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Siddiqui MS, Jimenez-Shahed J, Mari Z, Walter BL, De Jesus S, Panov F, Schwalb JM, York MK, Sarva H, Bertoni JM, Patel N, Zhang L, McInerney J, Rosenow JM. North American survey on impact of the COVID-19 pandemic shutdown on DBS care. Parkinsonism Relat Disord 2021; 92:41-45. [PMID: 34688029 PMCID: PMC8522505 DOI: 10.1016/j.parkreldis.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/14/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Background The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. Objective This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. Methods A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. Results Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. Conclusion The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.
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Affiliation(s)
- Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 1 Medical Center, Boulevard, Winston-Salem, NC, 27157, USA.
| | - Joohi Jimenez-Shahed
- Icahn School of Medicine at Mount Sinai, 1000 10th Ave., Suite 10c, New York, NY, 10019, USA.
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV, 89117, USA.
| | | | - Sol De Jesus
- Pennsylvania State University - Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2800 P.O. Box 859, Mail Code EC037, Hershey, PA, 17033, USA.
| | - Fedor Panov
- Mount Sinai Medical Center, 1000 10th Ave, Suite 10C, Brooklyn, NY, 11217, USA.
| | - Jason M Schwalb
- Henry Ford Medical Group, 6777 West Maple Road, West Bloomfield, MI, 48322, USA.
| | - Michele K York
- Baylor College of Medicine, 7200 Cambridge St, 9th Floor, Houston, TX, 77030, USA.
| | - Harini Sarva
- Weill Cornell Medicine, 428 E 72nd Street, STE 400, NY, NY, 10021, USA.
| | - John M Bertoni
- University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Neepa Patel
- Rush University Medical Center, 1725 West Harrison St. Suite 755, Chicago, IL, 60612, USA.
| | - Lin Zhang
- UCDavis, 4860 Y Street, ACC Building, Suite 3700, Sacramento, CA, 95817, USA.
| | - James McInerney
- Penn State Health, Milton S. Hershey Medical Center, Department of Neurosurgery, 30 Hope Drive, EC110, Hershey, PA, 17033, USA.
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine Department of Neurosurgery, 676 N St. Clair St, Suite 2210, Chicago, IL, USA.
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Candelari AE, Wojcik KD, Wiese AD, Goodman WK, Storch EA. Expert opinion in obsessive-compulsive disorder: Treating patients with obsessive-compulsive disorder during the COVID-19 pandemic. PERSONALIZED MEDICINE IN PSYCHIATRY 2021. [PMCID: PMC8012101 DOI: 10.1016/j.pmip.2021.100079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This commentary outlines assessment and treatment of patients with OCD during the era of COVID-19. The ongoing COVID-19 pandemic has required providers to make important considerations in treatment, including how usual risk is defined, as well as the use of personal protective equipment and telehealth services. These considerations have allowed providers to continue using both reliable and valid assessment procedures, as well as previously established and efficacious interventions. These adjustments create a context in which patient care for OCD remains fundamentally unchanged; however, important considerations should still be made because of the COVID-19 pandemic.
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Zhang C, Zhang J, Qiu X, Zhang Y, Lin Z, Huang P, Pan Y, Storch EA, Sun B, Li D. Deep Brain Stimulation for Parkinson's Disease During the COVID-19 Pandemic: Patient Perspective. Front Hum Neurosci 2021; 15:628105. [PMID: 33867957 PMCID: PMC8046912 DOI: 10.3389/fnhum.2021.628105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Public health guidelines have recommended that elective medical procedures, including deep brain stimulation (DBS) surgery for Parkinson’s disease (PD), should not be scheduled during the coronavirus (COVID-19) pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded. Methods We administered a newly developed phone questionnaire to 20 consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care. Results Most of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic. Conclusion The COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place.
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Affiliation(s)
- Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Jing Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xian Qiu
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Rupa R, Sass B, Morales Lema MA, Nimsky C, Voellger B. The Demand for Elective Neurosurgery at a German University Hospital during the First Wave of COVID-19. Healthcare (Basel) 2020; 8:healthcare8040483. [PMID: 33202727 PMCID: PMC7712298 DOI: 10.3390/healthcare8040483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Patients’ fear of the coronavirus disease 2019 (COVID-19) may delay inevitable treatment, putting potential benefits at risk. This single-center retrospective study aims to analyze temporal relationships of the first wave of the COVID-19 pandemic in Germany with the number of patients who sought and received elective neurosurgical treatment at a German university hospital. Methods: Daily outpatient numbers (ON) and elective procedures (EP) were recorded at our department between 1 January 2020 and 30 June 2020 (baseline: between 1 January 2019 and 30 June 2019). In patients who received EP, we recorded indication, outcome, and length of stay (LOS). Moving averages of ON (MAON) and of EP were calculated. Data on governmental action taken in response to the pandemic and on coronavirus-positive cases in Germany (CPCG) were superimposed. Exponential and arc tangent curves (ATC) were fitted to the absolute numbers of CPCG. Phase shifts were estimated, and Spearman’s rank correlation coefficient, rho, was calculated between the 2020 MAON and the derivative function of the fitted ATC (DFATC). Wilcoxon rank sum served as statistical test. Significance was assumed with p values of less than 0.05. Results: ON were significantly decreased in April 2020 as compared to April 2019 (p = 0.010). A phase shift between the German lockdown, the DFATC, and the decrease in MAON was not detected, while a phase shift of 10 days between the DFATC and the subsequent increase in MAON was detected. The DFATC was significantly negatively correlated (rho = −0.92, p < 0.0001) to the MAON until 31 March 2020, and, when shifted by 10 days, the DFATC was significantly negatively correlated (rho = −0.87, p < 0.0001) to the MAON from 01 April 2020. EP (p = 0.023), including the subset of non-oncological EP (p = 0.032), were significantly less performed in the first half of 2020 as compared to the first half of 2019. In March and April 2020, we conducted significantly more EP due to motor deficits (p = 0.0267, and less), visual disturbances (p = 0.0488), and spinal instability (p = 0.0012), and significantly less EP due to radicular pain (p = 0.0489), as compared to March and April 2019. LOS ranked significantly higher in patients who received cranial or spinal EP in March and April 2020 as compared to March and April 2019 (p = 0.0497). Significant differences in outcome were not observed. Conclusion: The beginning of the COVID-19 pandemic was correlated to an immediate and significant decrease in ON, and to a significant decrease in the number of EP performed. The subsequent increase in ON was delayed. Adequate measures to promote timely discharge of patients may become increasingly relevant as the pandemic proceeds. Although we observed a shift in the range of indications towards significantly more EP in patients with neurological deficiencies, care should be taken to avoid potentially deleterious delays of necessary elective treatment in future pandemic situations.
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Bara GA, Maciaczyk J. Should Deep Brain Stimulation Programs Be Halted During the COVID-19 Pandemic? Balancing the Risk of COVID-19 Infection Against the Survival Benefits of DBS. Neuromodulation 2020; 23:1222-1223. [PMID: 33181860 PMCID: PMC8721659 DOI: 10.1111/ner.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gregor A Bara
- Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jaroslaw Maciaczyk
- Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Kostick K, Storch EA, Zuk P, Blumenthal-Barby JS, Torgerson L, Yoshor D, Sheth S, Viswanathan A, Tarakad A, Jimenez-Shahed J, Goodman W, Lázaro-Muñoz G. Strategies to mitigate impacts of the COVID-19 pandemic on patients treated with deep brain stimulation. Brain Stimul 2020; 13:1642-1643. [PMID: 33017673 PMCID: PMC7530624 DOI: 10.1016/j.brs.2020.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kristin Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Peter Zuk
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sameer Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Arjun Tarakad
- Parkinson's Disease and Movement Disorders Center, Neurology, Movement Disorders, Baylor College of Medicine, Houston, TX, USA
| | - Joohi Jimenez-Shahed
- Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 10th Avenue, Suite 10C, New York, NY, 10019, USA
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Abstract
The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.
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Abstract
The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. Where face-to-face outpatient appointments have been cancelled, telemedicine can facilitate remote clinical consultations for new and follow-up epilepsy clinic patients while reducing the risk of infection to both patients and healthcare staff. First-seizure patients will need investigation pathways rationalised, while those with chronic epilepsy will need to have reliable alternative avenues to access clinical advice. At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.
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Affiliation(s)
- Guleed H Adan
- Institute of Systems, Molecular and Integrative Biology, Liverpool, UK and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - James W Mitchell
- Institute of Systems, Molecular and Integrative Biology, Liverpool, UK and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Tony Marson
- Institute of Systems, Molecular and Integrative Biology, Liverpool, UK and The Walton Centre NHS Foundation Trust, Liverpool, UK
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