1. TELEMEDICINE AND RESEARCH. THE TELEICTUS PROJECT IN THE HOSPITAL St JOHN OF GOD´S OF ALJARAFE. Antonio Fernández Moyano MD. PhD. Internal Medicine Service Chief Hospital St John of God´s to Aljarafe. Betica Province

2. Stroke is the second leading cause of death in our country and the first long-term disability.

3. Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Intravenous rtPA (alteplase) is recommended for selected patients who meet the following three conditions: -< 80 years old -within 4,5 hours of onset of symptoms, and -NIHSS scale between 4-20 points

4. “thrombolytic therapy should only be given if the diagnosis is established by a physician who has expertise in the diagnosis of stroke, and a computed tomography (CT) of the brain isassessed by physicians who have expertise in reading this imaging study”. 2003 European Stroke Initiative. Cerebrovasc Dis. 2004;17(suppl 2):30–46.

5. Much of the population live in geographically remote from major medical centers, and the permanent presence of a neurologist expert in each of the regional hospitals is unfeasible.

6. 2006  Telemedical support offers a novel and pragmatic way to extend the benefits of systemic thrombolysis to rural areas.  rtPA administration can be conducted in regional hospitals with similar treatment quality Stroke 2006, 37:1822-1827:

7.  Thrombolysis may be initiated at an outlying hospital (spoke) under the supervision of a vascular neurologist at the designated Regional stroke centre (Hub) via telephone or telemedicine (“telestroke”) Stroke. 2010;41:e18-e24.

8.  An organized protocol for the emergency evaluation of patients with suspected stroke.  Designation of an acute stroke team that includes physicians, nurses, and laboratory/radiology personnel. Stroke. 2010;41:e18-e24.

10. Population: 270.000 Hub: 80 m´ Spoke: 40 m´ ALJARAFE

11. Our program has developed a computer system to aid decision making in the clinical assessment of doctors and nurses,

12. … and treatment.