Aligning mission to digital health strategy in academic medical centers.

The strategies of academic medical centers arise from core values and missions that aim to provide unmatched clinical care, patient experience, research, education, and training. These missions drive nearly all activities. They should also drive digital health activities - and particularly now given the rapid adoption of digital health, marking one of the great transformations of healthcare; increasing pressures on health systems to provide more cost-effective care; the pandemic-accelerated funding and rise of well-funded new entrants and technology giants that provide more convenient forms of care; and a more favorable regulatory and reimbursement landscape to incorporate digital health approaches. As academic medical centers emerge from a pandemic-related reactionary digital health posture, where pressures to adopt more digital health technologies mount, a broad digital health realignment that leverages the strengths of such centers is required to accomplish their missions.

Stress and sleep across the onset of the novel coronavirus disease 2019 pandemic: impact of distance learning on US college students' health trajectories.

STUDY OBJECTIVES: This study examined associations between average and intraindividual trajectories of stress, sleep duration, and sleep quality in college students before, during, and after transitioning to online learning due to the COVID-19 pandemic. METHODS: One hundred and sixty-four first-year college students answered twice-weekly questionnaires assessing stress exposure and perception, sleep duration, and sleep quality from January until May, 2020 (N = 4269 unique observations). RESULTS: Multilevel growth modeling revealed that prior to distance learning, student stress was increasing and sleep duration and quality were decreasing. After transitioning online, students' stress exposure and perception trajectories immediately and continuously decreased; sleep quality initially increased but decreased over time; and sleep duration increased but then plateaued for the remainder of the semester. Days with higher stress exposure than typical for that student were associated with lower sleep quality, and both higher stress exposure and perception at the transition were linked with simultaneous lower sleep quality. Specific groups (eg, females) were identified as at-risk for stress and sleep problems. CONCLUSIONS: Although transitioning to remote learning initially alleviated college students' stress and improved sleep, these effects plateaued, and greater exposure to academic, financial, and interpersonal stressors predicted worse sleep quality on both daily and average levels. Environmental stressors may particularly dictate sleep quality during times of transition, but adaptations in learning modalities may help mitigate short-term detrimental health outcomes during global emergencies, even during a developmental period with considerable stress vulnerability. Future studies should examine longer-term implications of these trajectories on mental and physical health.

Faith and science mindsets as predictors of COVID-19 concern: A three-wave longitudinal study.

The COVID-19 pandemic allowed for a naturalistic, longitudinal investigation of the relationship between faith and science mindsets and concern about COVID-19. Our goal was to examine two possible directional relationships: (Model 1) COVID-19 concern ➔ disease avoidance and self-protection motivations ➔ science and faith mindsets versus (Model 2) science and faith mindsets ➔ COVID-19 concern. We surveyed 858 Mechanical Turk workers in three waves of a study conducted in March, April, and June 2020. We found that science mindsets increased whereas faith mindsets decreased (regardless of religious type) during the early months of the pandemic. Further, bivariate correlations and autoregressive cross-lagged analyses indicated that science mindset was positive predictor of COVID-19 concern, in support of Model 2. Faith mindset was not associated with COVID-19 concern. However, faith mindset was a negative predictor of science mindset. We discuss the need for more research regarding the influence of science and faith mindsets as well as the societal consequences of the pandemic.

The Digital Neurologic Examination

Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician’s reach, a new set of examination tools will redefine neurologic and neurosurgical care, serving as the basis for the digital neurologic examination. We describe its components and review specific technologies, which move beyond traditional video-based telemedicine encounters and include separate digital tools. A future suite of these clinical assessment technologies will blur the lines between history taking, examination, and remote monitoring. Prior to full-scale implementation, however, much more investigation is needed. Because of the nascent state of the technologies, researchers, clinicians, and developers should establish digital neurologic examination requirements in order to maximize its impact.

Practicing in a Pandemic: A Clinician's Guide to Remote Neurologic Care.

Neurologists around the country and the world are rapidly transitioning from traditional in-person visits to remote neurologic care because of the coronavirus disease 2019 pandemic. Given calls and mandates for social distancing, most clinics have shuttered or are only conducting urgent and emergent visits. As a result, many neurologists are turning to teleneurology with real-time remote video-based visits with patients to provide ongoing care. Although telemedicine utilization and comfort has grown for many acute and ambulatory neurologic conditions in the past decade, remote visits and workflows remain foreign to many patients and neurologists. Here, we provide a practical framework for clinicians to orient themselves to the remote neurologic assessment, offering suggestions for clinician and patient preparation before the visit; recommendations to manage common challenges with remote neurologic care; modifications to the neurologic examination for remote performance, including subspecialty-specific considerations for a variety of neurologic conditions; and a discussion of the key limitations of remote visits. These recommendations are intended to serve as a guide for immediate implementation as neurologists transition to remote care. These will be relevant not only for practice today but also for the likely sustained expansion of teleneurology following the pandemic.