{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T04:23:29Z","timestamp":1775535809682,"version":"3.50.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Telemedicine provides specialized medical expertise in underserved areas where neurological expertise is frequently not available on a daily basis for hospitalized stroke patients. While tele-consultations are well established in acute stroke assessment, the value of telemedicine-based ward-rounds in the subsequent in-patient stroke management is unknown.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Four telemedicine stroke networks in Germany, implemented in eight out of 16 federal states, participate in this prospective observational multi-center study. We plan to enroll 523 patients hospitalized due to acute (suspected or confirmed) stroke or transient ischemic attack. Each recruited patient will receive both a tele-consultation and an on-site consultation at the same day within the first three days after hospital admission. We will test non-inferiority of telemedicine-based assessments in ward-rounds in terms of quality of medical assessment and recommendations for hospitalized stroke patients. The correctness of the medical assessment and recommendation is defined as positive evaluation (binary, correct vs. in-correct) of six out of six predefined quality indicators by at least two out of three blinded independent raters. The non-inferiority margin for the difference in proportions of correct assessments is set to 5%-points.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>If non-inferiority of telemedicine-based ward-rounds compared to on-site ward-rounds by a neurologist were demonstrated, telemedicine-based neurological consultation for post-acute stroke patients may contribute to deliver evidence-based high-quality stroke care more easily in underserved regions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>DRKS - DRKS00028671 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/drks.de\/search\/de\/trial\/DRKS00028671\">https:\/\/drks.de\/search\/de\/trial\/DRKS00028671<\/jats:ext-link>; registration date 09-27-2022).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-024-11651-3","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T03:49:10Z","timestamp":1729136950000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["VISIT STROKE: non-inferiority of telemedicine-based neurological consultation for post-acute stroke patients \u2013 protocol of a prospective observational controlled multi-center study"],"prefix":"10.1186","volume":"24","author":[{"given":"Juliane","family":"Herm","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hebun","family":"Erdur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Aigner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Hengelbrock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anselm","family":"Angermaier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes","family":"Fl\u00f6el","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annegret","family":"Hille","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Gorski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Kinze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Schmehl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordian J.","family":"Hubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanni","family":"Wiestler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Siepmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Arndt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Gumbinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Heyse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim E.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich J.","family":"Audebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the ANNOTeM-network","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,17]]},"reference":[{"key":"11651_CR1","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1089\/tmj.2013.0348","volume":"20","author":"S Cutting","year":"2014","unstructured":"Cutting S, Conners JJ, Lee VH, Song S, Prabhakaran S. Telestroke in an urban setting. Telemed J E Health. 2014;20:855\u20137.","journal-title":"Telemed J E Health"},{"key":"11651_CR2","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/S1474-4422(06)70527-0","volume":"5","author":"HJ Audebert","year":"2006","unstructured":"Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL. Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol. 2006;5:742\u20138.","journal-title":"Lancet Neurol"},{"key":"11651_CR3","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1007\/s00115-021-01137-6","volume":"92","author":"J Barlinn","year":"2021","unstructured":"Barlinn J, Winzer S, Worthmann H, Urbanek C, H\u00e4usler KG, G\u00fcnther A, et al. Telemedicine in stroke\u2014pertinent to stroke care in Germany. Nervenarzt. 2021;92:593\u2013601.","journal-title":"Nervenarzt"},{"key":"11651_CR4","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1161\/STROKEAHA.112.657270","volume":"43","author":"TG Liman","year":"2012","unstructured":"Liman TG, Winter B, Waldschmidt C, Zerbe N, Hufnagl P, Audebert HJ, et al. Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study. Stroke. 2012;43:2086\u201390.","journal-title":"Stroke"},{"key":"11651_CR5","doi-asserted-by":"crossref","unstructured":"Lazarus G, Permana AP, Nugroho SW, Audrey J, Wijaya DN, Widyahening IS. Telestroke strategies to enhance acute stroke management in rural settings: a systematic review and meta-analysis. Brain Behav. 2020;10:e01787.","DOI":"10.1002\/brb3.1787"},{"key":"11651_CR6","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1161\/01.STR.0000226741.20629.b2","volume":"37","author":"HJ Audebert","year":"2006","unstructured":"Audebert HJ, Kukla C, Vatankhah B, Gotzler B, Schenkel J, Hofer S, et al. Comparison of tissue plasminogen activator administration management between telestroke network hospitals and academic stroke centers: the telemedical pilot project for integrative stroke care in Bavaria\/Germany. Stroke. 2006;37:1822\u20137.","journal-title":"Stroke"},{"key":"11651_CR7","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1161\/01.STR.0000153015.57892.66","volume":"36","author":"HJ Audebert","year":"2005","unstructured":"Audebert HJ, Kukla C, Von Claranau SC, K\u00fchn J, Vatankhah B, Schenkel J, et al. Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke. 2005;36:287\u201391.","journal-title":"Stroke"},{"key":"11651_CR8","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1212\/01.wnl.0000269671.08423.14","volume":"69","author":"S Schwab","year":"2007","unstructured":"Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, F\u00fcrst A, et al. Long-term outcome after thrombolysis in telemedical stroke care. Neurology. 2007;69:898\u2013903.","journal-title":"Neurology"},{"key":"11651_CR9","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/S1474-4422(08)70171-6","volume":"7","author":"BC Meyer","year":"2008","unstructured":"Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol. 2008;7:787\u201395.","journal-title":"Lancet Neurol"},{"key":"11651_CR10","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1002\/ana.26556","volume":"93","author":"H Erdur","year":"2023","unstructured":"Erdur H, Weber JE, Angermaier A, Kinze S, Sotoodeh A, Gorski C, et al. A Managed Care System with Telemedicine Support for Neurological emergencies. Ann Neurol. 2023;93:511\u201321.","journal-title":"Ann Neurol"},{"key":"11651_CR11","first-page":"34","volume":"20","author":"H Markus","year":"2020","unstructured":"Markus H. Personalising secondary prevention: different treatments for different strokes. Pract Neurol. 2020;20:34\u20138.","journal-title":"Pract Neurol"},{"key":"11651_CR12","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42:377\u201381.","journal-title":"J Biomed Inf"},{"key":"11651_CR13","doi-asserted-by":"publisher","first-page":"1422","DOI":"10.2307\/2533508","volume":"53","author":"J Nam","year":"1997","unstructured":"Nam J. Establishing equivalence of two treatments and sample size requirements in matched-pairs design - PubMed. Biometrics. 1997;53:1422\u201330.","journal-title":"Biometrics"},{"key":"11651_CR14","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<891::AID-SIM780>3.0.CO;2-B","volume":"17","author":"T Tango","year":"1998","unstructured":"Tango T. Equivalence test and confidence interval for the difference in proportions for the paired-sample design. Stat Med. 1998;17:891\u2013908.","journal-title":"Stat Med"},{"key":"11651_CR15","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/sim.1012","volume":"21","author":"J Liu","year":"2002","unstructured":"Liu J, Hsueh H, Hsieh E, Chen JJ. Tests for equivalence or non-inferiority for paired binary data. Stat Med. 2002;21:231\u201345.","journal-title":"Stat Med"},{"key":"11651_CR16","doi-asserted-by":"crossref","unstructured":"Gangadharan S, Tomari S, Levi CR, Weaver N, Holliday E, Bajorek B, et al. Rural versus metropolitan comparison of processes of care in the community-based management of TIA and minor stroke in Australia (an analysis from the INSIST study). Aust J Rural Health. 2023;31:272\u201384.","DOI":"10.1111\/ajr.12950"},{"key":"11651_CR17","doi-asserted-by":"publisher","first-page":"200","DOI":"10.7326\/0003-4819-158-3-201302050-00583","volume":"158","author":"AW Chan","year":"2013","unstructured":"Chan AW, Tetzlaff JM, Altman DG, Laupacis A, G\u00f8tzsche PC, Krle\u017ea-Jeri\u0107 K, et al. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158:200.","journal-title":"Ann Intern Med"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-024-11651-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-024-11651-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-024-11651-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T14:04:14Z","timestamp":1729173854000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11651-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,17]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["11651"],"URL":"https:\/\/doi.org\/10.1186\/s12913-024-11651-3","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,17]]},"assertion":[{"value":"17 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The VISIT STROKE study has been approved by the ethics committee (Charit\u00e9 Campus Mitte; Berlin\/Germany; no. EA4_065_22 and subsequently by the responsible ethics committees in Brandenburg (2022-162-BO), Mecklenburg-Western Pomerania (BB 133\/22a), Saxony-Anhalt (50\/22), Saxony (EK-BR-8\/23\u2009\u2212\u20091) University Hospital Dresden (BO-EK-328072022), University Hospital Heidelberg (S-666\/2022), Rhineland Palatinate (2022\u201316853), Baden Wuerttemberg (B-F-2023-004), Hesse (V\/1\/ewa 2023-3294-zvBO) and the Data Protection Department of the Charit\u00e9. Any changes to the study protocol, must be approved by the Ethics Committee before implementation. The study will be conducted in accordance with the Declaration of Helsinki in its current version, the guidelines of the International Conference on Harmonization of Good Clinical Practice (ICHGCP), and the applicable German laws. All patients or their legal guardians gave written informed consent prior to study participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JH, HE, AA, JH, AA, AH, CG, SK, IS, GJ, HW, MA, CG, MH, JEW report no disclosures. AF has received consulting fees from Bayer, Roche, Novartis, Biogen Idec, and NovagoTherapeutics, and honoraria for oral presentations from Novartis, B\u00f6hringer-Ingelheim, Eli-Lilly and Company, Biogen Idec, Paul-Martini Stiftung, and Daiichi-Sankyo. HJA reports speaker fees and consultancy honoraria received during the conduct of the study from Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers-Squibb, Novo Nordisk and Pfizer. TS reports speaker fees from Astrazeneca, royalties from Thieme and honoraria from Dresden International University.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1246"}}