ABSTRACT
Objective: To assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic. Background: The Coronavirus Disease 2019 (COVID-19) pandemic has changed healthcare systems. The pandemic presented practical and logistical challenges that disrupted medical education and training. Henry Ford Health System (HFHS) adopted a quick plan in response to the severity of the situation and the number of patients afflicted with COVID-19 that included modifications to training program routine workflow and didactics to comply with social distancing measures and limit the exposure of trainees. Design/Methods: We distributed two online, voluntary and anonymous surveys to trainees and teaching faculty of our neurology department at Henry Ford Hospital. Surveys inquired about trainees' stress, wellbeing, clinical experience, and satisfaction with medical education and available support resources during the first wave of the COVID-19 pandemic in Michigan. Results: 17/31 trainees and 25/42 faculty responded to the surveys. Eight (47%) trainees reported high stress levels. Nine (57%) were redeployed to cover COVID-19 units. Compared to nonredeployed trainees, redeployed residents reported augmented medical knowledge (89% vs 38%, p=0.05). There was no difference in the 2 groups regarding overall satisfaction with residency experience, stress levels, and didactics attendance. Twenty-one (84%) faculty felt that the redeployment interfered with trainees education but was appropriate, while 10 (59%) trainees describe a positive experience overall. Both trainees and faculty believed the pandemic positively impacted trainees experience by increasing maturity level, teamwork, empathy, and medical knowledge, while both agreed that increased stress and anxiety levels were negative outcomes of the pandemic. Twelve (70%) trainees and 13 (52%) faculty were interested in pursuing more virtual didactics in the future. Conclusions: Our findings provide an objective assessment of residents' experience during the COVID-19 pandemic and can guide teaching programs in their medical education response in the face of future global crises.
ABSTRACT
Offering a comprehensive review of the neuropathology of SARS-CoV-2, Neurological Care and the COVID-19 Pandemic provides up-to-date coverage of the wide array of the pathogen’s neurological symptoms and complications. Drs. Ahmad Riad Ramadan and Gamaledin Osman discuss the neuropathology of SARS-CoV-2, its neurological manifestations, and the impact the pandemic has had on the care of patients with pre-existing neurological conditions. The authors also offer an overview of emerging treatments and vaccines, as well as ways healthcare systems have reorganized in order to respond to the pandemic. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
The race for a search for therapeutics and vaccines began before the COVID-19 outbreak even became a pandemic. Existing medications used in other conditions have been repurposed and tried in patients with varying degrees of disease severity. This is the case, for instance, for the antimalarial hydroxychloroquine, the antiviral remdesivir, the anthelmintic ivermectin, or the interleukin-6 inhibitor tocilizumab. Dexamethasone rose as an essential cornerstone of therapy for the patient with COVID-19 on oxygen supplementation or mechanical ventilation, while remdesivir became the first (and only thus far) FDA-approved medication for patients with severe COVID-19 disease not requiring mechanical ventilation. The first part of this chapter gives an overview of the medical treatment approach for the hospitalized patient and the various neurological complications associated with each of the treatments in use in the United States. The second section of the chapter discusses vaccine development and types. It also goes over vaccines’ neurological side effects and special considerations for patients with different neurological conditions. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
COVID-19 has been on every human’s mind and lips for the past year, as it has undeniably transformed health care and social living, and disturbed the economy on a planetary scale. This novel disease, the product of a relative of SARS-CoV, saw the light in Wuhan, China and, with fulgurant speed, reached all continents in a matter of weeks. “Unprecedented” is a word that saw a revival with COVID-19. The 21st-century virus has brought death, unemployment, and social isolation to an extent unparalleled by any other pandemic. It has crippled health-care systems worldwide, overwhelming all tiers of hospital resources, from personnel to equipment, therapies, and beds. Yet despite the mayhem, a formidable international mobilization of researchers, pharmaceutical companies, policy makers, health officials, and health-care workers has been tirelessly working to contain the spread and eradicate the virus. New vaccines, some with novel, never-marketed-before mechanisms yield the promise of better days ahead and are paving the way to a new era in vaccine development. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
Headache is a common symptom and the most common neurological manifestation in COVID-19. Its pathophysiology in COVID-19 remains elusive. It is largely managed by usual headache treatments that are dependent on clinical phenotype. When managing headache patients with or without a history of a primary headache disorder, one should take into consideration access to care, particularly in virus hotspots. © 2021 Elsevier Inc. All rights reserved.
ABSTRACT
Background: Coronavirus 2019 (COVID19) has impacted acute stroke (AS) care with several reports globally showing drops in AS volumes during the pandemic. We studied the impact of COVID19 on AS and transient ischemic attack (TIA) care in a health system serving Southeast Michigan as we rolled out a policy aimed at limiting admissions and transfers. Methods: In this retrospective study conducted at 2 hospitals, we included consecutive patients presenting to the emergency department (ED) for whom a Stroke Alert (SA) was activated during the period 3/20 to 5/20/20 (COVID) and a similar period in 2019 (pre-COVID). We compared demographics, time metrics, and discharge outcomes. Results: 264 patients were seen pre-COVID compared to 121 during COVID (p<0.001). Patients seen during COVID had an equal proportion of males (55% vs 51%, p=0.444), were majority African American (57 vs 58%, p=0.74), but had a higher presenting NIHSS (median: 5 vs 2, p=0.01) and longer times since last-known-well to ED arrival (median: 9.4 vs 4.8 hours, p=0.03) compared to pre-COVID. Fewer patients were transferred from other centers (42 vs 27% p=0.008). SA activation on arrival (median: 9.6 vs 15 min, p=0.004) and imaging initiation from arrival (median: 26.4 vs 34.8 min, p=0.042) were faster as well as a trend toward statistical significance for time to tPA administration (median: 37.8 vs 51 min, p=0.051) compared to pre-COVID. There were higher rates of AS and TIA (69% vs 55%) and lower rates of stroke mimics (17 vs 37%, p<0.001). Patients discharged from the stroke unit had significantly higher discharge NIHSS (median: 3 vs 2, p=0.002) and were more likely to have an unfavorable discharge mRS (3-6) (56 vs 33%, p=0.004). There were no significant differences in medical, social histories, time to first pass for patient undergoing thrombectomy and stroke etiologies between the groups. In 2020, 9 patients (8%) were COVID19 positive, 2 had unfavorable mRS 3-5 while 3 died. Conclusion: There was greater than 50% reduction in stroke admissions during the COVID19 pandemic which is consistent with other reports. Although patients were managed more quickly, they tended to have more severe strokes, fewer stroke mimic diagnoses, and worse outcomes compared to patients treated in the pre-COVID period.
ABSTRACT
Background: We propose that social distancing policies during COVID-19 may have negatively impacted the timely administration of intravenous tPA and mechanical thrombectomy (MT) in acute ischemic strokes (AIS). Methods: In this retrospective study conducted at 2 large stroke centers serving Southeast Michigan, we included consecutive patients admitted to our stroke unit from 3/20/20 to 5/20/20 (COVID) and a similar epoch in 2019 (pre-COVID). We compared demographics and time metrics. Results: 247 patients with AIS were included in the tPA analysis, 167 (68%) in 2019 vs 80 (32%) in 2020. Overall mean age was 67.2, 60% male and 49% African Americans (AA). tPA was given in 13/80 in 2019 vs 17/167 patients in 2019 (16% vs 10%, p=0.143). There was no difference in tPA rates between AA and non-AA in 2020. There was a trend toward faster tPA administration in 2020 vs 2019 (median: 37.8 vs 51 min, p=0.051), significant among AA (37.8 vs 58.8 min, p=0.029). Mild/rapidly improving strokes was less frequently a tPA exclusion in 2020 vs 2019 (0% vs 10%). Delayed presentation was significantly less frequent among non-AA in 2020 vs 2019 (54% vs 66%, p=0.045) but there was a trend toward more frequent delayed presentations in AA vs non-AA in 2020 (76 vs 54%, P=0.073). 69 patients were eligible to receive MT, 42 (61%) in 2019 and 27 (39%) in 2020. Mean age was 67.9 and 36% were AA. No differences were detected between 2019 and 2020 in MT rates or time metrics. In 2020, there was a slight trend toward lower MT rates for AA vs non-AA patients (69% vs 30%, p=0.10). Conclusion: During the COVID-19 pandemic in Detroit there was a trend toward faster tPA administration compared to the same period pre-COVID, especially among AA. There was no significant difference in MT rates or time metrics. In our AA-majority city, there was a trend towards more delayed presentations and lower MT rates among AA during COVID. The reasons for these differences are yet to be determined and warrant further research.