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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 IMG_8025.JPG(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.IMG_8028.JPGIMG_8029.JPG
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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

https://www.youtube.com/watch?v=YaQjM-SSohg

The Predictive role of modified clinical diffusion mismatch in early neurological deterioration due to atherothrombotic ischemia in the anterior circulation.

A Japanese study on the relevance of ASPECTS scoring system and neurological impairment scales for predicting outcome was published on Acta Neurochir (Wien).

The journla is minor but the topic always convinced me.

About the usefulness of a 3 tesla MRI in hyperacute phase of a stroke. The analysis showed unexpected results.

see at Diffusion-weighted MRI in acute stroke within the first 6 hours: 1.5 or 3.0 Tesla? by Rosso C, Drier A, Lacroix D, Mutlu G, Pires C, Lehéricy S, Samson Y, Dormont D. from AP-HP, Urgences Cérébro-Vasculaires, Université Pierre et Marie Curie, Paris VI, Hôpital Pitié-Salpêtrière, Paris

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