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Andruskevicius S, Petrosian D, Dapkute A, Jokubaitis M, Ryliskiene K. Evolving migraine management: Lithuania's telemedicine experience. Front Neurol 2024; 15:1388100. [PMID: 38841702 PMCID: PMC11152170 DOI: 10.3389/fneur.2024.1388100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction COVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use. Methods A nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types. Results Eight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30-42) years and an average of 5 (IQR 3-9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent's opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007). Conclusions Our findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.
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Krett JD, Salter A, Newsome SD. Era of COVID-19 in Multiple Sclerosis Care. Neurol Clin 2024; 42:319-340. [PMID: 37980121 PMCID: PMC10288315 DOI: 10.1016/j.ncl.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
The unprecedented scope of the coronavirus disease 2019 (COVID-19) pandemic resulted in numerous disruptions to daily life, including for people with multiple sclerosis (PwMS). This article reviews how disruptions in multiple sclerosis (MS) care prompted innovations in delivery of care (eg, via telemedicine) and mobilized the global MS community to rapidly adopt safe and effective practices. We discuss how our understanding of the risks of COVID-19 in PwMS has evolved along with recommendations pertaining to disease-modifying therapies and vaccines. With lessons learned during the COVID-19 pandemic, we examine potential questions for future research in this new era of MS care.
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Affiliation(s)
- Jonathan D Krett
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Amber Salter
- Section on Statistical Planning & Analysis, Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Scott D Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA.
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Robblee J. Telemedicine in Headache Medicine: A Narrative Review. Curr Pain Headache Rep 2023; 27:371-377. [PMID: 37515743 DOI: 10.1007/s11916-023-01141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW The purpose of the study is to review and discuss the use of telemedicine in headache medicine. RECENT FINDINGS Before the COVID-19 pandemic, the use of telemedicine for headache was most common in Europe. In recent years, however, telemedicine has been used broadly within headache medicine, including for pediatric patients and behavioral interventions. Several randomized clinical trials have shown that telemedicine is non-inferior to face-to-face visits. Multiple studies have reported substantial benefits associated with telemedicine, including high satisfaction rates, improved access to headache specialists, reduced travel, quicker visits, greater cost-effectiveness, reduced wait times, reduced no-show rates, and the increased comfort of remaining in one's home environment. The main limitation reported is the lack of a physical examination, including fundus assessment. Telemedicine has become a vital tool in headache patient care, with the data supporting its use for patient follow-up in particular.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
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Ercoli T, Barbato F, Bombaci A, Cuffaro L, Di Lorenzo F, Iodice F, Romoli M, Solla P, Defazio G. Neurological Consequences of COVID-19: A Systematic Review of the Pandemic's Impact on Neurology Training. Brain Sci 2023; 13:1188. [PMID: 37626544 PMCID: PMC10452502 DOI: 10.3390/brainsci13081188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The COVID-19 pandemic had a significant impact on neurology training programs, leading to disruptions and changes that may have long-term implications for neurological education. The objective of this study was to investigate the impact of COVID-19 on neurological training programs, collecting available data relating to residents' experience worldwide. We performed a systematic search of the literature published on PubMed from January 2020 to March 2023, including studies referring to quantitative analysis of residents'/trainees' perspectives. Specifically, we included studies that examined how the pandemic has affected clinical and research activities, the use of telemedicine, the delivery of education and the psychological status of residents. Of the 95460 studies identified through database searching, 12 studies met the full criteria and underwent data extraction. In conclusion, the COVID-19 pandemic has had significant impacts on neurology training programs, highlighting the need for resilience and flexibility in medical education. Future research should focus on the long-term outcomes of these adaptations in the quality of neurology education and patient care.
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Affiliation(s)
- Tommaso Ercoli
- Neurological Unit, AOU Sassari, University of Sassari, 07100 Sassari, SS, Italy;
| | | | - Alessandro Bombaci
- “Rita Montalcini” Department of Neurology, University of Turin, 10124 Turin, TO, Italy;
| | - Luca Cuffaro
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, MI, Italy;
| | - Francesco Di Lorenzo
- Noninvasive Brain Stimulation Unit, Scientific Institute for Research, Hospitalisation and Health Care Santa Lucia Foundation, 00179 Rome, RM, Italy;
| | - Francesco Iodice
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Pisana, 00163 Rome, RM, Italy;
| | - Michele Romoli
- Neurology and Stroke Unit, “Maurizio Bufalini” Hospital, 47521 Cesena, FC, Italy;
| | - Paolo Solla
- Neurological Unit, AOU Sassari, University of Sassari, 07100 Sassari, SS, Italy;
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, SS, Italy
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70121 Bari, BA, Italy;
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Raes S, Annemans L, Willems R, Trybou J. Physicians' views on optimal use and payment system for telemedicine: a qualitative study. BMC Health Serv Res 2023; 23:292. [PMID: 36978073 PMCID: PMC10043843 DOI: 10.1186/s12913-023-09314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Telemedicine is already in use in daily practice, but appropriate reimbursement and physician payment is falling behind in many countries. One reason is the limited availability of research on the matter. This research therefore examined physicians' views on the optimal use and payment modalities for telemedicine. METHODS Sixty-one semi-structured interviews were conducted with physicians from 19 medical disciplines. Interviews were encoded using thematic analysis. RESULTS Telephone and video televisits tend not to be used as a first patient contact, except for triage of patients in urgency situations. Several minimum required modalities for the payment system of televisits and telemonitoring were identified. For televisits these were: (i) remuneration of both telephone- and videovisits to increase healthcare equity, (ii) little or no differentiation between videovisit and in-person visit fee to make videovisits financially attractive and sustainable for physicians, (iii) differentiation of televisit fee per medical discipline, and (iv) quality requirements such as mandatory reporting in the patient's medical file. The identified minimum required modalities for telemonitoring were: (i) an alternative payment scheme than fee-for-service, (ii) remunerating not only physicians but also other involved health professionals, (iii) designating and remunerating a coordinator, and (iv) distinguishing sporadic vs. continuously follow-up. CONCLUSIONS This research investigated the telemedicine usage behavior of physicians. Moreover, several minimum required modalities were identified for a physician-supported payment system of telemedicine, as these innovations necessitate challenging and innovation of the healthcare payment systems as well.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium.
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium
| | - Jeroen Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, 9000, Belgium
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Jokubaitis M, Bakutis J, Ryliškienė K. COVID-19 pandemic: Impact of quarantine on migraine and patients' care in Lithuania. Clin Neurol Neurosurg 2023; 226:107615. [PMID: 36791587 PMCID: PMC9899160 DOI: 10.1016/j.clineuro.2023.107615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE there is a scarcity of data regarding the long-term (one year or more) impact of COVID-19 related quarantine on migraine burden. The aim of this cross-sectional study was to assess the impact of quarantine on migraine course, and the implications of a shift in migraine patients' care. METHODS An anonymous online survey of 206 migraine patients in Lithuania was undertaken in April 2021. RESULTS During quarantine, 42.2% of respondents reported migraine worsening, 17.0% - migraine improvement, and 40.8% reported no change. The most common causes of improvement specified by respondents were improved sleep, increased physical activity, and better eating habits. The most common reasons for migraine worsening were decreased physical activity, use of masks and respirators, and anxiety about own health. Logistic regression revealed that the changes in migraine course were associated not only with the migraine severity and educational level, but also with lifestyle alterations such as changes in sleep, the use of personal protective equipment, and increased home workload. A quarter of respondents were unable to consult a doctor. Patients who failed this started using more analgesics (65.0% and 55.0%, p = 0.004). Almost one-third of consultations were conducted over the telephone. Treatment changes were more common during face-to-face than remote consultations (63.6% and 18.2%, p = 0.009), however, the efficacy of treatment changes did not differ significantly (61.9% and 50.0%, p = 0.741). CONCLUSION we found an overall rise in migraine burden because of lifestyle changes during the COVID-19 related quarantine. Inability to visit a doctor led to the emergence of remote consultations.
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Affiliation(s)
| | - Justas Bakutis
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Telemedicine for Individuals with epilepsy: Recommendations from International League Against Epilepsy Telemedicine Task Force. Seizure 2023; 106:85-91. [PMID: 36803864 DOI: 10.1016/j.seizure.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.
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Hmoud M, Salamatullah HK, Faidah DE, Makkawi S. Experience and perception of utilizing virtual clinic in neurological assessment in Saudi Arabia. Front Neurol 2023; 14:1111254. [PMID: 36873439 PMCID: PMC9983690 DOI: 10.3389/fneur.2023.1111254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction The World Health Organization defined electronic health as "the unified usage of information technology and electronic communications in the health sector." In the Kingdom of Saudi Arabia, outpatient encounters were largely shifted to virtual clinics due to the crisis caused by COVID-19. This study aimed to evaluate the neurology consultants', specialists', and residents' experience and perception of utilizing virtual services for neurological assessment in Saudi Arabia. Methods This cross-sectional study was conducted by sending an anonymous online survey to neurologists and neurology residents in Saudi Arabia. The survey was developed by the authors and contained three main sections: demographics, subspecialty and years of experience after residency, and virtual clinics during the coronavirus disease 2019 (COVID-19) pandemic. Result A total of 108 neurology-practicing physicians in Saudi Arabia responded to the survey. Overall, 75% experienced virtual clinics, and 61% of them used phones for consultation. In neurology clinical practice, there was a significant difference (P < 0.001) regarding the teleconsultations for follow-up patients compared to the newly referred patients, being more suitable for the follow-up cases. Additionally, most neurology practicing physicians showed more confidence in performing history-taking tasks virtually (82.4%) than in physical examination. However, it was found that consultants were significantly (P < 0.03) more confident to virtually perform the cranial nerve, motor, coordination, and extrapyramidal assessments than the neurology residents. Physicians deemed it more suitable to conduct teleconsultations for patients with headaches and epilepsy than for those with neuromuscular and demyelinating diseases/multiple sclerosis. Furthermore, they agreed that patients' experiences (55.6%) and physicians' acceptance (55.6%) were the two main limitations to implementing virtual clinics. Discussion This study revealed that neurologists were more confident in performing history-taking in virtual clinics than in physical exams. On the contrary, consultants were more confident in handling the physical examination virtually than the neurology residents. Moreover, the most accepted clinics to be handled electronically were the headache and epilepsy clinics in comparison to the other subspecialties, being mainly diagnosed using history. Further studies with larger sample sizes are warranted to observe the level of confidence in performing different duties in neurology virtual clinics.
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Affiliation(s)
- Mohammed Hmoud
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Hassan K Salamatullah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Dania E Faidah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Telemedicine in the Management of Parkinson's Disease: Achievements, Challenges, and Future Perspectives. Brain Sci 2022; 12:brainsci12121735. [PMID: 36552194 PMCID: PMC9775481 DOI: 10.3390/brainsci12121735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the global population grows, there is an increasing demand for neurologic consultation that prompts new ways to reach more patients. Telemedicine can provide an accessible, cost-effective, and high-quality healthcare services. OBJECTIVES In this article, we highlight recent developments, achievements, and challenges regarding outcomes, clinical care, tele-education, teletreatment, teleresearch, and cybersecurity for telemedicine applied to Parkinson´s disease (PD) and other neurological conditions. RESULTS A growing body of evidence supports the feasibility and effectiveness of telemedicine tools for PD and other movement disorders. Outcome variables regarding satisfaction and efficacy in clinical care and specific issues about education, research, and treatment are reviewed. Additionally, a specific legal framework for teleconsultation has been developed in some centers worldwide. Yet, the implementation of telemedicine is conditioned by the limitations inherent to remote neurological examination, the variable computer usage literacy among patients, and the availability of a reliable internet connection. At present, telemedicine can be considered an additional tool in the clinical management of PD patients. CONCLUSIONS There is an increasing use of remote clinical practice regarding the management of PD and other neurological conditions. Telemedicine is a new and promising tool aimed at special settings and subpopulations.
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Thompson CM, Pulido MD, Babu S, Zenzola N, Chiu C. Communication between persons with multiple sclerosis and their health care providers: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3341-3368. [PMID: 35927111 DOI: 10.1016/j.pec.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study undertakes a scoping review of research about communication between persons with MS and their health care providers. DESIGN PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information. RESULTS Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making. CONCLUSION This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes. PRACTICE IMPLICATIONS Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA.
| | - Manuel D Pulido
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Sara Babu
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Nicole Zenzola
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Urbana, USA
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Clausen TC, Greve NK, Müller KI, Kristoffersen ES, Schytz HW. Telemedicine in headache care: A systematic review. Cephalalgia 2022; 42:1397-1408. [PMID: 35787157 DOI: 10.1177/03331024221111554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Telemedicine is defined as video-based consultations with synchronous video and sound. This systematic review investigated the use of telemedicine for headache patients. The primary outcomes of interest were treatment efficacy, feasibility, safety, convenience, compliance, and patient satisfaction. METHODS A systematic literature search was performed using PubMed and Embase. Thirteen articles met the eligibility criteria and were included in the review. A systematic review protocol was registered on the International Prospective Register of Systematic Reviews, registration number CRD42021265875. RESULTS There were no significant differences in treatment efficacy, patient satisfaction, compliance or safety using telemedicine when compared to traditional consultations. Telemedicine was found to be convenient due to being less time-consuming and expensive, especially for patients with limited access to health care. Despite the frequent occurrence of technical errors, telemedicine was found to be feasible. CONCLUSION Telemedicine consultations are similar in quality to traditional in-office headache consultations and can be a more convenient solution for eligible headache patients.
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Affiliation(s)
| | | | - Kai Ivar Müller
- Department of Neurology and National Neuromuscular Centre Norway, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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Muacevic A, Adler JR. The First Case Series From Japan of Primary Headache Patients Treated by Completely Online Telemedicine. Cureus 2022; 14:e31068. [PMID: 36475218 PMCID: PMC9719403 DOI: 10.7759/cureus.31068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 01/26/2023] Open
Abstract
Background Since March 2020, the coronavirus disease 2019 pandemic has increased the need for telemedicine to avoid in-person consultations. Online clinics for most diseases officially started in Japan in April 2022. Here, we report the cases of eight Japanese headache patients treated by completely online telemedicine for three months from the first visit. Methodology From the medical records between July 2022 and October 2022, we retrospectively investigated eight consecutive first-visit primary headache patients who consulted our online headache clinic via telemedicine and continued to see us via telemedicine only. The Headache Impact Test-6 (HIT-6) score, monthly headache days (MHD), and monthly acute medication intake days (AMD) were investigated over the observation period. Results A total of eight women were included, and the median (interquartile range) age was 30 (24-51) years. The median HIT-6 scores before, one, and three months after treatment were 63 (58-64), 54 (53-62), and 52 (49-54), respectively. MHD before, one, and three months after treatment were 15 (9-28), 12 (3-17), and 2 (2-8), respectively. AMD before, one, and three months after treatment were 10 (3-13), 3 (1-8), and 2 (0-3), respectively. Significant reductions in HIT-6 and MDH were observed three months after the initial consultation (p = 0.007 and p = 0.042, respectively). AMD was not significantly decreased at three months (p = 0.447). Conclusions This is the first report of Japanese patients treated by completely online telemedicine for three months from the first visit. HIT-6 and MDH can be significantly decreased at three months by only telemedicine. Online telemedicine is expected to be widely used to resolve unmet needs in headache treatment.
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Pintér D, Járdaházi E, Janszky J, Kovács N. Potential clinical and economic benefits of remote deep brain stimulation programming. Sci Rep 2022; 12:17420. [PMID: 36261678 PMCID: PMC9579619 DOI: 10.1038/s41598-022-22206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/11/2022] [Indexed: 01/12/2023] Open
Abstract
Deep brain stimulation (DBS) teleprogramming may help reducing travel-related and other financial burdens for patients and maintaining DBS care in special situations. To determine travel-related burdens of DBS patients and explore effects of COVID-19 on DBS care. Travel- and visit-related data of 319 patients were retrospectively analyzed for the first year, five years, and ten years after initiating DBS. Frequencies of in-person and telemedicine visits over the 18-month periods just before and after the outbreak of COVID-19 in Hungary were also compared. Average travel distance during an in-person visit was 415.2 ± 261.5 km, while average travel time was 342.1 ± 199.4 min. Travel costs for the first year, five years, and ten years were 151.8 ± 108.7, 461.4 ± 374.6, and 922.7 ± 749.1 Euros, respectively. Travel distance, age, and type and severity of disease could help identify patients who would particularly benefit from teleprogramming. We detected a significant decrease in the number of visits during COVID-19 pandemic (from 3.7 ± 2.1 to 2.4 ± 2.7; p < 0.001) which mainly resulted from the decreased frequency of in-person visits (3.6 ± 2.0 vs. 1.7 ± 1.8; p < 0.001). Our results support the introduction of DBS teleprogramming in Hungary which could save money and time for patients while maintaining a secure delivery of DBS.
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Affiliation(s)
- Dávid Pintér
- grid.9679.10000 0001 0663 9479Department of Neurology, Medical School, University of Pécs, 7623, Pécs, Rét Utca 2, Pécs, Hungary ,ELKH-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Evelyn Járdaházi
- grid.9679.10000 0001 0663 9479Department of Neurology, Medical School, University of Pécs, 7623, Pécs, Rét Utca 2, Pécs, Hungary
| | - József Janszky
- grid.9679.10000 0001 0663 9479Department of Neurology, Medical School, University of Pécs, 7623, Pécs, Rét Utca 2, Pécs, Hungary ,ELKH-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Norbert Kovács
- grid.9679.10000 0001 0663 9479Department of Neurology, Medical School, University of Pécs, 7623, Pécs, Rét Utca 2, Pécs, Hungary ,ELKH-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Rayhill ML, Rosen N, Robbins MS. Headache Education Adaptation During the COVID-19 Pandemic: Impact on Undergraduate and Graduate Medical Education. Curr Pain Headache Rep 2022; 26:827-833. [PMID: 36190679 PMCID: PMC9528878 DOI: 10.1007/s11916-022-01084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Our goal was to describe the changes to headache and neurological education that occurred as a result of the COVID-19 pandemic, and the impact this had on medical learners. We also discuss subsequent implications for the future of education in the field of headache medicine. Recent Findings Both educators and learners faced many challenges during the pandemic. These include the following: cancellation of in-person educational meetings, limited in-person networking and wellness events, disengagement from virtual didactic curricula, limitations in procedure-based learning, redeployment to inpatient settings with a decrease in outpatient exposures, and blurred boundaries between home and work life due to more virtual collaboration and home computer use. The development of telehealth programs and trainee wellness initiatives, improved collaboration opportunities among geographically distant institutions, and greater access to conferences for learners are among the many improvements forged by these challenging times in medical education. Summary Given the high prevalence of headache disorders and the paucity of headache specialists, training new clinicians with competency in headache medicine is essential. There were many educational challenges and opportunities identified in the literature that resulted from the pressures of the pandemic. Educators need to develop assessments that capture any gaps in learning that may have occurred during this tumultuous time and be vigilant of remediation needs in our learners over the coming years. It is imperative to intentionally design curricula for the future by harnessing new pedagogical tools, innovations, and perspectives gleaned from our experience with the COVID-19 pandemic.
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Affiliation(s)
- Melissa L Rayhill
- Department of Neurology, University at Buffalo Jacobs School of Medicine, The State University of New York, 1010 Main Street, 2nd floor, Buffalo, Buffalo, NY, 14202, USA.
| | - Noah Rosen
- Department of Neurology, Northwell Health, Long Island, NY, USA
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15
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Zhang S, Wang S, Dong Y, Chen X, Hu M, Kou S, Zhang C, Wu S, Tian Y. Current care practices for patients with Duchenne muscular dystrophy in China. Brain Dev 2022; 44:623-629. [PMID: 35691779 PMCID: PMC9181563 DOI: 10.1016/j.braindev.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has presented challenges in the care of patients with chronic diseases. We identified the challenges faced by Chinese patients with Duchenne muscular dystrophy (DMD) during the pandemic. METHODS An online cross-sectional survey was conducted between March 27 and June 30, 2021. RESULTS Of the 2105 valid questionnaire responses, 2,056 patients were from non-lockdown areas. In these areas, 42.8% reduced outside daily activities, 49.4% reduced rehabilitation service use, 39.7% postponed regular follow-ups, and 40.8% reported accelerated motor function decline. These figures generally increased for patients from lockdown areas-67.3% reduced outside daily activities, 44.9% reduced rehabilitation service use, 79.6% postponed regular follow-ups, and 55.1% reported accelerated motor function decline. Ambulation loss was most commonly reported in September and March before 2020; however, this trend was absent in 2020. Regarding the informed prices of disease-modifying drugs in Europe and the United States, 86.7% could afford a maximum of one-twentieth of the prices, 8.0% could afford one-tenth of the prices, and only 0.6% of the patients could afford the full prices. CONCLUSIONS Implementation of standardized care for DMD in China is consistent with global practices, and the COVID-19 pandemic has affected the care of patients with chronic diseases worldwide, particularly in lockdown areas. Telemedicine is an effective model for providing healthcare to such patients. Healthcare workers should assist patients and establish more robust chronic disease management systems. Collaboration between governmental and non-governmental entities could address the cost of disease-modifying drugs in China and other developing countries.
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Affiliation(s)
- Shu Zhang
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China,Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Shaoxia Wang
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yuru Dong
- Department of Radiology, Third Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xinyu Chen
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Miao Hu
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Sen Kou
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Chunyan Zhang
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China
| | - Shiwen Wu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yaping Tian
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China.
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16
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Lleixa Sardañons M, Artola Ortiz M, Becerril Ríos N, Cordero Martín G, Hernando Andrés A, Lozano Ladero AM, Sabroso Mellado JR, Sánchez Franco CM, del Río Muñoz B. Nursing care of patients with multiple sclerosis during the COVID-19 pandemic. REVISTA CIENTÍFICA DE LA SOCIEDAD DE ENFERMERÍA NEUROLÓGICA (ENGLISH ED.) 2022. [PMCID: PMC9446056 DOI: 10.1016/j.sedeng.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Introduction Development Conclusions
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17
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Anghelescu A. Telerehabilitation: A Practical Remote Alternative for Coaching and Monitoring Physical Kinetic Therapy in Patients with Mild and Moderate Disabling Parkinson's Disease during the COVID-19 Pandemic. PARKINSON'S DISEASE 2022; 2022:4370712. [PMID: 35979169 PMCID: PMC9377913 DOI: 10.1155/2022/4370712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Background The COVID-19 pandemic imposed social/physical distancing, lockdown measures, and forced reorientation of the rehabilitation programs for people with Parkinson's disease (PD). Epidemiologic safety measures boosted remote exercise-based treatment. Objectives Remote delivery of rehabilitation care services is not typically used in our department. Therefore, this study aimed to assess and implement a telehealth physical rehabilitation program tailored for outpatients with idiopathic PD and slight or medium functional limitations. Methods A prospective study was performed on a group of outpatients with idiopathic PD, selected from the database of the neurorehabilitation clinic of the Emergency Teaching Hospital "Bagdasar-Arseni." We studied 17 patients (5 women and 12 men), aged between 54-70 years (average 65.9 ± 4.87), with a disease history of 7.3 ± 3.6 (years), with mild or moderate disabling clinical forms, quantified by an average Hoehn and Yahr score of 2.3 ± 0.35 (limits 1.5-3). All patients underwent pharmacologic treatment with unchanged doses throughout the study. No patients had disabling osteoarticular problems (all could walk independently) and had no significant psycho-cognitive dysfunction. Patients were supervised and coached online in tandem by the therapist and physician. In addition, a family member assisted and supervised the patient's performance and coordinated the technical electronic procedures. Walking biodynamics was assessed by timing "6-meters walking" and "Get up and walk 3 meters" (TUG) tests. Each person attended ten sessions of motor telerehabilitation procedures (2 per week) lasting 50 minutes each during social distancing (October-December 2021). Results None of the patients was at increased risk of falling. They all improved their locomotor performance, reflected in a significant decrease in TUG duration (the initial average time improved from 13.50 seconds to 10.57). The telerehabilitation program also significantly improved the average walking speed (initially, 44.5 cm/sec and finally, it raised to 56.8 cm/sec). Discussion. The TUG and "6-meters walking" tests are helpful tools for a global biodynamic remote assessment of PD patients. Limitations of the study: a small group of selected patients, restrictive working conditions (due to epidemiological social/physical restrictions and no direct physiotherapist-patient contact), and need for supervision by an attendant to assist the subject and perform the audio-video transmission. Further studies are necessary to identify the optimal web-based model of care and boost the implementation of this modern neurorehabilitation concept. Conclusions Telemedicine turned the virtual space into a new reality and may compensate for the restrictions imposed on face-to-face meetings in pandemic conditions. Moreover, with modern telecommunication techniques, a regular and individualized physical kinetic rehabilitation program can be performed even in pandemic conditions. Remote delivery of kinetic motor programs was appropriate for selected groups of PD patients.
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Affiliation(s)
- Aurelian Anghelescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Neurorehabilitation Clinic, Teaching Emergency Hospital “Bagdasar-Arseni”, Berceni Av., No. 12, Postal Code: 041915, 4th Sector, Bucharest, Romania
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18
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Jang Y, Moon J, Lee ST, Lee SK, Chu K. Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea. ENCEPHALITIS 2022; 2:65-72. [PMID: 37469460 PMCID: PMC10295915 DOI: 10.47936/encephalitis.2022.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 07/21/2023] Open
Abstract
Telemedicine is an emerging field of medicine that has become more important during the coronavirus disease 2019 (COVID-19) pandemic era and is being studied actively in various medical fields. In neurology, the introduction of telemedicine is accelerating worldwide under the label of teleneurology. So far, few studies have been conducted on telemedicine for patients with epilepsy. In nonmetropolitan areas, video-based clinics have been demonstrated to be effective for seizure control, and smartphone-based diagnosis has also been confirmed to be accurate. Indeed, after the onset of the COVID-19 pandemic, telemedicine has been used to treat patients with epilepsy around the world. Few studies have examined the use of telemedicine for patients with autoimmune encephalitis. One showed that telephone-based evaluation is sufficient to assess the cognitive reserve of leucine-rich glioma inactivated-1-antibody encephalitis patients, thereby diagnosing their dementia. Telephone-based outpatient clinics are temporarily permitted under Korean medical law, and telemedicine can be attempted for clinically stable patients with epilepsy in Korea. In addition, patients with autoimmune encephalitis in stable or improving status may also be candidates for treatment with telemedicine. This review presents evidence for the safety and efficacy of telemedicine to treat epilepsy and encephalitis patients and discusses indication guidelines. Based on our literature review and current Korean medical law, we suggest tentative guidelines for telemedicine in the fields of epilepsy and autoimmune encephalitis.
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Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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19
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Nakornchai T, Conci E, Hensiek A, Brown JWL. Clinician and patient experience of neurology telephone consultations during the COVID-19 pandemic. Postgrad Med J 2022; 98:533-538. [PMID: 37066507 PMCID: PMC8720641 DOI: 10.1136/postgradmedj-2021-141234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Telephone consultations are already employed in specific neurological settings. At Cambridge University Hospitals, the COVID-19 pandemic initially prompted almost all face-to-face appointments to be delivered by telephone, providing a uniquely unselected population to assess. OBJECTIVES We explored patient and clinician experience of telephone consultations; and whether telephone consultations might be preferable for preidentifiable subgroups of patients after the pandemic. METHODS Clinicians delivering neurological consultations converted to telephone between April and July 2020 were invited to complete a questionnaire following each consult (430 respondents) and the corresponding patients were subsequently surveyed (290 respondents). The questionnaires assessed clinician and patient goal achievement (and the reasons for any dissatisfaction). Clinicians also described consultation duration (in comparison to face to face) while patients detailed comparative convenience and preference. RESULTS The majority of clinicians (335/430, 78%) and patients (227/290, 78%) achieved their consultation goals by telephone, particularly during follow-up consultations (clinicians 272/329, 83%, patients 176/216, 81%) and in some disease subgroups (eg, seizures/epilepsy (clinicians 114/122 (93%), patients 71/81 (88%)). 95% of telephone consultations were estimated to take the same or less time than an equivalent face-to-face consultation. Most patients found telephone consultations convenient (69%) with 149/211 (71%) indicating they would like telephone or video consultations to play some role in their future follow-up. CONCLUSION Telephone consultations appear effective, convenient and popular in prespecified subgroups of neurological outpatients. Further work comparing telephone, video and face-to-face consultations across multiple centres is now needed.
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Affiliation(s)
- Tagore Nakornchai
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elena Conci
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anke Hensiek
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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20
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Lleixa Sardañons M, Artola Ortiz M, Becerril Ríos N, Cordero Martín G, Hernando Andrés A, Lozano Ladero AM, Sabroso Mellado JR, Sánchez Franco CM, del Río Muñoz B. Atención del personal de enfermería a pacientes con esclerosis múltiple durante la pandemia de la COVID-19. REVISTA CIENTÍFICA DE LA SOCIEDAD ESPAÑOLA DE ENFERMERÍA NEUROLÓGICA 2022. [PMCID: PMC9212886 DOI: 10.1016/j.sedene.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Spina E, Tedeschi G, Russo A, Trojsi F, Iodice R, Tozza S, Iovino A, Iodice F, Abbadessa G, di Lorenzo F, Miele G, Maida E, Cerullo G, Sparaco M, Silvestro M, Leocani L, Bonavita S, Manganelli F, Lavorgna L. Telemedicine application to headache: a critical review. Neurol Sci 2022; 43:3795-3801. [PMID: 35075575 PMCID: PMC8786371 DOI: 10.1007/s10072-022-05910-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migraine affects more than a billion people all over the world and requires critical employment of healthcare resources. Telemedicine could be a reasonable tool to manage people suffering from headaches, and it received a big push from the COVID-19 pandemic. OBJECTIVE This review aims to propose a practical approach for the virtual management of these patients. METHODS To do this, we conducted a literature search, including 32 articles relevant to the topic treated in this review. RESULTS The most challenging step in telemedicine applied to practical neurology remains the clinical assessment, but through a careful headache history and a recently proposed entirely virtual neurological assessment, this hitch can be easily overcome. Electronic diary compilations and virtual administration of disability-measuring scales, conversely, are the key features of effective long-term follow-up although we do not have apps that met the criteria of scientific reliability. Furthermore, tele-rehabilitation seems to be effective and has demonstrated to be a solution to alternatively treat chronic patients at home, and can be considered part of the remote management of headache patients. Moreover, virtual management of headaches finds an application in specific communities of patients, as pediatric patients and for rural communities of low- and middle-income countries suffer from health disparities, with inadequate resources and knowledge gaps. CONCLUSION Telemedicine could be promising for patients with no regular or convenient access to headache specialists and seems to be a priority in managing migraine patients to avoid non-urgent hospitalizations.
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Affiliation(s)
- Emanuele Spina
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy.
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Russo
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | | | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Giuseppina Miele
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Maddalena Sparaco
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Marcello Silvestro
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Luigi Lavorgna
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
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22
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Li R, St George RJ, Wang X, Lawler K, Hill E, Garg S, Williams S, Relton S, Hogg D, Bai Q, Alty J. Moving towards intelligent telemedicine: Computer vision measurement of human movement. Comput Biol Med 2022; 147:105776. [PMID: 35780600 PMCID: PMC9428734 DOI: 10.1016/j.compbiomed.2022.105776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022]
Abstract
Background: Telemedicine video consultations are rapidly increasing globally, accelerated by the COVID-19 pandemic. This presents opportunities to use computer vision technologies to augment clinician visual judgement because video cameras are so ubiquitous in personal devices and new techniques, such as DeepLabCut (DLC) can precisely measure human movement from smartphone videos. However, the accuracy of DLC to track human movements in videos obtained from laptop cameras, which have a much lower FPS, has never been investigated; this is a critical gap because patients use laptops for most telemedicine consultations. Objectives: To determine the validity and reliability of DLC applied to laptop videos to measure finger tapping, a validated test of human movement. Method: Sixteen adults completed finger-tapping tests at 0.5 Hz, 1 Hz, 2 Hz, 3 Hz and at maximal speed. Hand movements were recorded simultaneously by a laptop camera at 30 frames per second (FPS) and by Optotrak, a 3D motion analysis system at 250 FPS. Eight DLC neural network architectures (ResNet50, ResNet101, ResNet152, MobileNetV1, MobileNetV2, EfficientNetB0, EfficientNetB3, EfficientNetB6) were applied to the laptop video and extracted movement features were compared to the ground truth Optotrak motion tracking. Results: Over 96% (529/552) of DLC measures were within +/−0.5 Hz of the Optotrak measures. At tapping frequencies >4 Hz, there was progressive decline in accuracy, attributed to motion blur associated with the laptop camera’s low FPS. Computer vision methods hold potential for moving us towards intelligent telemedicine by providing human movement analysis during consultations. However, further developments are required to accurately measure the fastest movements.
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Affiliation(s)
- Renjie Li
- Discipline of Information and Communication Technology, Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
| | - Rebecca J St George
- Sensorimotor Neuroscience and Aging Group, School of Psychological Sciences, University of Tasmania, Australia.
| | - Xinyi Wang
- Discipline of Information and Communication Technology, Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
| | - Edward Hill
- Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
| | - Saurabh Garg
- Discipline of Information and Communication Technology, University of Tasmania, Australia.
| | | | - Samuel Relton
- School of Medicine, University of Leeds, United Kingdom.
| | - David Hogg
- School of Computing, University of Leeds, United Kingdom.
| | - Quan Bai
- Discipline of Information and Communication Technology, University of Tasmania, Australia.
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
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Teleneurology in a center for neuromuscular diseases during the COVID-19 pandemic. Acta Neurol Belg 2022; 122:721-724. [PMID: 34585321 PMCID: PMC8478629 DOI: 10.1007/s13760-021-01808-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has urged the adoption of telemedicine services as a measure of greater patients’ safety. This study aims to investigate efficacy and feasibility of teleneurology care for patients with neuromuscular diseases (NMD). Methods All patient visits from 4th March 2020 to 27th March 2021, the period of COVID-19 lockdown requiring partial transition to tele-consultation, were reviewed. Demographic data and medical records during the implementation of the “hybrid model” of both remote and in-person visits during COVID-19 era were analyzed and compared to those of the pre-pandemic era. Results A total of 2179 tele-consultation contacts for 182 patients (mean age 46.4 years, 42.3% female) were conducted. Tele-consultation was primarily performed by telephone calls. During that period, 1745 telephone calls were conducted, resulting in a 4.5 mean increase/patient compared to 2019. There was a 15.1% decrease in first time in-person consultations compared to 2019. However, the mean number of monitoring visits per person during pandemic was no different from previous years. With the exception of 3 patients with advanced stage of amyotrophic lateral sclerosis, no other patients required an unscheduled appointment or hospitalization for unforeseen reasons related to tele-consultation restrictions. Conclusion Monitoring of NMD patients could benefit from tele-provided multidisciplinary services. The experience gained during COVID-19 pandemic could be useful for further development of tele-medicine.
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Li V, Roos I, Monif M, Malpas C, Roberts S, Marriott M, Buzzard K, Nguyen AL, Seery N, Taylor L, Kalincik T, Kilpatrick T. Impact of telehealth on health care in a multiple sclerosis outpatient clinic during the COVID-19 pandemic. Mult Scler Relat Disord 2022; 63:103913. [PMID: 35661564 PMCID: PMC9137249 DOI: 10.1016/j.msard.2022.103913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/31/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Vivien Li
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
| | - Izanne Roos
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mastura Monif
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia
| | - Charles Malpas
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stefanie Roberts
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mark Marriott
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia
| | - Katherine Buzzard
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Ai-Lan Nguyen
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Nabil Seery
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Lisa Taylor
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia
| | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Trevor Kilpatrick
- Department of Neurology, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Meng G, McAiney C, Perlman CM, McKillop I, Tisseverasinghe T, Chen HH. Service process factors affecting patients' and clinicians' experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review. BMC Health Serv Res 2022; 22:534. [PMID: 35459134 PMCID: PMC9026006 DOI: 10.1186/s12913-022-07908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background The adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19. Methods Arksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07908-4.
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Affiliation(s)
- Guangxia Meng
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Ian McKillop
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | | | - Helen H Chen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Ghourchian S, Torres-Yaghi YA, Isaacson SH, Pagan F, Lyons KE, Nagle BJ, Patel S, Pahwa R. Movement Disorder Specialists Survey Regarding Use of Telemedicine During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1651-1657. [PMID: 35297666 DOI: 10.1089/tmj.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To assess the overall satisfaction level of movement disorder specialists using a virtual platform during the COVID-19 pandemic. Methods: This was a multicenter cross-sectional survey for a 6-month period during the beginning of the COVID-19 pandemic. Movement disorder specialists, who utilized telehealth visits from March 2020 to August 2020, were included. The study surveys, including provider's satisfaction with the care that they were able to provide and visit quality, were completed by the provider after each visit. Results: A total of 206 visits, provided by movement disorder specialists, were analyzed. Zoom was the most popular platform used for remote visits (70, 34%). A backup platform was not needed in the majority of movement disorder visits (171, 83%). The majority of physicians were very satisfied or satisfied with the care provided (72.9%) and visit quality (61%). Conclusions: The satisfaction level of specialists using telemedicine during COVID-19 was high despite having encounters with elderly patients with cognitive impairment or lacking advanced skills with technology.
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Affiliation(s)
- Shadi Ghourchian
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yasar A Torres-Yaghi
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kelly E Lyons
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian James Nagle
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sanskruti Patel
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Rajesh Pahwa
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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Bentivegna E, Tassorelli C, De Icco R, Sances G, Martelletti P. Tele-healthcare in migraine medicine: from diagnosis to monitoring treatment outcomes. Expert Rev Neurother 2022; 22:237-243. [PMID: 35196206 DOI: 10.1080/14737175.2022.2045954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION : Primary headaches represent a huge cost in terms of decreased productivity and migraine occupies the first position among disabilities in working population. Migraine has a high incidence, disproportionate to the available primary care centres. In most cases, migraine can be managed through the simple and accurate collection of clinical history, which makes it an ideal candidate for tele-healthcare. AREAS COVERED : In this narrative review we retrace the most important scientific evidence regarding use of tele-healthcare in headache medicine. Over the last few years, it has proved to be a valid and useful tool for the management of migraine. Furthermore, current pandemic has imposed a drastic change in the way of thinking and setting up medicine, forcing clinicians and patients to a huge expansion of telemedicine. EXPERT OPINION : We should permanently insert the culture of telemedicine in the headache care not only in academies and scientific societies, but extend it to specialized hospitals for the treatment of headaches. Only by broadening the old book-based strategy, we will be able to open the door to the multidimensional culture of headache medicine. Experts of excellence centres should set an example and pave the way for the rest of the clinicians.
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Affiliation(s)
- Enrico Bentivegna
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Impact of COVID-19 pandemic on frequency of clinical visits, performance of MRI studies, and therapeutic choices in a multiple sclerosis referral centre. J Neurol 2022; 269:1764-1772. [PMID: 35001198 PMCID: PMC8743162 DOI: 10.1007/s00415-021-10958-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
Introduction To evaluate the impact of the COVID-19 pandemic on (1) number of clinical visits, (2) magnetic resonance (MR) scans, and (3) treatment prescriptions in a multiple sclerosis (MS) referral centre.
Methods Retrospective study covering January 2018 to May 2021. Results The monthly mean (standard deviation [SD]) of visits performed in 2020 (814[137.6]) was similar to 2018 (741[99.7]; p = 0.153), and 2019 (797[116.3]; p = 0.747). During the COVID-19 period (2020 year), 36.3% of the activity was performed through telemedicine. The number of MR scans performed dropped by 76.6% during the “first wave” (March 14 to June 21, 2020) compared to the mean monthly activity in 2020 (183.5[68.9]), with a recovery during the subsequent two months. The monthly mean of treatment prescriptions approved in 2020 (24.1[7.0]) was lower than in 2019 (30[7.0]; p = 0.049), but similar to 2018 (23.8[8.0]; p = 0.727). Natalizumab prescriptions increased in the “first wave” and onwards, whereas anti-CD20 prescriptions decreased during the COVID-19 period. Conclusion Maintenance of the number of clinical visits was likely due to telemedicine adoption. Although the number of MR dramatically dropped during the “first wave”, an early recovery was observed. Treatment prescriptions suffered a slight quantitative decrease during 2020, whereas substantial qualitative changes were found in specific treatments.
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Roth EG, Minden SL, Maloni HW, Miles ZJ, Wallin MT. A Qualitative, Multiperspective Inquiry of Multiple Sclerosis Telemedicine in the United States. Int J MS Care 2022; 24:275-281. [PMID: 36545645 PMCID: PMC9749833 DOI: 10.7224/1537-2073.2021-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Telemedicine has expanded access to high-quality, appropriate, and affordable health care for people with multiple sclerosis (MS). This study explored how the expansion of MS telemedicine is perceived and experienced by people with MS, health care providers (HCPs), and payers and policy experts (PYs). METHODS Forty-five semistructured interviews with 20 individuals with MS, 15 HCPs, and 10 PYs were conducted between September 2020 and January 2021. The interviews were recorded on a televideo platform, transcribed, and analyzed for themes using qualitative data software. RESULTS Interviews revealed the following 4 themes. Technology: Telemedicine increases access and convenience. Technical challenges were the most cited downside to telemedicine. Clinical encounters: Confidence in MS care via telemedicine varies. Virtual "house calls" have clinical benefits. Financing and infrastructure: Reimbursement parity is critical to utilization and expansion of telemedicine. Stakeholders are hopeful and fearful as infrastructure and business models begin to shift. Shifting expectations: The familiar structure of the office visit is currently absent in telemedicine. Telemedicine visits need more intentionality from both providers and patients. CONCLUSIONS Telemedicine is an efficient, convenient way to deliver and receive many aspects of MS care. To expand telemedicine care, many HCPs need more training and experience, people with MS need guidance to optimize their care, and PYs in the United States need to pass legislation and adjust business models to incorporate benefits and reimbursement for telemedicine health in insurance plans. The future is promising for the ongoing use of telemedicine to improve MS care, and stakeholders should work to preserve and expand the policy changes made during the COVID-19 pandemic.
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Affiliation(s)
- Erin G. Roth
- From The Department of Sociology, Anthropology, & Public Health, University of Maryland Baltimore County (UMBC), Baltimore, MD, USA (EGR)
| | | | - Heidi W. Maloni
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence, Washington, DC, USA (HWM, MTW)
| | | | - Mitchell T. Wallin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence, Washington, DC, USA (HWM, MTW),George Washington University School of Medicine, Washington, DC, USA (MTW)
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30
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Bekkelund SI, Müller KI. One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial. J Med Internet Res 2021; 23:e30151. [PMID: 34898455 PMCID: PMC8713100 DOI: 10.2196/30151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/04/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023] Open
Abstract
Background Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177
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Affiliation(s)
- Svein Ivar Bekkelund
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Kai Ivar Müller
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Caponnetto V, Ornello R, De Matteis E, Papavero SC, Fracasso A, Di Vito G, Lancia L, Ferrara FM, Sacco S. The COVID-19 Pandemic as an Opportunity to Improve Health Care Through a Nurse-Coordinated Multidisciplinary Model in a Headache Specialist Center: The Implementation of a Telemedicine Protocol. Telemed J E Health 2021; 28:1016-1022. [PMID: 34756108 DOI: 10.1089/tmj.2021.0414] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Due to coronavirus disease-19 (COVID-19) pandemic, Italian outpatient clinics were suspended in March-April 2020 and subsequently slowed down. Telemedicine was shown to be useful in headache clinics, despite absence of a detailed protocol for its development. Objective: To describe the implementation of a structured telemedicine protocol during COVID-19 pandemic. Materials and Methods: Since May 2020, we performed a quality improvement study in a Headache Specialist Center in central Italy. We involved patients who had in-person follow-up visits scheduled during suspension and initial reopening of clinics. Patients had two appointments with a nurse specialized in headache care and a headache physician, respectively, using Microsoft Teams®. The service is still active. We collected sociodemographic and clinical characteristics of patients, technical details of telemedicine visits, patient feedback, medical judgment about complexity of clinical decisions, and need for in-person re-evaluation. We also performed a Strengths-Weaknesses-Opportunities-Threats analysis to provide a realistic picture of the service. Results: We performed 207 telemedicine visits involving 100 patients with a median age of 44 (interquartile range [IQR]: 35-56) years; 76.0% were women and lived at a median of 68 (IQR: 24-109) km from the Center. Thirty-nine (39.0%) were visited for migraine without aura. Patients mostly used a computer (68.1% visits) with high audio-video quality in 93.2% of visits. First and second appointments lasted in median 20 (IQR: 14-25) minutes and 9 (IQR: 7-13) minutes, respectively. Interacting with patients was very easy in 66.7% of visits. Patients reported no difficulty in sharing documents and high satisfaction in 78.6% and 93.5% of visits, respectively. Perceived complexity of clinical decisions was generally low (86.5%), whereas 8.2% of cases required in-person re-evaluation. Conclusions: Telemedicine facilitated follow-ups, ensuring multidisciplinary care and high patient satisfaction, justifying its wider adoption in headache care.
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Affiliation(s)
- Valeria Caponnetto
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.,Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Eleonora De Matteis
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Sara Consilia Papavero
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Fracasso
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Di Vito
- Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Lancia
- Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabrizio Massimo Ferrara
- ALTEMS: High School of Economics and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Landtblom A, Berntsson SG, Boström I, Iacobaeus E. Multiple sclerosis and COVID-19: The Swedish experience. Acta Neurol Scand 2021; 144:229-235. [PMID: 34028810 PMCID: PMC8222873 DOI: 10.1111/ane.13453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has brought challenges for healthcare management of patients with multiple sclerosis (MS). Concerns regarding vulnerability to infections and disease-modifying therapies (DMTs) and their complications have been raised. Recent published guidelines on the use of DMTs in relation to COVID-19 in MS patients have been diverse between countries with lack of evidence-based facts. In Sweden, there exists a particular interest in anti-CD20 therapy as a possible risk factor for severe COVID-19 due to the large number of rituximab-treated patients off-label in the country. Rapid responses from the Swedish MS Association (SMSS) and the Swedish MS registry (SMSreg) have resulted in national guidelines on DMT use for MS patients and implementation of a COVID-19 module in the SMSreg. Recently updated guidelines also included recommendations on COVID-19 vaccination with regard to the different DMTs. Social distancing policies forced implementation of telemedicine consultation to replace in-person consultations as part of regular MS health care. Patient-reported outcome measures (PROMs) in SMSreg have been useful in this respect. This paper reports our experiences on the progress of national MS health care during the COVID-19 pandemic, in addition to offering an overview of the present scientific context.
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Affiliation(s)
- Anne‐Marie Landtblom
- Department of Neuroscience Uppsala University Uppsala Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | | | - Inger Boström
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience Division of Neurology Karolinska Institute and Karolinska University Hospital Stockholm Sweden
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The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic. Epilepsy Behav 2021; 122:108229. [PMID: 34364025 PMCID: PMC8302842 DOI: 10.1016/j.yebeh.2021.108229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol. METHODS In January 2021, we initiated ASM tapering 24 h before-rather than on the first day after-EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital. RESULTS One hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10-30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1-5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12-34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital. CONCLUSIONS Initiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.
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Bodini B, Moro E, Jaarsma J, Cunningham E, Sellner J, Walsh D. Lessons learned from people with neurological diseases at the time of COVID-19: The EFNA-EAN survey. Eur J Neurol 2021; 29:318-323. [PMID: 34463009 PMCID: PMC8652681 DOI: 10.1111/ene.15087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The European Federation of Neurological Associations (EFNA), in partnership with the NeuroCOVID-19 taskforce of the European Academy of Neurology (EAN), has investigated the impact of the first wave of the COVID-19 pandemic on individuals with neurological diseases, as well as the hopes and fears of these patients about the post-pandemic phase. METHODS An EFNA-EAN survey was available online to any person living with a neurological disorder in Europe. It consisted of 18 items concerning the impact of the first wave of the COVID-19 pandemic on the medical care of people with neurological disorders, and the hopes and fears of these individuals regarding the post-pandemic phase. RESULTS For 44.4% of the 443 survey participants, the overall care of their neurological disease during the pandemic was inappropriate. This perception was mainly due to significant delays in accessing medical care (25.7%), insufficiently reliable information received about the potential impact of COVID-19 on their neurological disease (49.6%), and a substantial lack of involvement in their disease management decisions (54.3%). Participants indicated that their major concerns for the post-pandemic phase were experiencing longer waiting times to see a specialist (24.1%), suffering from social isolation and deteriorating mental well-being (23.1%), and facing delays in clinical trials with disinvestment in neuroscience research (13.1%). CONCLUSIONS Despite the great efforts of health services to cope with the first wave of the COVID-19 pandemic, individuals with neurological conditions feel they have been left behind. These findings provide invaluable insights for improving the care of patients with neurological disorders in the further course of the COVID-19 pandemic.
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Affiliation(s)
- Benedetta Bodini
- Paris Brain Institute, Sorbonne University, Paris, France.,Department of Neurology, Saint-Antoine Hospital, APHP, Paris, France
| | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Donna Walsh
- European Federation of Neurological Associations, Brussels, Belgium
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Landi D, Ponzano M, Nicoletti CG, Cola G, Cecchi G, Grimaldi A, Mataluni G, Mercuri NB, Sormani MP, Pacileo G, Marfia GA. Patient's point of view on the use of telemedicine in multiple sclerosis: a web-based survey. Neurol Sci 2021; 43:1197-1205. [PMID: 34283343 PMCID: PMC8289711 DOI: 10.1007/s10072-021-05398-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Restrictions in the access to healthcare facilities during COVID-19 pandemic have raised the need for remote monitoring of chronic medical conditions, including multiple sclerosis (MS). In order to enable the continuity of care in these circumstances, many telemedicine applications are currently tested. While physicians’ preferences are commonly investigated, data regarding the patients’ point of view are still lacking. We built a 37 items web-based survey exploring patients’ propensity, awareness, and opinions on telemedicine with the aim to evaluate the sustainability of this approach in MS. Analysing 613 questionnaires out of 1093 that were sent to persons with MS followed at the Multiple Sclerosis Center of Tor Vergata University, Rome, we found that more than half of respondents (54%) were open to having a televisit. Propensity toward telemedicine significantly depended on having a higher income (p = 0.037), living farther from the center (p = 0.038), using computer and tablet (p = 0.010) and using the Internet for other remote activities (p < 0.001), conversely it was not influenced by any specific disease characteristics (i.e. degree of disability). The main advantages and disadvantages of televisit reported by participants were respectively saving time (70%) and impossibility to measure physical parameters (71%). Although the majority of respondents are in favour of televisit, so far this approach is restricted to those displaying better socioeconomic conditions and higher familiarity with technology. Implications of the study are that telemedicine platforms should be better tailored to patients’ demands in order to spread the use of telemedicine, to enhance usability and to increase patients’ adherence.
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Affiliation(s)
- Doriana Landi
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
- Department of Systems Medicine, Tor Vergata University, Rome, Italy.
| | - Marta Ponzano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Gaia Cola
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Gianluca Cecchi
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Alfonso Grimaldi
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Nicola Biagio Mercuri
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Guglielmo Pacileo
- Centre of Research On Health and Social Care Management, Unit of Neurology, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Research and Clinical Unit, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (NEUROMED), Pozzilli, IS, Italy
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Houston E, Kennedy AG, O'Malley D, Rabinowitz T, Rose GL, Boyd J. Telemedicine in Neurology: A Scoping Review of Key Outcomes in Movement Disorders. Telemed J E Health 2021; 28:295-308. [PMID: 34101518 DOI: 10.1089/tmj.2021.0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Telemedicine for neurological care has been researched and practiced in various ways over the past three decades, but the recent COVID-19 pandemic has rapidly expanded its use and highlighted the need for a synthesis of the existing literature. We aimed to review the methodology and outcomes of previous studies that have evaluated the use of telemedicine in movement disorders. Methods: This scoping review was performed by searching PubMed, Ovid MEDLINE, and CINAHL databases from 1946 to November 2020. Studies that assessed the application of telemedicine for delivering care to patients with a movement disorder were included. We reported the aims and employed methodologies and categorized the outcomes from each study. Results: The search retrieved 228 articles, and 41 studies met the criteria for inclusion in the review. The majority of telemedicine studies were case series or randomized controlled pilot trials, investigating feasibility and acceptability in Parkinson's disease. Even with heterogeneity among outcome measures, they can be categorized into themes, such as feasibility, satisfaction, and efficacy. Conclusions: Telemedicine use has grown rapidly, due to the demands of providing care during a global pandemic. This application of telemedicine has been considered a promising way to expand care in Neurology, although research evaluating the dissemination of its use is dilatory. This review highlights the number of studies that have found telemedicine to be an acceptable and feasible way to deliver care for movement disorders. Further research is needed to expand on harmonization of outcomes, reach, adoption, and long-term use of telemedicine.
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Affiliation(s)
- Emily Houston
- Department of Neurology, University of Vermont Medical Center, Burlington, Vermont, USA.,Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Amanda G Kennedy
- Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Quality Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Donna O'Malley
- Dana Medical Library, University of Vermont Libraries, Burlington, Vermont, USA
| | - Terry Rabinowitz
- Department of Psychiatry and The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Psychiatry Consultation at the University of Vermont Medical Center, Burlington, Vermont, USA
| | - Gail L Rose
- Clinical Translational Science Program, Department of Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA.,Department of Psychiatry and The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - James Boyd
- Department of Neurology, University of Vermont Medical Center, Burlington, Vermont, USA.,Department of Neurological Sciences, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Rana A, Nguyen TN, Siegler JE. Stroke and neurointervention in the COVID-19 pandemic: a narrative review. Expert Rev Med Devices 2021; 18:523-531. [PMID: 33966557 DOI: 10.1080/17434440.2021.1928495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.
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Affiliation(s)
- Ameena Rana
- Cooper Medical School of Rowan University, Camden United States
| | - Thanh N Nguyen
- Department of Neurology, Radiology, and Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, United States
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, United States
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Rosenthal S, Yonker M. Telemedicine in Pediatric Headache: A Review and Practical Implementation. Curr Neurol Neurosci Rep 2021; 21:27. [PMID: 33844073 PMCID: PMC8038919 DOI: 10.1007/s11910-021-01112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review The purpose of this review was to summarize the current literature about telemedicine in pediatric headache and to provide practical guidance for its implementation. Recent Findings There are few studies dedicated to telemedicine in pediatric headache, and existing studies are small. Patients and families report high levels of satisfaction with telemedicine, and most are willing to continue telemedicine visits in the future. Telemedicine demonstrated similar reductions in headache frequency, severity, and duration as patients treated in-person. Remotely delivered psychologic interventions have some utility in reducing headache severity acutely. Families feel telemedicine reduces geographic and financial barriers to care. Summary Telemedicine in pediatric headache is a growing field. While there is limited research available, it appears safe, efficacious, and feasible. Headache-related outcomes, including frequency, severity, and duration, were similar amongst telemedicine and in-person visits. Future studies should include larger sample sizes and detailed analysis of adverse outcomes.
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Affiliation(s)
- Scott Rosenthal
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave., Aurora, CO, 80045, USA.
| | - Marcy Yonker
- Pediatric Headache Program Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave., Aurora, CO, 80045, USA
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Kristoffersen ES, Winsvold BS, Sandset EC, Storstein AM, Faiz KW. Experiences, distress and burden among neurologists in Norway during the COVID-19 pandemic. PLoS One 2021; 16:e0246567. [PMID: 33539418 PMCID: PMC7861439 DOI: 10.1371/journal.pone.0246567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has caused rapid changes in the healthcare system. Workforce reorganization, reduced standard of care and a lack of personal protection equipment (PPE) for health care workers were among the concerns raised in the first wave of the pandemic. Our aim was to explore the experiences, distress and burden among Norwegian neurologists during the first weeks of the pandemic. METHODS Hospital-based neurologists in Norway (n = 400) were invited to a web-based survey in April 2020. The study focused on patient management, organizational changes and personal stress during the first weeks of the pandemic lockdown. Work-home interface stress was assessed by the Cooper Job Stress Questionnaire. RESULTS In total, 135 neurologists participated. Seventy-three% experienced a change in their personal work situation, and 67% examined patients with suspected COVID-19 infection and neurological disease. Changed access to resources, and the perception that medical follow-up was unsatisfactory, were associated with a high degree of burden and stress. Neurologists were also worried about the potential lack of PPE and the fear of spreading SARS CoV-2 to close family members. The mean score of work-home interface stress was 2.8 with no significant differences between gender or specialist status. Reduced standard of care was reported for all neurological conditions, and in particular for non-emergency treatments. CONCLUSION The vast majority of neurologists in Norway experienced a change in their personal work situation during the first phase of the pandemic. The fear of becoming infected and ill was not a major contributor to burden and stress.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | | | - Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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