ABSTRACT
Objective: We aimed to assess whether SARS-CoV2 vaccines have any positive or negative impact on motor symptoms in PD patients. Background: Studies focusing on the relationship between SARSCoV- 2, COVID-19 and PD have provided conflicting results (1). Recently, few cases of severe dyskinesia after receiving BNT162b2 mRNA vaccine have been reported but there is no data about impact of vaccines on motor symptoms in larger series of PD patients (2). Methods: We reviewed the charts of the last two months of consecutive PD patients who were attended monthly by telemedicine during the pandemic and who had received one or two doses of any of the SARSCoV- 2 vaccines available in Peru (BNT162b2, Pfizer/BioNTech and BBIBP-CorV, Sinopharm). We specifically searched for any reported variation on motor symptoms including dyskinesia during a period of at least three days after any of each dose. Results: One hundred eighty-one PD patients met inclusion criteria. 107 males and 74 females were included. Mean age was 65 years old (range 31-99). 178 patients received two doses of SARSCoV2 vaccine (177 Pfizer/BioNTech and 1 Sinopharm respectively) and three patients received only one dose of Pfizer/BioNTech vaccine. Eleven patients (6%) had COVID19 infection during the pandemic. The effect of the infection on parkinsonian symptoms was not evaluated in this report. Only two patients (1.1%) reported some degree of exacerbation following one of the dose of the vaccine. First one presented with increased rigidity and gait impairment soon after the first dose and the second case presented with increased resting tremor that lasted for two weeks also after the first dose. In both cases exacerbation improved spontaneously. Conclusion: The approved mRNA-based vaccines and viral vector vaccines are not expected to interact with the neurodegenerative process nor modify motor symptoms in PD. SARS-CoV-2 vaccines are not known neither to interfere with the current therapies for PD. Some patients have developed exacerbation of motor symptoms or severe dyskinesia after vaccination and the reasons remain unclear but they might be explained by triggering a systemic inflammatory response, by stress or excessive anxiety or due to modification of habitual medication response. These very low incidence should not discourage patients to receive vaccines and we recommend COVID-19 vaccination with approved vaccines for persons with PD, unless there is a specific contraindication.
ABSTRACT
Intro/Background: The Stanford Emergency Department (ED) Help Desk was created to screen and refer patients to resources for social needs. Interested undergraduate students are taught about the social determinants of health in a classroom setting and use validated surveys paired with curated databases to identify local resources for social needs. In-person screening became impossible at the start of the COVID19 pandemic. In this work, we created a virtual screening program and process to replace in-person screening. Purpose/Objective: The Help Desk provides important resource linkages to the ED's most vulnerable patients. These patients might otherwise not receive resources for important needs not directly related to their ED visit. The Help Desk also serves as an experiential and service-learning educational model for students. When in-person screening was halted at the beginning of the COVID19 pandemic, we sought to create an alternate, virtual screening process in order to continue providing this service to our patients. Methods: We collaborated with the Stanford ED IT Department and Guest Services to gain HIPPA-compliant Zoom video conferencing access to individual ED rooms. Video conferencing was made possible via preexisting iPads stationed in each room. We then collaborated with ED physicians, residents, nurses, and social workers to create a workflow for our virtual screening process. This workflow was first trialed among undergraduate leaders, interested medical students, and faculty leads to identify and troubleshoot unforeseen implementation barriers. Outcomes (if available): We successfully created a new workflow to continue social needs screening and referrals during the COVID19 pandemic. In this new virtual workflow, undergraduate volunteers first call ED attendings on shift to identify patients that may be good candidates for screening. They then use existing screeners and databases to identify and refer resources. Resource summaries are texted or emailed to patients at the conclusion of the visit;follow-up phone calls are conducted at 2 weeks. Summary: The Stanford Emergency Department (ED) Help Desk was created to screen and refer patients to resources for social needs. Interested undergraduate students are taught about the social determinants of health in a classroom setting and use validated surveys paired with curated databases to identify local resources for social needs. The Help Desk provides important resource linkages to the ED's most vulnerable patients. These patients might otherwise not receive resources for important needs not directly related to their ED visit. The Help Desk also serves as an experiential and service-learning educational model for students. When in-person screening was halted at the beginning of the COVID19 pandemic, we sought to create an alternate, virtual screening process in order to continue providing this service to our patients. We collaborated with the Stanford ED IT Department and Guest Services to gain HIPPA-compliant Zoom video conferencing access to individual ED rooms. Video conferencing was made possible via preexisting iPads stationed in each room. We then collaborated with ED physicians, residents, nurses, and social workers to create a workflow for our virtual screening process. This workflow was first trialed among undergraduate leaders, interested medical students, and faculty leads to identify and troubleshoot unforeseen implementation barriers. In this new virtual workflow, undergraduate volunteers first call ED attendings on shift to identify patients that may be good candidates for screening. They then use existing screeners and databases to identify and refer resources. Resource summaries are texted or emailed to patients at the conclusion of the visit;follow-up phone calls are conducted at 2 weeks. We plan to evaluate the new workflow via qualitative semi-structured interviews among patients, attendings, ED staff, and undergraduate volunteers, and to update the workflow based on feedback we get from these groups.