AcuteCare Telemedicine Blog


Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.



AcuteCare Telemedicine Turns 3!

This October marks the third anniversary of AcuteCare Telemedicine (ACT). Over the course of its first three years, ACT has grown considerably during a period of significant change in the policy and industry of healthcare in America. The 4 Board Certified partners of ACT have retained a steady focus on their mission of filling a growing need for 24/7 neurology coverage.

Telemedicine has proven to be a burgeoning facet of the healthcare industry, with technological advancements and enhanced communications allowing providers to extend their reach over geographical boundaries to patients in need while simultaneously streamlining the healthcare delivery process and reducing associated financial and environmental costs. ACT has worked hard to stay ahead of the curve, offering the most cutting-edge solutions for saving lives in cases of neurological emergency.

Entering its fourth year of providing this expert neurological consultation via telemedicine technology to rural and underserved medical facilities throughout the Southeast, ACT looks forward to continued growth. As teleneurology continues to garner attention from hospitals as a practical and effective solution to neurologist staffing needs, the outlook for the company this year and beyond is extremely positive. “The message of ACT has really started to take hold in the healthcare community, and as our efforts for finding new hospital partners ramp up, we are optimistic that we will ultimately be able to reach even more patients with and offer them the level of care they deserve,” says Dr. Lisa Johnston, Partner, ACT.

“Following our rebrand of the company in 2011, we have stayed dedicated to our values as expert practitioners and our vision as a business,” adds Dr. Keith Sanders, Partner, ACT. “The standard of service we have been able to provide has only climbed higher. We are truly passionate about combating morbidity and mortality rates of acute stroke, right here at home in the Stroke Belt (a region of the Southeastern US with higher-than average stroke rates) and beyond.”

Hard work and diligence is paying off for the partners of ACT. As the group continues to practice neurology full time and commit themselves to reaching more patients in 2013, they hope to add to an already impressive list of achievements and accolades throughout their short history.

 



Telemedicine: Modern Breakthrough or Timeless Concept?

Telemedicine is the practice of medicine at a distance; interaction that occurs remotely with the physician removed from direct contact with either the patient or other physicians. Telemedicine can include all phases of the physician-patient relationship, from evaluation (including pathology) to diagnosis and treatment. Although  recent breakthroughs in telecommunications technologies have accelerated the advancement of telemedicine, the desire to seek medical counsel regardless of the proximity of the healthcare provider is a common thread throughout medical history. The mechanism has changed, but medicine has long worked to remove the barriers of distance and time.

As early as the Middle Ages, “telepathology” was employed in the form of sending urine samples over distance to physicians for analysis. Prescriptions were carried over miles to patients before the advent of postal services. With the postal service came written letters describing symptoms to physicians, who would reply with diagnoses and treatment plans. These are all examples distinctly foreshadowing the emails and blog centered care that is now gaining a foothold.

Eventually, a milestone was reached when the telegraph allowed transmission of x-ray images. By the late 1800’s, telephony allowed direct 2-way communication between physicians. Still, a physical connection was required, and physicians at sea or without telephone access were at a loss. The radio broke that barrier by the 1920’s, and by the middle of the century, television technology brought real time images into the equation.

Near the end of the last century the most rapid, indeed explosive, growth of telemedicine utilization resulted from the symbiosis of computer technology, wireless communication networks and the internet. The ease of access to telemedicine that modern communication technology provides has broadened the scope of services. “Telehealth,” the utilization of remote presence to monitor health conditions, rather than responding to acute emergencies, is essentially commonplace. Moreover, well-care and health education have benefitted as well.

Today, we do not think twice about calling patients or colleagues on a phone, logging onto a computer for laboratory results, or reviewing radiology images on a TV screen. Soon, electronic health records (EHR’s) will be the norm. There are even technologies on the horizon which will become a partner with the doctor in establishing a diagnosis. The question for our future is when does new remote presence technology become standard of care? Inevitably, we will lose the “tele” and acknowledge that we are completely free of distance as an obstacle to patient care.



The Impact of Technology on Neurological Care

Keeping up with technology remains as vital to the physicians of AcuteCare Telemedicine (ACT) now as it did 36 years ago.

In 1975, the neurology group which became ACT had the foresight to bring the first CT scanner to Georgia.  Installed in downtown Atlanta, this first-generation EMI scanner revolutionized neurological care in our region. Patients came from across the United States to be scanned on one of the first machines in the United States. The grainy images provided cutting-edge information that helped physicians diagnose and treat, saving lives.

Left: A 1975 brain CT. Right: A brain MRI in 2011. Notice the difference of detail in the images of brain structure in the newer scan.

ACT builds on this tradition of technological innovation by providing the highest quality neurological care to patients at distant hospitals.  Using high-quality video-conferencing technology, ACT’s neurologists swiftly evaluate patients in emergency rooms across the country.  When innovation is part of your culture, it is second nature.