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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.
Front Public Health ; 8: 574505, 2020.
Article in English | MEDLINE | ID: covidwho-1079618

ABSTRACT

Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural preparedness in sub-Saharan Africa. Currently, there is over 70% mobile phone penetration in most of the countries and virtually all of them have mobile internet services of different technologies and generations. Although the needed infrastructure is increasingly available, it should be improved upon. We have proposed the access, costs, ethics, and support (ACES) model as a bespoke, holistic strategy for the successful implementation and advancement of tele-neurology in sub-Saharan Africa.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Cell Phone , Neurology/standards , Telemedicine/standards , Africa South of the Sahara/epidemiology , COVID-19/epidemiology , Humans , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
5.
Rev Gastroenterol Mex (Engl Ed) ; 85(4): 428-436, 2020.
Article in English, Spanish | MEDLINE | ID: covidwho-935917

ABSTRACT

The COVID-19 pandemic has forced the establishment of preventive measures against contagion during the performance of diagnostic and therapeutic tests in gastroenterology. Digestive tract motility tests involve an intermediate and elevated risk for the transmission of COVID-19 infection. Given their elective or non-urgent indication in the majority of cases, we recommend postponing those tests until significant control of the infection rate in each Latin American country has been achieved during the pandemic. When the health authorities allow the return to normality, and in the absence of an effective treatment for or preventive vaccine against COVID-19 infection, we recommend a strict protocol for classifying patients according to their infectious-contagious status through the appropriate use of tests for the detection of the virus and the immune response to it, and the following of protective measures by the healthcare personnel to prevent contagion during the performance of a gastrointestinal motility test.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Infection Control/standards , Neurology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Breath Tests , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Esophageal pH Monitoring/standards , Gastrointestinal Diseases/therapy , Gastrointestinal Motility , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Latin America , Manometry/standards , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Societies, Medical
7.
Arq. neuropsiquiatr ; 78(7): 440-449, July 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-711473

ABSTRACT

ABSTRACT Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.


RESUMO Introdução: A pandemia causada pelo novo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2, COVID-19) apresenta novos e importantes desafios à gestão de saúde no Brasil. Além da difícil missão de prestar atendimento aos milhares de pacientes infectados pelo COVID-19, os sistemas de saúde têm que manter a assistência às emergências médicas comuns em períodos sem pandemia, tais como o acidente vascular cerebral (AVC), que continuam ocorrendo e requerem tratamento com presteza e eficiência. A alocação de recursos materiais e humanos para o enfrentamento à pandemia não pode comprometer o atendimento ao AVC agudo, uma emergência cujo tratamento é tempo-dependente e se não realizado implica em importante impacto na mortalidade e incapacitação a longo prazo. Objetivo: Este trabalho resume as recomendações do Departamento Científico de Doenças Cerebrovasculares da Academia Brasileira de Neurologia, da Sociedade Brasileira de Doenças Cerebrovasculares e da Sociedade Brasileira de Neurorradiologia para o tratamento do AVC agudo e para a realização de procedimentos de neurointervenção urgentes durante a pandemia de COVID-19, incluindo o uso adequado de ferramentas de triagem e equipamentos de proteção pessoal (para pacientes e profissionais de saúde), além da alocação apropriada de pacientes.


Subject(s)
Humans , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Coronavirus Infections/prevention & control , Coronavirus , Disease Management , Neurology/standards , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/epidemiology , Societies, Medical , Brazil , Coronavirus Infections , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Stroke/therapy , Pandemics/prevention & control , Betacoronavirus
8.
Stroke Vasc Neurol ; 5(3): 242-249, 2020 09.
Article in English | MEDLINE | ID: covidwho-639169

ABSTRACT

During the COVID-19 epidemic, the treatment of critically ill patients has been increasingly difficult and challenging. During the epidemic, some patients with neurological diseases also have COVID-19, which could be misdiagnosed and cause silent transmission and nosocomial infection. Such risk is high in a neurological intensive care unit (NCU). Therefore, prevention and control of epidemic in critically ill patients is of utmost importance. The principle of NCU care should include comprehensive screening and risk assessment, weighing risk against benefits and reducing the risk of COVID-19 transmission while treating patients as promptly as possible.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units/standards , Nervous System Diseases/therapy , Neurology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Critical Illness , Cross Infection/diagnosis , Cross Infection/transmission , Cross Infection/virology , Host-Pathogen Interactions , Humans , Nervous System Diseases/diagnosis , Occupational Health , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
9.
Indian J Ophthalmol ; 68(7): 1300-1305, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-615733

ABSTRACT

The COVID-19 Pandemic has prompted substantial changes in the way ophthalmology is practiced globally. General guidelines on safe ophthalmic practice have been issued by various bodies across the globe including the All India Ophthalmological Society. While these are suitable to ophthalmology overall, they are not entirely suitable to a subspecialty practice, particularly pediatric ophthalmology, strabismus and neuro-ophthalmology, which entails dealing with children, surgery under general anesthesia and managing possible life threatening situations. A group of sub-specialists and anesthetists met virtually and arrived at a consensus with regard to practice and general anesthesia protocols pertaining to these subspecialties of ophthalmology. The recommendations made by the expert group are specific yet can be universally followed to ensure the best and safest outcome for the practitioner and patient alike. The recommendations pertain to listing conditions which need emergency or urgent care in the fields of pediatric ophthalmology and neuro-ophthalmology, precautions and technique of pediatric and neuro-ophthalmic eye examination and a protocol for delivering a safe general anesthesia for a pediatriceye surgery.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Neurology/standards , Ophthalmology/standards , Pneumonia, Viral/epidemiology , Societies, Medical , Strabismus/therapy , COVID-19 , Child , Consensus , Coronavirus Infections/transmission , Disease Management , Humans , India , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2
10.
Neurogastroenterol Motil ; 32(7): e13930, 2020 07.
Article in English | MEDLINE | ID: covidwho-593251

ABSTRACT

BACKGROUND: During the peak of the COronaVIrus Disease 2019 (COVID-19) pandemic, care for patients with gastrointestinal motility and functional disorders was largely suspended. In the recovery phases of the pandemic, non-urgent medical care is resumed, but there is a lack of guidance for restarting and safely conducting motility and function testing. Breath tests and insertion of manometry and pH-monitoring probes carry a risk of SARS-CoV-2 spread through droplet formation. METHODS: A panel of experts from the European Society for Neurogastroenterology and Motility (ESNM) evaluated emerging national and single-center recommendations to provide the best current evidence and a pragmatic approach to ensure the safe conduct of motility and function testing for both healthcare professionals and patients. RESULTS: At a general level, this involves evaluation of the urgency of the procedure, evaluation of the infectious risk associated with the patient, the investigation and the healthcare professional(s) involved, provision of the test planning and test units, education and training of staff, and use of personnel protection equipment. Additional guidance is provided for specific procedures such as esophageal manometry, pH monitoring, and breath tests. CONCLUSIONS AND INFERENCES: The ESNM guidelines provide pragmatic and appropriate guidance for the safe conduct of motility and function testing in the COVID-19 pandemic and early recovery phase.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Gastroenterology/standards , Gastrointestinal Motility/physiology , Neurology/standards , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic/standards , Recovery of Function/physiology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Europe/epidemiology , Expert Testimony/methods , Expert Testimony/standards , Health Personnel/standards , Humans , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Protective Clothing/standards , SARS-CoV-2 , Societies, Medical/standards
12.
Neurol India ; 68(2): 246-254, 2020.
Article in English | MEDLINE | ID: covidwho-270267

ABSTRACT

BACKGROUND: The COVID-19 infection outbreak has aroused increasing attention and affected thousands of people nationwide. The long incubation period, high infectious rate, varied manifestation, and absence of effective treatment make it difficult to manage the disease transmission. OBJECTIVE: The intended goals are to encourage efficient management of neurological and neurosurgical patients, resource utilization, and protecting the healthcare provider during the COVID-19 epidemic. Herein, we present a consensus statement from various centers in India. METHODOLOGY: In addition to the literature review, recommendations were included from neurologists and neurosurgeons from various centers in India. RESULTS: Every patient presenting for treatment should be treated as a potential asymptomatic infected case. Patients should be categorized based upon the priority as acute (require immediate treatment/surgery within 24 h), sub-acute (requiring treatment within a maximum of 7-10 days), or chronic (requiring treatment within a month). Non-essential elective surgeries and outpatient clinics should be avoided after informing the patient(s). There is a high risk of aerosol dispersion during intubation and certain neurosurgical procedures particularly those involving drills and endoscopes. These procedures should be performed wearing full personal protective equipment. The workflow of the operating rooms should also be modified significantly. Minor modifications in personal and professional lifestyles and routine training to use the PPE will ensure efficient management of resources. CONCLUSION: These recommendations could be used to mitigate the risks and reduce exposure to other patients, public, and healthcare staff.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Infection Control/standards , Neurology/standards , Neurosurgery/standards , Pandemics , Patient Care/standards , Pneumonia, Viral , COVID-19 , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurosurgical Procedures , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
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