Telemedicine in pre-hospital care: a review of telemedicine applications in pre-hospital environment.

The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome

Renal function, electrolytes, and congestion monitoring in heart failure.

Congestion, renal function, and electrolyte imbalance (particularly potassium) are common problems in the management of the complex multi-morbid patient with heart failure (HF). Poor control of these fundamental clinical features is associated with adverse outcomes. Close monitoring of serum potassium and renal function is recommended by most current guidelines during the management of an episode of acute decompensated HF, yet the recommendations remain poorly implemented. Physicians are advised to treat a state of euvolaemia after an admission with decompensated HF and residual congestion is a marker of worse outcome, yet control of congestion is poorly assessed and managed in real-world practice. This document reflects the key points discussed by a panel of experts during a Heart Failure Association meeting on physiological monitoring of the complex multi-morbid HF patient, and here, we present to aspects related to renal function, electrolyte, and congestion monitoring

Spatial Epidemiology and Temporal Trends of Heart Attack and Stroke in Middle Tennessee

Despite declines in mortality risks of myocardial infarction (MI) and stroke in the US since the 1960’s, the burdens of these conditions remain high. These conditions require emergency and specialized care and therefore quick transportation of patients to appropriate hospitals is critical. Geographic disparities in MI and stroke burdens have been consistently reported in the US with the south-east having the highest risks. Most studies of geographic disparities have been performed at county or higher geographic units. Therefore, spatial patterns at neighborhood levels are unclear. Moreover, it’s important to investigate disparities at neighborhood levels to better understand neighborhood health needs. Therefore, the goal of this study was to investigate neighborhood disparities associated with MI and stroke in Middle Tennessee. Specific objectives were to investigate: (a) geographic disparities in timely access to emergency care; and (b) geographic disparities in MI and stroke mortality risks. Street network, hospital, population, and mortality data (1999-2007) were obtained from Streetmap USA, the Joint Commission on Accreditation of Health Organizations, US Census Bureau, and the Tennessee Department of Health, respectively. Network analysis was used to investigate and identify neighborhoods lacking timely access to emergency MI and stroke care. Moran’s I and Kulldorff’s spatial scan statistic were used to investigate geographic hot-spots of MI and stroke mortality risks at both the county and neighborhood levels. Poisson and negative binomial models were used to investigate predictors of identified geographic patterns. A temporal increase in the percentage of the population with timely geographic access to stroke and cardiac centers was observed. In 2010, about 5% of the population, located mainly in rural neighborhoods, lacked timely access to a stroke center. Significant (p\u3c0.05) hot-spots of MI and stroke mortality risks were identified at both neighborhood and county levels. However, clusters identified at the neighborhood level were more refined. Neighborhoods with higher proportions of older populations and those with lower education had significantly (p\u3c0.05) higher mortality risks. These findings are vital for guiding health planning, resource allocation and service provision in an effort to provide needs-based services to the population. This is important in reducing/eliminating neighborhood disparities and improving population health

Electrocardiologic and related methods of non-invasive detection and risk stratification in myocardial ischemia: state of the art and perspectives

Background: Electrocardiographic methods still provide the bulk of cardiovascular diagnostics. Cardiac ischemia is associated with typical alterations in cardiac biosignals that have to be measured, analyzed by mathematical algorithms and allegorized for further clinical diagnostics. The fast growing fields of biomedical engineering and applied sciences are intensely focused on generating new approaches to cardiac biosignal analysis for diagnosis and risk stratification in myocardial ischemia

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review

© 2020 American College of Cardiology Foundation Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic