RESUMEN
BACKGROUND AND PURPOSE: Immediate access to physicians experienced in acute stroke treatment may improve clinical outcomes in patients with acute stroke. Interactive telemedicine can make stroke specialists available to assist in the evaluation of patients at multiple urban or remote rural facilities. We tested whether interrater agreement for the NIH Stroke Scale (NIHSS), a critical component of acute stroke assessment, would persist if performed over a telemedicine link. METHODS: One bedside and 1 remote NIHSS score were independently obtained on each of 20 patients with ischemic stroke. The bedside examination was performed by a stroke neurologist at the patient's bedside. The remote examination was performed by a second stroke neurologist through an interactive high-speed audio-video link, assisted by a nurse at the patient's bedside. Kappa coefficients were calculated for concordance between bedside and remote scores. RESULTS: Remote assessments took slightly longer than bedside assessments (mean 9.70 versus 6.55 minutes, P<0. 001). NIHSS scores ranged from 1 through 24. Based on weighted kappa coefficients, 4 items (orientation, motor arm, motor leg, and neglect) displayed excellent agreement, 6 items (language, dysarthria, sensation, visual fields, facial palsy, and gaze) displayed good agreement, and 2 items (commands and ataxia) displayed poor agreement. Total NIHSS scores obtained by bedside and remote methods were strongly correlated (r=0.97, P<0.001). CONCLUSIONS: The NIH Stroke Scale remains a swift and reliable clinical instrument when used over interactive video. Application of this technology can bring stroke expertise to the bedside, regardless of patient location.
Asunto(s)
Evaluación de Resultado en la Atención de Salud , Accidente Cerebrovascular/diagnóstico , Telemedicina , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Estudios de Evaluación como Asunto , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , National Institutes of Health (U.S.) , Reproducibilidad de los Resultados , Estados UnidosRESUMEN
New technology is helpful in the treatment of patients with spinal cord injury, but we are still unable to reverse the effects of the initial injury. The major focus in the acute treatment of spinal cord trauma has remained prevention of secondary injury and complications thereafter. This article describes different types of spinal cord injuries, treatment, and statistics.
Asunto(s)
Traumatismos de la Médula Espinal , Actividades Cotidianas , Fenómenos Biomecánicos , Continuidad de la Atención al Paciente/organización & administración , Tratamiento de Urgencia , Humanos , Cuidados a Largo Plazo , Examen Neurológico/métodos , Evaluación en Enfermería/métodos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/terapia , Estados Unidos/epidemiologíaRESUMEN
Sophisticated nursing management is an integral part of treatment in GBS. Many difficulties are overcome if nurses have a sound basis of knowledge of the disease and can anticipate complications and explain the illness to patient and family. Most efforts are directed toward preventing the secondary medical complications of quadriparesis, bulbar paresis, and general disability. Plasma exchange is an important recent innovation in the therapy of GBS.