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Cilia R, Dekker MCJ, Cubo E, Agoriwo MW. Delivery of Allied Health Therapies to People with Parkinson's Disease in Africa. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230262. [PMID: 38143371 DOI: 10.3233/jpd-230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson's disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context.
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Affiliation(s)
- Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Mary W Agoriwo
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Walker R, Fothergill-Misbah N, Kariuki S, Ojo O, Cilia R, Dekker MCJ, Agabi O, Akpalu A, Amod F, Breckons M, Cham M, Del Din S, Dotchin C, Guggsa S, Kwasa J, Mushi D, Nwaokorie FO, Park T, Rochester L, Rogathi J, Sarfo FS, Shalash A, Ternent L, Urasa S, Okubadejo N. Transforming Parkinson's Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project. BMC Neurol 2023; 23:373. [PMID: 37858118 PMCID: PMC10585779 DOI: 10.1186/s12883-023-03414-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic characteristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent. METHODS Transforming Parkinson's Care in Africa (TraPCAf) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and interventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profiles, with differing resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the field with vast experience in PD, jointly led by a UK-based and Africa-based investigator. DISCUSSION Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Existing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to affordable services and medication. This multi-site study will be the first of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN77014546 .
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Affiliation(s)
- R Walker
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - N Fothergill-Misbah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - S Kariuki
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - O Ojo
- College of Medicine, University of Lagos, Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - R Cilia
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M C J Dekker
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - O Agabi
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Akpalu
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana
| | - F Amod
- University of KwaZulu-Natal, Durban, South Africa
| | - M Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Cham
- Richard Novati Catholic Hospital, Sogakope, Ghana
| | - S Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Guggsa
- Addis Ababa University, Addis Ababa, Ethiopia
| | - J Kwasa
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - D Mushi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F O Nwaokorie
- Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - T Park
- Parkinson's Africa, Kingston upon Thames, UK
| | - L Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rogathi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - F S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - A Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - L Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - N Okubadejo
- College of Medicine, University of Lagos, Lagos, Nigeria
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Hamid E, Okengo K, Ayele BA, Gams Massi D, Ben Sassi S, Tibar H, El-Sadig SM, Mahoui S, Razafimahefa J, Kouame-Assouan AE, Ben-Adji D, Modeste LYT, Mohamed MH, Nsengiyumva N, Alwahchi WA, Neshuku SN, Ocampo C, Sakadi F, Caiano JB, Rodrigues Fortes A, Fall M, Ngwende GW, Hooker J, Charway-Felli A, Atadzhanov M, Carr J, Okubadejo NU, Shalash A. The Gaps and Prospects of Movement Disorders Education and Research in Africa: A Continental Survey. Mov Disord 2023; 38:178-184. [PMID: 36703239 DOI: 10.1002/mds.29313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Biniyam A Ayele
- Black Lion Specialized Hospital, Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Gams Massi
- Douala General Hospital, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Samia Ben Sassi
- Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Houyam Tibar
- Neurology B and Neurogenetics Department, Hôpital des Spécialités de Rabat, IBN SINA University Hospital of Rabat, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Sarah Misbah El-Sadig
- Soba University Hospital, Khartoum, Sudan.,Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Soulaimane Mahoui
- Faculty of Medicine of Algaiers, Béjaia, Algeria.,Specialized Hospital of Benaknoun Algiers, Ben Aknoun, Algeria
| | - Julien Razafimahefa
- Faculté Médecine Antananarivo/Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | | | - Muhyadin Hassan Mohamed
- Department of Neurology, East Africa University Hospital and EAU Faculty of Medicine and Health Sciences, Bosaso, Somalia
| | | | | | | | | | - Foksouna Sakadi
- University Hospital Center of National Reference, N'djamena, Chad
| | | | | | | | | | | | | | | | - Jonathan Carr
- Division of Neurology, Stellenbosch University, Cape Town, South Africa
| | - Njideka U Okubadejo
- Department of Medicine, College of Medicine, University of Lagos, Idi Araba, Nigeria
| | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Telemedicine in the Management of Parkinson's Disease: Achievements, Challenges, and Future Perspectives. Brain Sci 2022; 12:brainsci12121735. [PMID: 36552194 PMCID: PMC9775481 DOI: 10.3390/brainsci12121735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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Hess SP, Levin M, Akram F, Woo K, Andersen L, Trenkle K, Brown P, Ouyang B, Fleisher JE. The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home. BMC MEDICAL EDUCATION 2022; 22:506. [PMID: 35761252 PMCID: PMC9238152 DOI: 10.1186/s12909-022-03430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. METHODS Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0-10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. RESULTS Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. CONCLUSIONS A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.
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Affiliation(s)
- Serena P Hess
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Melissa Levin
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Chicago Medical School - Rosalind Franklin University, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| | - Faizan Akram
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Loyola University Chicago College of Arts and Sciences, 1032 W. Sheridan Road, Chicago, IL, 60660, USA
| | - Lauren Andersen
- Department of Physical Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
| | - Kristie Trenkle
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
- Department of Occupational Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
| | - Patricia Brown
- Memorycare Corporation, 634 Brooklyn Drive, Aurora, IL, 60502, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jori E Fleisher
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA.
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Tenison E, James A, Ebenezer L, Henderson EJ. A Narrative Review of Specialist Parkinson’s Nurses: Evolution, Evidence and Expectation. Geriatrics (Basel) 2022; 7:geriatrics7020046. [PMID: 35447849 PMCID: PMC9027740 DOI: 10.3390/geriatrics7020046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Extended nursing roles have existed since the 1940s. The first specialist nurse for Parkinson’s disease, a complex neurodegenerative disease, was appointed in the United Kingdom (UK) in 1989. A review was undertaken using MEDLINE and Cumulative Index to the Nursing and Allied Health Literature (CINAHL), relating to the role and evidence for Parkinson’s disease nurse specialists (PDNSs). PDNSs fulfil many roles. Trials of their effectiveness have failed to show a positive benefit on health outcomes, but their input appears to improve the wellbeing of people with Parkinson’s. Now embedded in the UK Parkinson’s multidisciplinary team, this care model has since been adopted widely, including successful dissemination of training to countries in Sub-Saharan Africa. The lack of evidence to support the benefit of PDNSs may reflect an insufficient duration and intensity of the intervention, the outcome measures selected or the need to combine PDNS input with other evidence-based interventions. Whilst the current evidence base for their effectiveness is limited, their input appears to improve subjective patient wellbeing and they are considered a vital resource in management. Better evidence in the future will support the development of these roles and may facilitate the application of specialist nurses to other disease areas.
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Affiliation(s)
- Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
- Correspondence:
| | - Alice James
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
| | - Louise Ebenezer
- Cwm Taf Morgannwg University Health Board, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK;
| | - Emily J. Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
- Older People’s Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
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Asukile M, Chishimba L, Chomba M, Mataa M, Mutete F, Mwendaweli N, Yumbe K, Zimba S, Habanyama G, Shampile S, Makupe A, Saylor D. Implementation of a Teleneurology Clinic in Zambia during the COVID-19 Pandemic. Ann Neurol 2022; 91:445-454. [PMID: 35150000 PMCID: PMC9082463 DOI: 10.1002/ana.26323] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the feasibility, acceptability, and benefits of a teleneurology clinic serving adults usually attending a neurology outpatient clinic in Lusaka, Zambia during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Televisits were offered to patients scheduled for neurology appointments between March and July 2020 using the telephone, WhatsApp video, or Zoom calls based on patient accessibility. Visit outcomes were documented, and patient and neurologist satisfaction surveys were completed. RESULTS Of 323 patients, 195 (60%) were reachable by telephone, 179 of these were alive, and 74% (133/179) of those alive agreed to a televisit. Stroke (30%), seizures (20%), and headache (16%) were the most common diagnoses seen via televisit. Most televisits (80%) were by telephone call, 14% by WhatsApp video call, and 6% by Zoom. Nearly one-third (30%) of the patients were stable and discharged from the clinic, 32% only required medication refills, and 19% required an in-person visit. Sixty patients (out of 85 reachable and 71% response rate) and 7 of 9 neurologists (78% response rate) completed satisfaction surveys. Neurologists reported greater assessment confidence with Zoom, but confidence was high for all modalities. Patients preferring televisits (75%, 45/60) noted reduced expense and time requirements, whereas those preferring in-person visits (22%, 13/60) cited the desire for physical examinations. Overall, 98% of patients and 100% of neurologists were satisfied with televisits. INTERPRETATION Teleneurology visits were acceptable and feasible for adults attending an outpatient neurology clinic in Zambia and their neurologists. They offer a promising supplement to in-person visits in resource-limited settings, even when video-conference capabilities and electronic medical records are absent. ANN NEUROL 2022;91:445-454.
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Affiliation(s)
- Melody Asukile
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | - Lorraine Chishimba
- Department of Internal MedicineUniversity of Zambia School of MedicineLusakaZambia
| | - Mashina Chomba
- Department of Internal MedicineUniversity of Zambia School of MedicineLusakaZambia
| | - Moses Mataa
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | - Frighton Mutete
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | - Naluca Mwendaweli
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
- Department of Internal MedicineUniversity of Zambia School of MedicineLusakaZambia
| | - Kunda Yumbe
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | - Stanley Zimba
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | - Gloria Habanyama
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
| | | | | | - Deanna Saylor
- Department of Internal MedicineUniversity Teaching HospitalLusakaZambia
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMD
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Ionescu A, de Jong PGM, Drop SLS, van Kampen SC. A scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity. J Am Med Inform Assoc 2021; 29:713-722. [PMID: 34966930 PMCID: PMC8922198 DOI: 10.1093/jamia/ocab271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. MATERIALS AND METHODS Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. RESULTS A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. CONCLUSIONS Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes.
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Affiliation(s)
- Alma Ionescu
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Stenvert L S Drop
- Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands,Corresponding Author: Stenvert L.S. Drop, MD, PhD, Division of Endocrinology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, Sp2430, PO Box 2060, Rotterdam 3000 CB, The Netherlands;
| | - Sanne C van Kampen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Shalash A, Spindler M, Cubo E. Global Perspective on Telemedicine for Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:S11-S18. [PMID: 33579872 PMCID: PMC8385495 DOI: 10.3233/jpd-202411] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Telemedicine programs are particularly suited to evaluating patients with Parkinson’s disease (PD) and other movement disorders, primarily because much of the physical exam findings are visual. Telemedicine uses information and communication technologies to overcome geographical barriers and increase access to healthcare service. It is particularly beneficial for rural and underserved communities, groups that traditionally suffer from lack of access to healthcare. There is a growing evidence of the feasibility of telemedicine, cost and time savings, patients’ and physicians’ satisfaction, and its outcome and impact on patients’ morbidity and quality of life. In addition, given the unusual current situation with the COVID-19 pandemic, telemedicine has offered the opportunity to address the ongoing healthcare needs of patients with PD, to reduce in-person clinic visits, and human exposures (among healthcare workers and patients) to a range of infectious diseases including COVID-19. However, there are still several challenges to widespread implementation of telemedicine including the limited performance of parts of the neurological exam, limited technological savvy, fear of loss of a personal connection, or uneasiness about communicating sensitive information. On the other hand, while we are facing the new wave of COVID-19 pandemic, patients and clinicians are gaining increasing experience with telemedicine, facilitating equity of access to specialized multidisciplinary care for PD. This article summarizes and reviews the current state and future directions of telemedicine from a global perspective.
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Affiliation(s)
- Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Meredith Spindler
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Esther Cubo
- Neurology Department, Hospital University of Burgos, Burgos, Spain
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Mbiydzenyuy NE, Pieme CA, Brown RE, Nguemeni C. Neuroscience education and research in Cameroon: Current status and future direction. IBRO Neurosci Rep 2021; 10:216-224. [PMID: 34179870 PMCID: PMC8211920 DOI: 10.1016/j.ibneur.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/22/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Neurological disorders comprise 20% of hospital admissions in Cameroon. The burden of neurological disorders is increasing, especially in children and the elderly. However, there are very few neurologists, psychiatrists, gerontologists and neuropsychologists trained in the treatment of neurological disorders in Cameroon and there are very few facilities for training in basic and clinical neuroscience. Although non-governmental organizations such as the International Brain Research Organization (IBRO), International Society of Neurochemistry (ISN), and Teaching and Research in Natural Sciences for Development (TReND) in Africa have stepped in to provide short training courses and workshops in neuroscience, these are neither sufficient to train African neuroscientists nor to build the capacity to train neuroscience researchers and clinicians. There has also been little support from universities and the government for such training. While some participants of these schools have managed to form collaborations with foreign researchers and have been invited to study abroad, this does not facilitate the training of neuroscientists in Cameroon. Moreover, the research infrastructure for training in neuroscience remains limited. This is reflected in the low research output from Cameroonian universities in the field. In this review, we describe the burden of neurological disorders in Cameroon and outline the outstanding efforts of local scientists to develop the discipline of neuroscience, which is still an emerging field in Cameroon. We identify key actionable steps towards the improvement of the scientific capacity in neuroscience in Cameroon: (1) develop targeted neuroscience training programs in all major universities in Cameroon; (2) implement a thriving scientific environment supported by international collaborations; (3) focus on the leadership and the mentorship of both local and senior neuroscientists; (4) develop public awareness and information of policy makers to increase governmental funding for neuroscience research. Improving scientific capacity to tackle the neurological diseases burden in Cameroon is urgent. Neuroscience schools and advocated researchers shape the future of neuroscience in Cameroon. Public-private partnerships are required for sustainable country impact of neuroscience schools.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Department of Basic Medical Science, School of Medicine, Copperbelt University, Ndola, Zambia
| | | | - Richard E Brown
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carine Nguemeni
- Department of Neurology, University Hospital of Würzburg, Germany
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11
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Suarez-Cedeno G, Pantelyat A, Mils K, Murthy M, Alshaikh J, Rosenthal L, Bang J, Moukheiber E. Movement Disorders Virtual Fellowship Training in Times of Coronavirus Disease 2019: A Single-Center Experience. Telemed J E Health 2021; 27:1160-1165. [PMID: 33512273 DOI: 10.1089/tmj.2020.0419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the impact a global pandemic has had on a teaching movement disorders program, as well as its subsequent transition to telemedicine. Methods: In the midst of the coronavirus disease 2019 (COVID-19) pandemic, we transitioned our movement disorders fellowship program virtually over the course of a few days. Here we describe the parameters used for the telemedicine fellow supervised clinic visit over the course of 2 months. Fellow's input was obtained from a brief survey at the end of the experience. Faculty's experience was collected upon independent faculty discussions. We also summarize the challenges and advantages of this teaching experience and its downsides. Results: A total of 130 patients (102 follow-up and 28 new patients) were seen over 22 clinic days with any of our 3 fellows being supervised by 1 of the 6 attending physicians. The main challenges were related to technical difficulties and lack of portions of the examination such as tone, reflexes, and sensory testing. The main advantages were related to increased patient access and a decrease in scheduling barriers. The overall satisfaction with the experience of the fellows was positive (69%). Conclusions: This sample shows the feasibility (despite lack of prior experience) of virtual clinical supervision of movement disorders fellows for follow-up and new complex patient encounters. This novel method for movement disorders training has implications for training locally, nationally, and internationally. Limitations and possible future directions such as the inclusion of nonsynchronous recordings and devices for tone and balance testing are also discussed.
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Affiliation(s)
- Gerson Suarez-Cedeno
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Kelly Mils
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maitreiyi Murthy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jumana Alshaikh
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liana Rosenthal
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jee Bang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emile Moukheiber
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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12
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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] [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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13
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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14
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Escobar AM, Gomez P, Ortiz J, Avila C, Medina R. An experience at a movement disorders center in Honduras. Parkinsonism Relat Disord 2019; 63:238-239. [DOI: 10.1016/j.parkreldis.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
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Hassan A, Dorsey ER, Goetz CG, Bloem BR, Guttman M, Tanner CM, Mari Z, Pantelyat A, Galifianakis NB, Bajwa JA, Gatto EM, Cubo E. Telemedicine Use for Movement Disorders: A Global Survey. Telemed J E Health 2018; 24:979-992. [DOI: 10.1089/tmj.2017.0295] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - E. Ray Dorsey
- Department of Neurology, Center for Health + Technology, University of Rochester Medical Center, Rochester, New York
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Caroline M. Tanner
- Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center, San Francisco, California
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada
- Johns Hopkins University, Baltimore, Maryland
| | | | | | - Jawad A. Bajwa
- Parkinson's, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Emilia M. Gatto
- Department of Neurology, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Esther Cubo
- Servicio de Neurología, Hospital Universitario Burgos, Burgos, Spain
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16
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Abstract
PURPOSE OF REVIEW Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. RECENT FINDINGS Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.
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17
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Cubo E, Doumbe J, López E, Lopez GA, Gatto E, Persi G, Guttman M. Telemedicine Enables Broader Access to Movement Disorders Curricula for Medical Students. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:501. [PMID: 29123943 PMCID: PMC5673687 DOI: 10.7916/d8708cxw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/28/2017] [Indexed: 12/01/2022]
Abstract
Background The impact of tele-education for movement disorders on medical students is unknown. The present study had three objectives. First, to create a tele-education program for medical students in regions with limited access to movement disorders curricula. Second, to analyze the feasibility, satisfaction, and improvement of medical knowledge. Third, to assess the main reasons of medical students for attending this course. Methods In 2016, a program was piloted in a low-middle income (Cameroon) and a middle-high income (Argentina) country. Medical students were offered a free movement disorder tele-education program (four medical schools in Argentina, and 1 medical school in Cameroon). Six real-time videoconferences covering hyperkinetic and hypokinetic movement disorders were included. Evaluations included attendance, pre- and post-medical knowledge, and satisfaction questionnaires. Results The study included 151 undergraduate medical students (79.4% from Argentina, 20.6% from Cameroon). Feasibility was acceptable with 100% and 85.7% of the videoconferences completed in Argentina and Cameroon, respectively. Attendance was higher in Argentina compared to Cameroon (75% vs. 33.1%). According to student reports, the topics and innovative educational environment were the main reasons for attendance. Both groups ranked satisfaction as moderate to high, and medical knowledge improved similarly in both countries. Discussion Tele-education can improve movement disorders knowledge in medical schools in high-middle and low-middle income countries lacking access to other educational opportunities.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | - Jacques Doumbe
- Neurology Department, Laquintinie Hospital, Douala, Cameroon
| | - Emiliano López
- Área Gestión de la Información y Conocimiento del Ceunite, University of Buenos Aires, Buenos Aires, Argentina
| | - Guadalupe A Lopez
- Área Gestión de la Información y Conocimiento del Ceunite, University of Buenos Aires, Buenos Aires, Argentina
| | - Emilia Gatto
- Instituto de Neurociencias, Buenos Aires, Argentina.,Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Gabriel Persi
- Instituto de Neurociencias, Buenos Aires, Argentina.,Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
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18
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Sarfo FS, Adamu S, Awuah D, Ovbiagele B. Tele-neurology in sub-Saharan Africa: A systematic review of the literature. J Neurol Sci 2017; 380:196-199. [PMID: 28870567 DOI: 10.1016/j.jns.2017.07.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The rapid advancement in telecommunications on the African continent has opened up avenues for improving medical care to underserved populations. Although the greatest burden of neurological disorders is borne by Low-and-Middle Income Countries (LMICs) including sub-Saharan Africa (SSA), there is a profound paucity of neurologists to serve the population. Telemedicine presents a promising avenue for effective mobilization and utilization of the few neurologists in Africa. OBJECTIVE To systematically review the published literature on the use of telemedicine for improved care and outcomes for patients with neurological disorders in SSA. METHODS We searched PubMed and Cochrane library from January 1, 1980 to April 30, 2017 using the following keywords: "Telemedicine neurology Africa", "Teleneurology Africa", "Telestroke Africa", "Telerehabilitation Africa", "Telemedicine for epilepsy", "Telemedicine for Parkinson's disease Africa", "Telemedicine for dementia Africa", "Telehealth neurology Africa". Our inclusion criteria were randomized controlled trials, or case series that reported the utilization of telemedicine for care/education of individuals with neurological disorders in sub-Saharan Africa. RESULTS This search yielded 6 abstracts. By consensus between two investigators, 1 publication met the criteria for inclusion and further review. The one study identified utilized telemedicine for the purpose of improving education/knowledge of 16 doctors and 17 allied health professionals in Parkinson's disease (PD) in Cameroon. The study noted feasibility and satisfaction of participants with telemedicine as well as improved knowledge base of participants after the educational course but noted access to healthcare by patients did not change. No studies have evaluated the use of telemedicine for care of patients with neurological disorders. CONCLUSION The indication is that teleneurology may be feasible in SSA and studies are needed to assess feasibility, acceptability, efficacy, cost-effectiveness of this promising discipline of neurology in these resource-limited settings. We propose the setting up of trans‑continental, inter-regional, intra-regional, and national networks of neurologists to utilize teleneurology platforms to improve the reach of neurology care in SSA.
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Affiliation(s)
- Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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