On-call service of neurosurgeons in Germany: organization, use of communication services, and personal acceptance of modern technologies.

BACKGROUND: A significant proportion of acute care neurosurgical patients present to hospital outside regular working hours. The objective of our study was to evaluate the structure of neurosurgical on-call services in Germany, the use of modern communication devices and teleradiology services, and the personal acceptance of modern technologies by neurosurgeons. MATERIALS AND METHODS: A nationwide survey of all 141 neurosurgical departments in Germany was performed. The questionnaire consisted of two parts: one for neurosurgical departments and one for individual neurosurgeons. The questionnaire, available online and mailed in paper form, included 21 questions about on-call service structure; the availability and use of communication devices, teleradiology services, and other information services; and neurosurgeons' personal acceptance of modern technologies. RESULTS: The questionnaire return rate from departments was 63.1% (89/141), whereas 187 individual neurosurgeons responded. For 57.3% of departments, teleradiology services were available and were frequently used by 62.2% of neurosurgeons. A further 23.6% of departments described using smartphone screenshots of computed tomography (CT) images transmitted by multimedia messaging service (MMS), and 8.6% of images were described as sent by unencrypted email. Although 47.0% of neurosurgeons reported owning a smartphone, only 1.1% used their phone for on-call image communication. CONCLUSION: Teleradiology services were observed to be widely used by on-call neurosurgeons in Germany. Nevertheless, a significant number of departments appear to use outdated techniques or techniques that leave patient data unprotected. On-call neurosurgeons in Germany report a willingness to adopt more modern approaches, utilizing readily available smartphones or tablet technology.

Ischemia independent lesion evolution during focal stroke in rats.

Lesion evolution during focal cerebral ischemia may depend on flow restrictions or on accumulation of toxic mediators within the infarct and expansion of these factors to the periinfarct region. So far, the precise contribution of flow dependent versus spreading-mediated impairment of viable periinfarct tissue has not been determined. Therefore, we measured lesion expansion, flow restrictions and glutamate distribution on serial brain sections at different time points after experimental focal ischemia. Permanent focal ischemia was induced by occlusion of the right middle cerebral artery in male rats and the flow reduction was subsequently measured at 1, 12 and 24 h using iodo[14C]antipyrine autoradiography. Additionally, the necrotic volume was determined on serial brain sections and the glutamate content was measured in tissue samples from adjacent microdissections. Twelve hours after focal ischemia no noteworthy viable areas with blood flow restrictions of 20-40 ml 100 g(-1) min(-1) existed but at 24 h the necrotic tissue exceeded the hemodynamically compromised region by 40 +/- 21 mm3 (24%). Furthermore, at 12 and 24 h the glutamate content was elevated in areas surrounding the infarct. Relevant flow restrictions are detectable only during early stages of infarct maturation, whereas the propagation of secondary factors may be the predominant mechanism for delayed infarct evolution.