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Dragos VINEREANU

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Articles signed on MÆDICA, JCM:

Interdisciplinary Approach in a Complex Case of STEMI

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MÆDICA - a Journal of Clinical Medicine | Vol. 9, nr. 4, 2014

CNCSIS - CMR - B+ OBBCSSR

Interdisciplinary Approach in a Complex Case of STEMI

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ABSTRACT

We reported the case of a young man with ST-Segment Elevation Myocardial Infarction (STEMI), with ventricular fibrillation on debut and cardiogenic shock, who needed a complex interdisciplinary approach for a favourable long term outcome.

A 43-year-old man was admitted with inferior STEMI and cardiogenic shock. First coronary angiography revealed total chronic occlusion of left anterior descending artery (LAD) and tight stenosis with thrombus on right coronary artery (RCA). Thrombus aspiration and stent implantation on RCA was performed with good results. LAD couldn’t be opened. Intraaortic balloon pump was implanted. Fortyeight hours later, we try again to open LAD, without success. After a lot of complications, all solved with difficulty, patient was discharged cachectic and with progressive exertion on mild exercise. Two months later an implantable cardioverter-defibrillator (ICD) was decided for persistent ventricular tachycardia and after one year he was referred to a cardiac surgery centre abroad for aneurismectomy with left ventricle (LV) reconstruction and mitral valve repair. The patient is currently asymptomatic with a normal social and professional life.

In conclusion, high performance cardiac surgery, after a complete interventional treatment, can improve quality of life and long-term outcome to a patient with severe cardiovascular disease.

Team work between clinical cardiologists, interventional cardiologists, electrophisyologists, intensivists and cardiac surgeons is the key to success.

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Current Perception of Telemedicine in an EU Country

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MÆDICA - a Journal of Clinical Medicine | Vol. 9, nr. 4, 2014

CNCSIS - CMR - B+ OBBCSSR

Current Perception of Telemedicine in an EU Country

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ABSTRACT

Objectives: To assess the perception and expectation of beneficiaries and providers of telemedicine services in Romania.

Methods: Interview (on-line and face-to-face) of 109 representatives of medical community, from two categories: physicians, involved directly in the patient care, and medical and information technology directors of state and private owned clinics and hospitals. A third group, formed by executives from main technology service provider companies, was added in order to expand the results with their vision as potential suppliers of telemedicine projects.

Outcomes: We evaluated 4 important aspects of telemedicine: actual status of the services, development efforts and allocated budget, expected future services, and stoppers and enablers. On the actual status we identified in 48% of the cases the existence of core services good enough to start advanced telemedicine services. We developed a metric (SOR = Supporter/Opponents Ratio) to evaluate the suitability of telemedicine services to evolve and to deliver on expectations. The analysis shows that physicians see potential for development for EHR and PACS (both with SOR >25), but the executives start looking forward to more advanced services like remote patient monitoring. Main impact is expected in collaboration and patient quality life areas and, by far, the main stoppers are reduced budgets and organizational problems to adapt to the new data models.

Conclusions: We identified a strong support from the physicians related with the introduction of new type of healthcare services accompanied with high expectations. On the executive level, the expectations are different, ranging from low optimism on the technology side, to serious support on the medical side. However, there is a clear trend, able to create the first telemedicine services during the next years.

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