Potenzial und Wirksamkeit eines telemedizinischen Rettungsassistenzsystems

Background

The demographic change and an increasing multimorbidity of patients represent increasing challenges for the adequate prehospital treatment of emergency patients. The incorporation of supplementary telemedical concepts and systems can lead to an improved guideline-conform treatment. Beneficial evidence of telemedical procedures is only known for isolated disease patterns; however, no mobile telemedical concept exists which is suitable for use in the wide variety of different clinical situations.

Aim

This article presents a newly developed and evaluated total telemedical concept (TemRas) that encompasses organizational, medical and technical components. The use of intelligent and robust communication technology and the implementation of this add-on system allows the telemedical support of the rescue service for all emergencies.

Methods

After development of the telemedical rescue assistance system, which includes organizational, medical and technical components, a telemedical centre and six ambulances in five different districts in North-Rhine Westphalia were equipped with this new tool. During the evaluation phase of 1 year in the routine emergency medical service the rate of complications as well as differences between urban and rural areas were analyzed with respect to different target parameters.

Results

Between August 2012 and July 2013 a total of 401 teleconsultations were performed during emergency missions and 24 during secondary interhospital transfers. No complications due to teleconsultation were observed. The mean duration (±SD) of teleconsultations was longer in rural areas than in urban areas with 28.6±12.0?min vs. 25.5±11.1?min (p?<?0.0001). In 63.2?% of these missions administration of medications was delegated to the ambulance personnel (52.0?% urban vs. 73.6?% rural, p?<?0.0001). The severity of ailments corresponded to scores of III and VI in the National Advisory Committee for Aeronautics (NACA) classification.

Conclusion

Emergency medical care of patients with support by a telemedical system is technically feasible, safe for the patient and allows medical treatment independent of spatial availability of a physician in different emergency situations.

     

Three‐dimensional imaging and analysis of human cartilage degeneration using Optical Coherence Tomography

Optical Coherence Tomography (OCT) is an evolving imaging technology allowing non‐destructive imaging of cartilage tissue at near‐histological resolution. This study investigated the diagnostic value of real time 3‐D OCT in comparison to conventional 2‐D OCT in the comprehensive grading of human cartilage degeneration. Fifty‐three human osteochondral samples were obtained from eight total knee arthroplasties. OCT imaging was performed by either obtaining a single two‐dimensional cross‐sectional image (2‐D OCT) or by collecting 100 consecutive parallel 2‐D OCT images to generate a volumetric data set of 8 × 8 mm (3‐D OCT). OCT images were assessed qualitatively according to a modified version of the DJD classification and quantitatively by algorithm‐based evaluation of surface irregularity, tissue homogeneity, and signal attenuation. Samples were graded according to the Outerbridge classification and statistically analyzed by one‐way ANOVA, Kruskal Wallis and Tukey's or Dunn's post‐hoc tests. Overall, the generation of 3‐D volumetric datasets and their multiple reconstructions such as rendering, surface topography, parametric, and cross‐sectional views proved to be of potential diagnostic value. With increasing distance to the mid‐sagittal plane and increasing degeneration, score deviations increased, too. In conclusion, 3‐D imaging of cartilage with image analysis algorithms adds considerable potential diagnostic value to conventional OCT diagnostics. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:651–659, 2015.     

Level of response to alcohol measured on the self-rating of the effects of alcohol questionnaire in a group of 40-year-old women

A low level of response (LR) to alcohol (i.e., the need for higher amounts to have an effect) is a genetically influenced characteristic that is both found in populations at high risk for future alcoholism and that predicts alcohol-related life problems in the future. A simple paper-and-pencil test that asks subjects to estimate the number of drinks required to produce each of four effects at different times in their lives, the Self-Rating of the Effects of Alcohol (SRE) questionnaire, was developed to facilitate studies of LR. However, data to date on this indirect measure of LR have focused primarily on young male populations. The current study reports SRE values from 121 middle class, middle-aged women who were selected because they were married to men who participated in a longitudinal study of sons of alcoholics and controls. As predicted, the SRE measure of LR, which records the perceived responses of alcohol early in the drinking career (FIRST 5), correlated significantly with recent drinks per drinking day (0.18, p < 0.05), a diagnosis of an alcohol use disorder (0.33, p < 0.001), and with a family history of alcohol dependence (0.20, p < 0.05). The LR value from the SRE reflecting the perceived number of drinks required for effects in the most recent 3 months correlated more closely with both quantity and frequency of drinking (0.36 and higher, p < 0.001), and related to recent nicotine use (0.23, p < 0.05). These data indicate the potential usefulness of the SRE as a measure of LR as a risk factor for alcoholism in relatively highly functioning middle-aged women.     

Different response to balloon angioplasty of carotid and coronary arteries: effects on acute platelet deposition and intimal thickening

PTCA is a well-established intervention to reduce the severity of atherosclerotic coronary stenosis. Its primary success rate is seriously handicapped by the high incidence of late restenosis. Given the clinical and social importance of this proliferative process, new strategies are needed to prevent or reduce restenosis. Several animal models as well as different arteries have been used to study neointimal proliferation after arterial injury. A number of agents have shown to reduce neointimal proliferation after arterial injury in the carotids and iliac arteries of rodent models. Unfortunately, these results have not been replicated in humans. We have compared the acute and late response to vascular injury of the carotid and coronary arteries in the pig. Arterial injury was induced by performing balloon angioplasty of the carotid (elastic) and coronary (muscular) arteries in swine. Acute platelet-thrombus formation was evaluated by quantitation of Indium-labeled platelets deposited on the injured segments 1 h after procedure. Measurement of intimal area was performed by morphometry of the most stenotic cross-section at 28 days after balloon angioplasty. Platelet deposition after mild and severe injury in carotids (4±1 and 56±13×10⁶ platelets/cm², respectively) and coronaries (15±5 and 141±20×10⁶ platelets/cm², respectively) are significantly greater in deep, than in mild injury (P<0.005), and significantly greater in coronary than in carotid arteries after deep injury (P<0.05). Likewise, late neointima formation was significantly greater (P<0.05) after mild and severe injury in coronary (17±0.5 and 56 ±2%, respectively) than in carotid arteries (5±0.5 and 12±1%, respectively). Acute platelet-thrombus formation and late neointimal thickening are modulated by the degree of injury induced during the interventions; and after disruption of the internal elastic lamina, coronary arteries always had significantly more acute thrombus and neointimal thickening. This study emphasizes the importance of the animal species, the type of injury and the artery chosen for studies on restenosis post interventions.     

Validation of the TM-2564G device for in-hospital blood pressure measurement

OBJECTIVE: To perform clinical validation of the TM-2564G device for in-hospital blood pressure measurement according to the British Hypertension Society protocol. METHODS: The tests were carried out on 85 patients aged 19-82 years (41 male patients, mean age 50+/-19 years) with systolic blood pressure 75-219 mmHg and diastolic blood pressure 43-117 mmHg (mean 142+/-33/85+/-20 mmHg). For each patient, three readings of the TM-2564G device were compared with simultaneous auscultatory measurements by two trained independent observers. The observers used a mercury-calibrated sphygmomanometer and dual stethoscope. The results were graded according to the British Hypertension Society protocol 1993. RESULTS: The average difference was -1.85 mmHg for systolic blood pressure and -1.20 mmHg for diastolic blood pressure. The standard deviation of the difference between TM-2564G and the observers' results was 4.85 and 4.16 mmHg for systolic and diastolic blood pressures, respectively. Systolic blood pressure percentage of readings agreeing to within 5 mmHg was 75.7%, 10 mmHg 95.36% and 15 mmHg 99.6%, and for DBP 82.7, 97.6 and 99.8%, respectively. CONCLUSIONS: The TM-2564G device achieved A/A British Hypertension Society grade and can be recommended for in-hospital measurement of blood pressure.