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Wang X, Wang J, Du X, Yu L, Zhou Y, Zhou S, Wang Y, Ding Y. Telemedicine during the COVID-19 epidemic improves outcomes in children with tuberous sclerosis complex: A 1206 visits retrospective cohort study. CNS Neurosci Ther 2024; 30:e14549. [PMID: 38031962 PMCID: PMC11163188 DOI: 10.1111/cns.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS To evaluate the benefits of telemedicine in children with tuberous sclerosis complex during the COVID-19 pandemic. METHODS A retrospective cohort study was conducted, comparing telemedicine and in-person visits within the timeframe spanning from June 1, 2021, to June 1, 2022. Disparities in demographics, emergency visits, hospitalizations, adverse effects (AEs) associated with sirolimus, and the incidence of drug-refractory epilepsy (DRE) between telehealth and in-person care were assessed. Additionally, distinctions between audio and video telehealth, as well as varying frequencies of telehealth encounters, were investigated and reported as odds ratios (ORs). RESULTS A total of 378 patients with 1206 visits were included, of which 137 were telemedicine patients and 241 were in-person patients. The median age was 5.0 years (IQR 2.8-10.0 years). There were 197 males (52.12%), 691 in-person visits (57.30%), and 515 telemedicine visits (42.70%). Children under 12 years old, those farther away from the center, mothers with more than 12 years of education, and children treated with sirolimus were more likely to visit via telemedicine. Telehealth was associated with significantly fewer emergency visits, hospitalizations, AEs of sirolimus, and DRE. With 10 or more visits, the incidence of emergency visits, hospitalization, and DRE was significantly reduced. CONCLUSION Telemedicine visits are almost as close in number as in-person visits. Younger patients, patients in remote areas, and mothers with higher education levels are more willing to complete telemedicine visits. Telemedicine visits were associated with a significantly lower number of emergency visits, hospitalizations, and AEs of sirolimus. Patients with more than 10 visits per year seemed to have better clinical outcomes.
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Affiliation(s)
- Xia Wang
- Department of NeonatologyXinhua Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Ji Wang
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Xiaonan Du
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Lifei Yu
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Yuanfeng Zhou
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Shuizhen Zhou
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Yi Wang
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Yifeng Ding
- Department of Neurology, National Children Medical CenterChildren's Hospital of Fudan UniversityShanghaiChina
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Wang Y, Zhao J, Wan GM. Prolong the flushing and locking interval of TIVAD is feasible in COVID-19: An overview of systematic reviews. J Vasc Access 2023; 24:1253-1259. [PMID: 35430915 DOI: 10.1177/11297298221086129] [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: 12/17/2023] Open
Abstract
The aim of the overview was to synthesize existing systematic reviews (SRs) of flushing interval for patients who inserted totally implanted venous catheter devices (TIVAD). Regular flushing is indispensable for catheter patency, the recommended flushing interval of TIVAD is 4 weeks, however, there is an argument for prolonging the maintenance interval, which has been proved by many SRs. However, the flushing interval range from 4-week to 3-month. The discrepancy in maintenance period could puzzle health professionals and hinder best practice into the clinic. So, we performed the overview by following the PRISMA statement. The PubMed, Ovid, Wan Fang database, Web of Science, CINAHL, CNKI, EMBASE, Cochrane Library were searched from inception to November 2021. The AMSTAR-2, the PRISMA statement, and ROBIS tool were used to assess SRs' method, report quality, and risk of bias, respectively. Then all results were synthesized, the quality of SRs' results was evaluated with GRADE. Finally, five SRs were included. However, non-randomized and small sample size of original studies result in the limitation of SRs. The evidence grade of conclusions is low, bias of mixed factors in included studies, further large sample sizes, RCTs need to be conducted in the future. Prolonged flushing interval was feasible based on the recent evidence, especially during the COVID-19 pandemic because the overwhelming healthcare system and inconvenience of transportation made maintenance not as easy as it used to be. There is no difference of complication between prolonged flushing interval (⩾4-week) and 4-week period, and it can also reduce healthcare cost with no harm to patients.
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Affiliation(s)
- Yan Wang
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhao
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Guang-Ming Wan
- RN Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Olszewski C, Thomson S, Pring K, Cox S, Merrill R, Fishman E, Ambrosini A, Soltany KA, Bognet G, Strauss L, Graham R, Guzik A, Strowd RE. A comparison of telemedicine and in-person neurology visits: what are the factors that patients consider when selecting future visit type? J Neurol 2022; 269:5022-5037. [PMID: 35508812 PMCID: PMC9068349 DOI: 10.1007/s00415-022-11149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
Objective To identify factors that patients consider when choosing between future in-person, video, or telephone visits. Background Telemedicine has been rapidly integrated into ambulatory neurology in response to the COVID-19 pandemic. Methods Ambulatory neurology patients at a single center were contacted via telephone to complete: (1) a survey quantifying likelihood of scheduling a future telemedicine visit, and (2) a semi-structured qualitative interview following their visit in March 2021. Data were processed using the principles of thematic analysis. Results Of 2493 visits, 39% assented to post-visit feedback; 74% were in-person visits and 13% video and telephone. Patients with in-person visits were less likely than those with video and telephone visits to “definitely” consider a future telemedicine visit (36 vs. 59 and 62%, respectively; p < 0.001). Patients considered five key factors when scheduling future visits: “Pros of Visit Type,” “Barriers to Telemedicine,” “Situational Context,” “Inherent Beliefs,” and “Extrinsic Variables.” Patients with telemedicine visits considered convenience as a pro, while those with in-person visits cited improved quality of care. Accessibility and user familiarity were considered barriers to telemedicine by patients with in-person and telephone visits, whereas system limitations were prevalent among patients with video visits. Patients agreed that stable conditions can be monitored via telemedicine, whereas physical examination warrants an in-person visit. Telemedicine was inherently considered equivalent to in-person care by patients with telephone visits. Awareness of telemedicine must be improved for patients with in-person visits. Conclusion Across visit types, patients agree that telemedicine is convenient and effective in many circumstances. Future care delivery models should incorporate the patient perspective to implement hybrid models where telemedicine is an adjunct to in-person visits in ambulatory neurology. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11149-0.
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Affiliation(s)
| | | | - Kelly Pring
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Siobhan Cox
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Emily Fishman
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Lauren Strauss
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27104, USA
| | - Rachel Graham
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27104, USA
| | - Amy Guzik
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27104, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27104, USA.
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Olszewski C, Thomson S, Strauss L, Graham R, Ezzeddine M, Dodenhoff K, Ambrosini A, Smith LD, Silla L, Schreiber A, Caraci C, Guzik A, Strowd RE. Patient Experiences With Ambulatory Telehealth in Neurology: Results of a Mixed-Methods Study. Neurol Clin Pract 2022; 11:484-496. [PMID: 34992956 DOI: 10.1212/cpj.0000000000001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/28/2021] [Indexed: 01/01/2023]
Abstract
Objective To assess patient experiences with rapid implementation of ambulatory telehealth during the coronavirus disease 2019 (COVID-19) pandemic. Methods A mixed-methods study was performed to characterize the patients' experience with neurology telehealth visits during the first 8 weeks of the COVID-19 response. Consecutive patients who completed a telehealth visit were contacted by telephone. Assenting patients completed a survey quantifying satisfaction with the visit followed by a semistructured telephone interview. Qualitative data were analyzed using the principles of thematic analysis. Results A total of 2,280 telehealth visits were performed, and 753 patients (33%) were reached for postvisit feedback. Of these, 47% of visits were by video and 53% by telephone. Satisfaction was high, with 77% of patients reporting that all needs were met, although only 51% would consider telehealth in the future. Qualitative themes were constructed, suggesting that positive patient experiences were associated not only with the elimination of commute time and associated costs but also with a positive physician interaction. Negative patient experiences were associated with the inability to complete the neurologic examination. Overall, patients tended to view telehealth as a tool that should augment, and not replace, in-person visits. Conclusion In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed.
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Affiliation(s)
- Carly Olszewski
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Sharon Thomson
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Lauren Strauss
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Rachel Graham
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Mustapha Ezzeddine
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Kristen Dodenhoff
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Alexander Ambrosini
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Laura Daniela Smith
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Laura Silla
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Allysen Schreiber
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Caroline Caraci
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Amy Guzik
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
| | - Roy E Strowd
- Wake Forest School of Medicine (CO, ST, KD, AA, LDS, L. Silla, AS), Wake Forest Baptist Health, Winston Salem, NC; and Department of Neurology (L. Strauss, RG, ME, CC, AG, RES), Wake Forest Baptist Health, Winston Salem, NC
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Zhu W, Fang Y, Bai ZL, Li NN, Zhao JY, Hu Z. Effect of Emerging Major Infectious Diseases on Sleep Quality of Medical Workers: Findings from Medical Workers Providing Support During the COVID-19 Pandemic. Med Sci Monit 2021; 27:e931881. [PMID: 34117207 PMCID: PMC8207954 DOI: 10.12659/msm.931881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) outbreak has exerted immense pressure on medical systems in China and abroad. This study aimed to compare the sleep quality of medical personnel conscripted to the Wuhan Union Cancer Centre to offer support during the early stages of the COVID-19 pandemic to the sleep quality of those who remained at Anhui Medical University Hospital and to determine the role of interventions in improving sleep quality. Material/Methods Questionnaires were completed by 369 individuals who were conscripted to support Wuhan (N=137) and others who were not (the control group; N=232). The Pittsburgh Sleep Quality Index (PSQI) was used to measure the duration and quality of sleep. The Anhui Provincial Health Commission organized a comprehensive intervention, consisting of physical-psychological-social dimensions, over the course of 2 weeks. Results Only 34.21% of the Wuhan support workers reported better sleep quality, as opposed to the 55.60% of the control group at stage 1 (t/χ2=14.005, P<.001). Furthermore, despite the Wuhan support group being more prone to poor sleep quality, their sleep quality significantly improved after the interventions. Conclusions The findings from this study showed that medical staff who were conscripted to offer support during the early stages of the COVID-19 pandemic suffered from impaired quality of sleep. The use of questionnaire-based sleep assessments may provide individualized approaches to supporting medical personnel during future epidemics and pandemics. Furthermore, our results indicate that relevant interventions can significantly improve sleep quality, while a prolonged break after interventions does not affect sleep quality.
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Affiliation(s)
- Wen Zhu
- Graduate Student Affairs Office, First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Yue Fang
- First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Zhong-Liang Bai
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Nian-Nian Li
- Department of Business Administration, School of Management, University of Science and Technology of China, Hefei, Anhui, China (mainland)
| | - Jia-Yun Zhao
- Graduate Student Affairs Office, First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Zhi Hu
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, Anhui, China (mainland)
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