1
|
Shakir M, Irshad HA, Khowaja AH, Tahir I, Shariq SF, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Adjuvant therapy for brain tumors in LMICs: A systematic review of barriers and possible solutions. Clin Neurol Neurosurg 2024; 244:108460. [PMID: 39059287 DOI: 10.1016/j.clineuro.2024.108460] [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] [Received: 06/11/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Adjuvant therapy is an important tool in the arsenal of brain tumor management and can improve patients' outcomes significantly but low- and middle-income countries (LMICs) often face challenges in provision. Therefore, our study aims to highlight barriers and strategies to adjuvant therapy of brain tumors in low-resource settings. METHOD A comprehensive search of literature was conducted using PubMed, CINAHL, Google Scholar, and Scopus, from inception to October 20, 2022. The review included studies on adjuvant therapy for brain tumors in LMICs and identified themes using the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) domains. RESULTS 32 studies were included in the review. The most reported barriers to adjuvant care were limited access to healthcare (14 %), limited access to chemotherapy and radiation equipment (25 %), and traditional or alternative medications (11 %). Strategies for improvement include improving the availability of specialized radiation oncology training (8 %) and improving access to neuro-diagnostics and neurotherapeutics (12 %). In addition, efforts to subsidize treatment (4 %) and provide financial coverage through the Ministry of Health (4 %) can help to address the high cost of care and improve access to funding for chemotherapy. Finally, establishing documentation systems and registries (16 %), implementing standardized national treatment guidelines (8 %) can help to improve overall care for brain tumor patients in LMICs. CONCLUSION A multimodal approach of strategies targeting workforce, infrastructure, service delivery, financing, and information management is needed to improve adjuvant care for brain tumors. International collaboration and partnerships can also play a key role in addressing barriers and improving care in LMICs.
Collapse
Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | - Izza Tahir
- Medical School, Aga Khan University, Karachi, Pakistan
| | | | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| |
Collapse
|
2
|
Aguilera C, Wong G, Khan Z, Pivazyan G, Breton JM, Lynes J, Deshmukh VR. Patient outcomes after implementation of transitional care protocols in elective neurosurgery: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:362. [PMID: 39060496 DOI: 10.1007/s10143-024-02612-9] [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] [Received: 06/16/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE 30-day readmissions are a significant burden on the healthcare system. Postoperative transitional care protocols (TCPs) for safe and efficient discharge planning are being more widely adopted to reduce readmission rates. Currently, little evidence exists to justify the utility of TCPs for improving patient outcomes in elective neurosurgery. The objective of this systematic review was to determine the extent to which TCPs reduce adverse outcomes in patients undergoing elective neurosurgical procedures. MATERIALS AND METHODS A systematic review and meta-analysis was conducted after PROSPERO registration. Pubmed, Embase, and Cochrane review databases were searched through February 1, 2024. Keywords included: "transitional care AND neurosurgery", "Discharge planning AND neurosurgery". Articles were included if they assessed postoperative TCPs in an adult population undergoing elective neurosurgeries. Exclusion criteria were pediatric patients, implementation of Enhanced Recovery After Surgery (ERAS) protocols, or non-elective neurosurgical procedures. The primary outcome was readmission rates after implementation of TCPs. RESULTS 16 articles were included in this review. 2 articles found that patients treated with TCPs had significantly higher chances of home discharge. 7 articles found a significant association between implementation of TCP and reduced length of stay and intensive care unit stay. 3 articles reported an increase in patient satisfaction after implementation of TCPs. 3 found that TCP led to a significant decrease in readmissions. After meta-analysis, TCPs were associated with significantly decreased readmission rates (OR: 0.68, p < 0.0001), length of stay (mean difference: -0.57, p < 0.00001), and emergency department visits (OR: 0.33, p < 0.0001). CONCLUSIONS This systematic review and meta-analysis found that an overwhelming majority of the available literature supports the effectiveness of discharge planning on at least one measure of patient outcomes. However, the extent to which each facet of the TCP affects outcomes in elective neurosurgery remains unclear. Future efforts should be made to compare the effectiveness of different TCPs.
Collapse
Affiliation(s)
- Carlos Aguilera
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Georgia Wong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ziam Khan
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jeffrey M Breton
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John Lynes
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Vinay R Deshmukh
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
3
|
Kazemzadeh K, Akhlaghdoust M, Zali A. Advances in artificial intelligence, robotics, augmented and virtual reality in neurosurgery. Front Surg 2023; 10:1241923. [PMID: 37693641 PMCID: PMC10483402 DOI: 10.3389/fsurg.2023.1241923] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Neurosurgical practitioners undergo extensive and prolonged training to acquire diverse technical proficiencies, while neurosurgical procedures necessitate a substantial amount of pre-, post-, and intraoperative clinical data acquisition, making decisions, attention, and convalescence. The past decade witnessed an appreciable escalation in the significance of artificial intelligence (AI) in neurosurgery. AI holds significant potential in neurosurgery as it supplements the abilities of neurosurgeons to offer optimal interventional and non-interventional care to patients by improving prognostic and diagnostic outcomes in clinical therapy and assisting neurosurgeons in making decisions while surgical interventions to enhance patient outcomes. Other technologies including augmented reality, robotics, and virtual reality can assist and promote neurosurgical methods as well. Moreover, they play a significant role in generating, processing, as well as storing experimental and clinical data. Also, the usage of these technologies in neurosurgery is able to curtail the number of costs linked with surgical care and extend high-quality health care to a wider populace. This narrative review aims to integrate the results of articles that elucidate the role of the aforementioned technologies in neurosurgery.
Collapse
Affiliation(s)
- Kimia Kazemzadeh
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Neurosurgery and Artificial Intelligence (NONAI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Meisam Akhlaghdoust
- Network of Neurosurgery and Artificial Intelligence (NONAI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Network of Neurosurgery and Artificial Intelligence (NONAI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Anderson MG, Lambert W, Leclair N, Athar D, Martin JE, Bookland MJ, Hersh DS. Telemedicine Utilization in an Outpatient Pediatric Neurosurgical Clinic: A Prospective Survey of Patient and Family Preferences. World Neurosurg 2023; 176:e557-e568. [PMID: 37270096 DOI: 10.1016/j.wneu.2023.05.102] [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] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE After becoming widespread during the COVID-19 pandemic, telemedicine continues to play an important role in outpatient neurosurgical care. Nevertheless, the factors that influence individual decisions to choose telemedicine versus in-person appointments remain understudied. Here, we performed a prospective survey of pediatric neurosurgical patients and caregivers presenting for telemedicine or in-person outpatient visits, to identify factors associated with appointment choice. METHODS All patients and caregivers with an outpatient pediatric neurosurgical encounter at Connecticut Children's between January 31st and May 20th, 2022, were invited to participate in this survey. Data related to demographics, socioeconomics, technological access, COVID-19 vaccination status, and appointment preferences were collected. RESULTS During the study period, there were 858 unique pediatric neurosurgical outpatient encounters (86.1% in-person and 13.9% telemedicine). A total of 212 (24.7%) respondents completed the survey. Those with a telemedicine appointment were more likely to be white (P = 0.005), not Hispanic or Latino (P = 0.020), have private insurance (P = 0.003), be established patients (P < 0.001), have a household income >$80,000 (P = 0.005), and have caregivers who completed a 4-year college degree (P < 0.001). Those who were seen in-person cited the patient's condition, quality of care, and communication as important factors, whereas those who were seen via telemedicine cited time, travel, and convenience. CONCLUSIONS While convenience influences some to choose telemedicine, concerns regarding the quality of care persist among those who prefer in-person encounters. Recognizing these factors will minimize barriers to care, better define the appropriate populations/contexts for each encounter type, and improve the integration of telemedicine within an outpatient neurosurgical setting.
Collapse
Affiliation(s)
- Megan G Anderson
- Research Operations and Development, Connecticut Children's, Hartford, Connecticut, USA
| | - William Lambert
- Department of Neurosurgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Nathan Leclair
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | | | - Jonathan E Martin
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Markus J Bookland
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.
| |
Collapse
|
5
|
Wainwright K, Mayer I, Oliveira Gonçalves AS, Schulz RS, Kiel S, Chenot JF, Flöel A, von Podewils F, Angermaier A, Kurth T. Effect evaluation of a tele-neurologic intervention in primary care in a rural area in Germany-the NeTKoH study protocol of a stepped-wedge cluster randomized trial. BMC Health Serv Res 2023; 23:756. [PMID: 37452372 PMCID: PMC10347790 DOI: 10.1186/s12913-023-09724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Neurological disorders account for a large and increasing proportion of the global burden of disease. Therefore, it is important to strengthen the management of neurologic care, particularly in rural areas. The use of tele-neurology in primary care in rural areas is internationally considered to have the potential to increase access to health care services and improve the quality of care in these underserved areas. NeTKoH aims to address the existing knowledge gap regarding the effects of a tele-neurologic intervention in primary care under real-world conditions in a rural area in Germany. METHODS NeTKoH is a cluster-randomized controlled trial with a stepped-wedge design involving 33 outpatient general practitioner's (GP) offices (clusters) in a rural area in Northeast Germany. During 11 predetermined steps, all clusters are randomized before they cross over into groups from the control to the intervention arm. The targeted sample size is 1,089 patients with neurologic symptoms that are continuously being recruited. In the intervention arm, tele-neurologic consultations will be provided via a face-to-face video conferencing system with a neurologic expert at a university hospital. The control arm will receive usual care. The primary outcome is the proportion of neurologic problems being solved at the GP's office. Secondary outcomes will comprise hospital stays and days, time until neurologic specialist appointments and diagnostics, patients' health status and quality of life, outpatient and inpatient referrals. A concurrent observational study, together with a process, implementation, and health economic evaluation, will also be conducted. DISCUSSION Using a stepped-wedge cluster design in a real-life situation can help with logistic challenges and enhance the motivation of the participating GPs, as all, at some point, will be in the intervention phase. With the additional implementation evaluation pertaining to external validity, an observational study, and a health economic evaluation, NeTKoH will be able to provide an extensive evaluation for health policy decision-makers regarding the uptake into standard care. TRIAL REGISTRATION German Clinical Trials Register (DRKS00024492). Date registered: September 28, 2021. Date and protocol version: June 2023, version 1.
Collapse
Affiliation(s)
- Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Imke Mayer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ricarda S Schulz
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simone Kiel
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Anselm Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Chaganty SS, Walter H, Smith F, Sharma H. Evaluating patient and neurosurgeon perspectives on virtualisation of neurosurgery clinics in the COVID-19 era: a prospective mirror survey study. Br J Neurosurg 2023; 37:142-147. [PMID: 34546116 DOI: 10.1080/02688697.2021.1979192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has compelled a global shift in healthcare service delivery towards virtualisation, including in Neurosurgery. Our study aims to elucidate the patient and neurosurgeon perceptions of virtual neurosurgery consultations (VNCs) and formulate a guidance algorithm based on our experience. METHODS Between June 2020 and December 2020, we prospectively surveyed patients and neurosurgeons following their VNCs using a 10-item survey (four qualitative and six five-point Likert scale questions). Non-parametric hypothesis testing and grounded coding with inter-coder agreement was used to analyse quantitative and qualitative data, respectively. RESULTS 106 patients and 10 neurosurgeons completed the survey. Wilcoxon rank-sum test revealed a statistically significant difference between the neurosurgeon and patient responses (p < 0.001). Patients perceived VNCs benefits to be enhanced efficiency (n = 142) and communication (28); and VNCs drawbacks as safety (46), technological (32), and administration (15) issues. Neurosurgeons perceived VNCs benefits to be enhanced efficiency (13), reduced COVID-19 exposure (2); and VNCs drawbacks as examination practicality (14), technological (6), and concerns for patients (6). Neurosurgeons perceived the relative indications for VNCs as postoperative follow-up clinics, and scan result discussions; and relative contraindications as neuro-oncology, new patients, and patients with worsening neurological symptoms. CONCLUSIONS Our mirror-survey study provides preliminary evidence that VNCs render increased efficiency, communication, and safety in the current COVID-19 era. Going forward, we believe that further improvements in technology and administration are necessary, greater neurosurgeon appreciation of the patient-perceived benefits of VNCs is required, and neurosurgeons are to exercise clinical discernment on when to use VNCs.Key PointsWhat are the perceptions of patient and consultant neurosurgeons towards virtual neurosurgery consultations (VNCs)?Patient-perceived benefits of VNCs: enhanced efficiency/communication; VNC drawbacks: safety, technological, and administration issues. Neurosurgeon-perceived VNCs benefits of VNCs: enhanced efficiency, reduced COVID-19 exposure; VNC drawbacks: examination practicality, technological, and concerns for patients.Post-operative reviews and scan result discussions are perceived relative indications for VNCs; whereas new patient consultations, neuro-oncology and patients with new-onset neurological deficits are perceived relative contraindications for VNCs.Improvement in technology and administration is necessary; greater neurosurgeon appreciation of patient-perceived VNCs benefits is required, and neurosurgeons are to exercise clinical discernment on when to use VNCs.
Collapse
Affiliation(s)
| | - Hannah Walter
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Fiona Smith
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | |
Collapse
|
7
|
Willingness to engage in post-discharge follow-up service conducted via video telemedicine: Cross-sectional study. Int J Med Inform 2022; 168:104885. [DOI: 10.1016/j.ijmedinf.2022.104885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
|
8
|
Peterman N, Smith EJ, Liang E, Yeo E, Kaptur B, Naik A, Arnold PM, Hassaneen W. Geospatial evaluation of disparities in neurosurgical access in the United States. J Clin Neurosci 2022; 105:109-114. [PMID: 36148727 DOI: 10.1016/j.jocn.2022.09.001] [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: 02/27/2022] [Revised: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran's I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots.
Collapse
Affiliation(s)
| | | | - Edward Liang
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Eunhae Yeo
- Carle Illinois College of Medicine, Urbana, IL, USA
| | | | - Anant Naik
- Carle Illinois College of Medicine, Urbana, IL, USA
| | - Paul M Arnold
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
| | - Wael Hassaneen
- Carle Illinois College of Medicine, Urbana, IL, USA; Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA.
| |
Collapse
|
9
|
Morell AA, Patel NV, Eatz TA, Levy AS, Eichberg DG, Shah AH, Luther E, Lu VM, Kader M, Higgins DMO, Ivan ME, Komotar RJ. Safety of the utilization of telemedicine for brain tumor neurosurgery follow-up. Neurooncol Pract 2022; 10:97-103. [PMID: 36650891 PMCID: PMC9384682 DOI: 10.1093/nop/npac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background There is a need to evaluate the outcomes of patients who underwent brain tumor surgery with subsequent telemedicine or in-person follow-up during the COVID-19 pandemic. Methods We retrospectively included all patients who underwent surgery for brain tumor resection by a single neurosurgeon at our Institution from the beginning of the COVID-19 pandemic restrictions (March 2020) to August 2021. Outcomes were assessed by stratifying the patients using their preference for follow-up method (telemedicine or in-person). Results Three-hundred and eighteen (318) brain tumor patients who were included. The follow-up method of choice was telemedicine (TM) in 185 patients (58.17%), and in-person (IP) consults in 133 patients. We found that patients followed by TM lived significantly farther, with a median of 36.34 miles, compared to a median of 22.23 miles in the IP cohort (P = .0025). We found no statistical difference between the TM and the IP group, when comparing visits to the emergency department (ED) within 30 days after surgery (7.3% vs 6.01%, P = .72). Readmission rates, wound infections, and 30-day mortality were similar in both cohorts. These findings were also consistent after matching cohorts using a propensity score. The percentage of telemedicine follow-up consults was higher in the first semester (73.17%) of the COVID-19 pandemic, compared to the second (46.21%), and third semesters (47.86%). Conclusions Telehealth follow-up alternatives may be safely offered to patients after brain tumor surgery, thereby reducing patient burden in those with longer distances to the hospital or special situations as the COVID-19 pandemic.
Collapse
Affiliation(s)
- Alexis A Morell
- Corresponding Author: Alexis A. Morell, MD, Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL 33136, USA ()
| | - Nitesh V Patel
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tiffany A Eatz
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam S Levy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Kader
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dominique M O Higgins
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
10
|
Relevamiento sobre la atención médica en pacientes con epilepsia durante la pandemia del coronavirus. NEUROLOGÍA ARGENTINA 2022. [PMCID: PMC9197955 DOI: 10.1016/j.neuarg.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introducción La pandemia por el coronavirus 2019 significó un gran desafío para el sistema de salud. La demanda de camas de internación y de recursos destinados al tratamiento del coronavirus ha obligado al servicio sanitario a reorganizarse y al gobierno nacional a implementar estrictas medidas para disminuir la tasa de contagios. Objetivo El objetivo del trabajo se centró en determinar si se vio afectada la atención y el acceso a la medicación de los pacientes con epilepsia durante la cuarentena obligatoria. Materiales y métodos Se realizó un estudio transversal en 2 centros médicos de salud, uno público y otro privado, de la Ciudad Autónoma de Buenos Aires, Argentina. Se diseñó una encuesta en la plataforma Google Forms que se envió por correo electrónico entre abril y junio de 2020 a los pacientes con diagnóstico de epilepsia de ambas instituciones. Se incluyeron preguntas sobre características demográficas, vías de acceso al sistema de salud y cambios en la frecuencia de crisis comiciales. Resultados Se contactó a 488 pacientes, obteniendo una respuesta del 50,8%. Con respecto a la cobertura médica el 36,5% de los pacientes no contaban con ninguna. El 49,1% tuvo dificultades en el acceso a la medicación. El 29,7% de los pacientes contactados refirió aumento de frecuencia de crisis. Los métodos de contacto más utilizados con el sistema de salud fueron el correo electrónico (35%) y la vía telefónica (15,4%). El 59,6% obtuvo sus recetas por métodos alternativos al presencial, en tanto que el 13% refirió no tener acceso a ellas. Conclusiones Nuestros resultados reflejan la importancia de incorporar vías alternativas de comunicación ante situaciones especiales para garantizar la atención y el tratamiento de pacientes con enfermedades crónicas.
Collapse
|
11
|
Abramov I, Park MT, Gooldy TC, Xu Y, Lawton MT, Little AS, Porter RW, Smith KA, Eschbacher JM, Preul MC. Real-time intraoperative surgical telepathology using confocal laser endomicroscopy. Neurosurg Focus 2022; 52:E9. [PMID: 35921184 DOI: 10.3171/2022.3.focus2250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Communication between neurosurgeons and pathologists is mandatory for intraoperative decision-making and optimization of resection, especially for invasive masses. Handheld confocal laser endomicroscopy (CLE) technology provides in vivo intraoperative visualization of tissue histoarchitecture at cellular resolution. The authors evaluated the feasibility of using an innovative surgical telepathology software platform (TSP) to establish real-time, on-the-fly remote communication between the neurosurgeon using CLE and the pathologist. METHODS CLE and a TSP were integrated into the surgical workflow for 11 patients with brain masses (6 patients with gliomas, 3 with other primary tumors, 1 with metastasis, and 1 with reactive brain tissue). Neurosurgeons used CLE to generate video-flow images of the operative field that were displayed on monitors in the operating room. The pathologist simultaneously viewed video-flow CLE imaging using a digital tablet and communicated with the surgeon while physically located outside the operating room (1 pathologist was in another state, 4 were at home, and 6 were elsewhere in the hospital). Interpretations of the still CLE images and video-flow CLE imaging were compared with the findings on the corresponding frozen and permanent H&E histology sections. RESULTS Overall, 24 optical biopsies were acquired with mean ± SD 2 ± 1 optical biopsies per case. The mean duration of CLE system use was 1 ± 0.3 minutes/case and 0.25 ± 0.23 seconds/optical biopsy. The first image with identifiable histopathological features was acquired within 6 ± 0.1 seconds. Frozen sections were processed within 23 ± 2.8 minutes, which was significantly longer than CLE usage (p < 0.001). Video-flow CLE was used to correctly interpret tissue histoarchitecture in 96% of optical biopsies, which was substantially higher than the accuracy of using still CLE images (63%) (p = 0.005). CONCLUSIONS When CLE is employed in tandem with a TSP, neurosurgeons and pathologists can view and interpret CLE images remotely and in real time without the need to biopsy tissue. A TSP allowed neurosurgeons to receive real-time feedback on the optically interrogated tissue microstructure, thereby improving cross-functional communication and intraoperative decision-making and resulting in significant workflow advantages over the use of frozen section analysis.
Collapse
Affiliation(s)
- Irakliy Abramov
- 1The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Marian T Park
- 1The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Yuan Xu
- 1The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | | | | | | | - Jennifer M Eschbacher
- 3Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- 1The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| |
Collapse
|
12
|
Craig M, Chopra A, Lasry O, Dea N, Charest-Morin R, Street J, Paquette S, Dvorak M, Kwon BK, Fisher C, Ailon T. Telehealth for outpatient spine consultation: What do the patients think? INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Singh H, Tang T, Steele Gray C, Kokorelias K, Thombs R, Plett D, Heffernan M, Jarach CM, Armas A, Law S, Cunningham HV, Nie JX, Ellen ME, Thavorn K, Nelson MLA. Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review. JMIR Aging 2022; 5:e35929. [PMID: 35587874 PMCID: PMC9164100 DOI: 10.2196/35929] [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: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-045596
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,March of Dimes Canada, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Plett
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Heffernan
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carlotta M Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alana Armas
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle LA Nelson
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Ye IB, Thomson AE, Donahue J, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Similar Accuracy of Surgical Plans after Initial In-Person and Telemedicine Evaluation of Spine Patients. World Neurosurg 2022; 164:e1043-e1048. [DOI: 10.1016/j.wneu.2022.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
|
15
|
El Naamani K, Abbas R, Mukhtar S, El Fadel O, Sathe A, Kazan AS, El Hajjar R, Sioutas GS, Tjoumakaris SI, Menachem Maimonides Bhaskar S, Herial NA, Gooch MR, Rosenwasser RH, Jabbour P. Telemedicine During and Post-COVID 19: The Insights of Neurosurgery Patients and Physicians. J Clin Neurosci 2022; 99:204-211. [PMID: 35286972 PMCID: PMC8894734 DOI: 10.1016/j.jocn.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
Objective COVID-19 has caused a massive surge in telemedicine utilization as patients and physicians tried to minimize in-person contact to avoid the spread and impact of the pandemic. This study aims to expand on the knowledge of telemedicine during and beyond the COVID-19 era as it pertains to its use, efficacy, and patient and provider satisfaction through surveys. Methods This is a retrospective study involving 93 patients and 33 Neurosurgery physicians who anonymously participated in the survey about their experience with telemedicine visits. Results Most respondents indicated extreme satisfaction with their telemedicine encounters during the pandemic (77%). As for how comfortable physicians are in providing a diagnosis via telemedicine compared to clinic visits, 7 (21.9%) physicians felt extremely comfortable, 13 (40.6%) felt somewhat comfortable, 2 (6.4%) were neutral, 9 (28.1%) felt somewhat uncomfortable and 1 (3.1%) felt extremely uncomfortable. Physical examination was the main tool that telemedicine didn’t provide (n = 21, 100%). Conclusion Telemedicine has become a major force in the health care system under the circumstances the world is witnessing. Physicians and patients have displayed high levels of satisfaction with telemedicine which could be pivotal to improving healthcare access to underprivileged areas beyond the pandemic.
Collapse
Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Sarah Mukhtar
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Omar El Fadel
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Anish Sathe
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Adina S Kazan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Rayan El Hajjar
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Georgios S Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | | | - Sonu Menachem Maimonides Bhaskar
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health district, and NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, Australia.
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| |
Collapse
|
16
|
Rodrigues A, Li G, Zhang M, Jin MC, Hayden-Gephart M. High-quality neurosurgeon communication and visualization during telemedicine encounters improves patient satisfaction. J Clin Neurosci 2021; 94:18-23. [PMID: 34863435 DOI: 10.1016/j.jocn.2021.09.013] [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: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While recent studies have focused on confirming satisfaction with telemedicine during the coronavirus disease 2019 (COVID-19) era, we leveraged a novel survey instrument to identify associations between patient experience and telemedicine-specific factors such as device selection, audio/visual resolution, and connection stability. METHODS Telemedicine visit data were gathered from our institution between June 22, 2020 and February 14, 2021. Each patient indicated their overall visit score, likelihood-to-recommend (LTR) score, and device used for the encounter. Remaining questions were randomly distributed to patients to ensure equal distribution across respondents. RESULTS Over 34 weeks, there were 901 unique neurosurgical telemedicine visits linked to a post-visit survey at our institution. The LTR top box score percentage showed no significant change across 34 weeks (p = 0.218). After adjusting across available covariates, patients who experienced wait times exceeding 20 min were significantly less likely to report high overall scores (aOR: 0.12; 95% CI: 0.03-0.41; p = 0.001). Patients who indicated they were less able to understand the provider (aOR: 0.22; 95% CI: 0.07-0.66; p = 0.007), or who indicated the provider was not able to properly see them (aOR: 0.11; 95% CI: 0.03-0.43; p = 0.002) were associated with substantially lower overall scores. Visits with interrupted connectivity or those forced to move to a regular phone call were not important predictors of overall score. CONCLUSIONS In the largest description of patient satisfaction with telemedicine in the neurosurgical setting during the COVID-19 era, we identified timely and high-quality physician-patient visualization and communication as among the most important predictors of patient satisfaction in virtual settings.
Collapse
Affiliation(s)
- Adrian Rodrigues
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Guan Li
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Michael Zhang
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Michael C Jin
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | | |
Collapse
|
17
|
Lo WB, Herbert K, Rodrigues D. Clinical effectiveness of and family experience with telephone consultation in a regional pediatric neurosurgery center in the United Kingdom. J Neurosurg Pediatr 2021; 28:483-489. [PMID: 34388708 DOI: 10.3171/2021.3.peds20862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric neurosurgery outpatient consultation is conducted face-to-face (FTF) conventionally. Reasons for not using telemedicine include the perceived difficulty with obtaining a reliable history and an inability to perform a physical examination. However, FTF consultation can cause distress and inconvenience to the child and family. In 2018, the authors' department piloted a clinical nurse specialist-led telephone consultation (TC) for follow-up appointments. This was extended to the routine neurosurgery clinics in 2020. In this study, the authors evaluate 1) the effectiveness of TC, 2) families' experience with TC compared with traditional FTF appointments, and 3) the factors associated with their preferences. METHODS In this prospective study using a survey methodology, TCs carried out by 2 consultant neurosurgeons and 1 nurse specialist over 8 weeks were evaluated. Based on clinical background, each patient was assigned to a TC or FTF appointment. Clinical and surgical details and home postal code were recorded. At the end of each TC, the clinician recorded whether the child required an FTF appointment within 3 months. In addition, patients/families answered 1) how the current TC compared with FTF consultation, and 2) their preference of TC or FTF for the next consultation. RESULTS A total of 114 TCs were included. No child required an FTF appointment within 3 months. Overall, compared with an FTF appointment, the TC was the "same/better/much better" for 101 families (89%), and "worse/much worse" for 13 (11%). Two-thirds of families preferred the next appointment to be a TC. Families attending a TC for new appointments preferred the next appointment to be FTF compared with those attending a follow-up TC (6/8 [75%] vs 31/106 [29%], p = 0.006). A high rating of the current TC was associated with a preference for a TC as the next appointment (p < 0.0001). Families preferring TC over FTF lived farther from the hospital (mean 38 vs 27 km) (p = 0.029). CONCLUSIONS From the clinicians' perspective, TC is adequate in appropriately selected patients as either the primary mode of consultation or as a triage system. From a service users' perspective, the majority of families felt that the appointment was the same/better than traditional FTF appointments. The findings suggested that 1) new patients should be offered FTF appointments; 2) follow-up TCs should be offered to families when possible; and 3) clinicians should develop their skills in conducting TCs. The authors' results have led to a modification of our algorithm in delivering traditional outpatient service and telemedicine with telephone.
Collapse
|
18
|
Cruz MJ, Nieblas-Bedolla E, Young CC, Feroze AH, Williams JR, Ellenbogen RG, Levitt MR. United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2021; 89:364-371. [PMID: 34133724 PMCID: PMC8344865 DOI: 10.1093/neuros/nyab185] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/03/2021] [Indexed: 01/14/2023] Open
Abstract
Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons' familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.
Collapse
Affiliation(s)
- Michael J Cruz
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John R Williams
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| |
Collapse
|
19
|
Le S, Aggarwal A. The application of telehealth to remote and rural Australians with chronic neurological conditions. Intern Med J 2021; 51:1043-1048. [PMID: 32250055 DOI: 10.1111/imj.14841] [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] [Received: 01/21/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with chronic disease in rural and remote regions endure limited access to specialised medicine. Telehealth has addressed this issue with demonstrable benefits such as a reduction in costs to patients. AIMS To explore the patient satisfaction of telehealth in Australia. METHODS Patients from all around Australia, including Queensland, Victoria, Tasmania, South Australia, Australian Capital Territory and even Western Australia were referred to a Sydney-based neurologist. After their initial face to face consultation, review consultations were performed by telehealth. All had chronic diseases (trigeminal neuralgia, facial pain or Parkinson disease) and received a standardised questionnaire comprising of demographics, satisfaction of technical aspects and quality of the consultation. The questionnaires were administered by the Practice Manager to remove observer bias. RESULTS Twenty-nine patient questionnaires were completed by 13 patients who had follow-up telehealth consultations. One hundred per cent of patients reported satisfaction with the overall telehealth experience and would use it again. All were satisfied with the specialist and the privacy. The majority were satisfied with the voice quality (86%), visual quality (79%), ease of connectivity (93%) and length of the consultation (97%). In total, they saved nearly $17 000 in travel costs and on average, each patient avoided 937 km and saved $550. CONCLUSION Telehealth has proven to have multiple advantages, including improved access to healthcare, decreased costs, reduced inconvenience and improved management of chronic and complex conditions. The positive results advocate the use of telehealth for follow up of rural and remote patients with chronic disease.
Collapse
Affiliation(s)
- Sammy Le
- Concord Hospital, Sydney, New South Wales, Australia
| | - Arun Aggarwal
- Concord Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Abstract
Neurosurgeons receive extensive and lengthy training to equip themselves with various technical skills, and neurosurgery require a great deal of pre-, intra- and postoperative clinical data collection, decision making, care and recovery. The last decade has seen a significant increase in the importance of artificial intelligence (AI) in neurosurgery. AI can provide a great promise in neurosurgery by complementing neurosurgeons' skills to provide the best possible interventional and noninterventional care for patients by enhancing diagnostic and prognostic outcomes in clinical treatment and help neurosurgeons with decision making during surgical interventions to improve patient outcomes. Furthermore, AI is playing a pivotal role in the production, processing and storage of clinical and experimental data. AI usage in neurosurgery can also reduce the costs associated with surgical care and provide high-quality healthcare to a broader population. Additionally, AI and neurosurgery can build a symbiotic relationship where AI helps to push the boundaries of neurosurgery, and neurosurgery can help AI to develop better and more robust algorithms. This review explores the role of AI in interventional and noninterventional aspects of neurosurgery during pre-, intra- and postoperative care, such as diagnosis, clinical decision making, surgical operation, prognosis, data acquisition, and research within the neurosurgical arena.
Collapse
Affiliation(s)
- Mohammad Mofatteh
- Sir William Dunn School of Pathology, Medical Sciences Division, University of Oxford, South Parks Road, Oxford OX1 3RE, United Kingdom
- Lincoln College, University of Oxford, Turl Street, Oxford OX1 3DR, United Kingdom
| |
Collapse
|
21
|
To H, McMaster T, Stelmach W. Addressing telemedicine challenges for surgery clinics in the Post-COVID era. ANZ J Surg 2021; 91:1643-1644. [PMID: 34264549 PMCID: PMC8420328 DOI: 10.1111/ans.17089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Henry To
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,School of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Werribee Mercy Health, Melbourne, Victoria, Australia
| | - Thomas McMaster
- School of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Wanda Stelmach
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| |
Collapse
|
22
|
Lambert WA, Leclair NK, Knopf J, Mosha MH, Bookland MJ, Martin JE, Hersh DS. Predictors of Telemedicine Utilization in a Pediatric Neurosurgical Population During the COVID-19 Pandemic. World Neurosurg 2021; 153:e308-e314. [PMID: 34224882 DOI: 10.1016/j.wneu.2021.06.120] [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] [Received: 05/02/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In the wake of the COVID-19 pandemic, telemedicine has become rapidly adopted by the neurosurgical community; however, few studies have examined predictors of telemedicine utilization. Here, we analyze patient variables associated with the acceptance of a telemedicine encounter by a pediatric neurosurgical population during the early phases of the COVID-19 pandemic. METHODS All patients seen in a single institution's outpatient pediatric neurosurgery clinic between April 1, 2020 and July 31, 2020 were retrospectively reviewed. Demographic variables were collected for each patient's first completed encounter. Patients participating in telemedicine were compared with those seen in person. Univariate analysis was performed using the Wilcoxon rank sum test for continuous variables and Fischer exact test for categorical variables. A logistic regression multivariable analysis was then performed. RESULTS We included 682 patients (374 telemedicine and 308 in person). Univariate analysis demonstrated that telemedicine visits were more likely to occur at earlier study dates (P < 0.001) and that patients participating in telemedicine visits were more likely to be established rather than new patients (P < 0.001), White or Caucasian (P < 0.001), not Hispanic or Latino (P < 0.001), English-speaking (P < 0.001), non-Medicare/Medicaid recipients (P < 0.001), have lower no-show rates (P = 0.006), and live farther from the hospital (P = 0.005). Multivariable analysis demonstrated older age (P = 0.031), earlier appointment date (P < 0.01), established patient status (P < 0.001), English-speaking (P < 0.02), and non-Medicare/Medicaid insurance (P < 0.05) were significant predictors of telemedicine utilization. CONCLUSIONS Significant demographic differences exist among pediatric patients who participated in telemedicine versus those who requested an in-person visit at our institution. Addressing barriers to access will be crucial for promoting health equity in continued utilization of telemedicine.
Collapse
Affiliation(s)
| | | | - Joshua Knopf
- UConn School of Medicine, Farmington, Connecticut, USA
| | - Maua H Mosha
- Department of Research, Connecticut Children's, Hartford, Connecticut, USA
| | - Markus J Bookland
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Department of Pediatrics, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Jonathan E Martin
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - David S Hersh
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Department of Pediatrics, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA.
| |
Collapse
|
23
|
Haddad AF, Burke JF, Mummaneni PV, Chan AK, Safaee MM, Knightly JJ, Mayer RR, Pennicooke BH, Digiorgio AM, Weinstein PR, Clark AJ, Chou D, Dhall SS. Telemedicine in Neurosurgery: Standardizing the Spinal Physical Examination Using A Modified Delphi Method. Neurospine 2021; 18:292-302. [PMID: 34218612 PMCID: PMC8255762 DOI: 10.14245/ns.2040684.342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The use of telemedicine has dramatically increased due to the coronavirus disease 2019 pandemic. Many neurosurgeons are now using telemedicine technologies for preoperative evaluations and routine outpatient visits. Our goal was to standardize the telemedicine motor neurologic examination, summarize the evidence surrounding clinical use of telehealth technologies, and discuss financial and legal considerations.
Methods We identified a 12-member panel composed of spine surgeons, fellows, and senior residents at a single institution. We created an initial telehealth strength examination protocol based on published data and developed 10 agree/disagree statements summarizing the protocol. A blinded Delphi method was utilized to build consensus for each statement, defined as > 80% agreement and no significant disagreement using a 2-way binomial test (significance threshold of p < 0.05). Any statement that did not meet consensus was edited and iteratively resubmitted to the panel until consensus was achieved. In the final round, the panel was unblinded and the protocol was finalized.
Results After the first round, 4/10 statements failed to meet consensus (< 80% agreement, and p = 0.031, p = 0.031, p = 0.003, and p = 0.031 statistical disagreement, respectively). The disagreement pertained to grading of strength of the upper (3/10 statements) and lower extremities (1/10 statement). The amended statements clarified strength grading, achieved consensus (> 80% agreement, p > 0.05 disagreement), and were used to create the final telehealth strength examination protocol.
Conclusion The resulting protocol was used in our clinic to standardize the telehealth strength examination. This protocol, as well as our summary of telehealth clinical practice, should aid neurosurgical clinics in integrating telemedicine modalities into their practice.
Collapse
Affiliation(s)
- Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Rory R Mayer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Brenton H Pennicooke
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Anthony M Digiorgio
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Philip R Weinstein
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Aaron J Clark
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
24
|
Chau MJ, Quintero JE, Guiliani A, Hines T, Samaan C, Seybold K, Stowe M, Hanlon D, Gerhardth GA, van Horne CG. Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic. World Neurosurg 2021; 152:e617-e624. [PMID: 34129978 PMCID: PMC8220867 DOI: 10.1016/j.wneu.2021.06.018] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The COVID-19 pandemic has shifted the dynamics of health care and neurosurgical practice. Elective surgeries were suspended for 8 weeks in Kentucky. Our objective was to determine if telehealth (TH) visits could be sustained as an alternative to in-person visits. METHODS Deidentified data on TH usage, in-person clinic visits, and inpatient and neurosurgical case volumes from March 2, 2020 to June 26, 2020 were obtained for retrospective analysis. RESULTS TH use increased soon after the case suspension started and then decreased to little usage. The number of in-person visits were significantly lower during elective case suspension compared with when cases were resumed. Twenty-five percent of all visits during the suspension were conducted using TH. Thirty-nine percent of TH-visit patients were new patients, 11% were preoperative, 10% were postoperative, and 39% were other existing patients. Forty-eight percent of TH visits resulted in a later in-person clinic visit. After the suspension, in-person visits rebounded to 98% of the prepandemic numbers and TH visits were low. CONCLUSIONS TH visits were challenging due to the need for in-person physical examinations in neurosurgery. TH temporarily accommodated patient needs during the pandemic but could not totally replace in-person visits and was not sustained after 3.5 months of use. Video TH visits worked well for nonurgent issues, such as minor visual examinations. Our findings could help guide the implementation of TH should similar circumstances arise again.
Collapse
Affiliation(s)
- Monica J Chau
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge E Quintero
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Ashley Guiliani
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Tripp Hines
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | | | - Katie Seybold
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew Stowe
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Dean Hanlon
- Clinical Operations, University of Kentucky, Lexington, Kentucky, USA
| | - Greg A Gerhardth
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA; Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Craig G van Horne
- Neurosurgery, University of Kentucky, Lexington, Kentucky, USA; Brain Restoration Center, University of Kentucky, Lexington, Kentucky, USA; Neuroscience, University of Kentucky, Lexington, Kentucky, USA.
| |
Collapse
|
25
|
Hatcher-Martin JM, Busis NA, Cohen BH, Wolf RA, Jones EC, Anderson ER, Fritz JV, Shook SJ, Bove RM. American Academy of Neurology Telehealth Position Statement. Neurology 2021; 97:334-339. [PMID: 33986141 PMCID: PMC8377877 DOI: 10.1212/wnl.0000000000012185] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Telehealth services complement in-person neurologic care. The American Academy of Neurology supports patient access to telehealth services regardless of location, coverage for telehealth services by all subscriber benefits and insurance, equitable provider reimbursement, simplified state licensing requirements easing access to virtual care, and expanding telehealth research and quality initiatives. The roles and responsibilities of providers should be clearly delineated in telehealth service models.
Collapse
Affiliation(s)
- Jaime M Hatcher-Martin
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Neil A Busis
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Bruce H Cohen
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Rebecca A Wolf
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco.
| | - Elaine C Jones
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Eric R Anderson
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Joseph V Fritz
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Steven J Shook
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| | - Riley M Bove
- From SOC Telemed (J.M.H.-M., E.C.J., E.R.A.), Reston, VA; NYU Langone Health (N.A.B.), New York, NY; Akron Children's Hospital (B.H.C.), OH; American Academy of Neurology (R.A.W.), Minneapolis, MN; Corticare (E.R.A.), Carlsbad, CA; Intensive Neuro (E.R.A.), St. Petersburg, FL; Dent Neurologic Institute (J.V.F.), Amherst, NY; Neurological Institute (S.J.S.), Cleveland Clinic, OH; and University of California (R.M.B.), San Francisco
| |
Collapse
|
26
|
Reider-Demer M, Jalilian L, Roy S, Lee J, Dong X, Hitson H, Thomas E, Grogan T, Simkovic M, Kamdar N. Implementation and Evaluation of a Neurology Telemedicine Initiative at a Major Academic Medical Center. Telemed J E Health 2021; 28:158-166. [PMID: 33913758 DOI: 10.1089/tmj.2020.0502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: The COVID-19 pandemic forced rapid adoption of telemedicine for care of neurology patients. This study contributes to this literature by describing the structure and implementation of telemedicine-based outpatient neurology clinics at the UCLA Medical Center and estimates patient cost savings, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction. Methods: This was a retrospective, nonrandomized, case series study of telemedicine-based neurological management in an urban academic medical center from October 2018 to June 2020. We estimated roundtrip travel time, roundtrip travel distance, total savings, and surveyed patient and provider satisfaction with telemedicine care. We supported these findings through evaluation of 7,194 patients by telemedicine and conducted 9,189 video visits for neurological care. Results: The median telemedicine patient avoided a roundtrip driving distance of 33 miles and roundtrip travel time of 75 min. Within sample, median hourly earnings were $27/h. The median patient saved $18 on fuel and parking and $36 of time-based opportunity savings, for total savings of $54 per video visit. Eighty-six percent of patients surveyed were satisfied with their video visit experience. Conclusions: Telemedicine reduced travel time and also reduced costs for neurology patients. Patients and providers both reported high levels of satisfaction with telemedicine.
Collapse
Affiliation(s)
- Melissa Reider-Demer
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Laleh Jalilian
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Shuvro Roy
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - John Lee
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Xuezhi Dong
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Erin Thomas
- UCLA Telehealth, Los Angeles, California, USA
| | - Tristan Grogan
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Michael Simkovic
- USC Gould School of Law and Marshall School of Business, University of Southern California, Los Angeles, California, USA
| | - Nirav Kamdar
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| |
Collapse
|
27
|
Telemedicine in the Evaluation and Management of Neurosurgical Spine Patients: Questionnaire Assessment of 346 Consecutive Patients. Spine (Phila Pa 1976) 2021; 46:472-477. [PMID: 33186272 DOI: 10.1097/brs.0000000000003821] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective questionnaire study of all patients seen via telemedicine during the COVID-19 pandemic at a large academic institution. OBJECTIVE This aim of this study was to compare patient satisfaction of telemedicine clinic to in-person visits; to evaluate the preference for telemedicine to in-person visits; to assess patients' willingness to proceed with major surgery and/or a minor procedure based on a telemedicine visit alone. SUMMARY OF BACKGROUND DATA One study showed promising utility of mobile health applications for spine patients. No studies have investigated telemedicine in the evaluation and management of spine patients. METHODS An 11-part questionnaire was developed to assess the attitudes toward telemedicine for all patients seen within a 7-week period during the COVID-19 crisis. Patients were called by phone to participate in the survey. χ2 and the Wilcoxon Rank-Sum Test were performed to determine significance. RESULTS Ninety-five percent were "satisfied" or "very satisfied" with their telemedicine visit, with 62% stating it was "the same" or "better" than previous in-person appointments. Patients saved a median of 105 minutes by using telemedicine compared to in-person visits. Fifty-two percent of patients have to take off work for in-person visits, compared to 7% for telemedicine. Thirty-seven percent preferred telemedicine to in-person visits. Patients who preferred telemedicine had significantly longer patient-reported in-person visit times (score mean of 171) compared to patients who preferred in-person visits (score mean of 137, P = 0.0007). Thirty-seven percent of patients would proceed with surgery and 73% would proceed with a minor procedure based on a telemedicine visit alone. CONCLUSION Telemedicine can increase access to specialty care for patients with prolonged travel time to in-person visits and decrease the socioeconomic burden for both patients and hospital systems. The high satisfaction with telemedicine and willingness to proceed with surgery suggest that remote visits may be useful for both routine management and initial surgical evaluation for spine surgery candidates.Level of Evidence: 3.
Collapse
|
28
|
Eichberg DG, Basil GW, Di L, Shah AH, Luther EM, Lu VM, Perez-Dickens M, Komotar RJ, Levi AD, Ivan ME. Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond. Neurosurgery 2020; 88:E1-E12. [PMID: 32687191 PMCID: PMC7454774 DOI: 10.1093/neuros/nyaa306] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era. OBJECTIVE To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience. METHODS A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty. RESULTS A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes. CONCLUSION Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.
Collapse
Affiliation(s)
- Daniel G Eichberg
- Correspondence: Daniel G. Eichberg, MD University of Miami Miller School of Medicine, Department of Neurosurgery University of Miami Hospital 1321 N.W. 14th Street West Building, Suite 306 Miami, FL 33125, USA.
| | - Gregory W Basil
- University of Miami, Department of Neurosurgery, Miami, Florida
| | - Long Di
- University of Miami, Department of Neurosurgery, Miami, Florida
| | - Ashish H Shah
- University of Miami, Department of Neurosurgery, Miami, Florida
| | - Evan M Luther
- University of Miami, Department of Neurosurgery, Miami, Florida
| | - Victor M Lu
- University of Miami, Department of Neurosurgery, Miami, Florida
| | | | - Ricardo J Komotar
- University of Miami, Department of Neurosurgery, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Allan D Levi
- University of Miami, Department of Neurosurgery, Miami, Florida
| | - Michael E Ivan
- University of Miami, Department of Neurosurgery, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
| |
Collapse
|
29
|
Mohanty A, Srinivasan VM, Burkhardt JK, Johnson J, Patel AJ, Sheth SA, Viswanathan A, Yoshor D, Kan P. Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine. Neurosurg Focus 2020; 49:E13. [PMID: 33260126 DOI: 10.3171/2020.9.focus20596] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.
Collapse
Affiliation(s)
- Alina Mohanty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | | | - Jeremiah Johnson
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Akash J Patel
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | | | - Daniel Yoshor
- 1Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Peter Kan
- 2Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
30
|
Letter to the Editor Regarding “COVID-19's Impact on Neurosurgical Training in Southeast Asia”. World Neurosurg 2020; 144:331. [DOI: 10.1016/j.wneu.2020.08.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
|
31
|
An Evaluation of Risk Factors for Patient "No Shows" at an Urban Joint Arthroplasty Clinic. J Am Acad Orthop Surg 2020; 28:e1006-e1013. [PMID: 33156587 DOI: 10.5435/jaaos-d-19-00550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient physical health and provider financial health are both affected when patients are unable to attend scheduled clinic appointments. The purpose of this study is to identify risk factors for patients missing appointments to better target interventions to improve appointment attendance. METHODS We reviewed scheduled arthroplasty appointments at an urban academic orthopaedic clinic over a 3-year period. We collected information including sex, race, distance to clinic, language, insurance, median income of home zip code, appointment day, time, precipitation, and temperature. Mixed-level multiple logistic regression was used to model the odds of missing appointments in Stata v14. RESULTS Overall, 8,185 visits for 3,081 unique patients were reviewed and 90.7% of appointments were attended. After controlling for time and day of appointment, distance from the clinic, and the primary language spoken, patients with government insurance were two times as likely to miss an appointment compared with privately insured patients. White patients were two times as likely to attend scheduled appointments compared with black/Hispanic patients. Younger patients (<50 years) and older patients (>73 years) were 2.7 times and 1.8 times, respectively, more likely to miss appointments compared with those aged between 65 and 72 years. Appointments on the most temperate days were more likely to be missed, and those on the coldest days (14°F to 36°F) and warmest days (69°F to 89°F) were less likely to be missed. DISCUSSION Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations.
Collapse
|
32
|
Penas-Prado M, Armstrong TS, Gilbert MR. Proposed Additions to the NCCN Guidelines for Adult Medulloblastoma. J Natl Compr Canc Netw 2020; 18:1579-1584. [DOI: 10.6004/jnccn.2020.7650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022]
Abstract
Medulloblastoma is a rare brain tumor that occurs in both children and adults, with patients aged 15 to 39 years accounting for 30% of all cases. In adults, guidelines for diagnosis and treatment are often based on retrospective data and extrapolated from the pediatric experience due to limited availability of prospective trials or registries involving adults. Importantly, adult patients differ from pediatric patients in many aspects, including the molecular features of the tumor and tolerance to treatment. In 2017, the NCI was granted support from the Cancer Moonshot initiative to address the challenges and unmet needs of adults with rare central nervous system (CNS) tumors through the NCI Comprehensive Oncology Network for Evaluating Rare CNS Tumors (NCI-CONNECT). On November 25, 2019, NCI-CONNECT convened a multidisciplinary workshop on adult medulloblastoma. Working groups identified unmet needs in clinical care and research and developed specific action items, including a proposal for inclusion of new items in the NCCN Guidelines for Adult Medulloblastoma, delineated in this review along with the evidence supporting their incorporation. Recommendations included facilitating referral of patients to centers of excellence; promoting patient participation in clinical trials or registries; encouraging use of DNA methylation for confirmation of diagnosis and subgrouping; offering counseling on contraception and fertility preservation; evaluating patients for symptoms and medical management of endocrine, vision, hearing, and neurocognitive deficits; providing psychosocial support and referral to neurorehabilitation; minimizing delays in therapy; and incorporating imaging standards and criteria for progression.
Collapse
Affiliation(s)
- Marta Penas-Prado
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Terri S. Armstrong
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Mark R. Gilbert
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| |
Collapse
|
33
|
Clinicians' User Experience of Telemedicine in Neurosurgery During COVID-19. World Neurosurg 2020; 146:e359-e367. [PMID: 33203534 DOI: 10.1016/j.wneu.2020.10.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Restricted access to hospitals due to the 2019 novel coronavirus disease (COVID-19) pandemic has significantly altered practice patterns for elective neurosurgical care. Particularly, telemedicine has become the primary modality of patient visits for nonemergent conditions. This study aimed to characterize user experiences of neurosurgeons and advanced practice providers focusing on perceived utility and barriers of telemedicine in management of elective neurosurgical patients during COVID-19. METHODS An online survey was sent to clinicians involved in neurosurgical care using telemedicine with questions focusing on frequency of utilization, duration of patient encounters, benefits of telemedicine, and barriers to current forms of remote patient visits. Survey responses were stratified by clinical position (neurosurgeon vs. advanced practice provider) and subspecialty focus (cranial vs. spinal neurosurgery). RESULTS The survey was completed by 14 of 17 eligible clinicians. Respondents included 10 neurosurgeons and 4 APPs with 57% specializing in cranial neurosurgery and 43% specializing in spinal neurosurgery. During the COVID-19 period, 78% of respondents used teleconference/video conference visits multiple times in a week, and 86% planned to continue using telemedicine after the pandemic. The most common barrier for telemedicine was the inability to perform a neurological examination, while the most common perceived benefit was increased convenience for patients. CONCLUSIONS During the COVID-19 period, telemedicine was heavily relied on to ensure the continuation of perioperative care for patients with elective neurosurgical pathologies. While clinicians identified numerous barriers for current telemedicine platforms, the use of telemedicine will likely continue, as it has provided unique benefits for patients, clinicians, and hospitals.
Collapse
|
34
|
Yoon EJ, Tong D, Anton GM, Jasinski JM, Claus CF, Soo TM, Kelkar PS. Patient Satisfaction with Neurosurgery Telemedicine Visits During the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study. World Neurosurg 2020; 145:e184-e191. [PMID: 33045455 PMCID: PMC7546257 DOI: 10.1016/j.wneu.2020.09.170] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
Background Telemedicine refers to various modalities for remote care, including telephone calls, imaging review, and real-time video teleconferencing visits. Although it has not been widely used in outpatient neurosurgery settings, the COVID-19 (coronavirus disease 2019) pandemic has necessitated a broader adoption. Our goal is to show the level of patient satisfaction with their telemedicine care. Methods We prospectively studied consecutive telemedicine patients who scheduled outpatient neurosurgery visits from May 15 to June 8, 2020. Patients were seen by the surgeon via real-time video conferencing using Google Meet, and then completed a telemedicine satisfaction survey. Our primary outcome was telemedicine satisfaction scores. We compared satisfaction scores between new and established patients and between patients within and outside of a 15-mile radius of the nearest clinic location. Sensitivity analyses were performed to account for the nonrespondents. Descriptive and univariate analyses were performed. A P value of <0.05 was considered significant. Results Five-hundred and ninety patients completed a telemedicine visit during the study period. One patient from out of state was excluded. Three-hundred and ten patients (52.6%) responded. The average age was 60.9 ± 13.60 years; 59% were female, 20.6% were new patients; the average distance to the clinic was 28.03 ± 36.09 km (17.42 ± 22.43 miles). The mean overall satisfaction score was 6.32 ± 1.27. Subgroup analyses by new/established patient status and distance from their home to the clinic showed no significant difference in mean satisfaction scores between groups. Conclusions Telemedicine provided a viable and satisfactory option for neurosurgical patients in the outpatient setting during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Elise J Yoon
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA.
| | - Doris Tong
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Gustavo M Anton
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Jacob M Jasinski
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Chad F Claus
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Teck M Soo
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| | - Prashant S Kelkar
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
| |
Collapse
|
35
|
Brigo F, Bonavita S, Leocani L, Tedeschi G, Lavorgna L. Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic. Epilepsy Behav 2020; 110:107164. [PMID: 32480303 PMCID: PMC7225695 DOI: 10.1016/j.yebeh.2020.107164] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, I Clinic of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Letizia Leocani
- Department of Neurorehabilitation, IRCCS San Raffaele Hospital, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, I Clinic of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, I Clinic of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy.
| |
Collapse
|
36
|
Ashry AH, Alsawy MF. Doctor-patient distancing: an early experience of telemedicine for postoperative neurosurgical care in the time of COVID-19. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020; 56:80. [PMID: 32834718 PMCID: PMC7376313 DOI: 10.1186/s41983-020-00212-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Telemedicine remains an important tool of healthcare services delivery especially in the era of the COVID-19 pandemic. Its advantages include saving the time and money of the patients and the prevention of infection among healthcare providers. Objectives In this study, we aim to evaluate the effectiveness and safety of telemedicine visits in providing postoperative care of neurosurgical patients. Materials and methods We conducted this prospective study on 30 neurosurgical patients who were evaluated after surgery via telemedicine visits for 30 days. During the virtual visits, we discussed the clinical progress of patients, wound status, treatment modification, the time of return to work, postoperative complications, and the radiological data of the patients. All the patients were given an emergency number to call in case of urgent issues. The satisfaction of patients and doctors was measured with the aid of two questionnaires. Results The patients’ age ranged from 18 to 65 years. Twenty patients were male and 10 patients were female. We performed 20 cranial operations and 10 spinal operations. Most patients needed more than 4 h to reach the hospital. The total number of telemedicine visits was 67 visits. We received about 62 emergency calls. Pain management, seizures control, wound infection, and hydrocephalus is among issues that were evaluated and managed via telemedicine visits. The overall satisfaction rate among patients and doctors was 90% and 95%, respectively. Conclusion Virtual outpatient clinics seem to be a safe and effective way of postoperative care especially in the time of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ahmed Hamdy Ashry
- Department of Neurosurgery, Cairo University, Giza, Egypt.,Giza, Egypt
| | | |
Collapse
|
37
|
Roy B, Nowak RJ, Roda R, Khokhar B, Patwa HS, Lloyd T, Rutkove SB. Teleneurology during the COVID-19 pandemic: A step forward in modernizing medical care. J Neurol Sci 2020; 414:116930. [PMID: 32460041 PMCID: PMC7241381 DOI: 10.1016/j.jns.2020.116930] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic mandated rapid transition from face-to-face encounters to teleneurology visits. While teleneurology is regularly used in acute stroke care, its application in other branches of neurology was limited. Here we review how the recent pandemic has created a paradigm shift in caring for patients with chronic neurological disorders and how academic institutions have responded to the present need. METHOD Literature review was performed to examine the recent changes in health policies. Number of outpatient visits and televisits in the Department of Neurology was reviewed from Yale University School of Medicine and Johns Hopkins School of Medicine to examine the road to transition to televisit. RESULTS The federal government and the insurance providers extended their supports during the COVID-19 pandemic. Several rules and regulations regarding teleneurology were revised and relaxed to address the current need. New technologies for video conferencing were incorporated. The transition to televisits went smoothly in both the institutions and number of face-to-face encounters decreased dramatically along with a rapid rise in televisits within 2 weeks of the declaration of national emergency. CONCLUSION AND RELEVANCE The need for "social distancing" during the COVID-19 pandemic has created a major surge in the number of teleneurology visits, which will probably continue for the next few months. It may have initiated a more permanent transition to virtual technology incorporated medical care.
Collapse
Affiliation(s)
- Bhaskar Roy
- Yale University School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven 06519, CT, USA.
| | - Richard J Nowak
- Yale University School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven 06519, CT, USA.
| | - Ricardo Roda
- Johns Hopkins School of Medicine, Department of Neurology, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Babar Khokhar
- Yale University School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven 06519, CT, USA
| | - Huned S Patwa
- Yale University School of Medicine, Department of Neurology, 15 York Street, LCI 9, P.O. Box 208108, New Haven 06519, CT, USA
| | - Thomas Lloyd
- Johns Hopkins School of Medicine, Department of Neurology, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Seward B Rutkove
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Ave, Boston 02215, MA, USA
| |
Collapse
|
38
|
Lyon KA, Qi X, Benardete EA, Stevens AB, Huang JH. COVID-19: Initiating the Expansion of Telemedicine in Neurosurgery. ACTA ACUST UNITED AC 2020; 9:90-94. [PMID: 34164624 DOI: 10.34297/ajbsr.2020.09.001359] [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: 11/21/2022]
Abstract
Objective As COVID-19 spreads around the world, so does telemedicine across many medical specialties including neurosurgery. Given the unique patient population in neurosurgery, arising opportunities for integration and expansion of telemedicine into neurosurgery practice come with challenges for both the patient and the provider. Methods A literature review has been performed, and a survey has been sent out to neurosurgery providers in Texas to determine if providers are satisfied with the current state of telemedicine in their clinical practice. Results Patients who live far away from a medical center have cited increased convenience when routine postoperative visits have been converted to telemedicine. For providers, challenges have arisen in performing physical exams, especially when performing detailed neurological exams in the diagnosis of a spine disorder. Survey results of neurosurgery providers have revealed mixed opinions since the initiation of telemedicine. Conclusion Although it is unclear what role telemedicine will have after the social distancing restrictions are lifted, many providers surveyed have expressed interest in keeping telemedicine in their clinical practice.
Collapse
Affiliation(s)
- Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| | - Xiaoming Qi
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA
| | - Ethan A Benardete
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| | - Alan B Stevens
- College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA.,Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas, USA.,Center for Population Health & Aging, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, USA.,College of Medicine, Texas A&M University Health Science Center, College Station, Texas, USA
| |
Collapse
|
39
|
Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective. World Neurosurg 2020; 139:549-557. [PMID: 32426065 PMCID: PMC7229725 DOI: 10.1016/j.wneu.2020.05.066] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022]
Abstract
Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.
Collapse
|
40
|
Low JCM, Visagan R, Perera A. Neurosurgical Training During COVID-19 Pandemic: British Perspective. World Neurosurg 2020; 142:520-522. [PMID: 32414670 PMCID: PMC7198156 DOI: 10.1016/j.wneu.2020.04.178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Ravindran Visagan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Andrea Perera
- Department of Neurosurgery, St. George's Hospital, London, United Kingdom
| |
Collapse
|
41
|
Greven ACM, Rich CW, Malcolm JG, Bray DP, Rodts GE, Refai D, Gary MF. Letter: Neurosurgical Management of Spinal Pathology Via Telemedicine During the COVID-19 Pandemic: Early Experience and Unique Challenges. Neurosurgery 2020; 87:E192-E196. [PMID: 32343340 PMCID: PMC7197572 DOI: 10.1093/neuros/nyaa165] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Christopher W Rich
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| | - James G Malcolm
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| | - David P Bray
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| | - Gerald E Rodts
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| | - Daniel Refai
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| | - Matthew F Gary
- Department of Neurosurgery Emory University Medical Center Atlanta, Georgia
| |
Collapse
|
42
|
Eichberg DG, Shah AH, Luther EM, Menendez I, Jimenez A, Perez-Dickens M, O'Phelan KH, Ivan ME, Komotar RJ, Levi AD. Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model. Neurosurgery 2020; 87:E63-E65. [PMID: 32277754 PMCID: PMC7184381 DOI: 10.1093/neuros/nyaa118] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ashish H Shah
- Department of Neurosurgery University of Miami Miami, Florida
| | - Evan M Luther
- Department of Neurosurgery University of Miami Miami, Florida
| | - Ingrid Menendez
- Department of Neurosurgery University of Miami Miami, Florida
| | - Andrea Jimenez
- Department of Neurosurgery University of Miami Miami, Florida
| | | | | | - Michael E Ivan
- Department of Neurosurgery University of Miami Miami, Florida.,Sylvestor Comprehensive Cancer Center Miami, Florida
| | - Ricardo J Komotar
- Department of Neurosurgery University of Miami Miami, Florida.,Sylvestor Comprehensive Cancer Center Miami, Florida
| | - Allan D Levi
- Department of Neurosurgery University of Miami Miami, Florida
| |
Collapse
|
43
|
Hatcher-Martin JM, Adams JL, Anderson ER, Bove R, Burrus TM, Chehrenama M, Dolan O'Brien M, Eliashiv DS, Erten-Lyons D, Giesser BS, Moo LR, Narayanaswami P, Rossi MA, Soni M, Tariq N, Tsao JW, Vargas BB, Vota SA, Wessels SR, Planalp H, Govindarajan R. Telemedicine in neurology. Neurology 2019; 94:30-38. [DOI: 10.1212/wnl.0000000000008708] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022] Open
Abstract
PurposeWhile there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.Recent findingsStudies across multiple specialties report noninferiority of evaluations by telemedicine compared with traditional, in-person evaluations in terms of patient and caregiver satisfaction. Evidence reports benefits in expediting care, increasing access, reducing cost, and improving diagnostic accuracy and health outcomes. However, many studies are limited, and gaps in knowledge remain.SummaryTelemedicine use is expanding across the vast array of neurologic disorders. More studies are needed to validate and support its use.
Collapse
|
44
|
Kessel KA, Vogel MME, Kessel C, Bier H, Biedermann T, Friess H, Herschbach P, von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Bassermann F, Schmid R, Schwaiger M, Combs SE. Cancer clinical trials - Survey evaluating patient participation and acceptance in a university-based Comprehensive Cancer Center (CCC). Clin Transl Radiat Oncol 2018; 13:44-49. [PMID: 30345398 PMCID: PMC6192009 DOI: 10.1016/j.ctro.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
>50% of patients are willing to participate in clinical trials, only 18% are currently enrolled. The top reason to participate in trials was to serve medical progress and cancer research. Reasons for refusing were extensive travel time, no therapeutic advantage and too time-consuming. Good information strategies need to be implemented, and doctors need to be aware of running trials. Trial concepts must include patients’ needs, e.g. number of appointments, risk-benefit profile.
Introduction Prospective clinical trials are essential to translate new therapy concepts or rather any scientific development into the medical routine. Besides a sophisticated trial protocol, the success of clinical trials depends on patient recruitment and participation. Patient recruitment remains a challenge and depends on several factors. To get a current picture of the patients’ attitude, we conducted the present survey. Methods We designed a survey with seven questions, which was given to all oncological patients treated within a timeframe of three months between Mai and July 2017. Participation was voluntary and anonymous. The questionnaire mainly inquires patients’ participation in clinical trials in a university-based setting, their attitude towards clinical trials regarding risks and benefits, and their source of information in this context. Results 771 patients (1:1 male/female) participated with a median age of 61 years (range 18–91 years) with a response rate of 71.5%. Of all, 17.8% (137/771) were participating in a clinical trial. The most mentioned reason was to serve medical progress and cancer research. Out of the patients not currently participating in a trial, 79 (12.7%, 79/623) refusers named the following main reasons: extensive travel time to the clinic, no therapeutic advantage, and too time-consuming. Out of the patients not offered to take part in a trial, 265 (51.0%, 265/520) would participate if offered. Of all patients, 8.3% (64/771) used the clinics' homepage as a source of information, of those 79.7% (51/64) were satisfied with its content. To enhance patient recruitment strategies, we asked how patients wish to be informed about possible trials: More than half (52.0%) of the questioned patients preferred an individual medical consultation with their physician. We further analyzed the trial participation depending on age, gender, unit, and tumor entity. We could show a significant influence of age (p < 0.001) but not for gender (p = 0.724). The trial participation was also significantly associated with the treating unit (p < 0.001) and tumor entity (p = 0.001). Conclusion Patients are willing to participate in clinical trials. Better information strategies need to be implemented. Physicians need to be aware of running trials within their department and must counseling counsel patients effectively to improve recruitment. Trial concepts should keep in mind patients’ needs including an adequate number of appointments, positive risk-benefit profiles, and information material.
Collapse
Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Carmen Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Henning Bier
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Otorhinolaryngology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Tilo Biedermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Biedersteiner Straße 29, Munich, Germany
| | - Helmut Friess
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Peter Herschbach
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich (TUM), Trogerstraße 26, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Orthopedic Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Bernhard Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marion Kiechle
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gynecology and Obstetrics, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Ulrich Keller
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christian Peschel
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Florian Bassermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Roland Schmid
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gastroentereology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Markus Schwaiger
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Nuclear Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| |
Collapse
|