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1.
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
3.
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
8.
Neurology ; 95(13): 583-592, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-945310

ABSTRACT

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Hospital Departments/organization & administration , Medical Staff, Hospital/organization & administration , Neurology/organization & administration , Pandemics , Pneumonia, Viral , Ambulatory Care , Betacoronavirus , COVID-19 , Communication , Delivery of Health Care , Hospital Units/organization & administration , Hospitalization , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurology/education , Neuroscience Nursing , Nursing Staff, Hospital/organization & administration , Personal Protective Equipment , Personnel Staffing and Scheduling , SARS-CoV-2 , Telemedicine , Text Messaging
9.
Headache ; 60(10): 2665-2668, 2020 11.
Article in English | MEDLINE | ID: covidwho-810902

ABSTRACT

BACKGROUND: The care and management of migraine/headache patients in the Republic of Ireland over the last 25 years are summarized in this article. METHODS: Collaboration between voluntary patient organizations (the Migraine Association of Ireland or MAI), primary care services, and hospital/community shared healthcare professionals (most notably the headache specialist nurse), is highlighted as one of the key features of this management strategy in an underfunded and under-resourced public healthcare system. CONCLUSION: The migraine/headache community in Ireland is small, but they have been dedicated in their commitment to improving care for their patients for more than 2 decades. As a result, they have been successful in recent years, both nationally and internationally, in terms of financial funding and support for their multidisciplinary and collaborative approach.


Subject(s)
COVID-19 , Headache , Migraine Disorders , Neurology/trends , Humans , Ireland , Neurology/organization & administration , SARS-CoV-2
10.
Clin Neurol Neurosurg ; 197: 106156, 2020 10.
Article in English | MEDLINE | ID: covidwho-716620

ABSTRACT

The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.


Subject(s)
Coronavirus Infections/therapy , Hospital Departments/organization & administration , Neurology/organization & administration , Personnel Staffing and Scheduling , Pneumonia, Viral/therapy , Betacoronavirus , COVID-19 , Critical Care/organization & administration , Electroencephalography/methods , Hospitals, Urban , Humans , Internship and Residency/organization & administration , Neuroscience Nursing/organization & administration , New York City , Pandemics , SARS-CoV-2 , Safety-net Providers , Tertiary Care Centers
11.
Neurologia (Engl Ed) ; 35(4): 252-257, 2020 May.
Article in English, Spanish | MEDLINE | ID: covidwho-700407

ABSTRACT

INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.


Subject(s)
Coronavirus Infections , Health Care Surveys , Nervous System Diseases/therapy , Neurology/trends , Pandemics , Pneumonia, Viral , Administrative Personnel/psychology , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Clinical Trials as Topic/methods , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Distance Counseling , Forecasting , Hospital Departments/organization & administration , Humans , Nervous System Diseases/diagnosis , Neurologic Examination , Neurology/methods , Neurology/organization & administration , Pandemics/prevention & control , Patient Isolation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Spain/epidemiology
12.
Clin Med (Lond) ; 20(5): e173-e177, 2020 09.
Article in English | MEDLINE | ID: covidwho-688876

ABSTRACT

We describe the details of a COVID-19 outbreak in a 25-bedded Birmingham neurology/stroke ward in the early phase of the pandemic (March to May 2020). Twenty-one of 133 admissions (16%) tested positive for COVID-19 and of those, 8 (6% of all admissions to the ward) were determined to be nosocomial. Thus 38% (8/21) of COVID-19 infections were hospital-acquired. Ten of the patients that contracted COVID-19 died; of these three were hospital-acquired cases. Five of the 21 patients had negative swabs prior to receiving a positive test result. This study highlights the importance of appropriate use of personal protective equipment (PPE) with high-risk patients (including those with stroke and complex brain injury with tracheostomies) and the difficulties of COVID-19 management in a high-risk patient population.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/epidemiology , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Female , Hospital Departments , Hospitals, District , Hospitals, General , Humans , Incidence , Male , Medical Audit , Neurology/organization & administration , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , United Kingdom , Vulnerable Populations
13.
AJNR Am J Neuroradiol ; 41(6): 960-965, 2020 06.
Article in English | MEDLINE | ID: covidwho-642792

ABSTRACT

During the Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic, neuroradiology practices have experienced a paradigm shift in practice, which affected everything from staffing, workflow, work volumes, conferences, resident and fellowship education, and research. This article highlights adaptive strategies that were undertaken at the epicenter of the outbreak in New York City during the past 4-6 weeks, as experienced by 5 large neuroradiology academic departments.


Subject(s)
Coronavirus Infections , Neurology/organization & administration , Pandemics , Pneumonia, Viral , Radiology/organization & administration , Workflow , Betacoronavirus , COVID-19 , Humans , New York City , Radiology Department, Hospital/organization & administration , SARS-CoV-2
16.
Neurologia (Engl Ed) ; 35(6): 363-371, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-612930

ABSTRACT

INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.


Subject(s)
Betacoronavirus , Coronavirus Infections , Critical Pathways/organization & administration , Delivery of Health Care/organization & administration , Pandemics , Pneumonia, Viral , Stroke Rehabilitation , Stroke/therapy , Acute Disease , Ambulatory Care/organization & administration , Appointments and Schedules , Bed Conversion , COVID-19 , Coronavirus Infections/diagnosis , Delivery of Health Care/statistics & numerical data , Emergency Service, Hospital/organization & administration , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Hospital Bed Capacity , Hospital Departments/organization & administration , Hospitals, Urban/organization & administration , Hospitals, Urban/statistics & numerical data , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Mechanical Thrombolysis/statistics & numerical data , Neurology/organization & administration , Patient Admission/statistics & numerical data , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Spain/epidemiology , Stroke/epidemiology , Stroke Rehabilitation/statistics & numerical data , Telemedicine , Thrombolytic Therapy/statistics & numerical data
17.
Clin Med (Lond) ; 20(4): e104-e106, 2020 07.
Article in English | MEDLINE | ID: covidwho-592265

ABSTRACT

The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. Where face-to-face outpatient appointments have been cancelled, telemedicine can facilitate remote clinical consultations for new and follow-up epilepsy clinic patients while reducing the risk of infection to both patients and healthcare staff. First-seizure patients will need investigation pathways rationalised, while those with chronic epilepsy will need to have reliable alternative avenues to access clinical advice. At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.


Subject(s)
Coronavirus Infections/complications , Epilepsy/complications , Epilepsy/drug therapy , Neurology/organization & administration , Pneumonia, Viral/complications , Telemedicine , Anticonvulsants/supply & distribution , Anticonvulsants/therapeutic use , COVID-19 , Chronic Disease , Emergency Service, Hospital , Epilepsy/diagnosis , Epilepsy/etiology , Humans , Pandemics , Referral and Consultation
18.
J Stroke Cerebrovasc Dis ; 29(8): 104927, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-350500

ABSTRACT

BACKGROUND AND PURPOSE: The COVID-19 pandemic has required the adaptation of hyperacute stroke care (including stroke code pathways) and hospital stroke management. There remains a need to provide rapid and comprehensive assessment to acute stroke patients while reducing the risk of COVID-19 exposure, protecting healthcare providers, and preserving personal protective equipment (PPE) supplies. While the COVID infection is typically not a primary cerebrovascular condition, the downstream effects of this pandemic force adjustments to stroke care pathways to maintain optimal stroke patient outcomes. METHODS: The University of California San Diego (UCSD) Health System encompasses two academic, Comprehensive Stroke Centers (CSCs). The UCSD Stroke Center reviewed the national COVID-19 crisis and implications on stroke care. All current resources for stroke care were identified and adapted to include COVID-19 screening. The adjusted model focused on comprehensive and rapid acute stroke treatment, reduction of exposure to the healthcare team, and preservation of PPE. AIMS: The adjusted pathways implement telestroke assessments as a specific option for all inpatient and outpatient encounters and accounts for when telemedicine systems are not available or functional. COVID screening is done on all stroke patients. We outline a model of hyperacute stroke evaluation in an adapted stroke code protocol and novel methods of stroke patient management. CONCLUSIONS: The overall goal of the model is to preserve patient access and outcomes while decreasing potential COVID-19 exposure to patients and healthcare providers. This model also serves to reduce the use of vital PPE. It is critical that stroke providers share best practices via academic and vetted social media platforms for rapid dissemination of tools and care models during the COVID-19 crisis.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Delivery of Health Care, Integrated/organization & administration , Health Services Needs and Demand/organization & administration , Needs Assessment/organization & administration , Neurology/organization & administration , Pneumonia, Viral/therapy , Stroke/therapy , Academic Medical Centers , COVID-19 , California , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Critical Pathways/organization & administration , Host-Pathogen Interactions , Humans , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Models, Organizational , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Pandemics , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Time Factors
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