ABSTRACT
BACKGROUND: Stroke telemedicine is widely used to treat patients with acute stroke in Europe and North America but is seldom used in Australia. The Victorian Stroke Telemedicine (VST) programme aims to enhance acute stroke care in regional Australia. METHODS: Twelve-month pilot prospective, historical-controlled, implementation cohort study. Emergency Department (ED) at a large regional hospital in Victoria. Patients ≥ 18 years of age arriving < 4.5 h in the ED with a possible diagnosis of acute stroke. Telemedicine consultation by a Melbourne-based stroke specialist. Stroke thrombolysis rate, timelines for clinical processes, discharge outcomes. RESULTS: In the initial 12 month VST implementation, 62 patients arrived < 4.5 h of stroke onset (60% male; median age 75 years). Compared to pre-VST data (n = 58; 52% male; median age 77 years), stroke thrombolysis use increased from 17% to 26% (P = 0.26). Clinical process timelines improved including door to computed tomography time (reduced by 29 min, P = 0.006), and door to needle time (reduced by 21 min, P = 0.21). There was no significant increase in deaths (pre-VST 7% vs VST 10%), or symptomatic intracerebral haemorrhage (n = 1 tPA patient). More patients who received tPA were discharged to home or rehabilitation (pre-VST 33% vs VST 80%, P = 0.02), with significantly fewer transfers to other acute care services. CONCLUSIONS: The VST pilot implementation provides evidence that telemedicine can enhance the quality of acute stroke care in a regional hospital. Expanding VST to 16 regional hospitals, Australia's largest telestroke programme, will allow for a more comprehensive clinical and economic analysis.
Subject(s)
Health Services Accessibility/organization & administration , Stroke/therapy , Telemedicine/organization & administration , Translational Research, Biomedical/trends , Aged , Australia/epidemiology , Female , Humans , Male , Pilot Projects , Program Development , Program Evaluation , Prospective Studies , Stroke/epidemiology , Thrombolytic Therapy/methods , Treatment Outcome , Victoria/epidemiologyABSTRACT
BACKGROUND AND OBJECTIVE: Many couples have to cope with periods of involuntary childlessness and they often ask for medical help. In the Heidelberg Project of involuntary childlessness in men, andrological patients were surveyed from the time before diagnosis till the end of 1 year's andrological treatment. PATIENTS/METHODS: 145 andrological patients were interviewed and filled out questionnaires to assess their wishes for parenting and their self-esteem. RESULTS: As expected men with a normal spermiographic finding had an increased chance to father a child--even more so, when no andrological treatment was performed. For those who remained childless, the wish for parenting had a higher importance than for the eventual fathers. There was little change in self-esteem, either at the beginning of treatment or one year later--with one exception: men who became fathers and had been treated suffered from more social isolation than those who became fathers and had not been treated. CONCLUSIONS: Beyond the desired effects of medical treatment, psychological and social effects have to be considered in men with involuntary childlessness, especially with those patients whose spermiogram is not severely reduced.
