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Metzger S, Lee J, McDavid L. Literature Review: Support for caregivers of children on the ketogenic diet for epilepsy and other neurologic disorders. Epilepsy Behav 2024; 156:109830. [PMID: 38759426 DOI: 10.1016/j.yebeh.2024.109830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/07/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
Epilepsy affects millions of people and when medications are insufficient to maintain seizure control, individuals are diagnosed with refractory epilepsy (RE). Medical ketogenic diet therapy (KDT), a diet high in fat and low in carbohydrates and sufficient in protein, is a well-established treatment for RE. However, compliance is one of the main reasons for discontinuation of KDT and, with pediatric RE patients, the ability of informal caregivers, typically family members, to maintain diet adherence is vital for successful KDT treatment. The central role that informal caregivers play for effective KDT implementation is recognized, however, there is a need to elucidate the rationale and theoretical underpinnings of effective KDT caregiver support programs to inform best practices. Therefore, this systematic literature review aims to identify the existing fundamental understandings of KDT caregiver support to help build a foundation of theory-based knowledge to promote evidenced practice. After screening 137 publications, three studies that discussed potential underlying components of effective caregiver support were included in this review. These articles followed a similar approach as they 1) employed qualitative methods delving into caregiver needs, 2) findings highlighted the importance of support from family, friends, fellow caregivers and their child's medical team, and 3) the inclusion of caregiver support findings were a supplement to the main purpose of the manuscript. Research focused on KDT caregivers is in its infancy. There is a clear need for the systematic examination of support for KDT caregivers to build a foundation for effective support programs and to increase the access to quality support programming to foster KDT implementation, desirable patient outcomes, and caregiver well being. In this article we discuss opportunities to apply self-determination theory to the KDT caregiver support research and practice.
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Affiliation(s)
- Sarah Metzger
- SarahMetzgerNutrition, LLC 1418 Wembley Ct NE Atlanta, GA 30329, United States.
| | - Jessica Lee
- Co-Founder of Keto Hope Foundation and Director of Keto Friends support network. 845 Houston Northcutt Blvd #1066, Mt Pleasant, SC 29464, United States
| | - Lindley McDavid
- Senior Evaluation and Research Associate, Evaluation and Learning Research Center, Purdue University, 100 North University Street, West Lafayette, IN, United States
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Zöllner JP, Rosenow F, Schubert-Bast S, Roth C, Knake S, Eickhoff C, Scheuble P, Martin J, Bollensen E, Teepker M, Singer O, Schirmer S, Dietz A, Henn KH, Stolz E, Schüttler-Gahin K, Fischer M, Noda A, Mann C, Strzelczyk A. Consultation Requests and Satisfaction with a Telehealth Network for Epilepsy: Longitudinal Analysis of the Epilepsy Network Hessen Evaluation. Telemed J E Health 2024; 30:e2013-e2023. [PMID: 38683593 DOI: 10.1089/tmj.2023.0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Background: Telemedicine improves access to specialized medical expertise, as required for paroxysmal disorders. The Epilepsy Network Hessen Evaluation (ENHE) is a pilot cross-sectoral teleconsultation network connecting primary neurologists and pediatricians with epilepsy centers in Hessen, a federal German state. Methods: We prospectively and longitudinally evaluated telehealthcare in the ENHE. Participating physicians rated each consultation for satisfaction and impact on further management. The survey was administered at each consultation and 3 months later. Results: We analyzed 129 consultations involving 114 adult and pediatric patients. Their mean age was 34 years (standard deviation: 26, range: 0.1-91 years), 48% were female, and 34% were children and adolescents. The most common consultation requests were co-evaluation of an electroencephalogram (electroencephalogram [EEG]; 76%) and therapeutic (33%) and differential diagnosis (24%) concerns. Physicians transmitted one paraclinical examination on average (range: 1-4), predominantly EEG (85%), followed by magnetic resonance imaging (17%) and written records (9%). Response rates were 72% for the initial and 67% for the follow-up survey. Across respondents, 99% (n = 92) were satisfied with the ENHE. Overall, 80% of the consultations contributed to the diagnosis, and 90% were considered helpful for treatment, influencing it in 71% of cases. Seizure frequency had decreased more often (96%) than increased (4%) at 3 months. The initial diagnosis was confirmed in 78% of patients. Discussion: In this pilot teleconsultation network for paroxysmal disorders, diagnostic and therapeutic advice was perceived as helpful. Clinical outcomes were largely positive, suggesting tele-epileptology is viable for paroxysmal (seizure) disorders.
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Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
- Department of Neuropediatrics, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Christian Roth
- Department of Neurology, DRK Kliniken Kassel, Kassel, Germany
- Department of Neurology, Gesundheit Nordhessen-Klinikum Kassel, Kassel, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Pascal Scheuble
- Department of Pediatrics, St. Vincenz Krankenhaus, Limburg, Germany
| | | | - Edgar Bollensen
- Neurological Practice, Neurozentrum Eschwege, Eschwege, Germany
| | - Michael Teepker
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Neurological Practice, MVZ Hardtwaldklinik I, Bad Zwesten, Germany
| | | | - Svenja Schirmer
- Neuropediatric Practice, Sozialpädiatrisches Zentrum, Offenbach, Germany
| | - Andreas Dietz
- Department of Neurology, Hochtaunus-Kliniken, Bad Homburg, Germany
| | | | - Erwin Stolz
- Neurological Practice, Frankfurt am Main, Germany
| | | | - Michaela Fischer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Anna Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Medical Center for Adults with Disabilities (MZEB), Varisano Klinikum Frankfurt-Höchst, Frankfurt am Main, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital, Goethe University, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany
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Tiwari BB, Kulkarni A, Zhang H, Khan MM, Zhang DS. Utilization of telehealth services in low- and middle-income countries amid the COVID-19 pandemic: a narrative summary. Glob Health Action 2023; 16:2179163. [PMID: 36803538 PMCID: PMC9946329 DOI: 10.1080/16549716.2023.2179163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND During the current period of the pandemic, telehealth has been a boon to the healthcare system by providing quality healthcare services at a safe social distance. However, there has been slow progress in telehealth services in low- and middle-income countries with little to no evidence of the cost and effectiveness of such programmes. OBJECTIVE To provide an overview of the expansion of telehealth in low- and middle-income countries amid the COVID-19 pandemic and identify the challenges, benefits, and costs associated with implementing telehealth services in these countries. METHODS We performed a literature review using the search term: '*country name* AND ((telemedicine[Title][Abstract]) OR (telehealth[Title][Abstract] OR eHealth[Title][Abstract] OR mHealth[Title][Abstract]))'. Initially, we started with 467 articles, which were reduced to 140 after filtering out duplicates and including only primary research studies. Next, these articles were screened based on established inclusion criteria and 44 articles were finalised to be used in the review. RESULTS We found telehealth-specific software being used as the most common tool to provide such services. Nine articles reported patient satisfaction of greater than 90% with telehealth services. Moreover, the articles identified the ability to make a correct diagnosis to resolve the condition, efficient mobilisation of healthcare resources, increased accessibility for patients, increased service utilisation, and increased satisfaction as benefits of telehealth services, whereas inaccessibility, low technological literacy, and lack of support, poor security standards and technological concerns, loss of interest by the patients, and income impacts on physicians as challenges. The review could not find articles that explored the financial information on telehealth programme implementation. CONCLUSION Although telehealth services are growing in popularity, the research gap on the efficacy of telehealth is high in low- and middle-income countries. To better guide the future development of telehealth services, rigorous economic evaluation of telehealth is needed.
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Affiliation(s)
- Biplav Babu Tiwari
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA, USA
| | | | - Hui Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mahmud M. Khan
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Donglan Stacy Zhang
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA, USA,Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, USA,CONTACT Donglan Stacy Zhang Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY11501, USA
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Singh M, Kaushik JS, Yadav A, Khanna A, Dabla S. Parent's Perspective of Problems Faced during the COVID-19 Pandemic Lockdown on the Care of Children with Epilepsy: A Qualitative Study. Indian J Public Health 2023; 67:382-386. [PMID: 37929379 DOI: 10.4103/ijph.ijph_1564_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background COVID-19 has significantly impacted the care of children with chronic illness. There is a paucity of data on issues faced by parents of children with epilepsy (CWE) in an Indian setup. Objectives The objective was to describe the parental perspective of the problems faced by them on the care of their CWE during the first wave of the COVID-19 pandemic. Materials and Methods Parents of CWE who physically visited the clinic for their follow-up visit were asked to narrate their experiences about the problems they faced during the first lockdown due to COVID-19. The narratives were audio recorded, and transcripts were analyzed using thematic analysis to arrive at broad themes. Results Four broad themes were identified: transport-related issues, medication-related issues, issues related to doctor consultation, and diagnostic delay. Limited transportation facilities, lack of appropriate social distancing norms in public transport and outpatient units, rigorous frisking by personnel during travel, fear of viral transmission during outpatient visits, nonavailability of antiseizure medications (ASMs) in local markets, lack of discounts by pharmacy, change of brands of ASM, and inability to undergo scheduled diagnostic investigations were some of the major issues raised by parents of CWE. Conclusion Parents of CWE had trouble in transport to the hospital, inadequate access to ASMs, difficulties in doctor consultation, and delays in diagnostic investigations during the first COVID-19 pandemic lockdown.
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Affiliation(s)
- Manjeet Singh
- Medical Undergraduate Student, Department of Neurology, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jaya Shankar Kaushik
- Additional Professor, Department of Pediatrics, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Alka Yadav
- Professor, Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Alok Khanna
- Professor, Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Surekha Dabla
- Senior Professor, Department of Neurology, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Bara VB, Schoeler N, Carroll JH, Simpson Z, Cameron T. Patient and carer perspectives on the use of video consultations in the management of the ketogenic diet for epilepsy. Epilepsy Behav 2023; 145:109280. [PMID: 37315407 PMCID: PMC10259179 DOI: 10.1016/j.yebeh.2023.109280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/20/2023] [Accepted: 05/20/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a significant change in the way healthcare was delivered worldwide. During this time, a survey of Ketogenic Dietitians Research Network (KDRN) members found that all respondents expected digital platforms for clinics and/or education to continue post-pandemic. As a follow-up to this, we surveyed views about video consultations (VCs) of patients and carers of those following the ketogenic diet for drug-resistant epilepsy. METHODS The SurveymonkeyTM survey was distributed on Matthews' Friends and KDRN social media platforms and emailed from five United Kingdom ketogenic diet centers to their patients/carers. RESULTS Forty eligible responses were received. More than half of the respondents (23, 57.5%) had attended a VC. Eighteen respondents (45%) would like to have VCs for most (categorized as approximately 75%) or all of their consultations. Half as many (9, 22.5%) would not like video consultations. The most common benefits selected were saving travel time (32, 80%), less stress of finding somewhere to park and not having to take time off work (22, 55% each). Twelve (30%) responded that VCs lessened environmental impact. The most common disadvantages selected were not being able to get blood tests/having to make a separate consultation for blood tests (22, 55% overall), not being able to get weight or height checked/having to make a separate consultation for this and it is less personal/preferring face-to-face (17, 42.5% each). Three-quarters (30 respondents) felt it would be very easy or easy to accurately weigh the patient when not attending an in-person consultation. CONCLUSION Our results suggest that many patients and carers would welcome the option of VCs as well as face-to-face consultations. Where possible and appropriate patients and their families should be offered both options. This is in line with the NHS Long-Term Plan and the NHS response to climate change.
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Affiliation(s)
- Vanessa Bh Bara
- Department of Nutrition and Dietetics, Bristol Royal Hospital for Children, Bristol, UK.
| | - Natasha Schoeler
- UCL Great Ormond Street Institute of Child Health, London, UK; Dietetic Department, Great Ormond Street Hospital for Children, London, UK
| | | | - Zoe Simpson
- Dietetic Department, Great Ormond Street Hospital for Children, London, UK
| | - Tracy Cameron
- Paediatric Dietetic Department, Royal Aberdeen Children's Hospital, Aberdeen, UK
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Kaufman MC, Xian J, Galer PD, Parthasarathy S, Gonzalez AK, McKee JL, Prelack MS, Fitzgerald MP, Helbig I. Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic. Dev Med Child Neurol 2023; 65:406-415. [PMID: 38767061 DOI: 10.1111/dmcn.15406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. METHOD We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. RESULTS We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8; R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). INTERPRETATION Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.
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Affiliation(s)
- Michael C Kaufman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julie Xian
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Peter D Galer
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Alexander K Gonzalez
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jillian L McKee
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Marisa S Prelack
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Mark P Fitzgerald
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Koliouli F, Andrianakou M. COVID-19 and parents of children with epilepsy: Experiences and positive changes. Front Public Health 2023; 11:1079518. [PMID: 36844820 PMCID: PMC9947290 DOI: 10.3389/fpubh.2023.1079518] [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: 11/01/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction The aim of this study is to explore the ways that parents with children or adolescents with epilepsy (CAWE) experienced the restrictive measures, as well as the stressors and challenges that they had to face. Methods We employed an experiential approach and fifteen Greek-speaking parents answered to an in-depth semi-structured interview, during the second lockdown period. Data were analyzed through the Thematic Analysis (TA). Results The emerging themes were the challenges encountered in terms of medical monitoring, the "stay-home" impact on their everyday lives as a family, their psycho-emotional responses. More specifically, parents identified the irregular doctor appointments and their struggle to access the hospital services as the most important challenges. Moreover, parents reported that the "stay-home" impact has disrupted their children's daily routines among others. Finally, parents highlighted their emotional strain and worries experienced during the lockdown along with the positive changes that occurred.
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Affiliation(s)
- Flora Koliouli
- Psychology Department, National and Kapodistrian University of Athens, Athens, Greece,School of Early Childhood Education, Aristotle University of Thessaloniki, Thessaloniki, Greece,*Correspondence: Flora Koliouli ✉
| | - Marianna Andrianakou
- Psychology Department, National and Kapodistrian University of Athens, Athens, Greece
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Merrick H, Driver H, Main C, Kenny RPW, Richmond C, Allard A, Bola K, Morris C, Parr JR, Pearson F, Pennington L. Impacts of health care service changes implemented due to COVID-19 on children and young people with long-term disability: A mapping review. Dev Med Child Neurol 2023. [PMID: 36649197 DOI: 10.1111/dmcn.15503] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
AIM To identify the research on childhood disability service adaptations and their impact on children and young people with long-term disability during the COVID-19 pandemic. METHOD A mapping review was undertaken. We searched the World Health Organization Global COVID-19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0-19 years) with long-term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced. RESULTS Reduction of face-to-face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child-reported satisfaction or acceptability of service changes. INTERPRETATION The long-term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well-being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable.
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Affiliation(s)
- Hannah Merrick
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Driver
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chloe Main
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ryan P W Kenny
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Christopher Morris
- Peninsula Childhood Disability Research Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Pearson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Lavin B, Gray CL, Brodie M. Telemedicine and Epilepsy Care. Neurol Clin 2022; 40:717-727. [DOI: 10.1016/j.ncl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Armeno M, Caballero E, Verini A, Reyes G, Galarza N, Cresta A, Caraballo RH. Telemedicine- versus outpatient-based initiation and management of ketogenic diet therapy in children with drug-resistant epilepsy during the COVID-19 pandemic. Seizure 2022; 98:37-43. [DOI: 10.1016/j.seizure.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
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Kramer ZJ, Brandt C, Havens K, Pasupuleti A, Gaillard WD, Schreiber JM. Telehealth for patients with rare epilepsies. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076861. [PMID: 37180417 PMCID: PMC10032469 DOI: 10.1177/26330040221076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 05/16/2023]
Abstract
Recent developments in technology and exigencies of the COVID-19 pandemic have spurred innovations for telehealth in patients with rare epilepsies. This review details the many ways telehealth may be used in the diagnosis and management of rare, pharmacoresistant epilepsy and documents our experience as measured by surveying caregivers of pediatric patients with epilepsy. Most components of the epilepsy evaluation, including history and examination, neuroimaging, and electroencephalogram (EEG) can be performed or reviewed remotely, assuming similar technique and quality of diagnostic studies. Seizure and epilepsy diagnosis is enhanced through the assistance of caregiver smart phone video recordings and 'ambulatory' EEG. Monitoring patient seizure frequency through paper seizure diaries is now increasingly being replaced by electronic diaries in both clinical and research settings. Electronic seizure diaries have numerous advantages such as data durability, increased accessibility, real-time availability, and easier analysis. Telehealth enhances access to specialized epilepsy care, which has been shown to reduce mortality and improve patient compliance and outcomes. Telehealth can also enable evaluation of patients with rare epilepsy in centers of excellence and enhance enrollment in clinical trials. Reducing mortality risk in patients with epilepsy can be accomplished through remote counseling and addressing psychiatric co-morbidities. Findings from surveying caregivers of children with epilepsy treated at Children's National Hospital showed that 54/56 (96.4%) found that not having to commute to the appointment positively contributed to their telemedicine experience. Overall, most respondents had a positive experience with their telemedicine visit. Almost all respondents (98%) were either 'very happy' or 'happy' with their telemedicine visit and their ability to communicate over telemedicine with the provider and either 'very likely' or 'likely' to want to use telemedicine for some future clinic visits. Telehealth in rare epilepsies is feasible and, in many ways, comparable with traditional evaluation and management.
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Affiliation(s)
- Zachary J. Kramer
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Carrin Brandt
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Kathryn Havens
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Archana Pasupuleti
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - William D. Gaillard
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - John M. Schreiber
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC 20010, USA
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Beight LJ, Helton G, Avery M, Dussel V, Wolfe J. Parent and Adolescent Perspectives on the Impact of COVID on the Care of Seriously Ill Children. J Pain Symptom Manage 2022; 63:52-60. [PMID: 34333095 PMCID: PMC8319041 DOI: 10.1016/j.jpainsymman.2021.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Few studies have explored the impact of the Coronavirus Pandemic (COVID-19) on the care of seriously ill children which may be especially affected due to the child's vulnerability, complexity of care, and high reliance on hospital-based care. OBJECTIVE To explore parental and adolescent perspectives on the impact of COVID-19 on care of seriously children. METHODS We recruited a convenience sample of families of seriously ill children between September and December 2020. The study involved a semi-structured interview through Zoom followed by an online sociodemographic survey. Interviews were transcribed and coded using the constant comparison method. The sample intended to represent diversity in child age and diagnoses, and family sociodemographic characteristics. RESULTS Sixty-four families were approached; 29 enrolled (response rate 45%), including 30 parents and three AYAs. Most parents and AYAs identified as white (62%). Some families reported new financial hardships, with 17.2% having difficulty paying bills after March 2020 compared to 6.9% before. Emerging themes from interviews included additional roles parents managed due to cancelled services or shifting to telehealth, increased isolation, high emotional distress due increased in-home demands, uncertainty, and visitor restrictions in medical facilities, and benefits and challenges to telehealth. One positive outcome was the use of a hybrid care model whereby families choose telehealth appointments and in-person services, when necessary. CONCLUSION Families caring for seriously ill children during COVID-19 face increased challenges. Health systems should consider long-term telehealth/in-person hybrid care models that have potential to improve access to and satisfaction with care.
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Affiliation(s)
- Leah J Beight
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA
| | - Veronica Dussel
- Pediatric Palliative Care (V.D.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA; Center for Research and Implementation in Palliative Care (CII-CP) (V.D.), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires Argentina
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (L.J.B., G.H., M.A., V.D., J.W.), Dana-Farber Cancer Institute. Boston, MA, USA; Department of Pediatrics (J.W.), Boston Children's Hospital. Boston, MA, USA.
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Gangitano E, Tozzi R, Mariani S, Lenzi A, Gnessi L, Lubrano C. Ketogenic Diet for Obese COVID-19 Patients: Is Respiratory Disease a Contraindication? A Narrative Review of the Literature on Ketogenic Diet and Respiratory Function. Front Nutr 2021; 8:771047. [PMID: 34957183 PMCID: PMC8695871 DOI: 10.3389/fnut.2021.771047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022] Open
Abstract
Morbid obese people are more likely to contract SARS-CoV-2 infection and its most severe complications, as need for mechanical ventilation. Ketogenic Diet (KD) is able to induce a fast weight loss preserving lean mass and is particularly interesting as a preventive measure in obese patients. Moreover, KD has anti-inflammatory and immune-modulating properties, which may help in preventing the cytokine storm in infected patients. Respiratory failure is actually considered a contraindication for VLCKD, a very-low calorie form of KD, but in the literature there are some data reporting beneficial effects on respiratory parameters from ketogenic and low-carbohydrate high-fat diets. KD may be helpful in reducing ventilatory requirements in respiratory patients, so it should be considered in specifically addressed clinical trials as an adjuvant therapy for obese patients infected with SARS-CoV-2.
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Affiliation(s)
- Elena Gangitano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Rossella Tozzi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Mariani
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Licchetta L, Trivisano M, Baldin E, Mohamed S, Raschi E, Mostacci B, Zenesini C, Contin M, Vigevano F, Bisulli F, Tinuper P, Vignatelli L. TELEmedicine for EPIlepsy Care (TELE-EPIC): protocol of a randomised, open controlled non-inferiority clinical trial. BMJ Open 2021; 11:e053980. [PMID: 34862297 PMCID: PMC8646970 DOI: 10.1136/bmjopen-2021-053980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Epilepsy is a chronic condition requiring consistent follow-up aimed at seizure control, and monitoring of anti-seizure medication (ASM) levels and side effects. Telemedicine (TM) offers invaluable support to patient follow-up, guaranteeing the prompt availability of a team of experts for persons with epilepsy (PWE) widely distributed across the country. Although many health institutions have endorsed the use of TM, robust data on effectiveness, safety and costs of TM applied to epilepsy are lacking. TELEmedicine for EPIlepsy Care (TELE-EPIC) will evaluate the effectiveness of video consultation (VC) via TM compared with usual care (UC) for the monitoring of PWE (TELE-EPIC_RCT). Moreover, TELE-EPIC will apply an innovative Volumetric Absorptive Microsampling (VAMS) device for quantitation of ASM through finger prick blood sampling as an alternative to venipuncture sampling (TELE-EPIC_VAMS). METHODS AND ANALYSIS TELE-EPIC_RCT is a multicentre, open, pragmatic two-arm randomised controlled trial prospectively including adult and paediatric outpatients with established diagnosis of epilepsy consecutively attending the Epilepsy Centres of Bologna and Rome, respectively. The primary outcome is the non-inferiority of VC on seizure control compared with UC after an 18-month follow-up. Secondary outcomes are adherence to treatment, ASM-related adverse events, quality of life, mood disorders, patient and caregiver satisfaction, safety and costs. TELE-EPIC_VAMS is a cross-validation study for blood ASM quantitation through a novel, VAMS-based device, comparing (1) VAMS versus plasma samples (reference standard method); and (2) nurse-collected versus self-collected blood by VAMS device. ETHICS AND DISSEMINATION The study has been approved by the local ethics committee (349-2019-SPER-AUSLBO). Complete information about the state of project, relevant events and results will be regularly updated on the project's webpage on ClinicalTrials.gov. The project's results and data on the potential impact of TM in epilepsy will be disseminated on social media. A closeout meeting will be convened for the communication and dissemination of the project, highlighting its main achievements and impacts. TRIAL REGISTRATION NUMBER NCT04496310.
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Affiliation(s)
- Laura Licchetta
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
| | - Marina Trivisano
- Department of Neuroscience, Rare and Complex Epilepsies Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Elisa Baldin
- Epidemiology and Statistics Unit, IRCCS, Instituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Susan Mohamed
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
| | - Corrado Zenesini
- Epidemiology and Statistics Unit, IRCCS, Instituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Manuela Contin
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federico Vigevano
- Department of Neuroscience, Rare and Complex Epilepsies Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Francesca Bisulli
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS, Instituto delle Scienze Neurologiche di Bologna, Full Member of European Reference Network EpiCARE, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- Epidemiology and Statistics Unit, IRCCS, Instituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Kuroda N, Fujimoto A. Considerations for continuing diet therapy in patients with epilepsy during the COVID-19 pandemic: A scoping review. Epilepsy Behav Rep 2021; 16:100498. [PMID: 34778739 PMCID: PMC8574123 DOI: 10.1016/j.ebr.2021.100498] [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: 08/08/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Diet therapy is an option for managing patients with drug-resistant epilepsy (DRE). Diet therapies used for patients with epilepsy include the classic ketogenic diet, the modified Atkins diet, the medium chain triglyceride diet, and the low glycemic index diet. The effectiveness of diet therapy is highly dependent on dietary adherence. Coronavirus disease (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has substantially impacted the lifestyles of people worldwide. Therefore, continuing a specific diet during the COVID-19 pandemic is expected to be difficult in some aspects. Here, based on the available literature, we summarize the perspectives for maintaining diet therapy during the COVID-19 pandemic, as a scoping review. Epileptologists and dieticians need to understand the difficulty of maintaining diet therapy during the COVID-19 pandemic. In addition, the education of patients and all stakeholders to continue diet therapy even during the current COVID-19 pandemic is crucial to control epileptic seizures. In conclusion, continuing diet therapy is not a matter only for patients during the COVID-19 pandemic, but medical staff should also help patients to overcome the problems associated with the pandemic by understanding their situations.
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Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Wayne State University, Detroit, MI, United States.,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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16
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Caregiver perspectives on dietary therapies for epilepsy. Epilepsy Res 2021; 178:106803. [PMID: 34753070 DOI: 10.1016/j.eplepsyres.2021.106803] [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] [Received: 07/26/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
The objective of this research was to identify caregiver perspectives on dietary therapies for epilepsy, as well as provide future directions for improving caregiver support. A Qualtrics survey was distributed via social media platforms. The survey was aimed towards caregivers with children who are currently using or have previously used dietary therapy for epilepsy. A total of 192 respondents were included, though the number of respondents varied by question. Caregivers reported dietary therapy as 'somewhat to very challenging' with 76% of children and 99% of caregivers reporting at least one difficulty. Eighty percent of caregivers' children experienced at least one type of adverse event, with the most common event being constipation. Finally, caregivers reported high scores for quality of life, happiness with the diet, and feeling supported during treatment. Recommendations for how to improve the experience of families included increased clinic support, support group offerings, meal resources, educational resources, access to diet related equipment, financial assistance/relief, therapy/transition assistance, respect for the caregivers' concerns/thoughts, and restaurant options. In short, most caregivers are pleased with dietary therapy; however, there are specific changes that would significantly help caregivers during treatment. This information could be used by clinics to better support caregivers during treatment.
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Patients with epilepsy during the COVID-19 pandemic: Depressive symptoms and their association with healthcare access. Epilepsy Behav 2021; 122:108178. [PMID: 34252830 PMCID: PMC8412878 DOI: 10.1016/j.yebeh.2021.108178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak impacted the lives of worldwide people with epilepsy (PWE) in various aspects, particularly in those countries most significantly affected by this pandemic, such as Brazil. We aimed to investigate the prevalence of depressive symptoms in PWE and their correlation with epilepsy features and access to treatment. METHODS PWE were invited to answer a cross-sectional online-based survey to assess and rate depressive symptoms using the NDDI-E during the first year of the COVID-19 pandemic and its relation to multiple lifestyles epilepsy clinical aspects. RESULTS A total of 490 PWE were recruited. The prevalence of depressive symptoms during the COVID-19 pandemic was 35.3% (cutoff score > 15 on NDDI-E). The factors associated with higher NDDI-E scores were: female sex, increased seizure frequency, barriers to access to their treating physician and antiseizure medication, and unemployment. Regarding the pandemic impact on PWE healthcare, 29.2% reported restricted access to their medication, 46.1% barriers to access their physicians, 94.2% had their consultations canceled due to the pandemic, and 28.4% had seizure worsening in this period. CONCLUSION The COVID-19 pandemic affected PWE access to the healthcare system. Depressive symptoms were more severe in patients with higher seizure frequency who had difficulties obtaining proper medical care. The COVID-19 pandemic may impact the healthcare and mental wellbeing of patients with chronic diseases such as epilepsy. Nevertheless, prospective studies on epilepsy and COVID-19 are still lacking.
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18
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Challenges faced by people with epilepsy on ketogenic diet therapy and their caregivers during the COVID-19 pandemic in Brazil. Epilepsy Behav 2021; 122:108193. [PMID: 34256342 PMCID: PMC9761294 DOI: 10.1016/j.yebeh.2021.108193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although ketogenic diet therapy (KDT) is a well-established, nonpharmacologic therapeutic option for patients with pharmacoresistant epilepsy, its availability is still not widespread. The COVID-19 pandemic may have further restricted the access of people with pharmacoresistant epilepsy (PWE) to KDT. Thus, we evaluated the experiences of Brazilian PWE and their caregivers during the first year of the pandemic. METHODS An online self-assessed survey containing 25 questions was distributed via social media to be answered by PWE treated with KDT or their caregivers through Google Forms from June 2020 to January 2021. Mental health was assessed using the DASS and NDDI-E scales. RESULTS Fifty adults (>18 yo), of whom 68% were caregivers, answered the survey. During the pandemic, 40% faced adversities in accessing their usual healthcare professionals and 38% in obtaining anti-seizure medication (ASM). Despite these issues, 66% of those on KDT could comply with their treatment. Those struggling to maintain KDT (34%) named these obstacles mainly: diet costs, social isolation, food availability, and carbohydrate craving due to anxiety or stress. An increase in seizure frequency was observed in 26% of participants, positively associated with difficulties in obtaining ASM [X2 (1, N = 48) = 6.55; p = 0.01], but not with KDT compliance issues. CONCLUSIONS People with pharmacoresistant epilepsy and undergoing KDT, as well as their caregivers, faced additional challenges during the COVID-19 pandemic, not only difficulties in accessing healthcare and KDT maintenance but also on seizure control and mental health.
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19
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Alipour J, Hayavi-Haghighi MH. Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review. Appl Clin Inform 2021; 12:864-876. [PMID: 34528234 PMCID: PMC8443403 DOI: 10.1055/s-0041-1735181] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic. METHODS A structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS A total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively. CONCLUSION The COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.
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Affiliation(s)
- Jahanpour Alipour
- Health Information Management, Health Information Technology Department, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hosein Hayavi-Haghighi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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20
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Teng T, Sareidaki DE, Chemaly N, Bar C, Coste-Zeitoun D, Kuchenbuch M, Nabbout R. Physician and patient satisfaction with the switch to remote outpatient encounters in epilepsy clinics during the Covid-19 pandemic. Seizure 2021; 91:60-65. [PMID: 34098318 PMCID: PMC9525220 DOI: 10.1016/j.seizure.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Analyzing parents' and physicians' opinions regarding phone-based encounters in emergency shifts of a French pediatric epilepsy center compared to traditional face-to-face encounters during the first lockdown of the COVID-19 pandemic METHODS: Prospective monocentric study on remote encounters at Necker rare epilepsy reference center from March 20th, 2020 to April 23rd, 2020 due to lockdown measures. This study was conducted with a survey based on 5-point Likert scales (LS-2/2) designed for both parents and physicians. We compared first versus follow-up encounters as well as physicians' and parents' opinions. RESULTS We had a total of 224 responses, among which 204 were completed by physicians (91%) and 173 (84,4%) by parents. Twenty five were first encounters (14,2%). Physicians pointed out the need for clinical examination (42.6%), mainly for first encounters (p=0.0004). Physicians rated the quality of communication lower (p=0.003) as their capacity to answer parents' questions (p=0.004). They were significantly less satisfied with remote encounters compared to parents (p<10-4). We identified six urgent (2.9%) and 50 semi-urgent (24%) situations requiring programming face-to-face encounter during or shortly after the lockdown. CONCLUSION Remote encounters could be a helpful practice for pediatric patients with epilepsy in emergency situations such as pandemics. It allowed the identification and prioritization of emergency situations. Physicians were less positive than parents. We raised the possible use of remote encounters in association to face-to-face encounters for routine follow-up of pediatric patients with epilepsy.
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Affiliation(s)
- T Teng
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - D E Sareidaki
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - N Chemaly
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - C Bar
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - D Coste-Zeitoun
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - M Kuchenbuch
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, France
| | - R Nabbout
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, France.
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21
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The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105338. [PMID: 34067818 PMCID: PMC8156025 DOI: 10.3390/ijerph18105338] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 02/08/2023]
Abstract
The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic.
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Costa AM, Marchiò M, Bruni G, Bernabei SM, Cavalieri S, Bondi M, Biagini G. Evaluation of E-Health Applications for Paediatric Patients with Refractory Epilepsy and Maintained on Ketogenic Diet. Nutrients 2021; 13:1240. [PMID: 33918854 PMCID: PMC8069190 DOI: 10.3390/nu13041240] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
E-health technologies improve healthcare quality and disease management. The aim of this study was to develop a ketogenic diet management app as well as a website about this dietary treatment and to evaluate the benefits of giving caregivers access to various web materials designed for paediatric patients with refractory epilepsy. Forty families participated in the questionnaire survey, from January 2016 to March 2016. All caregivers were exposed to paper-based materials about the ketogenic diet, whereas only 22 received the app, called KetApp, and videos produced by dieticians. Caregivers with free access to web materials were more satisfied than the others with the informative material provided by the centre (p ≤ 0.001, Mann-Whitney test). Indeed, they showed a better attitude towards treatment, and they became more aware of dietary management in comparison to the control group (p ≤ 0.001). Moreover, caregivers provided with web materials were stimulated to pursue the treatment (p = 0.002) and to introduce it to their children and other people (p = 0.001). Additionally, caregivers supplied with web materials were more willing to help other families in choosing the ketogenic diet (p = 0.004). Overall, these findings indicate that web materials are beneficial for caregivers of paediatric patients with refractory epilepsy in our centres. Thus, the use of e-health applications could be a promising tool in the daily aspects of ketogenic diet management, and it is especially of value in the attempt to start or maintain the diet during the ongoing COVID-19 pandemic crisis.
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Affiliation(s)
- Anna-Maria Costa
- Laboratory of Experimental Epileptology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.-M.C.); (G.B.)
| | - Maddalena Marchiò
- Laboratory of Experimental Epileptology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.-M.C.); (G.B.)
| | - Giulia Bruni
- AOU Meyer Hospital Florence, 50139 Florence, Italy;
| | - Silvia Maria Bernabei
- Department of Paediatric Specialties and Liver, Kidney Transplant, UO Nutritional Rehabilitation, “Bambino Gesù” Children’s Hospital, 00165 Rome, Italy;
| | - Silvia Cavalieri
- Department of Foreign Languages and Literatures, University of Verona, 37129 Verona, Italy;
| | - Marina Bondi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Giuseppe Biagini
- Laboratory of Experimental Epileptology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.-M.C.); (G.B.)
- Centre for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Wanigasinghe J, Jayawickrama A, Hewawitharana G, Munasinghe J, Weeraratne CT, Ratnayake P, Wijesekara DS, Fernando S, Rupasinghe P. Experience during COVID-19 lockdown and self-managing strategies among caregivers of children with epilepsy: A study from low middle income country. Seizure 2020; 84:112-115. [PMID: 33321430 DOI: 10.1016/j.seizure.2020.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Abrupt halt of service provision due to pandemic state of COVID-19, significantly affected care of patients with chronic diseases like epilepsy; its impact being greater on caregivers of vulnerable groups such as children with epilepsy. We performed this study to describe difficulties posed by the lockdown to caregivers of children with epilepsy in a low-middle income country and describe their responses and self-management strategies to overcome difficulties and prepare for a recurrence. METHOD A cross-sectional all-island survey was carried out at paediatric neurology centers in Sri Lanka. Data was gathered via a face-to-face interview after the lockdown period. Parental stress level was evaluated using a self-rating Stress Assessment Questionnaire. RESULTS Caregivers of 140 children with epilepsy from seven centers served by paediatric neurologists were interviewed. Mean duration of epilepsy was 7.9 years(SD 4). Majority were on one (52.1 %) or two (20 %) anti-seizure medications regularly. The pandemic did not affect epilepsy control in majority (87.3 %), however, signficant proportion faced difficulties over regular reviews and presecription refills. Despite difficluties, 87.1 % of parents maintained dispensing anti-seizure medications to their child regularly. Caregivers demonstrated healthy self-management strategies such as awareness on medications and access methods to healthcare during lockdown and remained confident of accessability to services. Stress was experienced in < 5%. CONCLUSION Lockdown status for COVID-19 did not significantly affect the control of epilepsy in children though it posed difficulties for regular reviews and obtaining medications. Self-management strategies will help caregivers to adopt to new-normal status and potential future outbreaks.
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Affiliation(s)
| | - Ashan Jayawickrama
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Jagath Munasinghe
- Sirimavo Bandaranayaike Specialized Children's Hospital, Peradeniya, Sri Lanka
| | | | | | - Dimuthu S Wijesekara
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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