The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Bradford B Worrall - One of the best experts on this subject based on the ideXlab platform.
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teleradiology assessment of computerized tomographs online reliability study tractors for acute stroke evaluation
Telemedicine Journal and E-health, 2003Co-Authors: Karen C Johnston, Bradford B WorrallAbstract:Telemedicine has potential to increase the use of tissue plasminogen activator (t-PA) for ischemic stroke and is increasingly offered to provide stroke expertise to remote and underserved areas. The accuracy of stroke Neurologists' use of telemedicine to read head computed tomography scans (CT) has not been demonstrated. We sought to determine the validity and reliability of Neurologists' reading of acute stroke head CTs via teleradiology. The pilot study compared stroke Neurologists' reading of CTs via teleradiology to gold standard readings of hard copies on a view box. Head CTs obtained during consecutive acute evaluations for thrombolytic therapy between February and July 2001 were used. For this study, each stroke Neurologist was masked to all prior readings, clinical decisions regarding thrombolysis eligibility, and the reading of the other study Neurologist. Each Neurologist read one-half of the CT scans using teleradiology and the other one-half using a view box. We used the official reading by a ...
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teleradiology assessment of computerized tomographs online reliability study tractors for acute stroke evaluation
Telemedicine Journal and E-health, 2003Co-Authors: Karen C Johnston, Bradford B WorrallAbstract:Telemedicine has potential to increase the use of tissue plasminogen activator (t-PA) for ischemic stroke and is increasingly offered to provide stroke expertise to remote and underserved areas. The accuracy of stroke Neurologists' use of telemedicine to read head computed tomography scans (CT) has not been demonstrated. We sought to determine the validity and reliability of Neurologists' reading of acute stroke head CTs via teleradiology. The pilot study compared stroke Neurologists' reading of CTs via teleradiology to gold standard readings of hard copies on a view box. Head CTs obtained during consecutive acute evaluations for thrombolytic therapy between February and July 2001 were used. For this study, each stroke Neurologist was masked to all prior readings, clinical decisions regarding thrombolysis eligibility, and the reading of the other study Neurologist. Each Neurologist read one-half of the CT scans using teleradiology and the other one-half using a view box. We used the official reading by a neuroradiologist for comparison. The kappa statistic measured reliability. Validity was measured by sensitivity and specificity. Sixty scans were used for the analysis. The Neurologists identified the same four hemorrhages using teleradiology that they and the neuroradiologist identified using the light board. Compared to the readings on a view box, the kappa statistic for eligibility for thrombolysis via teleradiology was 1.0. Sensitivity was 100%, 95% CI = (0.93, 1.0); specificity was 100%, 95% CI = (0.40, 0.98) in both comparisons. This pilot study provides encouraging preliminary evidence that Neurologists with stroke expertise can determine radiological intravenous t-PA eligibility via teleradiology. Further analysis in a larger sample is necessary to validate these results.
David W Dodick - One of the best experts on this subject based on the ideXlab platform.
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smartphone teleradiology application is successfully incorporated into a telestroke network environment
Stroke, 2012Co-Authors: Bart M Demaerschalk, Jason E Vargas, Dwight D Channer, Brie N Noble, Terri Ellen J Kiernan, Elizabeth A Gleason, Bert B Vargas, Timothy J Ingall, Maria I Aguilar, David W DodickAbstract:Background and Purpose—ResolutionMD mobile application runs on a Smartphone and affords vascular Neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular Neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators. Methods—Fifty-three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry. Each CT was evaluated by a hub vascular Neurologist, a spoke radiologist, and by blinded telestroke adjudicators, and agreement over clinically important radiological features was calcula...
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smartphone teleradiology application is successfully incorporated into a telestroke network environment
Stroke, 2012Co-Authors: Bart M Demaerschalk, Jason E Vargas, Dwight D Channer, Brie N Noble, Terri Ellen J Kiernan, Elizabeth A Gleason, Bert B Vargas, Timothy J Ingall, Maria I Aguilar, David W DodickAbstract:Background and Purpose—ResolutionMD mobile application runs on a Smartphone and affords vascular Neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular Neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators. Methods—Fifty-three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry. Each CT was evaluated by a hub vascular Neurologist, a spoke radiologist, and by blinded telestroke adjudicators, and agreement over clinically important radiological features was calcula...
Karen C Johnston - One of the best experts on this subject based on the ideXlab platform.
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teleradiology assessment of computerized tomographs online reliability study tractors for acute stroke evaluation
Telemedicine Journal and E-health, 2003Co-Authors: Karen C Johnston, Bradford B WorrallAbstract:Telemedicine has potential to increase the use of tissue plasminogen activator (t-PA) for ischemic stroke and is increasingly offered to provide stroke expertise to remote and underserved areas. The accuracy of stroke Neurologists' use of telemedicine to read head computed tomography scans (CT) has not been demonstrated. We sought to determine the validity and reliability of Neurologists' reading of acute stroke head CTs via teleradiology. The pilot study compared stroke Neurologists' reading of CTs via teleradiology to gold standard readings of hard copies on a view box. Head CTs obtained during consecutive acute evaluations for thrombolytic therapy between February and July 2001 were used. For this study, each stroke Neurologist was masked to all prior readings, clinical decisions regarding thrombolysis eligibility, and the reading of the other study Neurologist. Each Neurologist read one-half of the CT scans using teleradiology and the other one-half using a view box. We used the official reading by a ...
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teleradiology assessment of computerized tomographs online reliability study tractors for acute stroke evaluation
Telemedicine Journal and E-health, 2003Co-Authors: Karen C Johnston, Bradford B WorrallAbstract:Telemedicine has potential to increase the use of tissue plasminogen activator (t-PA) for ischemic stroke and is increasingly offered to provide stroke expertise to remote and underserved areas. The accuracy of stroke Neurologists' use of telemedicine to read head computed tomography scans (CT) has not been demonstrated. We sought to determine the validity and reliability of Neurologists' reading of acute stroke head CTs via teleradiology. The pilot study compared stroke Neurologists' reading of CTs via teleradiology to gold standard readings of hard copies on a view box. Head CTs obtained during consecutive acute evaluations for thrombolytic therapy between February and July 2001 were used. For this study, each stroke Neurologist was masked to all prior readings, clinical decisions regarding thrombolysis eligibility, and the reading of the other study Neurologist. Each Neurologist read one-half of the CT scans using teleradiology and the other one-half using a view box. We used the official reading by a neuroradiologist for comparison. The kappa statistic measured reliability. Validity was measured by sensitivity and specificity. Sixty scans were used for the analysis. The Neurologists identified the same four hemorrhages using teleradiology that they and the neuroradiologist identified using the light board. Compared to the readings on a view box, the kappa statistic for eligibility for thrombolysis via teleradiology was 1.0. Sensitivity was 100%, 95% CI = (0.93, 1.0); specificity was 100%, 95% CI = (0.40, 0.98) in both comparisons. This pilot study provides encouraging preliminary evidence that Neurologists with stroke expertise can determine radiological intravenous t-PA eligibility via teleradiology. Further analysis in a larger sample is necessary to validate these results.
Bart M Demaerschalk - One of the best experts on this subject based on the ideXlab platform.
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smartphone teleradiology application is successfully incorporated into a telestroke network environment
Stroke, 2012Co-Authors: Bart M Demaerschalk, Jason E Vargas, Dwight D Channer, Brie N Noble, Terri Ellen J Kiernan, Elizabeth A Gleason, Bert B Vargas, Timothy J Ingall, Maria I Aguilar, David W DodickAbstract:Background and Purpose—ResolutionMD mobile application runs on a Smartphone and affords vascular Neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular Neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators. Methods—Fifty-three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry. Each CT was evaluated by a hub vascular Neurologist, a spoke radiologist, and by blinded telestroke adjudicators, and agreement over clinically important radiological features was calcula...
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smartphone teleradiology application is successfully incorporated into a telestroke network environment
Stroke, 2012Co-Authors: Bart M Demaerschalk, Jason E Vargas, Dwight D Channer, Brie N Noble, Terri Ellen J Kiernan, Elizabeth A Gleason, Bert B Vargas, Timothy J Ingall, Maria I Aguilar, David W DodickAbstract:Background and Purpose—ResolutionMD mobile application runs on a Smartphone and affords vascular Neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular Neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators. Methods—Fifty-three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry. Each CT was evaluated by a hub vascular Neurologist, a spoke radiologist, and by blinded telestroke adjudicators, and agreement over clinically important radiological features was calcula...
Howard L Fields - One of the best experts on this subject based on the ideXlab platform.
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is reflex sympathetic dystrophy complex regional pain syndrome type i a small fiber neuropathy
Annals of Neurology, 2009Co-Authors: Anne Louise Oaklander, Howard L FieldsAbstract:Neurologist S. Weir Mitchell first described "causalgia" following wartime nerve injury, with its persistent distal limb burning pain, swelling, and abnormal skin color, temperature, and sweating. Similar post-traumatic symptoms were later identified in patients without overt nerve injuries after trauma. This was labeled reflex sympathetic dystrophy (RSD; now complex regional pain syndrome type I [CRPS-I]). The pathophysiology of symptoms is unknown and treatment options are limited. We propose that persistent RSD/CRPS-I is a post-traumatic neuralgia associated with distal degeneration of small-diameter peripheral axons. Small-fiber lesions are easily missed on examination and are undetected by standard electrophysiological testing. Most CRPS features-spreading pain and skin hypersensitivity, vasomotor instability, osteopenia, edema, and abnormal sweating-are explicable by small-fiber dysfunction. Small fibers sense pain and temperature but also regulate tissue function through neuroeffector actions. Indeed, small-fiber-predominant polyneuropathies cause CRPS-like abnormalities, and pathological studies of nerves from chronic CRPS-I patients confirm small-fiber-predominant pathology. Small distal nerve injuries in rodents reproduce many CRPS features, further supporting this hypothesis. CRPS symptoms likely reflect combined effects of axonal degeneration and plasticity, inappropriate firing and neurosecretion by residual axons, and denervation supersensitivity. The resulting tissue edema, hypoxia, and secondary central nervous system changes can exacerbate symptoms and perpetuate pathology. Restoring the interest of Neurologists in RSD/CRPS should improve patient care and broaden our knowledge of small-fiber functions.
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is reflex sympathetic dystrophy complex regional pain syndrome type i a small fiber neuropathy
Annals of Neurology, 2009Co-Authors: Anne Louise Oaklander, Howard L FieldsAbstract:Neurologist S. Weir Mitchell first described “causalgia” following wartime nerve injury, with its persistent distal limb burning pain, swelling, and abnormal skin color, temperature, and sweating. Similar post-traumatic symptoms were later identified in patients without overt nerve injuries after trauma. This was labeled reflex sympathetic dystrophy (RSD; now complex regional pain syndrome type I [CRPS-I]). The pathophysiology of symptoms is unknown and treatment options are limited. We propose that persistent RSD/CRPS-I is a post-traumatic neuralgia associated with distal degeneration of small-diameter peripheral axons. Small-fiber lesions are easily missed on examination and are undetected by standard electrophysiological testing. Most CRPS features—spreading pain and skin hypersensitivity, vasomotor instability, osteopenia, edema, and abnormal sweating—are explicable by small-fiber dysfunction. Small fibers sense pain and temperature but also regulate tissue function through neuroeffector actions. Indeed, small-fiber–predominant polyneuropathies cause CRPS-like abnormalities, and pathological studies of nerves from chronic CRPS-I patients confirm small-fiber–predominant pathology. Small distal nerve injuries in rodents reproduce many CRPS features, further supporting this hypothesis. CRPS symptoms likely reflect combined effects of axonal degeneration and plasticity, inappropriate firing and neurosecretion by residual axons, and denervation supersensitivity. The resulting tissue edema, hypoxia, and secondary central nervous system changes can exacerbate symptoms and perpetuate pathology. Restoring the interest of Neurologists in RSD/CRPS should improve patient care and broaden our knowledge of small-fiber functions. Ann Neurol 2009;65:629 – 638
