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Jones EC, Kummer BR, Wilkinson JR. Teleneurology and Artificial Intelligence in Clinical Practice. Continuum (Minneap Minn) 2024; 30:904-914. [PMID: 38830075 DOI: 10.1212/con.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT As teleheath becomes integrated into the practice of medicine, it is important to understand the benefits, limitations, and variety of applications. Telestroke was an early example of teleneurology that arose from a need for urgent access to neurologists for time-sensitive treatments for stroke. It made a scarce resource widely available via video conferencing technologies. Additionally, applications such as outpatient video visits, electronic consultation (e-consult), and wearable devices developed in neurology, as well. Telehealth dramatically increased during the COVID-19 pandemic when offices were closed and hospitals were overwhelmed; a multitude of both outpatient and inpatient programs developed and matured during this time. It is helpful to explore what has been learned regarding the quality of telehealth, disparities in care, and how artificial intelligence can interact with medical practices in the teleneurology context.
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Tanhehco YC, Alsammak M, Chhibber V, Ibeh N, Li Y, Stephens LD, Noland DK, Wu DW, Zantek ND, DeChristopher PJ, Martin MCS, Lu W, Wehrli G. Apheresis practice variation during the COVID-19 pandemic: Results of a survey. J Clin Apher 2024; 39:e22109. [PMID: 38634419 DOI: 10.1002/jca.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic affected healthcare delivery across all specialties including apheresis. To describe the changes in apheresis service practices that occurred during the pandemic, the American Society for Apheresis (ASFA) Apheresis Medicine Attending Physician Subcommittee conducted a survey study. STUDY DESIGN AND METHODS A 32-question survey was designed and distributed to 400 ASFA physician members on September 7, 2022. Attending physicians responded to questions about whether and how apheresis service practices changed during the COVID-19 pandemic compared with the time period prior to the pandemic in terms of: (1) procedure types and volumes, (2) patient consultation workflow, and (3) the use of telemedicine. Descriptive analyses were reported as number and frequency of responses. RESULTS The survey response rate was 13.8% (55/400). Of these respondents, 96.4% (53/55) were attending physicians. The majority of respondents (42/53, 79.2%) indicated that the types of procedures performed during COVID-19 compared to pre-pandemic did not change. Most frequently for apheresis procedure volume, respondents reported: no change in their monthly inpatient volume (21/47, 44.7%) and a decrease in their monthly outpatient volume (28/46, 60.9%). Prior to COVID-19, 75.0% (30/40) of respondents performed consultations at bedside for inpatients and 67.4% (29/43) performed consultations at bedside for outpatients. Bedside consultations decreased in both settings during the pandemic but were still most frequently performed by attending physicians. At the same time, the use of telemedicine increased for 15.4% of survey respondents during COVID-19. CONCLUSION Some, but not all, respondents observed or made changes to their apheresis service during the COVID-19 pandemic. A subset of changes, such as increased utilization of telemedicine, may persist.
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Affiliation(s)
- Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mohamed Alsammak
- Blood Bank/Transfusion Medicine, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Vishesh Chhibber
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, New York, USA
| | - Nnaemeka Ibeh
- Department of Pathology and Laboratory Medicine, University of Texas Health Houston, Houston, Texas, USA
| | - Yanhua Li
- Transfusion Medicine, UMass Memorial Health and Departments of Medicine and Pathology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Daniel K Noland
- Department of Pathology, University of Texas Southwestern and Children's Health Dallas, Dallas, Texas, USA
| | - Ding Wen Wu
- Department of Pathology and Laboratories, New York University Langone Health, New York, New York, USA
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Phillip J DeChristopher
- Loyola University Health System, Department of Pathology and Laboratory Medicine, Maywood, Illinois, USA
| | | | - Wen Lu
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Center for Regenerative Biotherapeutics, Rochester, Minnesota, USA
| | - Gay Wehrli
- University Hospitals Samaritan Medical Center and Case Western Reserve University, Ashland, Ohio, USA
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Gotlieb E, Agarwal P, Blank LJ, Kwon CS, Muxfeldt M, Young JJ, Jette N. Disparities in Teleneurology Use in Medicaid Beneficiaries With Epilepsy by Practice Setting: Promoting Health Equity in Academic Centers. Neurology 2024; 102:e209348. [PMID: 38608210 DOI: 10.1212/wnl.0000000000209348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Medicaid beneficiaries in many American academic medical centers can receive care in a separate facility than those not covered by Medicaid. We aimed to identify possible disparities in care by evaluating the association between facility type (integrated faculty practice or Medicaid-only outpatient clinic) and telehealth utilization in people with epilepsy. METHODS We performed retrospective analyses using structured data from the Mount Sinai Health System electronic medical record data from January 2003 to August 2021. We identified people of all ages with epilepsy who were followed by an epileptologist after January 3, 2018, using a validated ICD-9-CM/10-CM coded case definition. We evaluated associations between practice setting and telehealth utilization, an outcome measure that captures the evolving delivery of neurologic care in a post-coronavirus disease 2019 era, using multivariable logistic regression. RESULTS We identified 4,586 people with epilepsy seen by an epileptologist, including Medicaid beneficiaries in the Medicaid outpatient clinic (N = 387), Medicaid beneficiaries in the faculty practice after integration (N = 723), and non-Medicaid beneficiaries (N = 3,476). Patients not insured by Medicaid were significantly older (average age 40 years vs 29 in persons seen in Medicaid-only outpatient clinic and 28.5 in persons insured with Medicaid seen in faculty practice [p < 0.0001]). Medicaid beneficiaries were more likely to have drug-resistant epilepsy (DRE), with 51.94% of people seen in Medicaid-only outpatient clinic, 41.63% of Medicaid beneficiaries seen in faculty practice, and 37.2% of non-Medicaid beneficiaries having DRE (p < 0.0001). Medicaid outpatient clinic patients were less likely to have telehealth visits (phone or video); 81.65% of patients in the Medicaid outpatient clinic having no telehealth visits vs 71.78% of Medicaid beneficiaries in the faculty practice and 70.89% of non-Medicaid beneficiaries (p < 0.0001). In an adjusted logistic regression analysis, Medicaid beneficiaries had lower odds (0.61; 95% CI 0.46-0.81) of using teleneurology compared with all patients seen in faculty practice (p = 0.0005). DISCUSSION Compared with the Medicaid-only outpatient clinic, we found higher telehealth utilization in the integrated faculty practice with no difference by insurance status (Medicaid vs other). Integrated care may be associated with better health care delivery in people with epilepsy; thus, future research should examine its impact on other epilepsy-related outcomes.
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Affiliation(s)
- Evelyn Gotlieb
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Parul Agarwal
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Leah J Blank
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Churl-Su Kwon
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Maria Muxfeldt
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - James J Young
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
| | - Nathalie Jette
- From the Departments of Neurology (L.J.B., M.M., J.J.Y., N.J.), Population Health Science (P.A., L.J.B., N.J.), and Policy and Institute for Healthcare Delivery Science (P.A., L.J.B., N.J.), Icahn School of Medicine at Mount Sinai (E.G., P.A.), New York; Departments of Neurology, Neurosurgery, and Epidemiology, and the Gertrude H. Sergievsky Center (C.-S.K.), Columbia University, New York, NY; and Department of Clinical Neurosciences (N.J.), University of Calgary, AB, Canada
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McGinley M, Carlson JJ, Reihm J, Plow M, Roser M, Sisodia N, Cohen JA, Misra-Hebert AD, Lazar AA, Bove R. Virtual versus usual in-office care for multiple sclerosis: The VIRTUAL-MS multi-site randomized clinical trial study protocol. Contemp Clin Trials 2024; 142:107544. [PMID: 38657731 DOI: 10.1016/j.cct.2024.107544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/19/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) affects nearly 1 million people and is estimated to cost $85.4 billion in the United States annually. People with MS have significant barriers to receiving care and telemedicine could substantially improve access to specialized, comprehensive care. In cross-sectional analyses, telemedicine has been shown to be feasible, have high patient and clinician satisfaction, reduce patient costs and burden, and enable a reasonable assessment of disability. However, no studies exist evaluating the longitudinal impact of telemedicine care for MS. Here we describe the study protocol for VIRtual versus UsuAL In-office care for Multiple Sclerosis (VIRTUAL-MS). The main objective of the study is to evaluate the impact of telemedicine for MS care on: patient clinical outcomes, economic costs, patient, and clinician experience. METHODS This two-site randomized clinical trial will enroll 120 adults with a recent diagnosis of MS and randomize 1:1 to receive in-clinic vs. telemedicine care for 24 months. The primary outcome of the study is worsening in any one of the four Multiple Sclerosis Functional Composite 4 (MSFC4) measures at 24 months. Other study outcomes include patient and clinician satisfaction, major healthcare costs, Expanded Disability Status Scale, treatment adherence, and digital outcomes. CONCLUSION The results of this study will directly address the key gaps in knowledge about longitudinal telemedicine-enabled care in an MS population. It will inform clinical care implementation as well as design of trials in MS and other chronic conditions. TRIAL REGISTRATION NCT05660187.
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Affiliation(s)
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, and Economics Institute (CHOICE), University of Washington, Seattle, WA, USA
| | - Jennifer Reihm
- UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Megan Roser
- Cleveland Clinic Mellen Center, Cleveland, OH, USA
| | - Nikki Sisodia
- UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | | | - Anita D Misra-Hebert
- Department of Internal Medicine and Healthcare Delivery and Implementation Science Center, Cleveland Clinic, USA
| | - Ann A Lazar
- Division of Oral Epidemiology, Division of Biostatistics, UCSF, USA
| | - Riley Bove
- UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, 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] [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] [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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Krett JD, Salter A, Newsome SD. Era of COVID-19 in Multiple Sclerosis Care. Neurol Clin 2024; 42:319-340. [PMID: 37980121 PMCID: PMC10288315 DOI: 10.1016/j.ncl.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
The unprecedented scope of the coronavirus disease 2019 (COVID-19) pandemic resulted in numerous disruptions to daily life, including for people with multiple sclerosis (PwMS). This article reviews how disruptions in multiple sclerosis (MS) care prompted innovations in delivery of care (eg, via telemedicine) and mobilized the global MS community to rapidly adopt safe and effective practices. We discuss how our understanding of the risks of COVID-19 in PwMS has evolved along with recommendations pertaining to disease-modifying therapies and vaccines. With lessons learned during the COVID-19 pandemic, we examine potential questions for future research in this new era of MS care.
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Affiliation(s)
- Jonathan D Krett
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
| | - Amber Salter
- Section on Statistical Planning & Analysis, Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Scott D Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA.
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Lechner-Scott J, Agland S, Allan M, Darby D, Diamond K, Merlo D, van der Walt A. Managing cognitive impairment and its impact in multiple sclerosis: An Australian multidisciplinary perspective. Mult Scler Relat Disord 2023; 79:104952. [PMID: 37683558 DOI: 10.1016/j.msard.2023.104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/10/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
Cognitive impairment in multiple sclerosis (MS) affects approximately 40-70% of patients and can have varying degrees of severity. Even mild cognitive impairment can impact on quality of life and productivity. Despite this, patients are not routinely screened or monitored for cognitive impairment in Australia due to a range of issues, with time and space being the main limiting factors. This Australian multidisciplinary perspective provides recommendations on cognition management in Australia. It gives a broad overview of cognition in MS, advice on the screening and monitoring tools available to clinicians, and strategies that can be implemented in clinics to help monitor for cognitive impairment in patients with MS. We suggest a routine baseline assessment and multidomain cognitive battery in regular intervals; a change should trigger a thorough investigation of the cause.
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Affiliation(s)
- Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia; Hunter Medical Research Institute, New Lambton, NSW, Australia.
| | - Susan Agland
- MSSN John Hunter Hospital, Hunter New England Health, Australia
| | - Michelle Allan
- Multiple Sclerosis Nurse Consultant, Monash Health, Australia
| | - David Darby
- Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Keri Diamond
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, MSNI Service, Alfred Health, Melbourne, Australia
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9
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Choi SL, Carr D, Namkung EH. Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care? J Gerontol B Psychol Sci Soc Sci 2023; 78:1735-1746. [PMID: 37422799 DOI: 10.1093/geronb/gbad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVES Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use. METHOD Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects. RESULTS Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators. DISCUSSION We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.
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Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Deborah Carr
- Department of Sociology and Center for Innovation in Social Science, Boston University, Boston, Massachusetts, USA
| | - Eun Ha Namkung
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
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10
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Perron AE, Garg H, Gallagher S, Kennedy B, Oxborough S, Schultz E, Thielman G, Zhang Q. Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2023; 47:227-237. [PMID: 37725807 DOI: 10.1097/npt.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND PURPOSE Since the COVID-19 pandemic, the use and implementation of telehealth has expanded, with implementation moving ahead of best practice recommendations due to necessity. Telehealth has improved access and care coordination for patients with various neurologic conditions; however, information regarding therapeutic intensity, safety, and appropriateness is lacking. In 2021, the Academy of Neurologic Physical Therapy formed a Telehealth Taskforce to provide clinical and educational resources for its members and the neurologic physical therapy (PT) community. The purpose of this special interest article is to provide consensus-driven best practice resources developed by the Taskforce and describe the process of creating these resources to assist with telehealth implementation in neurologic PT practice, advocate for continued utilization, and shine light on opportunities for future research. SUMMARY OF KEY POINTS In this special interest article, we describe the process, challenges, and opportunities of developing and disseminating resources to educate, train, and support telehealth implementation in neurologic clinical practice. Four key strategies to facilitate telehealth implementation emerged: (1) increase knowledge of resources related to telehealth and mobile applications; (2) develop and disseminate evidence-based and consensus-based best practice recommendations for telehealth in neurologic PT; (3) provide future recommendations for integrating telehealth in PT, education, research, and clinical practice; and (4) encourage advocacy for inclusion of telehealth within the PT community. We explain the need to continue research and provide recommendations to expand telehealth research in neurologic clinical practice. RECOMMENDATIONS FOR CLINICAL PRACTICE This article highlights the potential and future of telehealth in neurologic PT practice. Our recommendations provide current clinical tools and resources for telehealth implementation following a knowledge-to-action framework and suggest areas for future research.Video Abstract available for more insights from the authors (see the Video, the Supplemental Digital Content, available at: http://links.lww.com/JNPT/A447).
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Affiliation(s)
- Aimee E Perron
- Massachusetts General Hospital Institute of Health Professions, Boston, and Genesis Rehabilitation Services, Andover, Massachusetts (A.E.P.); Office of Research and Sponsored Projects, Rocky Mountain University of Health Professions, Provo, Utah (H.G.); South Valley Physical Therapy, Denver, Colorado (S.G.); St Francis University, Loretto, Pennsylvania (B.K.); M Health Fairview Minneapolis, Minnesota (S.O.); Re+active Physical Therapy and Wellness, Los Angeles, California (E.S.); St Joseph's University, Philadelphia, Pennsylvania (G.T.); and Hawaii Pacific University, Honolulu, Hawaii (Q.Z.)
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11
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Altieri M, Capuano R, Bisecco A, d'Ambrosio A, Risi M, Cavalla P, Vercellino M, Annovazzi P, Zaffaroni M, De Stefano N, Stromillo ML, D'Amico E, Zanghì A, Buscarinu MC, Lanzillo R, De Luca G, Calabrese M, Lorefice L, Di Filippo M, Valentino P, Gajofatto A, Marfia GA, Fuiani A, Nociti V, Tedeschi G, Gallo A. Quality of care provided by Multiple Sclerosis Centers during Covid-19 pandemic: Results of an Italian multicenter patient-centered survey. Mult Scler Relat Disord 2023; 77:104870. [PMID: 37454568 DOI: 10.1016/j.msard.2023.104870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Covid-19 pandemic impacted on management of people with Multiple Sclerosis (pwMS). Level of satisfaction of pwMS regarding the care received by the staff of Multiple Sclerosis Centers (MSCs) during the pandemic was not fully investigated. In a large patient-centered multicenter study, the therapeutic adherence and quality of care of MSCs was assessed. METHODS In April-May 2021, an online survey was widespread by 16 Italian MSCs. Frequencies, percentages and/or means and standard deviations were calculated to describe the sample. ANOVAs were performed to evaluate the effect of sociodemographic and clinical variables on overall pwMS' rating of MSC assistance. RESULTS 1670 pwMS completed the survey (67.3% women). During the pandemic, 88% did not change their disease modifying therapy schedule, and 89.1% reached their MSCs with no or little difficulties. Even if only 1.3% of participants underwent a tele-health follow-up visit with their MSC staff, the 80.1% believed that tele-health services should be improved regardless of pandemic. 92% of participants were satisfied of how their MSC took charge of their needs; ANOVAs revealed an effect of disease duration on pwMS' level of satisfaction on MSCs management during the pandemic. CONCLUSIONS The results revealed an efficient MSCs response to Covid-19 pandemic and provided the basis for the implementing of tele-health services that would further improve the taking charge of patients, particularly those with longer disease, higher disability, and/or living far from their MSC.
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Affiliation(s)
- Manuela Altieri
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Capuano
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro d'Ambrosio
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Risi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Marco Vercellino
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Nicola De Stefano
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emanuele D'Amico
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Maria Chiara Buscarinu
- Dept. of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital-site, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Dept. of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, Policlinico SS. Annunziata, Chieti, Italy
| | - Massimiliano Calabrese
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Dept. of Medical Sciences and Public Health, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Paola Valentino
- Institute of Neurology, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alberto Gajofatto
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | | | - Aurora Fuiani
- Dept. of Neuroscience, Riuniti Hospital of Foggia, Foggia, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioacchino Tedeschi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Gallo
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Wilkinson J, Myers L, Daggy J, Martin H, Bastin G, Yang Z, Damush T, Narechania A, Schriber S, Williams LS. The VA National Teleneurology Program (NTNP): Implementing Teleneurology to Improve Equitable Access to Outpatient Neurology Care. J Gen Intern Med 2023; 38:887-893. [PMID: 37340272 PMCID: PMC10356709 DOI: 10.1007/s11606-023-08121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Telehealth is increasingly utilized in many healthcare systems to improve access to specialty care and better allocate limited resources, especially for rurally residing persons who face unique barriers to care. OBJECTIVES The VHA sought to address critical gaps in access to neurology care by developing and implementing the first outpatient National Teleneurology Program (NTNP). DESIGN Pre-post evaluation of intervention and control sites. PARTICIPANTS NTNP sites and VA control sites; Veterans completing an NTNP consult and their referring providers. INTERVENTION Implementation of the NTNP at participating sites. MAIN MEASURES NTNP and community care neurology (CCN) volume of consults before and after implementation; time to schedule and complete consults; Veteran satisfaction. KEY RESULTS In FY2021, the NTNP was implemented at 12 VA sites; 1521 consults were placed and 1084 (71.3%) were completed. NTNP consults were scheduled (10.1 vs 29.0 days, p < 0.001) and completed (44.0 vs 96.9 days, p < 0.001) significantly faster than CCN consults. Post-implementation, monthly CCN consult volume was unchanged at NTNP sites compared to pre-implementation (mean change of 4.6 consults per month, [95% CI - 4.3, 13.6]), but control sites had a significant increase (mean change of 24.4 [5.2, 43.7]). The estimated difference in mean change in CCN consults between NTNP and control sites persisted after adjusting for local neurology availability (p < 0.001). Veterans (N = 259) were highly satisfied with NTNP care (mean (SD) overall satisfaction score 6.3 (1.2) on a 7-point Likert scale). CONCLUSIONS Implementation of NTNP resulted in more timely neurologic care than care in the community. The observed significant increase in monthly CCN consults at non-participating sites during the post-implementation period was not seen at NTNP sites. Veterans were highly satisfied with Teleneurology care.
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Affiliation(s)
- Jayne Wilkinson
- Corporal Michael J Crescenz VAMC, Philadelphia, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Laura Myers
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA
| | - Joanne Daggy
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, USA
| | - Holly Martin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA
- Regenstrief Institute, Inc., USA, Indianapolis, USA
| | - Grace Bastin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, USA
| | - Teresa Damush
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA
- Regenstrief Institute, Inc., USA, Indianapolis, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Aditi Narechania
- Jesse Brown VAMC, Chicago, USA
- University of Illinois Chicago, Chicago, USA
- Northwestern University, Evanston, USA
| | - Steve Schriber
- Tibor Rubin VAMC, Long Beach, USA
- University of California, Irvine, USA
| | - Linda S Williams
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, USA.
- Regenstrief Institute, Inc., USA, Indianapolis, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis, USA.
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13
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van Ierssel J, O'Neil J, King J, Zemek R, Sveistrup H. Clinician Perspectives on Providing Concussion Assessment and Management via Telehealth: A Mixed-Methods Study. J Head Trauma Rehabil 2023; 38:E233-E243. [PMID: 36731011 DOI: 10.1097/htr.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine clinician perspectives regarding the use of telehealth for concussion assessment and management. SETTING A Pan-Canadian survey. PARTICIPANTS Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14). DESIGN Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design. MAIN OUTCOME MEASURES Survey : A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups : 10 open-ended questions explored survey results in more detail. RESULTS Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented. CONCLUSIONS From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.
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Affiliation(s)
- Jacqueline van Ierssel
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada (Drs van Ierssel and Zemek); School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada (Drs O'Neil, King, and Sveistrup); Bruyère Research Institute, Ottawa, Canada (Drs O'Neil and Sveistrup); and Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada (Dr Zemek)
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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] [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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15
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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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND 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] [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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16
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Iodice R, Aceto G, Ruggiero L, Cassano E, Manganelli F, Dubbioso R. A review of current rehabilitation practices and their benefits in patients with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104460. [PMID: 36535234 DOI: 10.1016/j.msard.2022.104460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination of the nerves of the central nervous system that results in patients progressively losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation therapy is an important aspect of care; assisting patients to regain or retain function and improve their physical, mental and social wellbeing. At present there is no current consistent model of care for MS, likely due to the variable symptom presentation. Various forms of rehabilitation therapy are available, and these include physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy. Contrary to previous understanding, exercise-based therapies have shown various benefits for patients with MS, and in addition to improving MS-related physical symptoms, have been shown to reduce the risk of developing cardiovascular disease and can improve cognitive function. Cognition rehabilitation therapy specifically focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation, which offers cognitive functioning benefits, and restorative rehabilitation, which offers memory benefits. Excitation therapies include cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy and these non-invasive techniques may improve patient's physical ability. Additionally, more novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation, both of which are expected to play progressively more prominent roles in the future of rehabilitation therapy. The structure of the care team has been found to impact patient outcomes, and both in- and out-patient care settings have been found to be beneficial, dependant on the patient's circumstances, with certain patients better suited to a particular setting. While a single point of care is recommended for patients, a multidisciplinary care team and regular reassessment is recommended to manage changing symptoms and ensure continuity of care. The importance of the critical components of rehabilitation have been identified, and these are of vital importance in achieving beneficial outcomes. These components include the patients' participation in the treatment, goal setting with a multidisciplinary care team, a guiding-light purpose for the patient, which focusses on recognizing their personal potential and obtaining improvements through a tailored plan. The final critical component of rehabilitation is the results measurement, which highlights the need for a quantifiable reduction in impairment and improvement in activity and participation. Overall, a lack of standardisation in outcome measurements makes comparison challenging. This is particularly important when comparing standard methods of care with more novel rehabilitation techniques. However, within the broad area of rehabilitation therapies, it is clear that patients with MS can benefit from rehabilitation practices; physically, mentally and socially.
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Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy.
| | - Gabriella Aceto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Emanuele Cassano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Italy
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17
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Buyukturkoglu K, Dworkin JD, Leiva V, Provenzano FA, Guevara P, De Jager PL, Leavitt VM, Riley CS. Brain volumetric correlates of remotely versus in-person administered symbol digit modalities test in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104247. [PMID: 36274283 DOI: 10.1016/j.msard.2022.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/25/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior studies in multiple sclerosis (MS) support reliability of telehealth-delivered cognitive batteries, although, to date, none have reported relationships of cognitive test performance to neural correlates across administration modalities. In this study we aimed to compare brain-behavior relationships, using the Symbol Digit Modalities Test (SDMT), the most reliable and sensitive cognitive measure in MS, measured from patients seen via telehealth versus in-person. METHODS SDMT was administered to individuals with MS either in-person (N=60, mean age=39.7) or remotely via video conference (N=51, mean age=47.4). Magnetic resonance imaging (MRI) data was collected in 3-Tesla scanners. Using 3-dimensional T1 images cerebral, cortical, deep gray, cerebral white matter and thalamic nuclei volumes were calculated. Using a meta-analysis approach with an interaction term for participant group, individual regression models were run for each MRI measure having SDMT scores as the outcome variable in each model. In addition, the correlation and average difference between In-person and Remote group associations across the MRI measures were calculated. Finally, for each MRI variable I2 score was quantified to test the heterogeneity between the groups. RESULTS Administration modality did not affect the association of SDMT performance with MRI measures. Brain tissue volumes showing high associations with the SDMT scores in one group also showed high associations in the other (r = 0.83; 95% CI = [0.07, 0.86]). The average difference between the In-person and the Remote group associations was not significant (βRemote - βIn-person = 0.14, 95% CI = [-0.04, 0.34]). Across MRI measures, the average I2 value was 14%, reflecting very little heterogeneity in the relationship of SDMT performance to brain volume. CONCLUSION We found consistent relationships to neural correlates across in-person and remote SDMT administration modalities. Hence, our study extended the findings of the previous studies demonstrating the feasibility of remote administration of the SDMT.
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Affiliation(s)
- Korhan Buyukturkoglu
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA.
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, NY, USA
| | - Victor Leiva
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Frank A Provenzano
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Pamela Guevara
- Department of Biomedical Engineering, Universidad de Concepción, Santiago, Chile
| | - Philip L De Jager
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
| | - Victoria M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, PH 18-324, New York, NY 10032, USA; The Center for Translational and Computational Neuroimmunology, NY, USA; Columbia University MS Center, NY, USA
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18
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Feldhacker DR, Jewell VD, Jung LeSage S, Collins H, Lohman H, Russell M. Telehealth Interventions Within the Scope of Occupational Therapy Practice: A Systematic Review. Am J Occup Ther 2022; 76:23960. [DOI: 10.5014/ajot.2022.049417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Importance: With the increasing use of telehealth, it is imperative to synthesize the existing evidence to examine the effectiveness of telehealth interventions and inform practitioners and reimbursement entities.
Objective: To examine the effectiveness of telehealth occupational therapy interventions across the lifespan, delivered either independently or as part of an interdisciplinary team.
Data Sources: MEDLINE, CINAHL, SAGE, PsycInfo, Cochrane Database of Systematic Reviews, OTseeker, and OT Search and hand searches of systematic reviews, relevant journals, and known occupational therapy telehealth research.
Study Selection and Data Collection: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened and appraised articles that included an occupational therapy intervention delivered via telehealth and that were peer reviewed, written in English, published between 2009 and 2019, and Levels 1b to 3b evidence.
Findings: Twenty full-text articles (8 Level 1b, 9 Level 2b, and 3 Level 3b) met the inclusion criteria. Strong strength of evidence supports the use of telehealth approaches for occupational therapy interventions for people with neurological and pain conditions. Moderate strength of evidence supports the use of telehealth interventions to support education outcomes. Low strength of evidence was found for other outcomes for children with developmental disorders and additional conditions.
Conclusions and Relevance: There is evidence to support that occupational therapy interventions delivered via telehealth are similarly effective as those delivered face-to-face, especially for neurological and pain conditions.
What This Article Adds: The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy’s scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions.
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Affiliation(s)
- Diana R. Feldhacker
- Diana R. Feldhacker, PhD, OTD, OTR/L, BCPR, is Program Director, Department Chair, and Assistant Professor, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Vanessa D. Jewell
- Vanessa D. Jewell, PhD, OTR/L, is Research Associate Professor, Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill
| | - Sadie Jung LeSage
- Sadie Jung LeSage, OTD, OTR/L, is Occupational Therapist, Monkey Mouths LLC, Hurst, TX
| | - Haley Collins
- Haley Collins, OTD, OTR/L, is Occupational Therapist, Milestone Pediatric Therapy Services, Denver, CO
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Marion Russell
- Marion Russell, OTD, MOTR/L, SCFES, is Assistant Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Yu AYX, Penn J, Austin PC, Lee DS, Porter J, Fang J, Redelmeier DA, Kapral MK. Telemedicine use and outcomes after transient ischemic attack and minor stroke during the COVID-19 pandemic: a population-based cohort study. CMAJ Open 2022; 10:E865-E871. [PMID: 36195342 PMCID: PMC9544239 DOI: 10.9778/cmajo.20220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to an increase in telemedicine use. We compared care and outcomes in patients with transient ischemic attack (TIA) or minor ischemic stroke before and after the widespread adoption of telemedicine in Ontario, Canada, in 2020. METHODS In a population-based cohort study using linked administrative data, we identified patients with TIA or ischemic stroke discharged from any emergency department in Ontario before the widespread use of telemedicine (Apr. 1, 2015, to Mar. 31, 2020) and after (Apr. 1, 2020, to Mar. 31, 2021). We measured care, including visits with a physician, investigations and medication renewal. We compared 90-day death before and after 2020 using Cox proportional hazards models, and we compared 90-day admission using cause-specific hazard models. RESULTS We identified 47 601 patients (49.3% female; median age 73, interquartile range 62-82, yr) with TIA (n = 35 695, 75.0%) or ischemic stroke (n = 11 906, 25.0%). After 2020, 83.1% of patients had 1 or more telemedicine visit within 90 days of emergency department discharge, compared with 3.8% before. The overall access to outpatient visits within 90 days remained unchanged (92.9% before v. 94.0% after; risk difference 1.1, 95% confidence interval [CI] -1.3 to 3.5). Investigations and medication renewals were unchanged. Clinical outcomes were also similar before and after 2020; the adjusted hazard ratio was 0.97 (95% CI 0.91 to 1.04) for 90-day all-cause admission, 1.06 (95% CI 0.94 to 1.20) for stroke admission and 1.07 (95% CI 0.93 to 1.24) for death. INTERPRETATION Care and short-term outcomes after TIA or minor stroke remained stable after the widespread implementation of telemedicine during the COVID-19 pandemic. Our findings suggest that telemedicine is an effective method of health care delivery that can be complementary to in-person care for minor ischemic cerebrovascular events.
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Affiliation(s)
- Amy Y X Yu
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont.
| | - Jeremy Penn
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Peter C Austin
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Douglas S Lee
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Joan Porter
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Jiming Fang
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Donald A Redelmeier
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
| | - Moira K Kapral
- Division of Neurology (Yu, Penn), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; ICES Central (Yu, Austin, Lee, Porter, Fang, Kapral); Division of Cardiology (Lee), Department of Medicine, University of Toronto, University Health Network; Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, University Health Network, Toronto, Ont
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20
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Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol 2022; 21:1135-1150. [DOI: 10.1016/s1474-4422(22)00173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
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21
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Faheem F, Zafar Z, Razzak A, Kalia JS. Implementing Virtual Care in Neurology - Challenges and Pitfalls. J Cent Nerv Syst Dis 2022; 14:11795735221109745. [PMID: 35795886 PMCID: PMC9252001 DOI: 10.1177/11795735221109745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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22
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Monteith TS. Advocacy for Migraine Relief: Strategic Planning to Eliminate the Burden. Curr Pain Headache Rep 2022; 26:567-574. [PMID: 35716274 PMCID: PMC9206221 DOI: 10.1007/s11916-022-01059-1] [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] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review The goal of this article is to describe migraine advocacy as an essential means to advance the field of headache medicine. Special attention is spent outlining advocacy initiatives and priorities. Recent Findings There is little written about “migraine advocacy” in the literature. However, organizational and expert priorities include advocating for policies that improve systems of care, telemedicine, education, research, and public initiatives that reduce health disparities and the stigma of migraine. Summary This summary includes the latest advocacy efforts to support policies that may improve migraine care, strengthen the field of headache medicine, and eliminate the burden of migraine.
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23
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Matiello M, Cohen AB. Telehealth for Comprehensive Care of Acute Neurologic Disorders. Semin Neurol 2022; 42:12-17. [PMID: 35576927 DOI: 10.1055/s-0041-1742195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A teleneurology hospitalist model aims to address the demand for high-quality neurologic acute care and the shortage of neurologists. Here, we review concepts and models of teleneurology services to address access and care gaps in neurology beyond telestroke models. The goal of these emergent teleservices is to empower community hospitals to deliver the highest quality care, while also reducing unnecessary patient transfers to tertiary care hospitals. We highlight the clinical models, patient populations, and innovative approaches of different tele-neurohospitalist services. This includes challenges related to clinical limitations, legal issues, and reimbursement. We highlight specific areas of research that can further clarify and refine the appropriate use, cost-effectiveness, and clinical outcomes of these telemedicine-based care models.
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Affiliation(s)
- Marcelo Matiello
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam B Cohen
- Department of Neurology, Yale New Haven Health System, Yale Medical School, New Haven, Connecticut.,National Health Mission Area, The Johns Hopkins Applied Physics Lab, Laurel, Maryland
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24
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Sanchetee PC. Post-COVID Thunderstorm in Online Conferences. Ann Indian Acad Neurol 2022; 25:499-500. [PMID: 35936623 PMCID: PMC9350770 DOI: 10.4103/aian.aian_511_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Pratap C Sanchetee
- Department of Neurology, Sanchetee Neurology Research Institute, Jodhpur, Rajasthan, India
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25
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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] [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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26
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Remote measurement and home monitoring of tremor. J Neurol Sci 2022; 435:120201. [DOI: 10.1016/j.jns.2022.120201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/21/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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28
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Yim RLH, Leung KMM, Poon CCM, Irwin MG. Peri‐operative management of patients with Parkinson’s disease. Anaesthesia 2022; 77 Suppl 1:123-133. [DOI: 10.1111/anae.15617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- R. L. H. Yim
- Department of Anaesthesiology Queen Mary Hospital Hong Kong China
| | - K. M. M. Leung
- Department of Anaesthesiology University of Hong Kong Hong Kong China
| | - C. C. M. Poon
- Department of Anaesthesiology Queen Mary Hospital Hong Kong China
| | - M. G. Irwin
- Department of Anaesthesiology University of Hong Kong Hong Kong China
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29
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Gopal A, Bonanno V, Block VJ, Bove RM. Accessibility to Telerehabilitation Services for People With Multiple Sclerosis: Analysis of Barriers and Limitations. Int J MS Care 2022; 24:260-265. [PMID: 36545648 PMCID: PMC9749830 DOI: 10.7224/1537-2073.2022-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), telemedicine improves access to specialized medical care; however, barriers remain, including universal access and effective implementation. Focusing on telerehabilitation, ie, remotely delivered physical therapy, our goal was to identify barriers to telerehabilitation implementation and factors associated with patients completing telerehabilitation physical therapy treatment. METHODS Quantitative data included a review of electronic health records of patients with MS treated at the University of California San Francisco Physical Therapy Faculty Practice. We extracted demographic, clinical, and transit-related factors. For patients who scheduled an initial evaluation, we recorded the number of follow-ups, cancellations, completed physical therapy goals, and discharges. Qualitative data included interviews with 3 board-certified neurologic physical therapists and patients' perspectives recorded in the subjective portion of physical therapy notes. RESULTS We identified 111 patients with at least 1 visit (in-person or telerehabilitation) to physical therapy (82 women; mean ± SD age, 54.2 ± 12.7 years). Patients with no disability (Expanded Disability Status Scale [EDSS] score, 0) were 73% less likely to schedule a follow-up appointment (in-person or telerehabilitation) than those with some disability (EDSS score, >0) (odds ratio, 0.27; 95% CI, 0.09-0.75; P = .012). Neurologic physical therapists identified reduced travel burden and scheduling flexibility as benefits of telerehabilitation vs in-person visits. Barriers to telerehabilitation included low technological literacy, cognitive impairment, and fall risk. Patients described scheduling conflicts and pain/illness as barriers to telerehabilitation. CONCLUSIONS Patients with no disability were least likely to complete physical therapy treatment via telerehabilitation. Although both benefits and barriers to completing physical therapy via telerehabilitation are present, the neurologic physical therapists were supportive of a hybrid model for physical therapy.
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Affiliation(s)
- Arpita Gopal
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
| | - Valeria Bonanno
- The Multiple Sclerosis Center Sant’Andrea Hospital, University La Sapienza, Rome, Italy (VB)
| | - Valerie J. Block
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA,The Department of Physical Therapy and Rehabilitation Science (VJB), University of California San Francisco, San Francisco, CA, USA
| | - Riley M. Bove
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
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Linz W, Andrzejewski C, Hofmann JC. Apheresis medicine in the era of advanced telehealth technologies: An American Society for Apheresis position paper part II: Principles of apheresis medical practice in a 21st century electronic medical practice environment. J Clin Apher 2021; 37:122-126. [PMID: 34837406 DOI: 10.1002/jca.21951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Walter Linz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Chester Andrzejewski
- Transfusion and Apheresis Medicine Services, Department of Pathology, Baystate Medical Center, Baystate Health, Springfield, Massachusetts, USA
| | - Jan C Hofmann
- Department of Laboratory Medicine, UCSF School of Medicine, San Francisco, California, USA
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Reyes S, Cunningham AL, Kalincik T, Havrdová EK, Isobe N, Pakpoor J, Airas L, Bunyan RF, van der Walt A, Oh J, Mathews J, Mateen FJ, Giovannoni G. Update on the management of multiple sclerosis during the COVID-19 pandemic and post pandemic: An international consensus statement. J Neuroimmunol 2021; 357:577627. [PMID: 34139567 PMCID: PMC8183006 DOI: 10.1016/j.jneuroim.2021.577627] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 06/05/2021] [Indexed: 12/16/2022]
Abstract
In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.
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Affiliation(s)
- Saúl Reyes
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia; Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Julia Pakpoor
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Laura Airas
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Reem F Bunyan
- Department of Neurology, Neurosciences Center, King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Joela Mathews
- Department of Pharmacy, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
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Brigo F, Ponzano M, Sormani MP, Clerico M, Abbadessa G, Cossu G, Trojsi F, Colucci F, Tortorella C, Miele G, Spina E, Artusi CA, Carmisciano L, Servillo G, Bozzali M, Sparaco M, Leocani L, Lanzillo R, Tedeschi G, Bonavita S, Lavorgna L. Digital work engagement among Italian neurologists. Ther Adv Chronic Dis 2021; 12:20406223211029616. [PMID: 34367544 PMCID: PMC8299881 DOI: 10.1177/20406223211029616] [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: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Digital health, including telemedicine, is increasingly recommended for the management of chronic neurological disorders, and it has changed the roles of patients and clinicians. Methods In this cross-sectional study we aimed to investigate the digital work engagement of Italian neurologists through a survey collected between September 2020 and January 2021. Questionnaires were anonymous and collected demographic characteristics, attitudes towards digital devices and social media, and details about the clinician-patient relationship. We used logistic-regression models to identify characteristics associated with the propensity to communicate with patients using social media. Results Among the 553 neurologists who participated to the study, smartphones and computers were widely preferred compared with tablets; wearable devices were not common, although some neurologists desired them. A total of 48% of participants reported communicating with patients using social media but only a few were in favor of social friendship with patients; WhatsApp was the social media most popular for professional (86%) and personal (98%) purposes. Propensity to communicate with social media was significantly higher among those who were older (p < 0.001) and lived in regions outside northern Italy (center: p = 0.006; south and the islands: p < 0.001). For 58% of responders, social media improved their relationship with patients, but 72% usually warned patients about unreliable websites. Conclusions The preferred social media were those which were rapid and which safeguard privacy more effectively; neurologists made many efforts to disprove fake news circulating online, providing help to patients in various ways. This analysis can help direct future interventions for the management of chronic neurological disorders.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore, 1, Genova 16126, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, Torino, Italy
| | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | | | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Fabiana Colucci
- Clinical and Biological Sciences Department, University of Torino, Torino, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Luca Carmisciano
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | | | - Marco Bozzali
- Department of Neuroscience, University of Torino, Torino, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Letizia Leocani
- Institute of Experimental Neurology, Ospedale San Raffaele, and Department of Neurology, Vita-Salute San Raffaele University, Milano, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, II Clinic of Neurology, University of Campania 'Luigi Vanvitelli,' Caserta, Italy
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