RESUMO
The coronavirus disease 2019 crisis has forced the world to integrate telemedicine into health delivery systems in an unprecedented way. To deliver essential care, lawmakers, physicians, patients, payers, and health systems have all adopted telemedicine and redesigned delivery processes with accelerated speed and coordination in a fragmented way without a long-term vision or uniformed standards. There is an opportunity to learn from the experiences gained by this pandemic to help shape a better health-care system that standardizes telemedicine to optimize the overall efficiency of remote health-care delivery. This collaboration focuses on four pillars of telemedicine that will serve as a framework to enable a uniformed, standardized process that allows for remote data capture and quality, aiming to improve ongoing management outside the hospital. In this collaboration, we recommend learning from this experience by proposing a telemedicine framework built on the following four pillars-patient safety and confidentiality; metrics, analytics, and reform; recording of audio-visual data as a health record; and reimbursement and accountability.
RESUMO
A 63-year-old male presented with marked quadriparesis, three weeks after a pneumococcal meningitis. The MRI-scan was suggestive for extradural abscess in the craniocervical region extending into the lower thoracic spine. Cervical laminectomy was performed and a large abscess was drained. Culture revealed Streptococcus pneumoniae sensitive to benzylpenicillin. The patient was treated with antibiotics for six weeks. His neurological condition recovered completely, and he walked normally, without support, 6 weeks later. Pneumococcal infection of the extradural space is rare. The course of spinal epidural abscess is unpredictable and may present with quadriplegia. Complete recovery of the neurological deficit may occur if the abscess is drained before any ischaemic insult occurs to the cord.