo è il regalo che Loriano ci ha fatto lo scorso 29 Ottobre. E’ successo al San Giovanni Battista.

OLTRE 17 milioni di persone nel mondo – 200mila solo in Italia – vengono colpite da ictus cerebrale ogni anno (di queste ne muoiono 6 milioni). Senza contare poi che sono in molti quelli che seppur sopravvivono, dovranno convivere con gravi disabilità o con il terrore che l’ictus si ripresenti di nuovo. L’ictus cerebrale nel solo 2016 ha ucciso o reso invalida un’enorme quantità di persone, uomini, donne e persino bambini, rubando 116 milioni di anni di vita. E continua ad essere la seconda causa più probabile di morte nel mondo intero”.

·UNA GIORNATA PER INFORMARSI E PREVENIRE L’ICTUS
All’ictus (in inglese stroke, che significa “colpo”) viene dedicata ogni anno la Giornata mondiale (29 ottobre) e dal 2006 è stata istituita l’Organizzazione mondiale dell’ictus (World stroke organization, Wso), che coinvolge 85 Paesi nel mondo. Perché l’ictus – molto spesso invalidante – se si conosce, si può prevenire. “Investire in prevenzione oggi non è più solo intelligente, è obbligatorio – sottolinea l’associazione Alt – perché nessun governo avrà le risorse sufficienti per assistere tutti coloro che verranno colpiti da ictus o da un altro evento da trombosi nei prossimi anni. Dipende molto da noi: dobbiamo sapere quali sono le cause, modificare i fattori di rischio modificabili, imparare a riconoscere problemi nel battito del cuore in noi stessi o in chi ci sta accanto. Insomma, dobbiamo riconoscere i sintomi sospetti e agire immediatamente”.

Ricordarsi i sintomi dell’ictus può velocizzarne il riconoscimento, quindi la diagnosi e la sua cura. RAPIDO!

Ridi,

Alza il braccio,

Parla e DOmanda aiuto

queste le parole chiave che possono salvarci.

Teleneurology meeting in Erfurt

The issue of stroke is particularly noticeable in neurology due to the high prevalence rate and serious consequences. Accordingly, telenurology is also intensively concerned with this disease pattern and attempts to contribute to medical progress in the field of neurology, using knowledge of the use of modern technologies. In Thuringia, the stroke telemedicine network "SATELIT" has existed for almost 5 years and has shown during this time that telemedical developments and application can help to contribute to the improvement of care quality in neurological diseases by means of computer-supported communication and network technologies. In Umbria, Italy a stroke network was successfully deployed since 2016 using fix units in the west of the county and mobile units in the earthquake area to the east. In addition to acute stroke treatment, the German Society for Telemedicine, in cooperation with the Hans Berger Clinic for Neurology at the University Hospital of Jena, will also be discussing with the First German Telenurology Congress the health policy and socio-political significance of the Telemedicine in neurology. The conference is aimed at clinicians, doctors, nurses, therapists and costumers as well as companies interested in current medical developments in the field of neurology, rehabilitation and aftercare. The focus of the 2017 Congress will be telemedicine in stroke care as the most important field of application. Other neurological applications such as dizziness, Parkinson's disease, or epilepsy are also being investigated. In addition, telemedicine products and latest developments are presented in an accompanying industrial exhibition.

European Union Health Commission on Stroke

Brussels, 30th November 2016 – Jon Barrick SAFE President and Valeria Caso President of the European Stroke Organisation of Stroke Professionals had a meeting today at the European Union Health Commission to discuss the quality of Stroke prevention, care and support within the countries of Europe.

SAFE and ESO made a number of proposals aimed at gathering EU support for encouraging countries across Europe to improve stroke intervention. Stroke now accounts for more than 9% of all deaths in Europe and is the leading cause of long term severe disability.

Topics discussed included the Health Commissioners engagement with proceedings at a Stroke Summit meeting to be held in Brussels on May 11th 2017, the dissemination of the Burden of Stroke report with data on the stroke care pathway performance in each European country, and a report on the current situation  around acute stroke care. Also discussed were support for the SAFE, ESO and others initiative to produce a stroke European action plan to be launched in May 2018, and the potential for creation of an economic burden of stroke report by 2019.

The Stroke European action plan will be the sequel to the Helsingborg declaration of 2006, which set objectives to be achieved by 2015. This is now redundant and many new developments and treatments have occurred since its first appearance, and there is now an opportunity to create initiatives to drive down the death and disability rates from stroke.

Other topics covered were the need for greater awareness of stroke, more effort to be made in preventing stroke, and the need to allocate more resources for stroke research generally. SAFE and ESO were encouraged to provide more examples of good practice to be shared country to country, and questions were asked concerning possibilities of good practice pilot activity.

There was found to be a huge overlap between the work of SAFE and ESO, and that of the EU Health Commission, with all parties seeking to make sure stroke care is sustainable, efficient, and supports resilience within health care systems (the capacity to buffer change, learn and develop, enhance adaptive capacity in a situation of rapid treatment transformations).

As such there was agreement that more work to combat stroke makes a positive contribution to the Health programme aims of the EU http://ec.europa.eu/health/programme/policy/index_en.htm.

Airborne Stroke Unit

In the era of mechanical reperfusion, HEMS can be a powerful instrument for improving acute stroke delivery and research that is currently underutilized. The speed of HEMS may allow reperfusion for a large number of patients that would not have immediate access due to geography or traffic congestion. Also, HEMS critical early time period after a stroke where specific interventions to preserve penumbra and prevent reperfusion injury may have a significant influence on outcomes. The impact of physical factors generated by the helicopter on the ischemic brain needs to be studied. HEMS are also an opportunity to increase recruitment of patients in standard clinical trials. Addressing the HEMS stroke gap is necessary to homogenize the delivery of acute stroke care and research capabilities through all care settings, therefore minimizing disparities in outcomes based in geographical location.

European Stroke Journal Sept 2016