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Duren JV, Puttgen HA, Martinez J, Murray NM. Poisson Modeling Predicts Acute Telestroke Patient Call Volume. Telemed J E Health 2024. [PMID: 38603583 DOI: 10.1089/tmj.2023.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Predicting the frequency of calls for telestroke and emergency teleneurology consultation is essential to prepare staffing for the immediate management of time-sensitive strokes. In this study, we evaluate Poisson distribution count data using a generalized linear model that predicts the volume of hourly telestroke calls over a 24-h period. Methods: We performed an Institutional Review Board approved retrospective cohort review of patients (January 2019-December 2022) from an institutional telestroke database at a large nonprofit multihospital system in the United States. All patients ≥18 years with a telestroke activation were included. Telestroke calls were quantified in frequency per day and analyzed by multiple time and date intervals. Poisson probability mass function (PMF) and cumulative distribution function (CDF) were used to predict call probabilities. A univariable Poisson regression model was fit to predict call volumes. Results: A total of 8,499 patients at 21 hospitals met inclusion criteria, the mean calls/day were 5.82 ± 2.54, and mean calls/day within each hour increment ranged from a minimum of 0.07 from 5 a.m. to 6 a.m. to a maximum of 0.45 from 7 p.m. to 8 p.m. The Poisson distribution was the most appropriate parametric probability model for these data, confirmed by the fit of the data to the expected distributions corresponding to the calculated means. The predicted probabilities of call frequencies by hour were calculated using the Poisson PMF and CDF; the probability of two or fewer calls/day by hour ranged from 98.9% to 99.9%. Univariable Poisson regression modeled an increase of future calls/day from 6.7 calls/day in July 2023 to 7.6 calls/day in October 2025. Conclusion: Poisson modeling closely fits telestroke call volumes, predicts the future volumes, and can be applied to any health system in which the mean call volume is known, which may inform the number of physicians needed to cover calls in real-time.
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Affiliation(s)
- Joe Van Duren
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - H Adrian Puttgen
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Julie Martinez
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
| | - Nick M Murray
- Department of Neurology, Intermountain Healthcare, Murray, Utah, USA
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Soltany KA, Segovia Molina R, Pappo C, Thomson S, Pring K, Cox S, Merrill R, Fishman E, Ambrosini A, Bognet G, Dodenhoff K, Munger Clary H, Strauss L, Graham R, Guzik AK, Strowd RE. Interest and Satisfaction of Telemedicine Use Among Ambulatory Neurology Patients in Western North Carolina During the COVID-19 Pandemic. Telemed J E Health 2024; 30:e1071-e1080. [PMID: 37883644 DOI: 10.1089/tmj.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Introduction: During the COVID-19 pandemic, care shifted from exclusively telemedicine to hybrid models with in-person, video, and telephone visits. We explored how patient satisfaction and visit preferences have changed by comparing in-person versus virtual visits (telephone and video) in an ambulatory neurology practice across three time points. Methods: Patients who completed a virtual visit in March 2020 (early-pandemic), May 2020 (mid-pandemic), and March 2021 (later-pandemic) were contacted. Patients were assessed for visit satisfaction and desire for future telemedicine. Univariate and multivariable logistic regression analysis was conducted to determine factors independently associated with video visit completion. Results: Four thousand seven hundred seventy-eight the number of ambulatory visits (n = 4,778) were performed (1,004 early; 1,265 mid; and 2,509 later); 1,724 patients (36%) assented to postvisit feedback; mean age 45.8 ± 24.4 years, 58% female, 79% white, and 56% with Medicare/Medicaid insurance. Patient satisfaction significantly increased (73% early, 79% mid, 81% later-pandemic, p = 0.008). Interest in telemedicine also increased for patients completing telephone visits (40% early, 50% mid, 59% later, p = 0.027) and video visits (52% early, 59% mid, 62% later, p = 0.035). Patients satisfied with telemedicine visits were younger (p < 0.001). White patients were more interested in future telemedicine (p = 0.037). Multivariable analysis showed that older patients (for each 1 year older), Black patients, and patients with Medicare/Medicaid were 2%, 45%, and 54% less likely to complete a video visit than telephone, respectively. Discussion: Patients, especially younger ones, have become more satisfied and more interested in hybrid care models during the COVID-19 pandemic. Barriers to conducting video visits persist for older, Black patients with Medicare or Medicaid insurance.
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Affiliation(s)
- K Alexander Soltany
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Reyna Segovia Molina
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carly Pappo
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sharon Thomson
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kelly Pring
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Siobhan Cox
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Merrill
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily Fishman
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexander Ambrosini
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gabby Bognet
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristen Dodenhoff
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lauren Strauss
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachel Graham
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Roy E Strowd
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Thawani SP, Minen MT, Grossman SN, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Stainman RS, Seixas A, Galetta SL, Balcer LJ, Busis NA. A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis. Telemed J E Health 2024; 30:841-849. [PMID: 37624656 DOI: 10.1089/tmj.2023.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background and Objectives: To better understand patients' and neurologists' assessments of their experiences regarding effectiveness of teleneurology encounters. Methods: Following an audio-video telehealth visit, neurologists asked patients to participate in a survey-based research study about the encounter, and then, the neurologists also recorded their own evaluations. Data were analyzed using standard quantitative and qualitative techniques for dichotomous and ordered-category survey responses in this cross-sectional analysis. Results: The study included unique encounters between 187 patients and 11 general neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of the patients (66.8%, 125/187) were female. One third (33.2%; 62) were patients new to the NYU Langone Health neurology practices. The most common patient chief complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Most patients (94.7%, 177/187) reported that the teleneurology encounter satisfied their needs. Patients and their neurologists agreed that the experience was effective in 91% (162/178) of encounters, regardless of whether the visit was for a new or established patient visit. Discussion: More than 90% of new and established patients and their neurologists agreed that teleneurology encounters were effective despite some limitations of the examination, the occasional need for patient assistance, and technical difficulties. Our results provide further evidence to justify and to expand the clinical use of teleneurology.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mia T Minen
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott N Grossman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Steven Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nina H Kim
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Elina Zakin
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Arielle M Kurzweil
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisena Hasanaj
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Neil A Busis
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
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Pierce Pucci JU, Soloria HM, Eye PG. Managing pediatric-onset multiple sclerosis in an austere setting: A case report. J Telemed Telecare 2024:1357633X241235701. [PMID: 38425268 DOI: 10.1177/1357633x241235701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.
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Affiliation(s)
| | - Heather M Soloria
- Department of Pediatrics, United States Naval Hospital Guam, Agana Heights, Guam
| | - Philip G Eye
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
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Peterson IS, Belter LT, Curry MA, Jarecki J. Telemedicine Use, Comfort, and Perceived Effectiveness in the Spinal Muscular Atrophy Community. Telemed J E Health 2024; 30:536-544. [PMID: 37566530 PMCID: PMC10877388 DOI: 10.1089/tmj.2023.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/13/2023] Open
Abstract
Background: Telemedicine may increase access to clinical care, particularly for mobility-limited communities such as the spinal muscular atrophy (SMA) community. However, much of the information on exposure to and attitudes toward telemedicine in neuromuscular diseases generally and SMA specifically is anecdotal or from focus groups. Gaining greater insight into patient perspectives is important, given telemedicine's potential for expanding access to care and growing use of telemedicine as a result of technology advances and the COVID-19 pandemic. Methods: Cure SMA collected information on the SMA community's exposure to, comfort with, and perceived effectiveness of telemedicine through its 2021 Community Update Survey. The final analytic sample represented 463 SMA-affected individuals, resident in the United States. Descriptive analyses, correlations, and ordered logit regression models were used to characterize the sample and identify predictors of exposure, comfort, and perceived effectiveness. Data were analyzed on weighted and unweighted bases to account for differences between the survey sample and the SMA community. Stratified analyses were used to compare self-completed surveys with caregiver-completed surveys. Results: 463 individuals answered questions about telemedicine. Approximately four-fifths of these respondents had used telemedicine previously. Factors predicting greater likelihood of prior telemedicine use included male gender, increasing income, having received drug treatment for SMA, history of mental illness, and having non-neutral views regarding comfort and perceived effectiveness of telemedicine. Several factors were also significant predictors of comfort with and perceived effectiveness of telemedicine. Stratified analyses indicated differences between self-completed and caregiver-completed surveys. Conclusion: These results can provide insight into patient experiences with telemedicine and can inform approaches to its use by health care professionals and clinical trial sponsors.
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Affiliation(s)
- Ilse S. Peterson
- Faegre Drinker Biddle and Reath, LLP, Washington, District of Columbia, USA
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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Yakubu AO, Nwachukwu C, Morakinyo O, Amuta AC, Olajide TN, Yakubu W, Fagbemi A, Ogunjimi L. Survey of Teleneurology Use by Neurologists in a Low-Middle Income Country. Cureus 2024; 16:e53430. [PMID: 38435227 PMCID: PMC10908425 DOI: 10.7759/cureus.53430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Background Teleneurology has been in existence for decades, and the COVID-19 pandemic has escalated its widespread usage. Neurological conditions are a leading cause of death globally, with sub-Saharan Africa bearing the bulk of the burden. Nigeria has few trained neurologists with the few available concentrated in an urban region. The adoption of teleneurology will help close this treatment gap. Despite evidence of its advantage, the adoption and state of teleneurology in Nigeria are very low. This study aims to determine the state and perception of teleneurology in the care of neurological patients in Nigeria and identify challenges to its wide usage. Methods The primary research method was a descriptive cross-sectional survey among 48 neurologists in Nigeria across the six geo-political zones of the country. Descriptive statistics such as frequency and percentage were used to summarize and present the results. Results A total of 48 neurologists participated, of which 46 (95.8%) specialized in general neurology. Videoconferencing is the most preferred means of telemedicine (24, 50%), followed by phone calls (16, 33.3%) and short messages (6, 12.5%). Three-quarters of the respondents are concerned about legal actions from telemedicine use. The majority (34, 70.9%) are not familiar with telemedicine tools, and 40 (83.3%) indicate low telemedicine seminar attendance. More than 90% (46) of neurologists believe that it is a viable approach and can save time and money. Barriers to telemedicine included the lack of incentive to use the technology (38, 79.2%), poor Internet connectivity (36, 75%), and the lack of exposure to telemedicine (36, 75%). Conclusions It is important to overcome the existing barrier to teleneurology in order to fully harness its potential in addressing the shortage of health professionals in Nigeria as most neurologists are open to using it.
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Affiliation(s)
- Aliu O Yakubu
- Old Age Psychiatry, University Hospital Wishaw, Wishaw, GBR
| | - Chibuike Nwachukwu
- Breast Surgery, St George's University Hospitals NHS Foundation Trust, London, GBR
| | | | - Augustine C Amuta
- Health and Wellness, Prince George's County Health Department, Upper Marlboro, USA
| | - Tobi N Olajide
- Medicine and Surgery, College Research and Innovation Hub, Ibadan, NGA
- Medicine, University of Ibadan, Ibadan, NGA
| | | | | | - Luqman Ogunjimi
- Pharmacology and Therapeutics, Obafemi Awolowo College of Health Science, Olabisi Onabanjo University, Sagamu, NGA
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Angelopoulou E, Kontaxopoulou D, Fragkiadaki S, Stanitsa E, Pavlou D, Papatriantafyllou J, Koros C, Dimovski V, Šemrov D, Papageorgiou SG. Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project. Geriatrics (Basel) 2023; 9:3. [PMID: 38247978 PMCID: PMC10801565 DOI: 10.3390/geriatrics9010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands. METHODS Data were derived from the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network", March 2021-March 2023. The survey included 10 questions (5-point Likert scale). RESULTS We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information. CONCLUSIONS The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Dionysia Kontaxopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Stella Fragkiadaki
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Dimosthenis Pavlou
- School of Topography and Geoinformatics, University of West Attica, Ag. Spyridonos Str., 12243 Aigalew, Greece;
| | - John Papatriantafyllou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Christos Koros
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Vlado Dimovski
- School of Economics and Business, University of Ljubljana, Kardeljeva ploščad 17, 1000 Ljubljana, Slovenia
| | - Darja Šemrov
- Faculty of Civic and Geodetic Engineering, University of Ljubljana, Jamova Cesta 2, 1000 Ljubljana, Slovenia
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
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Fereshtehnejad SM, Lökk J. Challenges of Teleneurology in the Care of Complex Neurodegenerative Disorders: The Case of Parkinson's Disease with Possible Solutions. Healthcare (Basel) 2023; 11:3187. [PMID: 38132077 PMCID: PMC10742857 DOI: 10.3390/healthcare11243187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Teleneurology is a specialist field within the realm of telemedicine, which is dedicated to delivering neurological care and consultations through virtual encounters. Teleneurology has been successfully used in acute care (e.g., stroke) and outpatient evaluation for chronic neurological conditions such as epilepsy and headaches. However, for some neurologic entities like Parkinson's disease, in which an in-depth physical examination by palpating muscles and performing neurologic maneuvers is the mainstay of monitoring the effects of medication, the yield and feasibility of a virtual encounter are low. Therefore, in this prospective review, we discuss two promising teleneurology approaches and propose adjustments to enhance the value of virtual encounters by improving the validity of neurological examination: 'hybrid teleneurology', which involves revising the workflow of virtual encounters; and 'artificial intelligence (AI)-assisted teleneurology', namely the use of biosensors and wearables and data processing using AI.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Edmond J. Safra Program in Parkinsonߣs Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Johan Lökk
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, 171 77 Stockholm, Sweden;
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Arumuganathan P, Adcock AK, Espinosa C, Findley S. Analysis of Telestroke Usage in Rural Critical Access Emergency Departments. Telemed J E Health 2023; 29:1828-1833. [PMID: 37205846 PMCID: PMC10714255 DOI: 10.1089/tmj.2022.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/30/2022] [Accepted: 01/04/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction: Telestroke is an effective strategy to increase appropriate stroke treatments among patients in resource-limited environments. Despite the well-documented benefits of telestroke, there is limited literature regarding its utilization. The purposes of this study are: (1) determine the percentage of potential stroke patients who generate a telestroke consult in rural critical access hospitals (CAHs) and (2) validate an electronic medical record (EMR)-derived report as a stroke screen. Methods: This retrospective chart review analyzed patients presenting between September 1, 2020 and February 1, 2021 to three CAHs. Visits with triage complaints suggesting acute ischemic stroke (AIS)/transient ischemic attack (TIA) were pooled for analysis using an EMR-derived report. Patients with confirmed AIS/TIA at discharge over this period were used to validate the EMR tool. Results: The EMR report pooled 252 possible AIS/TIA visits out of 12,685 emergency department visits for analysis. It had a specificity of 98.78% and sensitivity of 58.06%. Of the 252 visits, 12.7% met telestroke criteria and 38.89% received telestroke evaluation. Among these, a definite diagnosis of AIS/TIA was made in 92.86%. Of the remaining population who met criteria but didn't undergo consultation, 61.11% were diagnosed with AIS/TIA at discharge. Conclusion: This study provides novel characterization of stroke presentations and telestroke in rural CAHs. The EMR-derived report is a reasonable tool to concentrate potential AIS/TIA cases for review and resource allocation but is not sensitive enough to detect stroke as a stand-alone tool. The majority (56%) of eligible patients did not undergo telestroke consultation. Future studies are critical to further understand reasons contributing to this.
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Affiliation(s)
- Priya Arumuganathan
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Amelia K. Adcock
- Department of Neurology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Cristal Espinosa
- Department of Pediatric Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Scott Findley
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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10
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Rautell T, Niiranen M, Kuusisto H. Neurologists' Experiences and Attitudes Towards Teleneurology - Has Covid-19 Pandemic Made a Difference? Stud Health Technol Inform 2023; 309:210-214. [PMID: 37869844 DOI: 10.3233/shti230780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Teleneurology is an adaption of telemedicine used in neurological practices. Due to the widespread availability of the Internet and the development of information and communication technology (ICT), the use of teleneurology has increased in healthcare systems. This study aimed to determine how the Covid-19 pandemic has affected neurologists' attitudes towards teleneurology as well as their experiences of remote health care before and after the pandemic. The study was conducted as a web-based questionnaire sent to all Finnish neurologists. Two identical surveys were sent via e-mail from the National Neurology Society. The first survey was conducted in spring 2021 and second in spring 2023. The results show that the pandemic moderately increased the use of teleneurology, which enhanced neurologists' technical skills. Neurologists estimated that the use of teleneurology will continue to increase in the future.
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Affiliation(s)
| | - Marja Niiranen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Kuusisto
- Tampere University Hospital, Neurology, Tampere, Finland
- University of Eastern Finland, Kuopio, Finland
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11
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Hier DB, Carrithers MD, Rodríguez-Fernández JM, Kummer B. Editorial: The digitalization of neurology. Front Digit Health 2023; 5:1291110. [PMID: 37877125 PMCID: PMC10593442 DOI: 10.3389/fdgth.2023.1291110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- Daniel B. Hier
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
- Kummer Institute for Artificial Intelligence and Autonomous Systems, Missouri University of Science and Technology, Rolla, MO, United States
| | - Michael D. Carrithers
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Benjamin Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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Taheri Amin A, Faber J, Önder D, Kimmich O, Synofzik M, Ashizawa T, Klockgether T, Grobe‐Einsler M. Comparison of Live and Remote Video Ratings of the Scale for Assessment and Rating of Ataxia. Mov Disord Clin Pract 2023; 10:1404-1407. [PMID: 37772290 PMCID: PMC10525045 DOI: 10.1002/mdc3.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 09/30/2023] Open
Abstract
Background Video recordings of neurological examinations are often used in clinical trials. The Scale for Assessment and Rating of Ataxia (SARA) is a widely used clinical scale for ataxic patients. Despite several advantages of video ratings, correlation between live ratings and remote video-ratings has not been systematically investigated. Objective To compare live and remote video assessment of SARA. Methods Full SARA examinations of 69 patients with cerebellar ataxia were recorded on video. Live rating from site investigators were compared with remote video rating of three experienced ataxia clinicians using Bland-Altman analysis. Results Live and remote video ratings showed a high level of agreement for the complete score (bias = 0.09, with standard deviation = 2.00) and all single SARA items (bias <0.20 for all items). Conclusion Remote video ratings of SARA are a reliable means to assess severity of ataxia.
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Affiliation(s)
- Arian Taheri Amin
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Demet Önder
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Okka Kimmich
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative DiseasesHertie‐Institute for Clinical Brain Research and Center of Neurology, University of TübingenTübingenGermany
- German Center for Neurodegenerative Diseases (DZNE)TübingenGermany
| | - Tetsuo Ashizawa
- Houston Methodist Research Institute and Department of Neurology, Houston Methodist Neurological InstituteHoustonTexasUSA
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
| | - Marcus Grobe‐Einsler
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Department of NeurologyUniversity Hospital BonnBonnGermany
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13
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Poongkunran M, Ulep RD, Stuntz GA, Mitchell S, Gaines KJ, Vidal G, Chehebar D, Iwuchukwu IO, McGrade H, Mohammed AE, Zweifler RM. Diagnostic accuracy of telestroke consultation: a Louisiana based tele-network experience. Front Neurol 2023; 14:1141059. [PMID: 37333002 PMCID: PMC10273670 DOI: 10.3389/fneur.2023.1141059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background and purpose Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics. Methods We conducted a retrospective study of all the consultations in our Ochsner Health's TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis. Results Eight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR- were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749-0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3-2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis. Conclusion We report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.
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Affiliation(s)
- Mugilan Poongkunran
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Robin D. Ulep
- Ochsner Clinical School, New Orleans, LA, United States
| | | | - Sara Mitchell
- Ochsner Clinical School, New Orleans, LA, United States
| | - Kenneth J. Gaines
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Gabriel Vidal
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Daniel Chehebar
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | | | - Harold McGrade
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Alaa E. Mohammed
- Ochsner Center for Outcomes Research, Office of Epidemiology and Biostatistical Collaborations, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Richard M. Zweifler
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
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14
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Gudlavalleti ASV, Elliott JO, Asadi R. Factors Associated With No-Show to Ambulatory Tele-Video Neurology Visits. Cureus 2023; 15:e38947. [PMID: 37313074 PMCID: PMC10259680 DOI: 10.7759/cureus.38947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Telehealth visits (TH) have become an important pillar of healthcare delivery during the COVID pandemic. No-shows (NS) may result in delays in clinical care and in lost revenue. Understanding the factors associated with NS may help providers take measures to decrease the frequency and impact of NS in their clinics. We aim to study the demographic and clinical diagnoses associated with NS to ambulatory telehealth neurology visits. Methods We conducted a retrospective chart review of all telehealth video visits (THV) in our healthcare system from 1/1/2021 to 5/1/2021 (cross-sectional study). All patients at or above 18 years of age who either had a completed visit (CV) or had an NS for their neurology ambulatory THV were included. Patients having missing demographic variables and not meeting the ICD-10 primary diagnosis codes were excluded. Demographic factors and ICD-10 primary diagnosis codes were retrieved. NS and CV groups were compared using independent samples t-tests and chi-square tests as appropriate. Multivariate regression, with backward elimination, was conducted to identify pertinent variables. Results Our search resulted in 4,670 unique THV encounters out of which 428 (9.2%) were NS and 4,242 (90.8%) were CV. Multivariate regression with backward elimination showed that the odds of NS were higher with a self-identified non-Caucasian race OR = 1.65 (95%, CI: 1.28-2.14), possessing Medicaid insurance OR = 1.81 (95%, CI: 1.54-2.12) and with primary diagnoses of sleep disorders OR = 10.87 (95%, CI: 5.55-39.84), gait abnormalities (OR = 3.63 (95%, CI: 1.81-7.27), and back/radicular pain OR = 5.62 (95%, CI: 2.84-11.10). Being married was associated with CVs OR = 0.74 (95%, CI: 0.59-0.91) as well as primary diagnoses of multiple sclerosis OR = 0.24 (95%, CI: 0.13-0.44) and movement disorders OR = 0.41 (95%, CI: 0.25-0.68). Conclusion Demographic factors, such as self-identified race, insurance status, and primary neurological diagnosis codes, can be helpful to predict an NS to neurology THs. This data can be used to warn providers regarding the risk of NS.
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Affiliation(s)
| | - John O Elliott
- Department of Medical Education, OhioHealth, Columbus, USA
| | - Rafah Asadi
- Information Analytics, OhioHealth, Columbus, USA
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15
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McDonald M, Sevilis T, Boudreau M, Chen H, Boyd C, Avila A, Zaman M, Heath G, Gao L, Devlin T. The impact of race and ethnicity on acute telestroke care: A multistate experience. J Telemed Telecare 2023:1357633X231166028. [PMID: 37073123 DOI: 10.1177/1357633x231166028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Previous analyses suggest that ethnic and racial differences exist in acute stroke care including thrombolytic treatment rates. The current study evaluates ethnic or racial differences in acute stroke treatment within a multi-state telestroke program. METHODS Acute telestroke consultations seen in the Emergency Department in 203 facilities and 23 states were extracted from the Telecare by TeleSpecialistsTM database. Cases were reviewed for age, race, ethnicity, sex, last known normal time, arrival time, treatment with thrombolytic therapy, door-to-needle (DTN) time, and baseline National Institutes of Health Stroke Scale score. Race was defined as Black, White, or Other; ethnicity was defined as Hispanic or non-Hispanic. RESULTS The current study included 13,221 acute telestroke consultations consisting of 9890 White, 2048 Black, and 1283 patients classified as Other. A total of 934 patients were Hispanic and 12,287 patients were non-Hispanic. There were no statistically significant differences noted in thrombolytic treatment rates when comparing White (7.9%) patients with non-White patients (7.4%), p = 0.36, or comparing Black (8.1%) with non-Black patients (7.8%), p = 0.59. In addition, there were no statistically significant differences in treatment rates comparing Hispanic (6.3%) with non-Hispanic (7.9%) patients, p = 0.072. We noted no measurable differences in DTN times by race or ethnicity. CONCLUSIONS Contrary to previous reports, we failed to detect any significant differences in thrombolytic treatment rates and DTN times by race or ethnicity among stroke patients in a multistate telestroke program. These findings support the hypothesis that telestroke may mitigate racial and ethnic disparities which may be attributable to local variability in stroke procedures or access to healthcare.
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Affiliation(s)
| | | | | | | | | | | | | | - Gregory Heath
- University of Tennessee Chattanooga, Department of Health and Human Performance, Chattanooga, TN, USA
| | - Lan Gao
- University of Tennessee Chattanooga, Department of Mathematics Chattanooga, TN, USA
| | - Thomas Devlin
- Telespecialists, LLC, Fort Myers, FL, USA
- University of Tennessee Health Science Center, Department of Neurology, Memphis, TN, USA
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16
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Thawani SP, Minen MT, Stainman RS, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Galetta SL, Balcer LJ, Busis NA. Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters. Telemed J E Health 2023; 29:442-453. [PMID: 35834603 DOI: 10.1089/tmj.2021.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: To better understand neurologists' assessments of the experiences and effectiveness of teleneurology encounters. Methods: After completing an audio-video telehealth visit with verbally consenting patients, neurologists recorded their evaluations of the encounter. Data were analyzed using standard quantitative and qualitative techniques. Results: The study included unique encounters between 187 patients and 11 neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of patients (66.8%, 125/187) were female. One third of patients (33.2%; 62) were new patients. The most common patient complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Neurologists reported that they completed a virtual examination that provided enough information for medical decision-making in 94.9% of encounters (169/178, 9 missing responses). Fourteen of 25 examination elements important for medical decision-making could be performed sufficiently during virtual encounters. Examination assistance was needed for 16.4% (30/183) of patients, who were, on average, 17.3 years older than those who did not require assistance (62.9 years vs. 45.6 years, p = 0.0002). In 19.1% (34/178) of encounters, neurologists learned clinically relevant information from seeing patients in their homes. Neurologists' assessments of the effectiveness of encounters were not related to the presence (97.2%, 35/36 effective) or absence (95%, 134/141 effective) of technical difficulties (p = 0.5729) in 177 encounters (10 missing responses). Discussion: Neurologists reported that nearly 95% of teleneurology encounters were effective despite limitations of the virtual examination, occasional need for patient assistance, and technical difficulties.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Mia T Minen
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Friedman
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Nina H Kim
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Elina Zakin
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | | | - Lisena Hasanaj
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Steven L Galetta
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Neil A Busis
- Department of Neurology and NYU Langone Health, New York, New York, USA
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17
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Torres-Castaño A, Abt-Sacks A, Toledo-Chávarri A, Suarez-Herrera JC, Delgado-Rodríguez J, León-Salas B, González-Hernández Y, Carmona-Rodríguez M, Serrano-Aguilar P. Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review. Int J Environ Res Public Health 2023; 20:3694. [PMID: 36834388 PMCID: PMC9962592 DOI: 10.3390/ijerph20043694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
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Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - José Carlos Suarez-Herrera
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- UNITWIN/UNESCO Chair, Research, Planning and Development of Local Health Systems, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Janet Delgado-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Department of Philosophy I, University of Granada, 18071 Granada, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Montserrat Carmona-Rodríguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Tenerife, Spain
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18
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León-Salas B, González-Hernández Y, Infante-Ventura D, de Armas-Castellano A, García-García J, García-Hernández M, Carmona-Rodríguez M, Olazarán J, Dobato JL, Rodríguez-Rodríguez L, Trujillo-Martín MM. Telemedicine for neurological diseases: A systematic review and meta-analysis. Eur J Neurol 2023; 30:241-254. [PMID: 36256522 DOI: 10.1111/ene.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to systematically review the effectiveness and safety of telemedicine combined with usual care (in-person visits) compared to usual care for the therapeutic management and follow-up assessment of neurological diseases. METHODS The electronic databases MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched (June 2021). Randomized controlled trials (RCTs) on patients of any age with neurological diseases were considered. Two reviewers screened and abstracted data in duplicate and independently and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 2). When possible, pooled effect estimates were calculated. RESULTS Of a total of 3018 records initially retrieved, 25 RCTs (n = 2335) were included: 11 (n = 804) on stroke, four (n = 520) on Parkinson's disease, three (n = 110) on multiple sclerosis, two (n = 320) on epilepsy, one (n = 63) on dementia, one (n = 23) on spina bifida, one (n = 40) on migraine, one (n = 22) on cerebral palsy and one (n = 433) on brain damage. Types of telemedicine assessed were online visits (11 studies), tele-rehabilitation (seven studies), telephone calls (three), smartphone apps (two) and online computer software (two). The evidence was quite limited except for stroke. Compared to usual care alone, telemedicine plus usual care was found to improve depressive symptoms, functional status, motor function, executive function, generic quality of life, healthcare utilization and healthy lifestyle in patients in post-stroke follow-up. CONCLUSIONS Well-designed and executed RCTs are needed to confirm our findings on stroke and to have more scientific evidence available for the other neurological diseases.
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Affiliation(s)
- Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Aythami de Armas-Castellano
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Javier García-García
- Quality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Tenerife, Spain
| | - Miguel García-Hernández
- Teaching Unit of Family and Community Medicine 'La Laguna-Tenerife Norte', Primary Care Management of Tenerife, Canary Islands Health Service (SCS), Tenerife, Spain
| | - Montserrat Carmona-Rodríguez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.,Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Olazarán
- Neurology Service, Gregorio Marañón University Hospital, Madrid, Spain
| | - José Luis Dobato
- Neurology Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - María M Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
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19
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Cubo E, Delgado-López PD. Telemedicine in the Management of Parkinson's Disease: Achievements, Challenges, and Future Perspectives. Brain Sci 2022; 12. [PMID: 36552194 DOI: 10.3390/brainsci12121735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the global population grows, there is an increasing demand for neurologic consultation that prompts new ways to reach more patients. Telemedicine can provide an accessible, cost-effective, and high-quality healthcare services. OBJECTIVES In this article, we highlight recent developments, achievements, and challenges regarding outcomes, clinical care, tele-education, teletreatment, teleresearch, and cybersecurity for telemedicine applied to Parkinson´s disease (PD) and other neurological conditions. RESULTS A growing body of evidence supports the feasibility and effectiveness of telemedicine tools for PD and other movement disorders. Outcome variables regarding satisfaction and efficacy in clinical care and specific issues about education, research, and treatment are reviewed. Additionally, a specific legal framework for teleconsultation has been developed in some centers worldwide. Yet, the implementation of telemedicine is conditioned by the limitations inherent to remote neurological examination, the variable computer usage literacy among patients, and the availability of a reliable internet connection. At present, telemedicine can be considered an additional tool in the clinical management of PD patients. CONCLUSIONS There is an increasing use of remote clinical practice regarding the management of PD and other neurological conditions. Telemedicine is a new and promising tool aimed at special settings and subpopulations.
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20
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Rink JS, Froelich MF, Nour M, Saver JL, Szabo K, Hoyer C, Fassbender KC, Schoenberg SO, Tollens F. Lifetime economic potential of mobile stroke units in acute stroke care: A model-based analysis of the drivers of cost-effectiveness. J Telemed Telecare 2022:1357633X221140951. [PMID: 36484406 DOI: 10.1177/1357633x221140951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND PURPOSE To simulate patient-level costs, analyze the economic potential of telemedicine-based mobile stroke units for acute prehospital stroke care, and identify major determinants of cost-effectiveness, based on two recent prospective trials from the United States and Germany. METHODS A Markov decision model was developed to simulate lifetime costs and outcomes of mobile stroke unit. The model compares diagnostic and therapeutic pathways of ischemic stroke, hemorrhagic stroke, and stroke mimic patients by conventional care or by mobile stroke units. The treatment outcomes were derived from the B_PROUD and the BEST-mobile stroke unit trials and further input parameters were derived from recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. A lifetime horizon based on the US healthcare system was adopted to evaluate different cost thresholds for mobile stroke unit and the resulting cost-effectiveness. Willingness-to-pay thresholds were set at 1x and 3x gross domestic product per capita, as recommended by the World Health Organization. RESULTS In the base case scenario, mobile stroke unit care yielded an incremental gain of 0.591 quality-adjusted life years per dispatch. Mobile stroke unit was highly cost-effective up to a maximum average cost of 43,067 US dollars per patient. Sensitivity analyses revealed that MSU cost-effectiveness is mainly affected by reduction of long-term disability costs. Also, among other parameters, the rate of stroke mimics patients diagnosed by MSU plays an important role. CONCLUSION This study demonstrated that mobile stroke unit can possibly be operated on an excellent level of cost-effectiveness in urban areas in North America with number of stroke mimic patients and long-term stroke survivor costs as major determinants of lifetime cost-effectiveness.
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Affiliation(s)
- Johann S Rink
- Department of Radiology and Nuclear Medicine, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Mannheim, BW, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Mannheim, BW, Germany
| | - May Nour
- Departments of Neurology and Radiology, 21767Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Jeffrey L Saver
- Department of Neurology, UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristina Szabo
- Department of Neurology, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany, Mannheim, BW, Germany
| | - Carolin Hoyer
- Department of Neurology, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany, Mannheim, BW, Germany
| | - Klaus C Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Mannheim, BW, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, 36642University Medical Centre Mannheim, University of Heidelberg, Mannheim, Mannheim, BW, Germany
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21
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Muacevic A, Adler JR, Faheem F, Bhatti D, Kalia JS. Medical Education 4.0: A Neurology Perspective. Cureus 2022; 14:e31668. [PMID: 36545165 PMCID: PMC9762427 DOI: 10.7759/cureus.31668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Medical education faces a difficult challenge today; an exponential increase in knowledge and the rise and rise of disruptive technologies are making traditional education obsolete. As the world nears the era of Industry and Healthcare 4.0, the medical community needs to keep up and prepare physicians for a hyper-connected digital world. Virtual neurological care is poised to be at the forefront of care delivery claims, yet the virtual communication of neurological knowledge is still in its infancy. This increasing digitalization of care and education is both an opportunity and a challenge. With this paper, the authors aim to bridge the gap between technology and neurological education. After a thorough review of recent literature and assessing current trends, the authors propose that contemporary medical education must adhere to the following tenets: Hybrid, Mobile, Mixed-reality, Open Access, Collaborative, Peer-reviewed, Intelligent, Game-based, and Global. We identify and align education objectives with the needs of future digital neurologists. The authors also discuss real-world advances that are aligned to serve the next generation of patients and providers.
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22
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Abstract
Virtual care is here to stay. The explosive expansion of telehealth caused by the SARS-CoV-2 pandemic is more than a necessary measure of protection. The key drivers of this transition in healthcare delivery to a virtual setting are changes in patient behavior and expectations and societal attitudes, and prevailing technologies that are impossible to ignore. The younger population - Generation Z - is increasingly connected and mobile-first. We are heading to a world where we expect to see healthcare in general and neurology, in particular, delivered virtually. The medical community should prepare for this overhaul; proper implementation of virtual care from the ground up is the need of the hour. In an era of virtualization, it is up to the medical community to ensure a well-informed patient population, overcome cultural differences and build digital infrastructure with enhanced access and equity in care delivery, especially for the aging neurological patient population, which is not technologically savvy. Virtual care is a continuum of care that needs deeper integration at systematic levels. The design principles of a patient's journey need to be incorporated while simultaneously placing physician satisfaction with a better user experience at the center of implementation. In this paper, we discuss common challenges and pitfalls of virtual care implementation in neurology - logistical, technical, medicolegal, and those faced in incorporating health and medical education into virtual care - intending to provide solutions and strategies.
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Affiliation(s)
| | | | - Aisha Razzak
- University of Texas at Dallas, Richardson, TX, USA
| | - Junaid Siddiq Kalia
- Founder, NeuroCare.AI.,Editor-in-Chief, neurologypocketbook.com.,Founder, Institute of Health Innovation and Education
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23
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PJ J, AM T, RE S, LD S, R G, L B, C M, M E, EP P, J B, S K, C O, CT T, Guzik AK. Inpatient Telemedicine for Neurology Consultation at Satellite Hospitals: Patient and Provider Perspectives. Neurohospitalist 2022; 12:476-483. [PMID: 35755219 PMCID: PMC9214951 DOI: 10.1177/19418744221100364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Background and Purpose: Describe an inpatient teleneurology consultation service novel to our hospital system, and capture feedback from patients, ordering providers, and consulting neurologists. Methods: A single cohort of teleneurology consult patients was surveyed via telephone. Ordering and consulting providers completed online surveys. Quantitative survey data was reported using descriptive statistics and free-response survey data was summarized. Patient demographics and consult data were gathered via retrospective chart review. Results: Telephone survey was obtained from 25 of 53 patients receiving teleneurology consults from June 1-September 30, 2020. Patient-reported benefits included better understanding of condition (72%) and ability to remain close to home. Online surveys were completed by 11 ordering providers and by consulting neurologists on 20 telemedicine encounters. Ordering providers reported they were likely to use the service again (98.7%), agreed it added value to patient care (91%) and was valued by patients (82%), with concern for missed diagnosis (46%) and potential patient transfer (36%) without the service. In contrast, fewer consulting neurologists predicted need for transfer (5%) or missed diagnosis (10%) in the absence of teleneurology, though 20% indicated that length of stay may increase without the service. Conclusion: We confirm feasibility of an inpatient teleneurology service run by an academic medical center. Satisfaction was high among all key stakeholders, with few transfers to a tertiary care center. This service is valuable to patients, ordering providers, and potentially the hospital network, as a community based care model of neurological care, centered on the needs of the patient and hospitalist.
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Affiliation(s)
- Juneja PJ
- Department of Neurology, Columbia University, New York, NY, USA
| | - Tolczyk AM
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Strowd RE
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Strauss LD
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Graham R
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Burton L
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Michael C
- Wake Forest Baptist Health, Lexington Medical Center, Lexington, NC, USA
| | - Ezzeddine M
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Pharr EP
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Boggs J
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Kumar S
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - O’Donovan C
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Tegeler CT
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Amy K Guzik
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA
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24
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Wills AM, Pantelyat A, Espay A, Chan J, Litvan I, Xie T, Dale ML, Gunzler SA, Tartaglia MC, Fox SH, Rodriguez-Porcel F, Sharma M, Lang AE, Boxer AL, Golbe LI. A Modified Progressive Supranuclear Palsy Rating Scale for Virtual Assessments. Mov Disord 2022; 37:1265-1271. [PMID: 35363932 PMCID: PMC9232989 DOI: 10.1002/mds.28991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/20/2022] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The reliability of the Progressive Supranuclear Palsy Rating Scale (PSPRS) using teleneurology has not been assessed. OBJECTIVES To test whether removing items inadequately assessed by video would impact measurement of PSP severity and progression. METHODS We performed secondary analyses of two data sets: the phase 2/3 trial of Davunetide in PSP and a large single-center cohort. We examined two modifications of the PSPRS: (1) removing neck rigidity, limb rigidity, and postural stability (25 items; mPSPRS-25) and (2) also removing three ocular motor items and limb dystonia (21 items; mPSPRS-21). Proportional agreement relative to the possible total scores was measured using the intraclass correlation coefficient, compared to the original PSPRS baseline values and change over 6 and 12 months. We examined the ability of both scales to predict survival in the single-center cohort using proportional hazards models. RESULTS The mPSPRS-25 showed excellent agreement (0.99; P < 0.001) with the original PSPRS at baseline, 0.98 (P < 0.001) agreement in measuring change over 6 months, and 0.98 (P < 0.001) over 12 months. The mPSPRS-21 showed agreement of 0.94 (P < 0.001) with the original PSPRS at baseline, 0.92 (P < 0.001) at 6 months, and 0.95 (P < 0.001) at 12 months. Baseline and 6-month change in both modified scales were highly predictive of survival in the single-center cohort. CONCLUSIONS Modified versions of the PSPRS which can be administered remotely show excellent agreement with the original scale and predict survival in PSP. The mPSPRS-21 should facilitate clinical care and research in PSP via teleneurology. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anne-Marie Wills
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Correspondence to: Dr. Anne-Marie Wills, Assistant Professor of Neurology, Director of the CurePSP Center of Care, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alberto Espay
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - James Chan
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, UC San Diego, Department of Neurosciences, La Jolla, California, USA
| | - Tao Xie
- Movement Disorder Program, Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Marian L. Dale
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven A. Gunzler
- Parkinson’s and Movement Disorders Center, Neurological Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Rossy Progressive Supranuclear Palsy Centre, University of Toronto, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan H. Fox
- Edmond J. Safra Program in Parkinson’s Disease, Rossy Progressive Supranuclear Palsy Centre, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | | | - Mansi Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson’s Disease, Rossy Progressive Supranuclear Palsy Centre, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | | | - Lawrence I. Golbe
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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25
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Ghourchian S, Torres-Yaghi YA, Isaacson SH, Pagan F, Lyons KE, Nagle BJ, Patel S, Pahwa R. Movement Disorder Specialists Survey Regarding Use of Telemedicine During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1651-1657. [PMID: 35297666 DOI: 10.1089/tmj.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To assess the overall satisfaction level of movement disorder specialists using a virtual platform during the COVID-19 pandemic. Methods: This was a multicenter cross-sectional survey for a 6-month period during the beginning of the COVID-19 pandemic. Movement disorder specialists, who utilized telehealth visits from March 2020 to August 2020, were included. The study surveys, including provider's satisfaction with the care that they were able to provide and visit quality, were completed by the provider after each visit. Results: A total of 206 visits, provided by movement disorder specialists, were analyzed. Zoom was the most popular platform used for remote visits (70, 34%). A backup platform was not needed in the majority of movement disorder visits (171, 83%). The majority of physicians were very satisfied or satisfied with the care provided (72.9%) and visit quality (61%). Conclusions: The satisfaction level of specialists using telemedicine during COVID-19 was high despite having encounters with elderly patients with cognitive impairment or lacking advanced skills with technology.
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Affiliation(s)
- Shadi Ghourchian
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yasar A Torres-Yaghi
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kelly E Lyons
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian James Nagle
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sanskruti Patel
- Department of Neurology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Rajesh Pahwa
- Department of Neurology, Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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26
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Tropea TF, Fuentes A, Roberts Z, Spindler M, Yuan K, Perrone C, Do D, Jacobs D, Wechsler L. Provider Experience with Teleneurology in an Academic Neurology Department. Telemed J E Health 2022; 28:374-383. [PMID: 34077285 PMCID: PMC9022168 DOI: 10.1089/tmj.2021.0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teleneurology has become widely adopted during severe acute respiratory syndrome coronavirus 2 pandemic. However, provider impressions about the teleneurology experience are not well described. Methods: A novel questionnaire was developed to collect provider impressions about video teleneurology encounters. All providers in the University of Pennsylvania Health System (UPHS) Neurology Department (N = 162) were asked to complete a questionnaire after each video teleneurology patient encounter between April and August 2020. Individual patient and encounter-level data were extracted from the electronic medical record. Results: One thousand six hundred three surveys were completed by 55 providers (response rate of 10.12%). The history obtained and the ability to connect with the patient were considered the same or better than an in-person visit in almost all encounters. The quality of the physician-patient relationship was good or excellent in 93%, while the overall experience was the same as an in-person visit in 73% of visits and better in 12%. Sixty-eight percent of respondents reported that none of the elements of the neurological examination if performed in person would have changed the assessment and plan. Assessment of the visit as the same or better increased from 83% in April to 89% in July and 95% in August. Headache (91%), multiple sclerosis and neuroimmunology (96%), and movement disorder (89%) providers had the highest proportion of ratings of same or better overall experience and neuromuscular providers the lowest (60%). Conclusions: Provider impressions about the teleneurology history, examination, and provider-patient relationship are favorable in the majority of responses. Important differences emerge between provider specialty and visit characteristics groups.
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Affiliation(s)
- Thomas F. Tropea
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Fuentes
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zachary Roberts
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meredith Spindler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy Yuan
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Perrone
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Do
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dina Jacobs
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence Wechsler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Lawrence Wechsler, MD, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, 330 S. 9th St, Philadelphia, PA 19107, USA
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27
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Kummer BR, Agarwal P, Sweetnam C, Robinson-Papp J, Blank LJ, Katz Sand I, Naasan G, Palmese CA, Jimenez-Shahed J, Grant J, Patterson S, Navis A, Stein LK, Jetté N. Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System. Front Neurol 2022; 13:834708. [PMID: 35222258 PMCID: PMC8873082 DOI: 10.3389/fneur.2022.834708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patient groups traditionally affected by health disparities were less likely to use video teleneurology (TN) care during the initial COVID-19 pandemic surge in the United States. Whether this asymmetry persisted later in the pandemic or was accompanied with a loss of access to care remains unknown. METHODS We conducted a retrospective cohort study using patient data from a multicenter healthcare system in New York City. We identified all established pediatric or adult neurology patients with at least two prior outpatient visits between June 16th, 2019 and March 15th, 2020 using our electronic medical record. For this established pre-COVID cohort, we identified telephone, in-person, video TN or emergency department visits and hospital admissions for any cause between March 16th and December 15th, 2020 ("COVID period"). We determined clinical, sociodemographic, income, and visit characteristics. Our primary outcome was video TN utilization, and our main secondary outcome was loss to follow-up during the COVID period. We used multivariable logistic regression to model the relationship between patient-level characteristics and both outcomes. RESULTS We identified 23,714 unique visits during the COVID period, which corresponded to 14,170 established patients from our institutional Neurology clinics during the pre-COVID period. In our cohort, 4,944 (34.9%) utilized TN and 4,997 (35.3%) were entirely lost to follow-up during the COVID period. In the adjusted regression analysis, Black or African-American race [adjusted odds ratio (aOR) 0.60, 97.5%CI 0.52-0.70], non-English preferred language (aOR 0.49, 97.5%CI 0.39-0.61), Medicaid insurance (aOR 0.50, 97.5%CI 0.44-0.57), and Medicare insurance (aOR 0.73, 97.5%CI 0.65-0.83) had decreased odds of TN utilization. Older age (aOR 0.98, 97.5%CI 0.98-0.99), female sex (aOR 0.90 97.5%CI 0.83-0.99), and Medicaid insurance (aOR 0.78, 0.68-0.90) were associated with decreased odds of loss to follow-up. CONCLUSION In the first 9 months of the COVID-19 pandemic, we found sociodemographic patterns in TN utilization that were similar to those found very early in the pandemic. However, these sociodemographic characteristics were not associated with loss to follow-up, suggesting that lack of TN utilization may not have coincided with loss of access to care.
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Affiliation(s)
- Benjamin R. Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Clinical Informatics, Mount Sinai Health System, New York, NY, United States
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Chloe Sweetnam
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Leah J. Blank
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Clinical Informatics, Mount Sinai Health System, New York, NY, United States
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christina A. Palmese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jihan Grant
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shanna Patterson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laura K. Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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28
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Mishra VN, Pathak A, Chaurasia RN, Kumar A, Joshi D, Singh VK. Observations in a Virtual Telephone and WhatsApp Video-Enabled Neurology Clinic During Lockdown in Varanasi, India - A Preliminary Report. Neurol India 2021; 69:1234-1240. [PMID: 34747790 DOI: 10.4103/0028-3886.329546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Globally, social distancing has been practiced during the ongoing coronavirus disease 2019 (COVID-19) pandemic to prevent the transmission of the virus. One of the measures to ensure social distancing and restricting the movements has been national lockdown, to break the chain of transmission. Telemedicine is a cost-effective measure to provide medical services to remote underserved areas. Objective The present study aimed to evaluate the efficacy and acceptability of teleconsultation as an alternative option to in-person consultation in providing continued medical care for neurology patients during the national lockdown period of the COVID-19 pandemic. Materials and Methods The clinical demographic profile, frequency of different neurological disorders, and treatment details of the patients attending the teleneurology consultation (TNCO) outpatient department (OPD) at Sir Sunderlal Hospital (S.S.H.), Institute of Medical Sciences (I.M.S.), BHU, Varanasi, India, were recorded in a prespecified pro forma. Results A total of 1,567 patients attended the TNCO OPD over 90 days. The average patient attendance was 35 per day, and 72% were males. Out of these, 77% of patients were from the same district, and the majority of patients (68%) were regularly followed up in-person by the neurology OPD. The most common illness for consultation was epilepsy (19%) followed by low backache and stroke (18% each). The satisfaction rate among the patients with respect to teleservices was high (90%). Conclusion TNCO seems to be as effective as in-person OPD in the management of neurological disorders. During the lockdown due to the COVID-19 pandemic, avoiding physical visits through TNCO may reduce the spread of the virus. Parallel tele-OPD with routine OPD is a good option in the future.
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Affiliation(s)
- Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anand Kumar
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Bragin I, Cohen DT. Certified Examination Assistants in the Age of Telemedicine: A Blueprint Through Neurology. JMIR Med Educ 2021; 7:e28335. [PMID: 34612828 PMCID: PMC8529478 DOI: 10.2196/28335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/26/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
The optimal approach to a clinical physical examination via telemedicine is still being explored. The medical community has no standardized or widely followed criteria for telemedicine examinations, so a broad spectrum of approaches is used. Unfortunately, the need for telemedicine is outpacing physical examination validation research. Given that certain specialties have been using telemedicine longer than others, lessons from those specialties might aid in developing standardized protocols for telemedicine. Neurology has been at the forefront of telemedicine use, initially through stroke care and later in multiple subspecialties. We present a framework for optimizing the history taking and physical examination process via telemedicine based on our experience in neurology. This mainly includes remotely examining a patient unassisted or with an untrained assistant present on the patient side of the connection. We also discuss the need for trained, certified assistants to assist the off-site physician in history taking and physical examination. These certified assistants would be allied health professionals who perform high-quality cued patient examinations under direct physician supervision with no responsibility to diagnose or treat. This contrasts with the approach seen in advanced practice providers such as physician assistants and nurse practitioners who undergo years of training to diagnose and treat patients under supervision. This training process would serve as a stepping stone for the development of dedicated certification programs for neurology and other medical specialties; however, assessments of practical training, costs, implementation, and longitudinal quality are warranted.
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Affiliation(s)
- Ilya Bragin
- St. Luke's University Health Network, Bethlehem, PA, United States
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Dylan T Cohen
- St. Luke's University Health Network, Bethlehem, PA, United States
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
- SUNY Downstate Medical Center, Brooklyn, NY, United States
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Goyal T, Probasco JC, Gold CA, Klein JP, Weathered NR, Thakur KT. Neurohospitalist Practice and Well-Being During the COVID-19 Pandemic. Neurohospitalist 2021; 11:333-341. [PMID: 34567394 DOI: 10.1177/19418744211016691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose Neurohospitalists play an important role in, and have been variably affected by, the ongoing COVID-19 pandemic. In this study, we survey neurohospitalists to characterize practice changes and the impact of the pandemic on their well-being. Methods A 22-item survey was distributed to neurohospitalists through the Neurohospitalist Society and the American Academy of Neurology Neurohospitalist, Stroke & Vascular Neurology, and Critical Care & Emergency Neurology Sections. Results After 2 weeks of collection, 123 responses were received, with 57% of respondents practicing in academic settings, 23% in private practice, and 7% in community hospitals. A minority of neurohospitalists (8%) were redeployed to care for COVID-19 or non-COVID-19 medicine patients. The most common neurologic diagnoses they reported in COVID-19 patients were delirium (85%), cerebrovascular events (75%), and seizure (35%); however, most neurohospitalists (59%) had evaluated fewer than 10 patients with COVID-19. Respondents observed that fewer patients with unrelated neurological diseases were admitted to the hospital compared to before the pandemic. Neurohospitalists experienced changes in administrative (27%), educational (15%), and research duties (11%), and had overall worse well-being and work-life balance (77%). Conclusions The most common neurologic diagnoses seen in COVID-19 patients by neurohospitalists in this sample are delirium, cerebrovascular disease, and seizure. Though the majority of survey respondents reported not being primary frontline providers, they report key clinical and operational roles during the pandemic, and report worse well-being as compared to before the pandemic. Our data suggests that there are opportunities to improve neurohospitalists' experience through flexible work practices and providing family care support.
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Affiliation(s)
- Tarini Goyal
- Department of Neurology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY, USA
| | - John C Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua P Klein
- Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | | | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center and the NewYork-Presbyterian Hospital, New York, NY, USA
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Kühne Escolà J, Nagel S, Panitz V, Reiff T, Gutschalk A, Gumbinger C, Purrucker JC. Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine. J Clin Med 2021; 10:1956. [PMID: 34063203 DOI: 10.3390/jcm10091956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Managing acute ischemic stroke (AIS) in patients receiving treatment with vitamin K antagonists (VKA) or non-VKA oral anticoagulants (NOACs) is difficult and the challenge this poses for stroke telemedicine remains unexplored. Methods: We analyzed data from a random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017. Management of patients suffering AIS with and without prior oral anticoagulation treatment was characterized, including potential vs. actual treatment with intravenous thrombolysis (IVT) and reasons for withholding it. Results: n = 359 patients had suffered an AIS, of whom 63 (17.5%) were under treatment with oral anticoagulants (VKA, n = 24; NOAC, n = 39). Administration of IVT was more common in patients who had not received prior oral anticoagulation treatment (20.3% vs. 3.2%, p < 0.001). NOAC intake was the primary reason for withholding IVT in 37% of orally anticoagulated patients who were found potentially eligible for IVT. Furthermore, patients under oral anticoagulation tended to be transported to the comprehensive stroke center more often (23.8% vs. 13.9%, p = 0.056). Conclusions: AIS in patients on oral anticoagulation treatment is a frequent reason for telestroke consultation, and NOAC intake constitutes an important barrier to administering IVT.
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Kühne Escolà J, Nagel S, Verez Sola C, Doroszewski E, Jaschonek H, Gutschalk A, Gumbinger C, Purrucker JC. Diagnostic Accuracy in Teleneurological Stroke Consultations. J Clin Med 2021; 10:jcm10061170. [PMID: 33799590 PMCID: PMC7998723 DOI: 10.3390/jcm10061170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological diagnosis and hospital discharge diagnosis were compared. Diagnoses were then grouped into two main categories: cerebrovascular disease (CVD) and noncerebrovascular disease. Test characteristics were calculated. Results: Out of 1078 consultations, 52% (n = 561) had a final diagnosis of CVD. Patients with CVD could be accurately identified via teleneurological consultation (sensitivity 95.2%, 95% CI 93.2–96.8), but we observed a tendency towards false-positive diagnosis (specificity 77.4%, 95% CI 73.6–80.8). Characteristics of patients with a false-negative CVD diagnosis were similar to those of patients with a true-positive diagnosis, but patients with a false-negative CVD diagnosis had ischemic heart disease less frequently. In retrospect, one patient would have been considered a candidate for intravenous thrombolysis (0.2%). Conclusions: Teleneurological consultations are accurate for identifying patients with CVD, and there is a very low rate of missed candidates for thrombolysis. Apart from a lower prevalence of ischemic heart disease, characteristics of “stroke chameleons” were similar to those of correctly identified CVD patients.
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McCormick R, Estrada J, Whitney C, Hinrichsen M, Lee PT, Cohen AB, Schwamm L, Matiello M. Teleneurology Comprehensive Inpatient Consultations Expedite Access to Care and Decreases Hospital Length of Stay. Neurohospitalist 2021; 11:229-234. [PMID: 34163548 DOI: 10.1177/19418744211000951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose While the successful provision of telestroke care has been well documented in the literature, studies on the impact of comprehensive teleneurology service (TN) to hospital measures are lacking. We evaluated 3 traditional health services metrics of hospital performance: time from consult request to consult completion, inpatient length of stay (LOS), and the rate of patients transferred for tertiary care. Methods Medical records (n = 899) from 3 community hospitals and our TN consultation database were retrospectively reviewed during the 2 years before (n = 703, 3 hospitals) and 4 months (n = 2 hospitals) to 2 years (n = 1 hospital) after implementation (n = 196) of a TN program for routine and urgent consult requests. Consult order time, consult completion time, total length of stay and discharge disposition were compared across the pre-TN implementation group, which consisted of in-person consultations and the post-TN implementation group, which consisted of TN consultations only. Results After TN implementation, median length of stay decreased 28% (3.9 vs. 2.8 days, p < 0.0001) and median time from consult order to consult completion decreased by 74% across all diagnoses (5.8 vs. 1.5 hours, p < 0.0001). There were no significant differences in the percentage of patients discharged home (52.3% vs. 56.1%, p = 0.10) or transferred to tertiary care (6.1% to 9.2%, p = 0.10). Conclusions Implementation of TN program was associated with significant reductions in LOS and time to consultation completion without an increase in shunting of patients to more advanced facilities. Further research is warranted to confirm these findings in independent cohorts and other models of teleneurology delivery.
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Affiliation(s)
- Robert McCormick
- Department of Neurology, Boston Medical Center, Boston University, Boston, MA, USA
| | - Juan Estrada
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cynthia Whitney
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Hinrichsen
- Department of Medicine, North Shore Medical Center, Salem, MA, USA
| | - Patrick T Lee
- Department of Medicine, North Shore Medical Center, Salem, MA, USA
| | - Adam B Cohen
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lee Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo Matiello
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Eilam-Stock T, Shaw MT, Sherman K, Krupp LB, Charvet LE. Remote administration of the symbol digit modalities test to individuals with multiple sclerosis is reliable: A short report. Mult Scler J Exp Transl Clin 2021; 7:2055217321994853. [PMID: 33643663 PMCID: PMC7890734 DOI: 10.1177/2055217321994853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Symbol Digit Modalities Test (SDMT) is the gold standard for cognitive screening in multiple sclerosis (MS). Objective Due to the recent COVID-19 pandemic and the increased need for virtual clinical visits, we examined the reliability of remote administration of the SDMT vs. standard in-person administration to individuals with MS. Methods Pearson’s correlation analysis was performed between SDMT scores on the in-person and remote administrations. Results For n = 132 participants, remote and in-person SDMT scores were strongly correlated (r = .80, p = .000). Conclusion Remote administration of the SDMT is a reliable cognitive screening approach in MS.
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Affiliation(s)
| | - Michael T Shaw
- Departmernt of Psychology, Binghamton University, Binghamton, USA
| | | | | | - Leigh E Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, USA
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35
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Sharawat IK, Panda PK. Caregiver Satisfaction and Effectiveness of Teleconsultation in Children and Adolescents With Migraine During the Ongoing COVID-19 Pandemic. J Child Neurol 2021; 36:296-303. [PMID: 33170754 DOI: 10.1177/0883073820968653] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ongoing COVID-19 pandemic and the lockdown measures have forced clinicians across the world to look on telemedicine. Although migraine as such seems an ideal option for telemedicine, a systematic study reviewing feasibility, efficacy, and advantages of current advanced telecommunication technologies in children with migraine is lacking. METHODS Clinical details of telephonic consultations performed between March 25 and June 4, 2020, including migraine characteristics, analgesic/prophylactic drug regimens, headache frequency/severity/disability, compliance, drug-related/unrelated adverse effects and unavailability of drugs were recorded. Suitable change in the dose/commercial brand of drug regimen and the addition of new drugs were done as required. Voice call, text messages, picture/video messages, and all other possible measures were used to accumulate maximum clinical information in real time. Unless contacted for trivial reasons, most children were later followed up telephonically to ensure health care concern was resolved and to fill up one 6-item trichotomous quality control questionnaire. RESULTS A total of 146 telephone consultations were performed in 51 participants. Thirty-six patients were identified to have 42 significant clinical events (worsening clinical status/partial response to medications [18; 44%], drug-related adverse effects [10; 19%], unrelated systemic complaints [7; 13%], and worsening of headache due to stress/triggers [7; 13%]). In the rest of the patients, the query of the caregiver included concern regarding COVID-19-related symptoms. Twenty-nine children required increment in drug dose or addition of new drug or commercial brand. Around 90% of caregivers were satisfied with the quality of teleconsultation. CONCLUSION Teleconsultation is a feasible and efficacious option, with excellent caregiver satisfaction for children with migraine.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Agarwal M, Arushi A, Dhingra LS, Patel LJ, Agrawal S, Srivastava P, Tripathi M, Srivastava A, Bhatia R, Singh MB, Prasad K, Vibha D, Vishnu VY, Rajan R, Pandit AK, Singh RK, Gupta A, Radhakrishnan DM, Das A, Ramanujam B, Agarwal A, Elavarasi A. Patient Experience of a Neurology Tele-Follow-Up Program Initiated During the Coronavirus Disease 2019 Pandemic: A Questionnaire-Based Study. Telemed Rep 2021; 2:88-96. [PMID: 35720744 PMCID: PMC8989087 DOI: 10.1089/tmr.2020.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
Background: Teleneurology consultations can be highly advantageous since neurological diseases and disabilities often limit patient's access to health care, particularly in a setting where they need to travel long distances for specialty consults. Patient satisfaction is an important outcome assessing success of a telemedicine program. Materials and Methods: A cross-sectional study was conducted to determine satisfaction and perception of patients toward an audio call based teleneurology follow-up initiated during the coronavirus disease 2019 pandemic. Primary outcomes were satisfaction to tele-consult, and proportion of patients preferring telemedicine for future follow-up. Results: A total of 261 patients who received tele-consult were enrolled. Satisfaction was highest for domain technological quality, followed by patient-physician dialogue (PPD) and least to quality of care (QoC). Median (interquartile range) patient satisfaction on a 5-point Likert scale was 4 (3-5). Eighty-five (32.6%; 95% confidence interval 26.9-38.6%) patients preferred telemedicine for future follow-up. Higher overall satisfaction was associated with health condition being stable/better, change in treatment advised on tele-consult, diagnosis not requiring follow-up examination, higher scores on domains QoC and PPD (p < 0.05). Future preference for telemedicine was associated with patient him-/herself consulting with doctor, less duration of follow-up, higher overall satisfaction, and higher scores on domain QoC (p < 0.05). On thematic analysis, telemedicine was found convenient, reduced expenditure, and had better physician attention; in-person visits were comprehensive, had better patient-physician relationship, and better communication. Discussion: Patient satisfaction was lower in our study than what has been observed earlier, which may be explained by the primitive nature of our platform. Several variables related to the patients' disease process have an effect on patient satisfaction. Conclusion: Development of robust, structured platforms is necessary to fully utilize the potential of telemedicine in developing countries.
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Affiliation(s)
- Mudit Agarwal
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | - Arushi Arushi
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Appireddy R, Bendahan N, Chaitanya J, Shukla G. Virtual Care for Neurological Practice. Ann Indian Acad Neurol 2021; 23:587-591. [PMID: 33623255 PMCID: PMC7887478 DOI: 10.4103/aian.aian_415_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 crisis has worsened the pre-existing barriers to accessing neurological specialist care in Low and middle income countries. Telemedicine has been available for well over 2 decades but has not been widely adopted in LMIC's due to issues around cost, feasibility, infrastructure and regulation. Virtual care is an offshoot of traditional telemedicine leveraging the widely available internet enabled devices to connect patients with their healthcare providers. In this manuscript, we provide an overview of the virtual care, relevance to neurology and some guidance on implementing virtual care in an Indian context.
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Affiliation(s)
- Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nathaniel Bendahan
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jsk Chaitanya
- Consultant Intensivist, Royalcare Super Speciality Hospital, Coimbatore, Tamil Nadu, India
| | - Garima Shukla
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Adebayo PB, Oluwole OJ, Taiwo FT. COVID-19 and Teleneurology in Sub-Saharan Africa: Leveraging the Current Exigency. Front Public Health 2021; 8:574505. [PMID: 33569366 PMCID: PMC7868436 DOI: 10.3389/fpubh.2020.574505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/30/2020] [Indexed: 12/22/2022] Open
Abstract
Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural preparedness in sub-Saharan Africa. Currently, there is over 70% mobile phone penetration in most of the countries and virtually all of them have mobile internet services of different technologies and generations. Although the needed infrastructure is increasingly available, it should be improved upon. We have proposed the access, costs, ethics, and support (ACES) model as a bespoke, holistic strategy for the successful implementation and advancement of tele-neurology in sub-Saharan Africa.
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Affiliation(s)
- Philip Babatunde Adebayo
- Neurology Section, Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
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Wong A, Bhyat R, Srivastava S, Boissé Lomax L, Appireddy R. Patient Care During the COVID-19 Pandemic: Use of Virtual Care. J Med Internet Res 2021; 23:e20621. [PMID: 33326410 PMCID: PMC7822645 DOI: 10.2196/20621] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 01/27/2023] Open
Abstract
Virtual care, the use of videoconferencing technology to connect with patients, has become critical in providing continuing care for patients during the current COVID-19 pandemic. Virtual care has now been adopted by health care providers across the spectrum, including physicians, residents, nurse practitioners, nurses, and allied health care professionals. Virtual care is novel and nuanced compared to in-person care. Most of the health care providers who are delivering or expected to deliver virtual care have little to no prior experience with it. The nuances of virtual care involve regulatory standards, platforms, technology and troubleshooting, patient selection, etiquette, and workflow, all of which comprise critical points in the provision of health care. It is important to consistently deliver high-quality, equitable, and professional virtual care to inspire patients with the trust they need to continue follow-up of their care in these difficult times. We have been adopting virtual care in our clinical practice for over two years. In partnership with Canada Health Infoway, we have assembled a primer for virtual care that can serve as a guide for any health care provider in Canada and globally, with the goal of providing seamless transitions between in-person and virtual care.
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Affiliation(s)
- Andy Wong
- Division of Neurology, Queen's University, Kingston, ON, Canada
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40
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Baxter SL, Kuo DE, Robbins SL. Internal carotid artery aneurysm presenting as diplopia via telemedicine during COVID-19. J Telemed Telecare 2021; 28:296-300. [PMID: 33412986 PMCID: PMC7820513 DOI: 10.1177/1357633x20985392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.
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Affiliation(s)
- Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA.,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - David E Kuo
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Shira L Robbins
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
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41
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Stuart CM, Varatharaj A, Domjan J, Philip S, Galea I. Physical activity monitoring to assess disability progression in multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320975185. [PMID: 33343919 PMCID: PMC7727071 DOI: 10.1177/2055217320975185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Clinical outcome measurement in multiple sclerosis (MS) usually requires a physical visit. Remote activity monitoring (RAM) using wearable technology provides a rational alternative, especially desirable when distance is involved or in a pandemic setting. Objective To validate RAM in progressive MS using (1) traditional psychometric methods (2) brain atrophy. Methods 56 people with progressive MS participated in a longitudinal study over 2.5 years. An arm-worn RAM device measured activity over six days, every six months, and incorporated triaxial accelerometry and transcutaneous physiological variable measurement. Five RAM variables were assessed: physical activity duration, step count, active energy expenditure, metabolic equivalents and a composite RAM score incorporating all four variables. Other assessments every six months included EDSS, MSFC, MSIS-29, Chalder Fatigue Scale and Beck’s Depression Inventory. Annualized brain atrophy was measured using SIENA. Results RAM was tolerated well by people with MS; the device was worn 99.4% of the time. RAM had good convergent and divergent validity and was responsive, especially with respect to step count. Measurement of physical activity over one day was as responsive as six days. The composite RAM score positively correlated with brain volume loss. Conclusion Remote activity monitoring is a valid and acceptable outcome measure in MS.
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Affiliation(s)
- Charlotte M Stuart
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Aravinthan Varatharaj
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janine Domjan
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sheaba Philip
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Saliba-Gustafsson EA, Miller-Kuhlmann R, Kling SMR, Garvert DW, Brown-Johnson CG, Lestoquoy AS, Verano MR, Yang L, Falco-Walter J, Shaw JG, Asch SM, Gold CA, Winget M. Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation. J Med Internet Res 2020; 22:e24328. [PMID: 33245699 PMCID: PMC7732357 DOI: 10.2196/24328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology's ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. OBJECTIVE To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. METHODS Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. RESULTS Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient's technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. CONCLUSIONS Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.
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Affiliation(s)
- Erika A Saliba-Gustafsson
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Rebecca Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Samantha M R Kling
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Donn W Garvert
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Anna Sophia Lestoquoy
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Mae-Richelle Verano
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Laurice Yang
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jessica Falco-Walter
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jonathan G Shaw
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Steven M Asch
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Marcy Winget
- Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States
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Rosengard JL, Donato J, Ferastraoaru V, Zhao D, Molinero I, Boro A, Gursky J, Correa DJ, Galanopoulou AS, Hung C, Legatt AD, Patel P, Rubens E, Moshé SL, Haut S. Seizure control, stress, and access to care during the COVID-19 pandemic in New York City: The patient perspective. Epilepsia 2020; 62:41-50. [PMID: 33258109 PMCID: PMC7753328 DOI: 10.1111/epi.16779] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Objective Our epilepsy population recently experienced the acute effects of the COVID‐19 pandemic in New York City. Herein, we aimed to determine patient‐perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient‐perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. Methods We performed a cross‐sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID‐19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one‐time survey via telephone or secure online platform (REDCap). Results Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID‐19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID‐19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. Significance Of the nearly 20% of subjects who reported worsened seizure control during the COVID‐19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.
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Affiliation(s)
- Jillian L Rosengard
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jad Donato
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Victor Ferastraoaru
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Dan Zhao
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac Molinero
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Alexis Boro
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jonathan Gursky
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Daniel José Correa
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA
| | - Christine Hung
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Alan D Legatt
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Puja Patel
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Elayna Rubens
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Sheryl Haut
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
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Harper K, Roof M, Wadhawan N, Terala A, Turchan M, Bagnato F, Upender R, Pham H, Eoff B, Charles D. Vanderbilt University Medical Center Ambulatory Teleneurology COVID-19 Experience. Telemed J E Health 2020; 27:701-705. [PMID: 33216703 PMCID: PMC8215411 DOI: 10.1089/tmj.2020.0382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Telehealth has proliferated since the 1950s, but adoption and coverage of telehealth services for the U.S. public have been slow. In response to the coronavirus disease 2019 (COVID-19) pandemic, the federal government has implemented temporary policy changes that removed barriers and catalyzed the unprecedented adoption of telehealth. Methods: To assess ambulatory teleneurology satisfaction, we analyzed postvisit questionnaire data from patients and clinicians who completed teleneurology visits during the COVID-19 pandemic at Vanderbilt University Medical Center Department of Neurology (VUMC). Results: From March 18 to May 8, 2020, VUMC completed 3,935 teleneurology visits. More than 97% of patients were very highly or highly confident in the telehealth care they received, whereas almost 99% of clinicians were very likely or somewhat likely to recommend telehealth to other clinicians. Conclusions: Teleneurology satisfaction at VUMC has been positive, and going forward, we must advance upon this unprecedented adoption of telehealth and never revert to former restrictive policies.
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Affiliation(s)
- Kelly Harper
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mikayla Roof
- College of Arts and Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Nivan Wadhawan
- College of Arts and Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Ananya Terala
- College of Arts and Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Maxim Turchan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Francesca Bagnato
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raghu Upender
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Huong Pham
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryan Eoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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45
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Constanzo F, Aracena-Sherck P, Peña L, Marrugo M, Gonzalez J, Vergara G, Alvarado C. Characterization of the Teleneurology Patients at the Hospital Las Higueras de Talcahuano-Chile. Front Neurol 2020; 11:595577. [PMID: 33329347 PMCID: PMC7711163 DOI: 10.3389/fneur.2020.595577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Chile has a shortage of medical experts, including neurologists. The remote neurology program at Las Higueras Hospital in Talcahuano (HHT) was implemented in 2015 to decrease the number of patients waiting for their first appointment. Methods: This retrospective study analyzed a cohort of 2,904 ambulatory patients evaluated in the teleneurology program at the HHT between 2015 and 2019 who were referred from 16 primary and 3 tertiary healthcare centers. Results: Out of the 2,904 patients included in the study, 1,020 patients (35%) were male, and 1,884 (65%) were female. In total, 1,346 (46.0%) patients were under 60 years old (408 male and 938 female), and 1,558 (54%) were over 60 years old (612 male and 946 female). The patients were referred to a neurologist in the teleneurology program from different primary healthcare centers (93.5%) and tertiary healthcare centers (6.5%). The most common diseases diagnosed through teleneurology were, in decreasing order, headache (29.4%), Alzheimer's disease and other dementias (15.9%), and epilepsy (11.4%). From July 2018, we analyzed the patients' destination after the first teleneurology consultation. In the cohort of 634 patients who had their first consultation via the teleneurology program, 547 (86.3%) were instructed to continue follow-up via telemedicine. Conclusions: Data from this study show, for the first time in Chile, the significant contribution of the teleneurology program at the HHT to the diagnosis of a broad range of diseases in a substantial number of patients referred from primary and tertiary healthcare centers.
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Affiliation(s)
- Freddy Constanzo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Paula Aracena-Sherck
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
| | - Lorena Peña
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Mery Marrugo
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Jonathan Gonzalez
- Neurology Unit, Hospital Las Higueras, Talcahuano, Chile
- Medical Program in Adult Neurology, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Gerardo Vergara
- Unit of Teleprocesses, Hospital Las Higueras, Talcahuano, Chile
| | - Cristóbal Alvarado
- Department of Science, School of Medicine and Science, Universidad San Sebastián, Concepción, Chile
- Department of Basic Sciences, School of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
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Ali F, Hamid U, Zaidat O, Bhatti D, Kalia JS. Role of Artificial Intelligence in TeleStroke: An Overview. Front Neurol 2020; 11:559322. [PMID: 33117259 PMCID: PMC7576935 DOI: 10.3389/fneur.2020.559322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
Teleneurology has provided access to neurological expertise and state-of-the-art stroke care where previously they have been inaccessible. The use of Artificial Intelligence with machine learning to assist telestroke care can be revolutionary. This includes more rapid and more reliable diagnosis through imaging analysis as well as prediction of hospital course and 3-month prognosis. Intelligent Electronic Medical Records can search free text and provide decision assistance by analyzing patient charts. Speech recognition has advanced enough to be reliable and highly convenient. Smart contextually aware communication and alert programs can enhance efficiency of patient flow and improve outcomes. Automated data collection and analysis can make quality improvement and research projects quicker and much less burdensome. Despite current challenges, these synergistic technologies hold immense promise in enhancing the clinician experience, helping to reduce physician burnout while improving patient health outcomes at a lower cost. This brief overview discusses the multifaceted potential of AI use in telestroke.
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Affiliation(s)
- Faryal Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Umair Hamid
- Department of Neurology, University of Illinois, College of Medicine, Peoria, IL, United States
| | - Osama Zaidat
- Departments of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States
| | - Danish Bhatti
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Junaid Siddiq Kalia
- AINeuroCare, Dallas, TX, United States.,Clinical Strategy, VeeMed Inc., Roseville, CA, United States
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47
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Garg D, Dhamija RK. Teleneurorehabilitation for Parkinson's Disease: A Panacea for the Times to Come? Ann Indian Acad Neurol 2020; 23:592-597. [PMID: 33623256 PMCID: PMC7887501 DOI: 10.4103/aian.aian_566_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
Telemedicine is witnessing a rebirth due to the COVID-19 pandemic and the continuing need for limited-contact or contactless care in medicine. Telerehabilitation, an offshoot of telemedicine, is a valuable yet underexplored tool in the therapeutic armamentarium of patients with neurological conditions, particularly Parkinson's disease (PD). Although there is evidence in literature reporting the use of telerehabilitation and virtual reality-based services in providing rehabilitation to improve speech, swallowing, gait, and postural instability among persons with PD, the evidence is limited due to small patient numbers. Teleneurorehabilitation (TNR) is an underutilized strategy that may be as effective and perhaps more feasible and affordable among Indian PD patients and also allows sustained rehabilitation. In this article, we encapsulate the evidence on the utility and efficacy of TNR among persons with PD and call upon the neurology community to recognize and utilize the valuable asset that TNR may be for PD patients.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Harper KA, Butler EC, Hacker ML, Naik A, Eoff BR, Phibbs FT, Isaacs DA, Gallion SJ, Thomas EP, Scott JL, Ploucher S, Meystedt JC, McLeod ME, Charles PD. A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities. Clin Rehabil 2020; 35:589-594. [PMID: 33040604 DOI: 10.1177/0269215520963845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the performance of telehealth as a screening tool for spasticity compared to direct patient assessment in the long-term care setting. DESIGN Cross-sectional, observational study. SETTING Two long-term care facilities: a 140-bed veterans' home and a 44-bed state home for individuals with intellectual and developmental disabilities. SUBJECTS Sixty-one adult residents of two long-term care facilities (aged 70.1 ± 16.2 years) were included in this analysis. Spasticity was identified in 43% of subjects (Modified Ashworth Scale rating mode = 2). Contributing diagnoses included traumatic brain injury, spinal cord injury, birth trauma, stroke, cerebral palsy, and multiple sclerosis. MAIN MEASURES Movement disorders neurologists conducted in-person examinations to determine whether spasticity was present (reference standard) and also evaluated subjects with spasticity using the Modified Ashworth Scale. Telehealth screening examinations, facilitated by a bedside nurse, were conducted remotely by two teleneurologists using a three-question screening tool. Telehealth screening determinations of spasticity were compared to the reference standard determination to calculate sensitivity, specificity, and the area under the curve (AUC) in receiver operating characteristics. Teleneurologist agreement was evaluated using Cohen's kappa. RESULTS Teleneurologist 1 had a specificity of 89% and sensitivity of 65% to identify the likely presence of spasticity (n = 61; AUC = 0.770). Teleneurologist 2 showed 100% specificity and 82% sensitivity (n = 16; AUC = 0.909). There was almost perfect agreement between the two examiners at 94% (kappa = 0.875, 95% CI: 0.640-1.000). CONCLUSION Telehealth may provide a useful, efficient method of identifying residents of long-term care facilities that likely need referral for spasticity evaluation.
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Affiliation(s)
- Kelly A Harper
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaditi Naik
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Bryan R Eoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen J Gallion
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Esmeralda P Thomas
- Tennesse Department of Intellectual and Developmental Disabilities, Middle Tennessee Homes, Nashville, TN, USA
| | - Jim L Scott
- Tennesse Department of Intellectual and Developmental Disabilities, Middle Tennessee Homes, Nashville, TN, USA
| | - Shelby Ploucher
- Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Megan E McLeod
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Philip David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Lau SC, Bhattacharjya S, Fong MW, Nicol GE, Lenze EJ, Baum C, Hardi A, Wong AW. Effectiveness of theory-based digital self-management interventions for improving depression, anxiety, fatigue and self-efficacy in people with neurological disorders: A systematic review and meta-analysis. J Telemed Telecare 2020; 28:547-558. [PMID: 32954920 DOI: 10.1177/1357633x20955122] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION This study aimed to (a) review what theories have been applied to the development of digital self-management interventions for people with neurological disorders; (b) examine their effectiveness to improve depression, anxiety, fatigue and self-efficacy; and (c) identify the optimal mode of intervention delivery. METHODS Electronic databases (SCOPUS, MEDLINE, EMBASE, CINAHL, Cochrane Library and Clinicaltrials.gov) were searched. Two investigators independently screened studies and extracted data. Study quality and use of theory were also assessed. RESULTS A total of 944 studies were screened, and 16 randomised controlled trials were included. Theory-based digital self-management interventions were effective in reducing depression (standardised mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.04 to -0.49), anxiety (SMD = -0.88, 95% CI -1.54 to -0.21) and fatigue (SMD = -0.62, 95% CI -0.96 to -0.27) and in enhancing self-efficacy (SMD = 1.15, 95% CI 0.11-2.18). Cognitive-behavioural theory (CBT)-based interventions were effective in reducing depression (SMD = -0.81, 95% CI -1.22 to -0.39), anxiety (SMD = -1.15, 95% CI -1.85 to -0.44) and fatigue (SMD = -0.75, 95% CI -0.97 to -0.54) and in improving self-efficacy (SMD = 0.84, 95% CI 0.63-1.05), whereas social cognitive theory (SCT)-based interventions were effective in reducing depression (SMD = -0.73, 95% CI -1.17 to -0.28). Partially digital interventions were more effective than fully digital interventions. DISCUSSION Our findings support the use of theory to guide the development of digital self-management interventions to increase intervention effectiveness. In particular, CBT-based interventions have a positive impact on depression, anxiety, fatigue and self-efficacy, whereas SCT-based interventions have a positive impact on depression.
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Affiliation(s)
- Stephen Cl Lau
- Program in Occupational Therapy, Washington University School of Medicine, USA
| | | | - Mandy Wm Fong
- Department of Neurology, Washington University School of Medicine, USA
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, USA.,Department of Neurology, Washington University School of Medicine, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, USA
| | - Alex Wk Wong
- Program in Occupational Therapy, Washington University School of Medicine, USA.,Department of Neurology, Washington University School of Medicine, USA.,Department of Psychiatry, Washington University School of Medicine, USA
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50
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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