Application of the scenario could be improved by including the weighing equipment and a simulation of the software used in the telestroke. We were not able to assess medical and paramedical patient management separately due to the few questions in this subcategory. Furthermore, while our evaluation with pretraining and posttraining testing demonstrated an obvious gain in knowledge following the training, this might not necessarily translate the same improvement in the skills required to manage this complex situation in a real-life setting.
The evaluation of our training model, as for most other studies, only reached the second level of the Kirkpatrick's hierarchy.
In order to demonstrate the safety of the system, we conducted an observational study to compare rt-PA treatment initiation directly at the bedside in our stroke unit and through telemedicine in the first 2 active spoke centers. We did not find any significant difference for time-to-treatment and patient outcome.
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- Simulation training for emergency teams to manage acute ischemic stroke by telemedicine.
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The protocol has now to be implemented in other areas with rigorous evaluation to compare intrahospital times in spoke centers and patient outcomes before and after training. Furthermore, the gain in knowledge and operational skills of this simulation training compared to classic theoretical teaching also remains to be demonstrated. Moreover, the improvement in the posttraining test partially reflects the results of immediate knowledge after training.
Even if we can consider that the skills are maintained and improved by repeating the procedures in reality, long-term evaluation should be performed. In conclusion, our medical simulation model is a useful tool not only to train the medical and paramedical teams of spoke emergency departments to examine stroke patients and administer rt-PA treatment, but also to support the organization of telestroke.
It can be simply applied in all medical simulation centers and could be the basis of a standardized training for medical and paramedical staff in this setting. Further studies should now try to demonstrate the clinical gain brought about by this action in terms of time to treatment and patient outcome.
Renaud Fay as biostatistician for having reviewed Statistical Analysis and Results parts, and Felicity Neilson Matrix Consultants for having reviewed the English language with scientific expertise. Supplemental Digital Content is available for this article. The authors have no conflicts of interests to disclose. National Center for Biotechnology Information , U. Journal List Medicine Baltimore v. Medicine Baltimore. Published online Jun Find articles by Serge Bracard. Find articles by Marc Braun. Author information Article notes Copyright and License information Disclaimer.
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All rights reserved. This is an open access article distributed under the Creative Commons Attribution License 4. This article has been corrected. See Medicine Baltimore. This article has been cited by other articles in PMC. Supplemental Digital Content. Abstract Telemedicine contributes to initiating early intravenous recombinant tissue plasminogen activator rt-PA treatment for patients with acute cerebral infarction in areas without a stroke unit. Keywords: acute cerebral infarction, emergency team, hub and spoke, intravenous rt-PA, medical simulation training, telemedicine, telestroke.
Introduction The benefit of thrombolytic therapy with intravenous recombinant tissue plasminogen activator rt-PA to treat patients at the acute phase of ischemic stroke has been widely demonstrated since s. Methods 2. Telestroke Our telestroke system is composed of 1 hub and 6 spokes.
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Simulation scenario The patient in the scenario is a previously self-sufficient year-old man with a medical history of hypertension and arrhythmia admitted to the emergency department of a spoke at am following a fall and left hemiplegia see Table 1, Supplemental Content which precisely describes the scenario. Training assessment Learners were made aware that they would undergo the same pretraining and posttraining test.
Results From February to May , learners from emergency teams including 73 physicians, nurses, 9 auxiliary nurses, and 4 radiology technicians underwent the training in sixteen sessions. Open in a separate window. Figure 1. Figure 2. Figure 3. Discussion The advantages of telemedicine for administering intravenous rt-PA treatment to ischemic stroke patients are now well demonstrated.
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All these persons gave permission to be named in this section. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med ; —7.
Thrombolysis with alteplase 3 to 4. N Engl J Med ; — Lancet ; —4. Effect of telestroke on emergent stroke care and stroke outcomes. Stroke ; 45 —0. Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke: a meta-analysis. J Telemed Telecare ; 21 — Stroke ; 44 — TeleStroke units serving as a model of care in rural areas: year experience of the TeleMedical project for integrative stroke care. Stroke ; 45 — Telemedicine in stroke: organizing a network—rationale and baseline principles. Cerebrovasc Dis ; 27 suppl 4 :S1—8. Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population.
Neurol Sci ; 35 —5. Telestroke-guided intravenous tissue-type plasminogen activator treatment achieves a similar clinical outcome as thrombolysis at a comprehensive stroke center. Stroke ; 42 —3. A randomized trial of intraarterial treatment for acute ischemic stroke. Endovascular therapy for ischemic stroke with perfusion-imaging selection. Improving the efficiency of delivery of thrombolysis for acute stroke: a systematic review. Does the ternary framework of pre-modernity, modernity, postmodernity reflect the gradual emancipation of the individual in society?
Modernity is connected with the ideal developed by the philosophers during the Enlightenment period. Authority and tradition are replaced by reason and science, which will allow progress based on so-called true and objective knowledge. Modern science should allow Man to dominate nature.
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Capitalism appears as a new mode of production and consumption supported by technological innovation. Modernity goes hand in hand with a growing trend towards individualisation. Education should free the individual through rational knowledge. Overestimated scientific knowledge is transmitted in a top-down process. Scientists, techno-scientists, hold a privileged position; they are the experts who replace the priests of pre-modernity. The link between scientific reasoning and social, moral, ethical reasoning is not questioned.
Modernity has favoured the emergence of the sociotechnical regime of intensive agriculture, which seems to be the finalised version of man's control over nature. For some, modernity is still prevalent and must be defended Habermas. Others consider that we have entered into a period of post-modernity.
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The hope set on progress has been shaken up by the dangers associated with the technosciences nuclear weapons, pollution, health. From 17th to Global idea of The laypersons need to 20th century Enlightenment, of rationalist know more science to or even up to science. Rationality is appreciate and support today superior to other ways of good politics. Necessity to thinking. Logical positivism, Karl Understand science first, Popper.