Using routine data for quality assessment in NeuroNet telestroke care.

BACKGROUND: Systematic clinical trials are often unavailable to evaluate and optimize operational telestroke networks. In a complementary approach, readily available routine clinical data were analyzed in this study to evaluate the effect of a telestroke network over a 4-year period. METHODS: Routine clinical data from the HELIOS hospital information system were compared before and after implementation of the NeuroNet concept, including neurologic acute stroke teleconsultations, standard operating procedures, and peer review quality management in 3 hospital cohorts: 5 comprehensive stroke centers, 5 NeuroNet hospitals, and 5 matched control hospitals. RESULTS: During the study period, the rate of thrombolytic therapy increased by 4.8% in NeuroNet hospitals, while ischemic stroke in-hospital mortality decreased (relative risk reduction ~29% in NeuroNet and control hospitals). The odds ratio for thrombolytic therapy in comprehensive stroke centers compared to NeuroNet hospitals was reduced from 3.7 to 1.3 between 2006 and 2009. Comprehensive stroke care coding according to German Diagnosis Related Groups definitions increased by 45% in NeuroNet (P < .0001) and by 18% in control hospitals. CONCLUSIONS: Routine clinical data on in-hospital mortality, the rate of thrombolytic therapy, and comprehensive stroke care coding reflect different aspects of acute stroke care improvement related to the implementation of the telemedical NeuroNet concept and unified quality management (standard operating procedure teaching concept, peer review process). Similar evaluation processes could contribute to quality monitoring in other telestroke networks.

10Be climate fingerprints during the Eemian in the NEEM ice core, Greenland.

Several deep Greenland ice cores have been retrieved, however, capturing the Eemian period has been problematic due to stratigraphic disturbances in the ice. The new Greenland deep ice core from the NEEM site (77.45 °N, 51.06 °W, 2450 m.a.s.l) recovered a relatively complete Eemian record. Here we discuss the cosmogenic (10)Be isotope record from this core. The results show Eemian average (10)Be concentrations about 0.7 times lower than in the Holocene which suggests a warmer climate and approximately 65-90% higher precipitation in Northern Greenland compared to today. Effects of shorter solar variations on (10)Be concentration are smoothed out due to coarse time resolution, but occurrence of a solar maximum at 115.26-115.36 kyr BP is proposed. Relatively high (10)Be concentrations are found in the basal ice sections of the core which may originate from the glacial-interglacial transition and relate to a geomagnetic excursion about 200 kyr BP.