A Novel Use of Prehospital Telemedicine to Decrease Door to Computed Tomography Results in Acute Strokes.

INTRODUCTION: Timely emergency department (ED) recognition of acute strokes reduces morbidity and mortality and improves outcomes. Prehospital telehealth evaluation rapidly assesses patients with stroke symptoms and mobilizes resources before ED arrival, decreasing ED arrival to computed tomography (CT) result times. Expediting CT results reduces the decision time to determining thrombolytic therapy eligibility. METHODS: Seventeen ambulances in our region were supplied with equipment to perform a nonrecordable video examination with an ED physician. Emergency Medical Service requested a physician video examination on patients with a positive prehospital Cincinnati Stroke Scale. The physician and paramedic conducted an NIH-8 scale, and, based on the assessment, the patients were placed directly on the CT scanner table. RESULTS: Four time intervals that impact CT acquisition and thrombolytic decision-making were measured. There was improvement in all time intervals. Time from ED arrival to CT order decreased 1.7 minutes. Time from arrival to study start decreased 5.7 minutes. Time from CT order to result decreased 3.89 minutes and time from ED arrival to CT result decreased 5.6 minutes. DISCUSSION: Prehospital telehealth consults with paramedics, and the receiving hospital for acute strokes significantly decreased times for all metrics studied including the time from ED arrival to CT result.

Antiangiogenic agents for the treatment of glioblastoma.

Glioblastomas are highly vascularized and, therefore, antiangiogenic agents are increasingly being explored as therapeutic options. This review summarizes the present data on antiangiogenic agents in glioblastoma treatment. The angiogenic pathway in gliomas and the proposed mechanisms of antiangiogenic agents are reviewed briefly, and details of the drugs in clinical trial are provided. In addition to their effects on blood vessels, these agents also have potent antiedema effects that may have therapeutic benefit. The review concludes with a discussion of the role of biomarkers and neuroimaging in the assessment of tumor response. Although preliminary studies of these drugs in glioblastoma have been promising, larger prospective trials that include survival as an end point will be required to determine the ultimate utility of this class of agents. It seems likely that a combination of antiangiogenesis agents with other cytotoxic therapies will be required to achieve maximal efficacy.