Integrated Telehealth Infrastructure for Ambulatory Stroke Pathway Tyrol.

BACKGROUND: The Integrated Treatment Pathway Stroke Tyrol was introduced for the care of people after an acute stroke event and includes four phases: acute prehospital care, inpatient treatment, inpatient rehabilitation and ambulatory, outpatient rehabilitation. For the 4th phase, the ambulatory rehabilitation of patients after discharge, the ICT platform "StrokeNet Tyrol" was established. METHODS: Requirements and processes along the pathway and between the interdisciplinary team were taken into account for implementation based on a modular software architecture. Flexible rights and role concept was developed to support efficient collaboration of the heterogenic professions. RESULTS: The routine usage of 342 users with 8 different roles, 2,219 registered patient cases within the last 4 years and first results of the integrated benchmarking solution give a positive impression regarding feasibility and effectiveness. CONCLUSION: To this point, a comprehensive infrastructure for the Ambulatory Tyrolean Stroke Pathway has been established. Results from outcome analyses and comparative studies could help to further improve usability and to expand the area of application for other indications.

[Tyrolean stroke pathway]. / Schlaganfallpfad Tirol.

Background: Recent advances in acute stroke therapy have been shown to improve clinical outcome and therefore reduce long-term disability. Acute therapy procedures in stroke have a limited time frame after onset of symptoms; thus, rapid emergency management is critical. The Tyrolean Stroke Pathway was developed to optimize the entire treatment pathway from stroke onset to outpatient rehabilitation. Objectives: The description of the Tyrolean Stroke Pathway as an example to optimize the entire treatment pathway of stroke patients in a central European alpine region with a focus on prehospital management. Materials and methods: In four subprojects from the prehospital phase up to outpatient rehabilitation, the project optimized intersections between different phases of care and evaluated the care processes using quality assurance measures. Results: After implementation, thrombolysis rates doubled and functional outcome of stroke patients after 3 months improved and complications, e.g., pneumonia, declined. Access to rehabilitation improved, particularly because of the establishment of quality assured and funded outpatient rehabilitation. Conclusions: The project showed that a holistic standardized stroke pathway from acute management up to outpatient rehabilitation can be successfully implemented in clinical routine. The project improved the entire health care pathway of stroke patients. The Stroke Action Plan for Europe 2018-2030 recommends to have national plans for stroke that encompass the entire chain of care.

eHealth Service for Integrated Care and Outpatient Rehabilitation - Pilot Application of the Tyrol Stroke Pathway.

BACKGROUND: Stroke is one of third most common causes of death and the main cause for permanent disabilities. The Tyrol Stroke Pathway covers, all steps from stroke onset to outpatient rehabilitation. OBJECTIVES: The main objective of this paper is to describe how the paper-based documentation in the outpatient rehabilitation can be implemented in an eHealth service for integrated care. METHODS: First a state analysis followed by a requirement analysis was performed. An interactive mock-up was designed for further discussion with the stakeholders. After the implementation of the system the evaluation was performed in two steps: feedback from a virtual test phase and a pilot operation was analyzed. RESULTS: First experiences during the virtual test phase with key stakeholders of the therapy pathway showed a high level of acceptance. Users reported an improvement in the communication and documentation processes. CONCLUSION: Initial results illustrate how a shift from paper-based documentation to an integrated eHealth service can improve communication and documentation in an independent therapy network.

Event-related brain potentials and the efficiency of visual search for vertically and horizontally oriented stimuli.

Reports that visual search is more efficient for vertically than for horizontally shaded objects suggested that search is influenced by a priori knowledge about the source of light. In this study, we examined search for targets defined by the orientation of luminance gradients and measured event-related brain potentials (ERPs). In Experiment 1, we examined search for stimuli that comprised gradual luminance differences. Response times showed the expected orientation anisotropy effect. ERP amplitudes in the P1 latency range were slightly more positive in response to horizontally oriented stimuli, whereas P3 amplitudes were more positive in response to nonsingleton vertically oriented stimuli. Experiment 2 compared search for stimuli that comprised gradual versus step differences in luminance. All the anisotropies that we observed in Experiment 1 could be replicated in Experiment 2. Moreover, these anisotropies were not dependent on the type of the luminance gradient. This finding is inconsistent with the view that search efficiency is influenced by a priori knowledge about the source of light. The behavioral and electrophysiological data are consistent with a context model of visual search. We propose that contextual modulation reduces redundancy and contributes to computing the saliency of visual information by implementing divisive normalization and multiplicative filtering.