INTRODUCTION Although voices have been the primary content transmitted, technological advances in... more INTRODUCTION Although voices have been the primary content transmitted, technological advances in wireless communications in recent years and those expected in coming years have put into focus non-voice data communications between moving ambulances and consulting ...
P191 Background: Telemedicine (TM) is emerging as a time-saving, efficient means for acute stroke... more P191 Background: Telemedicine (TM) is emerging as a time-saving, efficient means for acute stroke evaluation. Absence of a local consulting stroke physician, and short therapeutic time window make TM an ideal alternative for providing patients at remote facilities optimal care. We describe our stroke treatment center (STC) experiences and report safety of rt-PA administration during TM consultation. Methods: The University of Maryland Medical Center (UMM) uses VTEL TC2000 units with triplexed ISDN line providing 30 fps video link to St. Mary’s Hospital, >100 miles distance. The Millard Fillmore Gates Circle Hospital (Gates) uses Sony TriniCom 3000 Plus Model 256 units with ISDN line at 256 Khz, linked to Millard Fillmore Suburban Hospital, 15 miles distance. An additional unit links to the stroke neurologist’s home. Both systems use pan, tilt and zoom camera with remote site control allowing two-way, realtime, audiovisual communication and CT transfer. Results: 2/18 patients rece...
To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used ... more To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used for suspected status epilepticus (SE) can reduce time to diagnosis and on‐call workforce demands and whether it can be applied to patients in respiratory isolation.
This article reviews emergency medicine evaluation and management performance standards for cereb... more This article reviews emergency medicine evaluation and management performance standards for cerebrovascular event patients and provides a practical process for ensuring high quality care. Areas of practice that most frequently generate questions and controversy are highlighted. The term "cerebrovascular event" is used throughout the text when both stroke and transient ischemic attack apply to the discussion. Recommendations are based on literature review and the author's experience with the successful certification of multiple primary stroke centers and appointments in neurology, emergency medicine, and nursing specialties.
A mobile telemedicine system was designed, implemented, and tested for en route neurological exam... more A mobile telemedicine system was designed, implemented, and tested for en route neurological examinations which required evaluation of facial expressions and movement of arms and legs. The system uses multiple public wireless cellular phones to transmit video and patient biosignals from a moving ambulance and delivers to the desktop computer of the receiving physician. Tests and questionnaires completed by users indicated that it conveyed critical clinical information and it was adequate for conducting clinical examinations.
Proceedings of the First Joint BMES/EMBS Conference. 1999 IEEE Engineering in Medicine and Biology 21st Annual Conference and the 1999 Annual Fall Meeting of the Biomedical Engineering Society (Cat. No.99CH37015), 1999
The project team of TRW and the University of Maryland Medicine have been investigating the feasi... more The project team of TRW and the University of Maryland Medicine have been investigating the feasibility and practicality of transmitting real-time patient vital signs data, audio, and video images of care activities from inside an ambulance en-route to a trauma center using wireless digital cellular communications and in-hospital Intranet technology. The objective of the mobile telemedicine testbed is to improve
Williams syndrome is a genetic disorder characterized by a high incidence of heart disease, arter... more Williams syndrome is a genetic disorder characterized by a high incidence of heart disease, arterial stenosis, and hypertension. Despite these features, cerebrovascular accidents have been described only recently and only in association with stenoses of the cerebral vasculature. A 19-year-old girl with Williams syndrome developed an acute-onset hemiparesis. MRI demonstrated an infarct involving the internal capsule and putamen. No stenotic areas were seen on angiography. Stroke should be considered as a possible consequence of Williams syndrome, even in the absence of stenoses of the cerebral vasculature. Comparison of this case with those previously reported in the literature emphasizes the multiplicity of features in Williams syndrome that can contribute to the risk of stroke.
A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral m... more A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral meningitis was performed at two institutions over 3 years. Forty-one patients with cerebrospinal fluid confirmation of aseptic meningitis (increased protein; increased white count; negative gram stain; and negative fungal, tuberculosis, and bacterial cultures) were analyzed. All the patients had headache, which was typically severe and bilateral in 39 of the 41 patients. The headache was of abrupt onset or the worst of the patient's life in 24 of the patients. The quality of the headache, when described, was usually throbbing (11 of 14). Nineteen patients had prodromal symptoms, including malaise, myalgia, gastrointestinal symptoms, and urinary tract infections. All had associated symptoms, including nausea (25), vomiting (23), photophobia (18), stiff neck (25), and back pain (11). Thirty patients were febrile. Lumbar puncture was performed for headache and fever unexplained by systemic illness in 30 patients, meningeal signs in 15, headache of abrupt onset or the worst headache ever in 24, neurologic signs or symptoms in 12, and for other reasons in 2. Computerized tomography, when performed, was negative in all cases. Focal neurologic findings were present in 5 patients, a decreased level of consciousness in 6, and papilledema in 1. A severe headache that worsens, is abrupt in onset, or is the worst of the patient's life could be due to aseptic meningitis, bacterial meningitis, or a subarachnoid hemorrhage. Although not universally present, meningeal signs, fever, and neurologic signs or symptoms should alert one to a possible central nervous system infection.
INTRODUCTION Although voices have been the primary content transmitted, technological advances in... more INTRODUCTION Although voices have been the primary content transmitted, technological advances in wireless communications in recent years and those expected in coming years have put into focus non-voice data communications between moving ambulances and consulting ...
To investigate the frequency, mortality rate, and characteristics of stroke in heparin-induced th... more To investigate the frequency, mortality rate, and characteristics of stroke in heparin-induced thrombocytopenia and the effect of argatroban therapy in that setting. Retrospective analysis of two prospective studies of argatroban therapy in heparin-induced thrombocytopenia. Hospitalized care. Patients were 960 patients with heparin-induced thrombocytopenia (767 argatroban-treated patients, 193 historical controls). Argatroban 2 microg x kg x min, adjusted to achieve activated partial thromboplastin times 1.5-3 times baseline Case records were reviewed to identify patients with stroke present at or within 37 days of study entry and to assess 37-day outcomes. Stroke occurred in 30 (3.1%) patients (stroke at entry, n = 9; new stroke during follow-up, n = 24; more than one stroke, n = 4). By logistic regression with treatment, protocol, age, and gender as covariates, females were significantly more likely to suffer stroke (odds ratio, 2.48; 95% confidence interval, 1.11-5.53; p =.026) and stroke-associated mortality (odds ratio, 4.10; 95% CI, 1.12-15.01; p =.033), and argatroban-treated patients had significantly reduced odds, vs. control, of new stroke (odds ratio, 0.31; 95% confidence interval, 0.10-0.96; p =.041) and stroke-associated mortality (odds ratio, 0.18; 95% confidence interval, 0.03-0.92; p =.039). Stroke (odds ratio, 3.66; 95% confidence interval, 1.73-7.73; p <.001) and age (odds ratio per year, 1.017; 95% confidence interval, 1.004-1.029; p =.008) were significant predictors of all-cause death. In the argatroban group, baseline platelet counts were significantly less in patients with, vs. without, stroke (medians, 42 x 10/L vs. 72 x 10/L; p =.006). Of 35 stroke events, 33 (94%) were ischemic and two (6%) were hemorrhagic (one per group, none during argatroban infusion); 30 (86%) were present at or within 13 days of entry. Stroke, particularly ischemic stroke, is common in heparin-induced thrombocytopenia and significantly increases mortality risk. Stroke in heparin-induced thrombocytopenia occurs most often in females, in patients with more severe thrombocytopenia, and within 2 wks of heparin-induced thrombocytopenia presentation. Argatroban therapy vs. control significantly reduces the likelihood of new stroke and stroke-associated mortality in heparin-induced thrombocytopenia without increasing intracranial hemorrhage.
INTRODUCTION Although voices have been the primary content transmitted, technological advances in... more INTRODUCTION Although voices have been the primary content transmitted, technological advances in wireless communications in recent years and those expected in coming years have put into focus non-voice data communications between moving ambulances and consulting ...
P191 Background: Telemedicine (TM) is emerging as a time-saving, efficient means for acute stroke... more P191 Background: Telemedicine (TM) is emerging as a time-saving, efficient means for acute stroke evaluation. Absence of a local consulting stroke physician, and short therapeutic time window make TM an ideal alternative for providing patients at remote facilities optimal care. We describe our stroke treatment center (STC) experiences and report safety of rt-PA administration during TM consultation. Methods: The University of Maryland Medical Center (UMM) uses VTEL TC2000 units with triplexed ISDN line providing 30 fps video link to St. Mary’s Hospital, >100 miles distance. The Millard Fillmore Gates Circle Hospital (Gates) uses Sony TriniCom 3000 Plus Model 256 units with ISDN line at 256 Khz, linked to Millard Fillmore Suburban Hospital, 15 miles distance. An additional unit links to the stroke neurologist’s home. Both systems use pan, tilt and zoom camera with remote site control allowing two-way, realtime, audiovisual communication and CT transfer. Results: 2/18 patients rece...
To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used ... more To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used for suspected status epilepticus (SE) can reduce time to diagnosis and on‐call workforce demands and whether it can be applied to patients in respiratory isolation.
This article reviews emergency medicine evaluation and management performance standards for cereb... more This article reviews emergency medicine evaluation and management performance standards for cerebrovascular event patients and provides a practical process for ensuring high quality care. Areas of practice that most frequently generate questions and controversy are highlighted. The term "cerebrovascular event" is used throughout the text when both stroke and transient ischemic attack apply to the discussion. Recommendations are based on literature review and the author's experience with the successful certification of multiple primary stroke centers and appointments in neurology, emergency medicine, and nursing specialties.
A mobile telemedicine system was designed, implemented, and tested for en route neurological exam... more A mobile telemedicine system was designed, implemented, and tested for en route neurological examinations which required evaluation of facial expressions and movement of arms and legs. The system uses multiple public wireless cellular phones to transmit video and patient biosignals from a moving ambulance and delivers to the desktop computer of the receiving physician. Tests and questionnaires completed by users indicated that it conveyed critical clinical information and it was adequate for conducting clinical examinations.
Proceedings of the First Joint BMES/EMBS Conference. 1999 IEEE Engineering in Medicine and Biology 21st Annual Conference and the 1999 Annual Fall Meeting of the Biomedical Engineering Society (Cat. No.99CH37015), 1999
The project team of TRW and the University of Maryland Medicine have been investigating the feasi... more The project team of TRW and the University of Maryland Medicine have been investigating the feasibility and practicality of transmitting real-time patient vital signs data, audio, and video images of care activities from inside an ambulance en-route to a trauma center using wireless digital cellular communications and in-hospital Intranet technology. The objective of the mobile telemedicine testbed is to improve
Williams syndrome is a genetic disorder characterized by a high incidence of heart disease, arter... more Williams syndrome is a genetic disorder characterized by a high incidence of heart disease, arterial stenosis, and hypertension. Despite these features, cerebrovascular accidents have been described only recently and only in association with stenoses of the cerebral vasculature. A 19-year-old girl with Williams syndrome developed an acute-onset hemiparesis. MRI demonstrated an infarct involving the internal capsule and putamen. No stenotic areas were seen on angiography. Stroke should be considered as a possible consequence of Williams syndrome, even in the absence of stenoses of the cerebral vasculature. Comparison of this case with those previously reported in the literature emphasizes the multiplicity of features in Williams syndrome that can contribute to the risk of stroke.
A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral m... more A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral meningitis was performed at two institutions over 3 years. Forty-one patients with cerebrospinal fluid confirmation of aseptic meningitis (increased protein; increased white count; negative gram stain; and negative fungal, tuberculosis, and bacterial cultures) were analyzed. All the patients had headache, which was typically severe and bilateral in 39 of the 41 patients. The headache was of abrupt onset or the worst of the patient's life in 24 of the patients. The quality of the headache, when described, was usually throbbing (11 of 14). Nineteen patients had prodromal symptoms, including malaise, myalgia, gastrointestinal symptoms, and urinary tract infections. All had associated symptoms, including nausea (25), vomiting (23), photophobia (18), stiff neck (25), and back pain (11). Thirty patients were febrile. Lumbar puncture was performed for headache and fever unexplained by systemic illness in 30 patients, meningeal signs in 15, headache of abrupt onset or the worst headache ever in 24, neurologic signs or symptoms in 12, and for other reasons in 2. Computerized tomography, when performed, was negative in all cases. Focal neurologic findings were present in 5 patients, a decreased level of consciousness in 6, and papilledema in 1. A severe headache that worsens, is abrupt in onset, or is the worst of the patient's life could be due to aseptic meningitis, bacterial meningitis, or a subarachnoid hemorrhage. Although not universally present, meningeal signs, fever, and neurologic signs or symptoms should alert one to a possible central nervous system infection.
INTRODUCTION Although voices have been the primary content transmitted, technological advances in... more INTRODUCTION Although voices have been the primary content transmitted, technological advances in wireless communications in recent years and those expected in coming years have put into focus non-voice data communications between moving ambulances and consulting ...
To investigate the frequency, mortality rate, and characteristics of stroke in heparin-induced th... more To investigate the frequency, mortality rate, and characteristics of stroke in heparin-induced thrombocytopenia and the effect of argatroban therapy in that setting. Retrospective analysis of two prospective studies of argatroban therapy in heparin-induced thrombocytopenia. Hospitalized care. Patients were 960 patients with heparin-induced thrombocytopenia (767 argatroban-treated patients, 193 historical controls). Argatroban 2 microg x kg x min, adjusted to achieve activated partial thromboplastin times 1.5-3 times baseline Case records were reviewed to identify patients with stroke present at or within 37 days of study entry and to assess 37-day outcomes. Stroke occurred in 30 (3.1%) patients (stroke at entry, n = 9; new stroke during follow-up, n = 24; more than one stroke, n = 4). By logistic regression with treatment, protocol, age, and gender as covariates, females were significantly more likely to suffer stroke (odds ratio, 2.48; 95% confidence interval, 1.11-5.53; p =.026) and stroke-associated mortality (odds ratio, 4.10; 95% CI, 1.12-15.01; p =.033), and argatroban-treated patients had significantly reduced odds, vs. control, of new stroke (odds ratio, 0.31; 95% confidence interval, 0.10-0.96; p =.041) and stroke-associated mortality (odds ratio, 0.18; 95% confidence interval, 0.03-0.92; p =.039). Stroke (odds ratio, 3.66; 95% confidence interval, 1.73-7.73; p <.001) and age (odds ratio per year, 1.017; 95% confidence interval, 1.004-1.029; p =.008) were significant predictors of all-cause death. In the argatroban group, baseline platelet counts were significantly less in patients with, vs. without, stroke (medians, 42 x 10/L vs. 72 x 10/L; p =.006). Of 35 stroke events, 33 (94%) were ischemic and two (6%) were hemorrhagic (one per group, none during argatroban infusion); 30 (86%) were present at or within 13 days of entry. Stroke, particularly ischemic stroke, is common in heparin-induced thrombocytopenia and significantly increases mortality risk. Stroke in heparin-induced thrombocytopenia occurs most often in females, in patients with more severe thrombocytopenia, and within 2 wks of heparin-induced thrombocytopenia presentation. Argatroban therapy vs. control significantly reduces the likelihood of new stroke and stroke-associated mortality in heparin-induced thrombocytopenia without increasing intracranial hemorrhage.
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Papers by Marian Lamonte