[The application of telemedicine for stroke in the Balearic Islands: the Balearic Telestroke project]. / Telemedicina aplicada al ictus en las Islas Baleares: el proyecto Teleictus balear.

INTRODUCTION: Currently, clinical benefits of stroke units and thrombolysis in ischaemic stroke are evidence-based. However, inequities in coverage and in treatment provided to these patients still persist due to geographical differences in residence, technological capacity and organization among health care systems. Telestroke is considered to be an effective tool for reducing inequities in coverage and health outcomes of stroke patients. DEVELOPMENT: This paper reviews the requirements of implementation of telestroke units, their deployment in the Health Service of the Balearic Islands, and the main experiences reported so far. Further, preliminary results of an ongoing formal assessment of effectiveness and safety of telestroke relative to conventional stroke treatment are advanced. CONCLUSIONS: Implementation of a telestroke system is feasible and allows increasing specialized treatment coverage. The Health Service of the Balearic Islands is fulfilling its goal of improving thrombolysis coverage by means of telestroke. Its effectiveness and safety appear to be similar to those of conventional treatment.

Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial.

The aim of the present study was to assess the impact of nasal continuous positive airway pressure (nCPAP) in ischaemic stroke patients followed for 2 yrs. Stroke patients with an apnoea-hypopnoea index ≥ 20 events·h⁻¹ were randomised to early nCPAP (n = 71; 3-6 days after stroke onset) or conventional treatment (n = 69). The Barthel Index, Canadian Scale, Rankin Scale and Short Form-36 were measured at baseline, and at 1, 3, 12 and 24 months. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9 versus 56.3% (p < 0.01); Canadian scale 88.2 versus 72.7% (p < 0.05)). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 versus 7.9 months; p = 0.044), although cardiovascular event-free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (p = 0.161). Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients' survival or quality of life was not shown.