Sharma Sudhir, Padma M V, Bhardwaj Amit, Sharma Ashish, Sawal Nishit, Thakur Suresh
Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2016 Sep-Oct;64(5):934-40. doi: 10.4103/0028-3886.190243.
Telemedicine is a major effort to tackle the uneven availability of facilities for thrombolysis in acute ischemic stroke. We present a telestroke model introduced in a small hilly state of Himachal Pradesh in India.
To provide acute ischemic stroke treatment with tissue plasminogen activator in all district hospitals of Himachal Pradesh with computerized axial tomographic scan facility through Telemedicine.
Smartphone-based hub and spoke telestroke model was used with two tertiary care hospitals (with neurologists) as hub and 17 district hospitals (without onsite neurologists) as spokes.
The telestroke project was launched in the state of Himachal Pradesh in April 2014. Medical officers in district hospitals (Medicine graduates and Internal Medicine postgraduates) were trained in the treatment of stroke through workshops. Tissue plasminogen activator was made available at all these centers, free of cost through hospital pharmacies. Four neurologists at two tertiary care centers were made available for consultation on phone.
Between June 2014 and May 2015, a total of 26 patients received thrombolysis under the telestroke project at nine district hospitals without onsite presence of a neurologist. Eight patients were females and 18 males. The age of patients ranged from 26 to 80 years. Only 2 patients developed an intracranial bleed following thrombolysis, and both were nonfatal.
Smartphone-based telestroke services may be a much cheaper alternative to video-conferencing-based telestroke services and are more portable with less technical glitches. To the best of our knowledge, this is the first telestroke model being reported from India. It seems to be the way forward in providing timely treatment in acute ischemic stroke in underserved and resource poor settings.
远程医疗是解决急性缺血性卒中溶栓治疗设施分布不均问题的一项重大举措。我们介绍了在印度喜马偕尔邦一个小山丘地区引入的远程卒中模式。
通过远程医疗，在喜马偕尔邦所有具备计算机断层扫描设备的 district 医院，为急性缺血性卒中患者提供组织纤溶酶原激活剂治疗。
采用基于智能手机的中心辐射型远程卒中模式，以两家三级护理医院（配备神经科医生）为中心，17 家 district 医院（无现场神经科医生）为辐射点。
2014 年 4 月，喜马偕尔邦启动了远程卒中项目。district 医院的医务人员（医学毕业生和内科研究生）通过研讨会接受了卒中治疗培训。所有这些中心均通过医院药房免费提供组织纤溶酶原激活剂。两家三级护理中心的四名神经科医生提供电话咨询服务。
2014 年 6 月至 2015 年 5 月期间，共有 26 例患者在远程卒中项目下于 9 家无现场神经科医生的 district 医院接受了溶栓治疗。8 例为女性，18 例为男性。患者年龄在 26 至 80 岁之间。溶栓后仅 2 例患者出现颅内出血，且均非致命性。
基于智能手机的远程卒中服务可能是基于视频会议的远程卒中服务更便宜的替代方案，并且更便于携带，技术故障更少。据我们所知，这是印度首次报道的远程卒中模式。在服务不足和资源匮乏的地区，它似乎是为急性缺血性卒中提供及时治疗的前进方向。
