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1.
Neurosciences (Riyadh) ; 27(1): 4-9, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1622940

ABSTRACT

Telemedicine is defined as the remote medical practice of delivering healthcare services to the underserved using information and communication technology. It encompasses a wide range of medical activities, including diagnosis, treatment, disease prevention, and education. The coronavirus disease of 2019 (COVID-19) pandemic has caused significant social dislocation, negative economic impact, and a major change in medical practice in Saudi Arabia. Telemedicine has rapidly moved to the frontline of healthcare practice due to the demand for prevention and mitigation strategies. It has been encouraged and facilitated with huge government support. Herein, we describe the virtual clinical practice of the neurology department at King Abdulaziz Medical City-Jeddah in response to the COVID-19 pandemic. This narrative review is an urgent call to improve the perception and knowledge of both medical personnel and patients concerning telemedicine and to support the utilization of advanced information and communication technology.


Subject(s)
COVID-19 , Neurology , Telemedicine , Humans , Pandemics , SARS-CoV-2
2.
Brain Nerve ; 74(1): 33-35, 2022 Jan.
Article in Japanese | MEDLINE | ID: covidwho-1614285

ABSTRACT

The COVID-19 pandemic has had a significant impact on neurology residency education and services in the United States. The responsibility of residents was shifted from traditional house staff to frontline providers in the face of the pandemic. As such, a dynamic and rapid transformation was required, involving the development of strong leadership and teamwork skills, while protecting patients and providers from infection and ensuring the quality of education and training. Because of the increased demand from inpatient care and the risk of potential exposure to the virus, a modified rotation schedule was implemented by removing residents from outpatient clinics and minimizing their role in inpatient services. In order to maintain social distances, didactic lectures were conducted only via online platforms, and outpatients were only provided telemedicine. Although the pandemic has taken some of the in-person educational opportunities from residents, innovative changes including video conferences and telemedicine will likely continue to be used as a useful mode of medical training for residents. Herein, the author reports the changes made to the neurology residency program in response to the COVID-19 pandemic, as well as the evolution of leadership roles during this unprecedented time.


Subject(s)
COVID-19 , Internship and Residency , Neurology , Humans , Pandemics , SARS-CoV-2 , United States
3.
Eur J Neurol ; 28(10): 3303-3323, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1603795

ABSTRACT

The COVID-19 pandemic is a global public health issue. Neurological complications have been reported in up to one-third of affected cases, but their distribution varies significantly in terms of prevalence, incidence and phenotypical characteristics. Variability can be mostly explained by the differing sources of cases (hospital vs. community-based), the accuracy of the diagnostic approach and the interpretation of the patients' complaints. Moreover, after recovering, patients can still experience neurological symptoms. To obtain a more precise picture of the neurological manifestations and outcome of the COVID-19 infection, an international registry (ENERGY) has been created by the European Academy of Neurology in collaboration with European national neurological societies and the Neurocritical Care Society and Research Network. ENERGY can be implemented as a stand-alone instrument for patients with suspected or confirmed COVID-19 and neurological findings or as an addendum to an existing registry not targeting neurological symptoms. Data are also collected to study the impact of neurological symptoms and neurological complications on outcomes. The variables included in the registry have been selected in the interests of most countries, to favour pooling with data from other sources and to facilitate data collection even in resource-poor countries. Included are adults with suspected or confirmed COVID-19 infection, ascertained through neurological consultation, and providing informed consent. Key demographic and clinical findings are collected at registration. Patients are followed up to 12 months in search of incident neurological manifestations. As of 19 August, 254 centres from 69 countries and four continents have made requests to join the study.


Subject(s)
COVID-19 , Neurology , Adult , Humans , Pandemics , Registries , SARS-CoV-2
4.
Eur J Neurol ; 28(10): 3339-3347, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607258

ABSTRACT

OBJECTIVE: To describe the spectrum of neurological complications observed in a hospital-based cohort of COVID-19 patients who required a neurological assessment. METHODS: We conducted an observational, monocentric, prospective study of patients with a COVID-19 diagnosis hospitalized during the 3-month period of the first wave of the COVID-19 pandemic in a tertiary hospital in Madrid (Spain). We describe the neurological diagnoses that arose after the onset of COVID-19 symptoms. These diagnoses could be divided into different groups. RESULTS: Only 71 (2.6%) of 2750 hospitalized patients suffered at least one neurological complication (77 different neurological diagnoses in total) during the timeframe of the study. The most common diagnoses were neuromuscular disorders (33.7%), cerebrovascular diseases (CVDs) (27.3%), acute encephalopathy (19.4%), seizures (7.8%), and miscellanea (11.6%) comprising hiccups, myoclonic tremor, Horner syndrome and transverse myelitis. CVDs and encephalopathy were common in the early phase of the COVID-19 pandemic compared to neuromuscular disorders, which usually appeared later on (p = 0.005). Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction was negative in 15/15 samples. The mortality was higher in the CVD group (38.1% vs. 8.9%; p = 0.05). CONCLUSIONS: The prevalence of neurological complications is low in patients hospitalized for COVID-19. Different mechanisms appear to be involved in these complications, and there was no evidence of direct invasion of the nervous system in our cohort. Some of the neurological complications can be classified into early and late neurological complications of COVID-19, as they occurred at different times following the onset of COVID-19 symptoms.


Subject(s)
COVID-19 , Nervous System Diseases , Neurology , COVID-19 Testing , Humans , Nervous System Diseases/epidemiology , Pandemics , Prospective Studies , Registries , SARS-CoV-2
5.
Med Educ Online ; 26(1): 1899642, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1574515

ABSTRACT

Background: During the current COVID-19 pandemic, offline clinical education was mandated to suspend at the neurology department of many teaching hospitals globally, yet there is insufficient evidence regarding the preferred practice and methods for online neurology intern training course.Objective: The investigation aimed to examine whether the online neurology training course based on Small Private Online Course (SPOC) and blending learning mode can achieve a good effect and cater for interns from different medical programs and whether the learning group size affects the teaching effect.Design: The subjects were 92 students enrolled in the neurology internship at the Second Xiangya Hospital of China from 9 March to 9 August 2020. After completing the online course, the final scores and evaluation results were compared among different groups of interns, and their preference to distinct contents of the course was analyzed. Statistical analysis was performed using the SPSS program (version 22.0).Results: Our online course received consistent positive recognition from the interns. Ninety-nine percent of the interns recommended incorporating the online course into the conventional offline training program after the pandemic. There was no significant difference between interns from different programs concerning the final scores and course evaluation. A smaller learning group size (<15 students) could achieve a better teaching effect than a larger group size (p < 0.05). The interns preferred interactive discussions, and course contents that they can get practice and feedback from, rather than video watching and didactic lectures.Conclusions: The online neurology intern training course based on SPOC and blending learning mode is worthy of popularization in a large student base. The teaching effect of an online intern training program may be improved by limiting the group size to less than 15 students and encouraging more interactive discussion, more practice and feedback.


Subject(s)
COVID-19/epidemiology , Education, Distance/organization & administration , Internship and Residency/organization & administration , Neurology/education , China/epidemiology , Clinical Competence , Group Processes , Humans , Inservice Training , Learning , Pandemics , SARS-CoV-2
6.
J Neurol Sci ; 432: 120085, 2022 01 15.
Article in English | MEDLINE | ID: covidwho-1560798

ABSTRACT

Teleneurology had been best studied in acute stroke care, but the Coronavirus (COVID)-19 pandemic has highlighted applicability in outpatient practice. Telepharmacy is a convenient method for pharmacists to provide medication management to enhance care. Studies in the outpatient space suggest non-inferiority of teleneurology to increase access to specialized care for patients in rural locations. The role of telemedicine based interdisciplinary collaborations in a metropolitan and under-resourced setting has not been explored. We describe our approach to a teleneurology-telepharmacy collaboration at an urban academic medical center. Since its implementation pre-COVID, the program has expanded and transformed to serve the community further.


Subject(s)
COVID-19 , Neurology , Pharmacy , Telemedicine , Humans , SARS-CoV-2
7.
Neurol India ; 69(5): 1234-1240, 2021.
Article in English | MEDLINE | ID: covidwho-1502576

ABSTRACT

Background: Globally, social distancing has been practiced during the ongoing coronavirus disease 2019 (COVID-19) pandemic to prevent the transmission of the virus. One of the measures to ensure social distancing and restricting the movements has been national lockdown, to break the chain of transmission. Telemedicine is a cost-effective measure to provide medical services to remote underserved areas. Objective: The present study aimed to evaluate the efficacy and acceptability of teleconsultation as an alternative option to in-person consultation in providing continued medical care for neurology patients during the national lockdown period of the COVID-19 pandemic. Materials and Methods: The clinical demographic profile, frequency of different neurological disorders, and treatment details of the patients attending the teleneurology consultation (TNCO) outpatient department (OPD) at Sir Sunderlal Hospital (S.S.H.), Institute of Medical Sciences (I.M.S.), BHU, Varanasi, India, were recorded in a prespecified pro forma. Results: A total of 1,567 patients attended the TNCO OPD over 90 days. The average patient attendance was 35 per day, and 72% were males. Out of these, 77% of patients were from the same district, and the majority of patients (68%) were regularly followed up in-person by the neurology OPD. The most common illness for consultation was epilepsy (19%) followed by low backache and stroke (18% each). The satisfaction rate among the patients with respect to teleservices was high (90%). Conclusion: TNCO seems to be as effective as in-person OPD in the management of neurological disorders. During the lockdown due to the COVID-19 pandemic, avoiding physical visits through TNCO may reduce the spread of the virus. Parallel tele-OPD with routine OPD is a good option in the future.


Subject(s)
COVID-19 , Epilepsy , Neurology , Remote Consultation , Communicable Disease Control , Humans , Male , Pandemics , SARS-CoV-2 , Telephone
8.
Neurologist ; 26(6): 225-230, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1501225

ABSTRACT

BACKGROUND: To determine the exposure risk for coronavirus 2019 (COVID-19) during neurology practice. Neurological manifestations of COVID-19 are increasingly being recognized mandating high level of participation by neurologists. METHODS: An American Academy of Neurology survey inquiring about various aspects of COVID-19 exposure was sent to a random sample of 800 active American Academy of Neurology members who work in the United States. Use of second tier protection (1 or more including sterile gloves, surgical gown, protective goggles/face shield but not N95 mask) or maximum protection (N95 mask in addition to second tier protection) during clinical encounter with suspected/confirmed COVID-19 patients was inquired. RESULTS: Of the 81 respondents, 38% indicated exposure to COVID-19 at work, 1% at home, and none outside of work/home. Of the 28 respondents who did experience at least 1 symptom of COVID-19, tiredness (32%) or diarrhea (8%) were reported. One respondent tested positive out of 12 (17%) of respondents who were tested for COVID-19 within the last 2 weeks. One respondent received health care at an emergency department/urgent care or was hospitalized related to COVID-19. When seeing patients, maximum protection personal protective equipment was used either always or most of the times by 16% of respondents in outpatient setting and 56% of respondents in inpatient settings, respectively. CONCLUSIONS: The data could enhance our knowledge of the factors that contribute to COVID-19 exposure during neurology practice in United States, and inform education and advocacy efforts to neurology providers, trainees, and patients in this unprecedented pandemic.


Subject(s)
COVID-19 , Neurology , Humans , Personal Protective Equipment , SARS-CoV-2 , Surveys and Questionnaires , United States
9.
J Huntingtons Dis ; 10(4): 479-484, 2021.
Article in English | MEDLINE | ID: covidwho-1496974

ABSTRACT

BACKGROUND: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington's disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. OBJECTIVE: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. METHODS: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. RESULTS: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. CONCLUSION: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.


Subject(s)
COVID-19 , Huntington Disease/therapy , Neurology/standards , Patient Acceptance of Health Care , Patient Preference , Telemedicine/standards , Adult , Ambulatory Care , COVID-19/prevention & control , Cohort Studies , Facilities and Services Utilization , Female , Humans , Male , Middle Aged , Neurology/organization & administration , Software Design , Telemedicine/organization & administration , Tertiary Care Centers
10.
Curr Neurol Neurosci Rep ; 21(11): 63, 2021 10 27.
Article in English | MEDLINE | ID: covidwho-1491371

ABSTRACT

PURPOSE OF REVIEW: Behavioral therapies are proven treatments for many neurologic conditions. However, the COVID-19 pandemic has posed significant challenges for conducting behavioral research. This article aims to (1) highlight the challenges of running behavioral clinical trials during the pandemic, (2) suggest approaches to maximize generalizability of pandemic-era studies, and (3) offer strategies for successful behavioral trials beyond the pandemic. RECENT FINDINGS: Thousands of clinical trials have been impacted by the COVID-19 pandemic, from undergoing protocol revisions to suspension altogether. Furthermore, for ongoing trials, recruitment of diverse populations has suffered, thereby exacerbating existing inequities in clinical research. Patient adherence and retention have been affected by a myriad of pandemic-era restraints, and medical, psychiatric, and other complications from the pandemic have the potential to have long-term effects on pandemic-era study results. In the development of post-pandemic study protocols, attention should be given to designing studies that incorporate successful aspects of pre-pandemic and pandemic-era strategies to (1) broaden recruitment using new techniques, (2) improve access for diverse populations, (3) expand protocols to include virtual and in-person participation, and (4) increase patient adherence and retention.


Subject(s)
COVID-19 , Neurology , Behavioral Research , Humans , Pandemics , SARS-CoV-2
11.
BMC Med Educ ; 21(1): 549, 2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1486573

ABSTRACT

BACKGROUND: In response to the cancellation of clinical clerkships due to COVID-19, the Johns Hopkins (JH) Neurology Education Team developed a virtual elective to enhance medical students' clinical telemedicine skills and foster community between academic institutions. METHODS: This two-week clinical elective, entitled "Virtual Patient Rounds in Neurology," was administered once in April 2020 and once in May 2020. The curriculum included attending/fellow-led Virtual Rounds, Student Presentations, and Asynchronous Educational Activities. We also developed a new lecture series entitled JHNeuroChats, which consisted of live synchronous lectures presented by JH faculty and Virtual Visiting Professors. Trainees and faculty from outside institutions were invited to participate in the JHNeuroChats. Students and faculty completed pre- and post-elective surveys to assess the educational impact of the elective. Student's t-tests were used to compare scores between pre- and post-elective surveys. RESULTS: Seven JH medical students enrolled in each iteration of the elective, and an additional 337 trainees and faculty, representing 14 different countries, registered for the JHNeuroChats. We hosted 48 unique JHNeuroChats, 32 (66.7%) of which were led by invited Virtual Visiting Professors. At the end of the elective, students reported increased confidence in virtually obtaining a history (P < 0.0001) and performing a telehealth neurological physical exam (P < 0.0001), compared to the start of the course. In addition, faculty members reported increased confidence in teaching clinical medicine virtually, although these findings were not statistically significant (P = 0.15). CONCLUSIONS: Despite the constraints imposed by COVID-19, this virtual Neurology elective increased medical students' confidence in certain telemedicine skills and successfully broadened our learning community to encompass learners from around the world. As virtual medical education becomes more prevalent, it is important that we are intentional in creating opportunities for shared learning across institutions. We believe that this elective can serve as a model for these future educational collaborations.


Subject(s)
COVID-19 , Clinical Clerkship , Neurology , Students, Medical , Telemedicine , Curriculum , Humans , SARS-CoV-2
12.
Neuron ; 109(20): 3199-3202, 2021 10 20.
Article in English | MEDLINE | ID: covidwho-1474921

ABSTRACT

The COVID-19 pandemic has had a profound impact on neuroscientists, including those involved in translational research. In this NeuroView, we discuss the positive and negative effects of the pandemic on preclinical research and clinical studies in humans.


Subject(s)
Alzheimer Disease/epidemiology , Biomedical Research/methods , COVID-19/epidemiology , Clinical Trials as Topic/methods , Neurology/methods , Alzheimer Disease/therapy , Biomedical Research/trends , COVID-19/prevention & control , Humans , Neurodegenerative Diseases/epidemiology , Neurodegenerative Diseases/therapy , Neurology/trends
13.
J Neurol Sci ; 430: 120025, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1446885

ABSTRACT

Global health electives in neurology residencies provide opportunities for high-income country trainees, but have limited benefits-and may create burdens-for lower-income country hosts. Current suspension of global health electives for U.S. neurology residents due to the COVID-19 pandemic provides an opportunity to reflect on ways to reimagine global health education during this period and beyond. The framework proposed in this article underscores the need for equitable, bidirectional international partnerships and highlights global health educational innovations developed during the pandemic.


Subject(s)
COVID-19 , Internship and Residency , Neurology , Global Health , Humans , Pandemics , SARS-CoV-2
14.
J Clin Neurosci ; 93: 96-102, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1428192

ABSTRACT

PURPOSE: To describe the spectrum of hospitalized NeuroCOVID on admission in a tertiary neurology centre in Kolkata, the largest and most populated metropolitan city in Eastern India. METHOD: We retrospectively studied confirmed COVID-19 patients admitted with a neurological condition from 1st May 2020 to 30th January 2021. Neurological diagnoses and their temporal relationship to respiratory features along with clinicodemographic profile for such patients was ascertained. RESULT: 228 patients were diagnosed with NeuroCOVID at our centre. Of the 162 included population (median age was 59 (50-70) and 62.3% (101) were male) and 73.5% were diagnosed with NeuroCovid before any respiratory or febrile features. 46 patients (28.8%) had a pre/co-existing neurological illness, and 103 (63.6%) had systemic comorbidities. No significant difference was observed when comparing demographics and comorbidities of NeuroCOVID patients presenting with and without fever and respiratory features. Moreover, no individual NeuroCOVID diagnosis was more prone to present with respiratory or febrile features. Diabetes mellitus was the only comorbidity which was significantly higher in the ischemic stroke group, all other comorbidities and characteristics were evenly distributed between stroke and non-stroke NeuroCOVID patients and encephalopathy non encephalopathy NeuroCOVID patients. CONCLUSION: Stroke and encephalopathy are the most prevalent parainfectious neurological conditions occurring with COVID-19 in the Indian population. This study demonstrates seemingly low-risk individuals (i.e. people without pre-existing systemic and neurological comorbidities) may develop neurological conditions. Moreover, NeuroCOVID may manifest independent of respiratory features and fever.


Subject(s)
COVID-19 , Neurology , Comorbidity , Humans , India/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Tertiary Healthcare
17.
Indian J Ophthalmol ; 69(9): 2554, 2021 09.
Article in English | MEDLINE | ID: covidwho-1371002

Subject(s)
COVID-19 , Neurology , Eye , Face , Humans , SARS-CoV-2
18.
J Neuroophthalmol ; 41(3): 362-367, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1367100

ABSTRACT

BACKGROUND: The COVID-19 public health emergency (PHE) has significantly changed medical practice in the United States, including an increase in the utilization of telemedicine. Here, we characterize change in neuro-ophthalmic care delivery during the early COVID-19 PHE, including a comparison of care delivered via telemedicine and in office. METHODS: Neuro-ophthalmology outpatient encounters from 3 practices in the United States (4 providers) were studied during the early COVID-19 PHE (March 15, 2020-June 15, 2020) and during the same dates 1 year prior. For unique patient visits, patient demographics, visit types, visit format, and diagnosis were compared between years and between synchronous telehealth and in-office formats for 2020. RESULTS: There were 1,276 encounters for 1,167 patients. There were 30% fewer unique patient visits in 2020 vs 2019 (477 vs 670) and 55% fewer in-office visits (299 vs 670). Compared with 2019, encounters in 2020 were more likely to be established, to occur via telemedicine and to relate to an efferent diagnosis. In 2020, synchronous telehealth visits were more likely to be established compared with in-office encounters. CONCLUSIONS: In the practices studied, a lower volume of neuro-ophthalmic care was delivered during the early COVID-19 public health emergency than in the same period in 2019. The type of care shifted toward established patients with efferent diagnoses and the modality of care shifted toward telemedicine.


Subject(s)
COVID-19/epidemiology , Eye Diseases/epidemiology , Neurology/organization & administration , Office Visits/trends , Ophthalmology/organization & administration , Pandemics , Telemedicine/methods , Comorbidity , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
19.
Neurol Sci ; 42(11): 4425-4431, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1349293

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severely impacted the Italian healthcare system, underscoring a dramatic shortage of specialized doctors in many disciplines. The situation affected the activity of the residents in neurology, who were also offered the possibility of being formally hired before their training completion. AIMS: (1) To showcase examples of clinical and research activity of residents in neurology during the COVID-19 pandemic in Italy and (2) to illustrate the point of view of Italian residents in neurology about the possibility of being hired before the completion of their residency program. RESULTS: Real-life reports from several areas in Lombardia-one of the Italian regions more affected by COVID-19-show that residents in neurology gave an outstanding demonstration of generosity, collaboration, reliability, and adaptation to the changing environment, while continuing their clinical training and research activities. A very small minority of the residents participated in the dedicated selections for being hired before completion of their training program. The large majority of them prioritized their training over the option of earlier employment. CONCLUSIONS: Italian residents in neurology generously contributed to the healthcare management of the COVID-19 pandemic in many ways, while remaining determined to pursue their training. Neurology is a rapidly evolving clinical field due to continuous diagnostic and therapeutic progress. Stakeholders need to listen to the strong message conveyed by our residents in neurology and endeavor to provide them with the most adequate training, to ensure high quality of care and excellence in research in the future.


Subject(s)
COVID-19 , Neurology , Humans , Italy/epidemiology , Pandemics , Reproducibility of Results , SARS-CoV-2
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