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Tagi VM, Eletti F, Dolor J, Zuccotti G, Montanari C, Verduci E. Telemedicine in nutritional management of children with severe neurological impairment: implication for quality of life. Front Nutr 2024; 11:1452880. [PMID: 39224181 PMCID: PMC11366627 DOI: 10.3389/fnut.2024.1452880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Children with severe neurological impairment (SNI) frequently present feeding problems requiring a close monitoring of their nutritional status. In addition to constant clinical monitoring of body composition and nutritional indexes in these patients, frequent reports of dietary intake and weight gain variations are useful to ensure proper nutritional management. Furthermore, non-oral feeding is often needed to avoid malnutrition or aspiration pneumonia, constantly necessitating medical assistance. Despite their necessity for frequent hospital accesses, these patients' disabilities represent an important obstacle to accessing care, generating anxiety and concern in children and their families. Telemedicine has proven to be a promising instrument for improving pediatric patients' healthcare in several fields. By breaking down geographical and temporal barriers, telehealth may represent a valuable tool to implement in clinical practice, in order to improve patients' outcomes and quality of life. The aim of this narrative review is to provide an overview of the main nutritional issues in children with SNI, the potential implications of telemedicine in their management and the available evidence regarding the effects and benefits of telehealth.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Francesca Eletti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Jonabell Dolor
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, Milan, Italy
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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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.
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Affiliation(s)
| | - Hannah Walter
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Fiona Smith
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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Xu JC, Haider SA, Sharma A, Blumenfeld K, Cheng J, Mazzola CA, Orrico KO, Rosenow J, Stacy J, Stroink A, Tomei K, Tumialán LM, Veeravagu A, Linskey ME, Schwalb J. Telehealth in Neurosurgery: 2021 Council of State Neurosurgical Societies National Survey Results. World Neurosurg 2022; 168:e328-e335. [DOI: 10.1016/j.wneu.2022.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
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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.
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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
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5
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Kilipiris EG, Horn F, Kolnikova M, Ochoa JV, Matuskova O, Jelovac D, Stebel A. Parental Satisfaction from Telemedicine in the Follow-up of Children Operated for Craniosynostosis during COVID-19 Pandemic. Cleft Palate Craniofac J 2022; 60:562-568. [PMID: 35043707 PMCID: PMC10102827 DOI: 10.1177/10556656221074214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The current study aimed to evaluate the satisfaction level of parents from telemedicine use in the long-term follow-up of children operated for craniosynostosis during the COVID-19 pandemic. DESIGN A cross-sectional 9-question survey analysis using Qualtrics survey software. SETTING An institutional study carried out at a national, tertiary level academic center in the Slovak Republic. PATIENTS All patients operated for non-syndromic and syndromic craniosynostosis in our department, who participated in the virtual postoperative follow-up consultations from March 23, 2020, through July 2, 2021, were included in our series. They were enrolled 498 patients, with the parents of 256 children being responding to the survey. INTERVENTIONS The survey remained open until July 16, 2021, two weeks after the last virtual consultations. It was delivered to the parents by e-mail to generate closed 5-point Likert scale responses. RESULTS Overall, 72.3% of parents were satisfied with the telemedicine program, and 67.2% found it convenient. Collectively, 89.1% reported that the received instructions were helpful to them. However, only 18.7% of them answered that they would prefer telemedicine consultations in the future. CONCLUSION The results of this study showed a high satisfaction from the parents during the virtual follow-up of children operated for craniosynostosis. However, despite their positive experience with telemedicine, the vast majority of parents stated that they would prefer in-person visits in the future.
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Affiliation(s)
- Evangelos G Kilipiris
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Frantisek Horn
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Miroslava Kolnikova
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | | | - Olga Matuskova
- National Institute of Children's Diseases and Comenius University, Bratislava, Slovak Republic
| | - Drago Jelovac
- Clinic for Maxillofacial Surgery, School of Dentistry, 119082University of Belgrade, Belgrade, Serbia
| | - Adam Stebel
- 112816University Hospital with Polyclinic at F. D. Roosevelt, Banska Bystrica and Comenius University, Bratislava, Slovak Republic
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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.
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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
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7
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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.
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Affiliation(s)
- Sammy Le
- Concord Hospital, Sydney, New South Wales, Australia
| | - Arun Aggarwal
- Concord Hospital, Sydney, New South Wales, Australia
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8
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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.
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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
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9
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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.
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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
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Wright J, Elder T, Gerges C, Reisen B, Wright C, Jella T, Shah S, Yang G, Ngwenya LB, Wang V, Parr AM. A systematic review of telehealth for the delivery of emergent neurosurgical care. J Telemed Telecare 2021; 27:261-268. [PMID: 34006136 DOI: 10.1177/1357633x211015548] [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: 11/17/2022]
Abstract
INTRODUCTION In 2017, the American Association of Neurological Surgeons and Congress of Neurological Surgeons published a statement in support of adopting telemedicine technologies in neurosurgery. The position statement detailed the principles for use and summarised the active efforts at the time to address barriers that limited expansion of use, such as reimbursement, liability, credentialing and patient confidentiality. The primary aim of this systematic literature review was to identify the available published literature on the application of telemedicine to neurosurgical patient care, with a specific focus on neurotrauma and emergent neurological conditions. METHODS This Level II systematic review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Following removal of duplicates, 359 studies were yielded from database query. Following application of inclusion and exclusion criteria, 78 articles were identified for full-text review. RESULTS Full-text screening yielded a total of 11 studies for the final analysis. The study interventions took place in seven unique countries and included both developed and developing nations. Data captured spanned the years 1997 to 2019. The total cumulative number of patients who received neurosurgical telemedicine consultations captured by this review was 37,224. DISCUSSION This review of the literature suggests that telemedicine in emergent settings offers safe, feasible, and cost-reducing methods of increasing access to high acuity neurosurgical care and may serve to limit unnecessary inter-facility transfers. As infrastructure and regulatory guidelines continue to evolve, neurosurgical patients, both domestic and abroad, will benefit from improved access to expertise afforded by telemedicine technologies.
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Affiliation(s)
- James Wright
- Center for Spine Health, Cleveland Clinic Foundation, USA.,School of Medicine, Case Western Reserve University, USA
| | - Theresa Elder
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, USA
| | | | | | - Christina Wright
- Center for Spine Health, Cleveland Clinic Foundation, USA.,School of Medicine, Case Western Reserve University, USA
| | - Tarun Jella
- School of Medicine, Case Western Reserve University, USA
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati, USA
| | - George Yang
- Department of Neurosurgery, University of Cincinnati, USA
| | | | - Vincent Wang
- Department of Neurosurgery, Ascension Seton Brain and Spine Institute, USA
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, USA
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11
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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: 38] [Impact Index Per Article: 9.5] [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.
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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
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12
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Ferraris KP, Golidtum JP, Zuñiga BKW, Bautista MCG, Alcazaren JC, Seng K, Navarro JE. Recapitulating the Bayesian framework for neurosurgical outpatient care and a cost-benefit analysis of telemedicine for socioeconomically disadvantaged patients in the Philippines during the pandemic. Neurosurg Focus 2020; 49:E14. [DOI: 10.3171/2020.9.focus20695] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn the Philippines during recent months, a neurosurgical center that caters primarily to socioeconomically disadvantaged patients has encountered unprecedented changes in practice patterns brought about by the COVID-19 pandemic. In particular, the usual task of outpatient care has shifted to the telemedicine format, bringing along all of its attendant advantages and gargantuan challenges. The authors sought to determine the responsiveness of this telemedicine setup to the needs of their disadvantaged patients and explored the application of Bayesian inference to enhance the use of teleconsultation in daily clinical decision-making.METHODSThe authors used the following methods to assess the telemedicine setup used in a low-resource setting during the pandemic: 1) a cross-sectional survey of patients who participated in a medical consultation via telemedicine during the 16-week period from March 16, 2020, to July 15, 2020; 2) a cost-benefit analysis of the use of telemedicine by patients; and 3) a case illustration of a Bayesian approach application unique to the teleconsultation scenario.RESULTSOf the 272 patient beneficiaries of telemedicine in a 16-week period, 57 responded to the survey. The survey responses regarding neurosurgical outpatient care through telemedicine yielded high ratings of utility for the patients and their caregivers. According to 64% of respondents, the affordability of the telemedicine setup also prevented them from borrowing money from others, among other adverse life events prevented. There were realized financial gains on the part of the patients in terms of cost savings and protection from further impoverishment. The benefit-cost ratio was 3.51 for the patients, signifying that the benefits outweighed the costs. An actual teleconsultation case vignette was reported that is meant to be instructive and contributory to the preparedness of the neurosurgeon on the provider end of the service delivery.CONCLUSIONSTelemedicine holds promise as a viable and safe method for health service delivery during the pandemic. In the setting of a health system that is continually challenged by shortages of resources, this study shows that an effective telemedicine setup can come with high benefit-cost ratios and quality of care, along with the assurance of patient satisfaction. The potential for high-quality care can be enhanced by the inclusion of the Bayesian framework to the basic toolkit of remote clinical assessment. When confronted with choices in terms of differential diagnosis and tests, the rigor of a simple application of the Bayesian framework can minimize costs arising from uncertainties.
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Affiliation(s)
- Kevin Paul Ferraris
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Jared Paul Golidtum
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Brian Karlo W. Zuñiga
- 2Health Sciences Program, School of Science and Engineering, Loyola Schools, Ateneo de Manila University, Quezon City
| | - Maria Cristina G. Bautista
- 3Department of Economics, Finance and Accounting, Graduate School of Business, Professional Schools, Ateneo de Manila University, Makati; and
| | - Jose Carlos Alcazaren
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
| | - Kenny Seng
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
- 4Division of Neurosurgery, Department of Neurosciences, University of the Philippines–Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
| | - Joseph Erroll Navarro
- 1Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila
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13
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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]
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14
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Examining emergency department utilization in the post-foregut surgery patient. Surg Endosc 2020; 35:4563-4568. [PMID: 32804264 DOI: 10.1007/s00464-020-07877-x] [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: 04/08/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to examine emergency department (ED) utilization following minimally invasive foregut surgery and determine its impact on costs. Furthermore, we sought to determine their relationship to the index procedure, whether they are preventable, and describe strategies for decreasing unnecessary ED visits. METHODS A retrospective review was conducted for all patients undergoing foregut procedures from January 2018 through June 2019. ED utilization was examined from 0 to 90 days. The proportion of visits related to surgery, preventable visits, and median ED costs were compared between visits occurring 0-30 days (early) versus 31-90 days (delayed) postoperatively as well as occurring from 8 am to 5 pm versus 5 pm to 8 am. RESULTS Of 458 patients who underwent foregut surgery, 72.5% were female and the mean age was 60 years old. 92 patients (20%) presented to the ED within 90 days. Of these, 59 patients (64.1%) presented to the ED early versus 33 patients (35.9%) delayed. 56.5% of ED visits occurred during clinic hours. 56 (60.9%) ED visits were related to the procedure and 20 (35.7%) were preventable. The median ED return cost was $970. Early ED visits were significantly more likely to be related to surgery (72.9% vs 39.4%, p = 0.0016). There was no significant difference in the proportion of visits that were preventable (32.6% vs 46.2%, p = 0.3755) and ED return cost did not vary significantly ($995 vs $965, p = 0.43) between early and delayed visits. CONCLUSIONS ED visits are common after foregut surgery and represent a financial burden on healthcare. Most visits occur early and are more likely to be related to surgery. Importantly, more than one-third of ED visits related to surgery were preventable and most occurred during clinic hours on weekdays. Providers should consider implementation of strategies to improve outpatient utilization and decrease unnecessary ED visits.
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15
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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
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16
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LoPresti MA, McDeavitt JT, Wade K, Jahn LK, Viswanathan A, Fordis M, Yoshor D. Letter: Telemedicine in Neurosurgery—A Timely Review. Neurosurgery 2020; 87:E208-E210. [DOI: 10.1093/neuros/nyaa175] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Kristin Wade
- Administrative Departments Baylor Medicine Houston, Texas
| | - Laura K Jahn
- Administrative Departments Baylor Medicine Houston, Texas
| | | | - Michael Fordis
- Administrative Departments Baylor Medicine Houston, Texas
| | - Daniel Yoshor
- Department of Neurosurgery Baylor College of Medicine Houston, Texas
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17
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Onyia CU, Ojo OA. Letter to the Editor. Barriers to global surgery academic collaborations. J Neurosurg 2019; 130:1402-1403. [PMID: 30095332 DOI: 10.3171/2018.5.jns181337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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