Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital

Janssen, Frank; Awadallah, Mohammed; Alhalabi, Awed; Körber, Barbara; Lang, Reinhard; Scibor, M.; Handschu, René

doi:10.1007/s00415-018-8756-4

Cited by 13 publications

(24 citation statements)

References 19 publications

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“…Videoconference was only used by a minority of the neurologists responding this survey because most healthcare facilities could not offer these platforms with such short notice. Videoconference, however, may be more convenient to reinforce the relationship with patients and to perform the neurological examination [8]. It is likely that if this type of attention continues in the future and if video is available, more neurologists will take on also first visits in this way.…”

Section: Discussionmentioning

confidence: 99%

Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic

Conde‐Blanco

Centeno

Tió

et al. 2020

Epilepsy & Behavior

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Teleneurology in Spain had not been implemented so far in clinical practice, except in urgent patients with stroke. Telemedicine was hardly used in epilepsy, and patients and neurologists usually preferred onsite visits. Our goal was to study impressions of adult and pediatric epileptologists about the use of telemedicine after emergent implementation during the new coronavirus 2019 (COVID-19) pandemic. Methods: An online survey was sent to the members of the Spanish Epilepsy Society and the members of the Epilepsy Study Group of the Catalan Neurological Society, inquiring about different aspects of telemedicine in epilepsy during the pandemic lockdown. Results: A total of 66 neurologists responded, mostly adult neurologists (80.3%), the majority with a monographic epilepsy clinic (4 out of 5). Of all respondents, 59.1% reported to attend more than 20 patients with epilepsy (PWE) a week. During the pandemic, respondents handled their epilepsy clinics mainly with telephone calls (88%); only 4.5% used videoconference. Changes in antiseizure medications were performed less frequently than during onsite visits by 66.6% of the epileptologists. Scales were not administered during these visits, and certain types of information such as sudden expected unrelated death in epilepsy (SUDEP) were felt to be more appropriate to discuss in person. More than 4 out of 5 of the neurologists (84.8%) stated that they would be open to perform some telematic visits in the future. Conclusions: In Spain, emergent implantation of teleneurology has shown to be appropriate for the care of many PWE. Technical improvements, extended use of videoconference and patient selection may improve results and patient and physician satisfaction.

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Section: Discussionmentioning

confidence: 99%

Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic

Conde‐Blanco

Centeno

Tió

et al. 2020

Epilepsy & Behavior

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“…In past studies, tele-neurology through videoconferencing has been shown to feasible for new and follow-up evaluations for a variety of neurological disorders and performed as well as face-to-face assessment for the diagnosis and planning of treatment [14,26]. In a comparison of standard telephone advice and audio-visual conferencing by a neurologist, audio-visual conferencing was found to increase quality and safety and led to a change of initial diagnosis in more than half of cases suggesting higher rates of diagnostic accuracy [31]. Tele-neurology has been proven to be feasible in the evaluation of movement disorders, multiple sclerosis, headache, dementia, and remote sleep assessments [5,7].…”

Section: Reviewmentioning

confidence: 99%

Multidisciplinary Approach and Outcomes of Tele-neurology: A Review

Patel¹,

Malik²,

DeMasi³

et al. 2019

Cureus

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In rural and underserved areas, there are restrictions in healthcare due to the lack of availability of neurologists; patients have to travel long distances to receive the required care. Considering the fact that neurological conditions have large mortality and disability rates, there is a need for innovative services like tele-neurology. It is an important tool in improving the health and quality of life by using different ways of communication between neurologists and patients, or neurologists and other providers. We examine the current types of facilities available in tele-neurology, as well as outcomes, barriers, limitations, legal litigations, and the multidisciplinary nature based on prior studies. We have also suggested recommendations for the future of tele-neurology including effective-accessibility and inexpensive-utilization in developing countries. There are various tele-health programs created by The Veterans Health Administration including a clinical video tele-health (CVT) system. This system allows direct patient care of veterans by neurologists. The University of South Carolina implemented a web-based tele-stroke program in which acute ischemic stroke patients were treated in the Emergency Department (ED) of rural hospitals by neurologists, after consulting with rural ED physicians. With growing technology and popularity of tele-neurology, there are now international collaborative efforts in tele-medicine that are looking to be adapted to tele-neurology. Thus, tele-neurology can provide quality neurological care with patient satisfaction, as well as time and cost savings. The tele-stroke group established by TRUST-tPA trial (Therapeutic Trial Evaluating Efficacy of Telemedicine (TELESTROKE) of Patients With Acute Stroke) has 10 community hospital-emergency rooms that were connected to a stroke center. It was found that tele-stroke is appropriate in places where there is no way for a patient to access a stroke unit within a 4.5-hour time window. Like other tele-neurology subtypes, tele-epilepsy and pediatric tele-neurology also offer more follow-up care to people of remote areas which have limited access. There are other subtypes like mental health, chronic neurological care, and hospitalist which are very effective in improving outcome and quality of life of people living in remote areas. Tele-neurology has effectively reduced travel costs and times; there is high patient satisfaction and reduced disparity for general and specialized neurological care. But there are certain limitations like large equipment costs, certain bandwidth requirement, and trained staff to use the equipment. Transmission of patient information using public internet raises the concern of legality. There should be sufficient encryption to satisfy the Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure patient confidentiality and safety of personal data. The adaptation of tele-neurology is a powerful and innovative way to enhance healthcare in areas with a shortage o...

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“…The study was parallel to a feasibility study of telemedicine in neurological acute care [14] and was supported by a grant of the Bavarian State Ministry of Health.…”

Section: Methodsmentioning

confidence: 99%

“…Data safety technology and regulations, therefore, were adopted from the STENO network [13]. Before this study, the telemedicine unit was already used for assessments in about 500 cases and also in an accompanying feasibility study with the same technical standards [14].…”

Section: Methodsmentioning

confidence: 99%

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine

Awadallah¹,

Janssen²,

Körber³

et al. 2018

Eur Neurol

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Introduction: While there are several studies on reliability of telemedicine in assessing stroke scales, little is known about the validity of a general neurological examination performed via telemedicine. Therefore, we sought to test the agreement between bedside and remote examination in acute patients of the emergency room. Methods: Acute patients at the emergency room of a 450-bed academic teaching hospital were included in this study. A clinical neurological examination consisting of 22 items was performed at bedside and also remotely via an audio-visual link by a different neurologist; both were experienced clinicians at the consultant level. Kappa statistics were calculated for each item of the examination. Results: Forty three patients completed both examinations (mean age 58.3 years, 56% female). Patients were seen between 8 and 72 min after admission (mean 36.3 min). Total time for remote examination was 12.6 min (8–21 min) and 8.9 min (5–18 min) for bedside examination. K-coefficients ranged from 0.32 (muscle tone) – 0.82 (language) indicating a fair to excellent agreement in most items. Conclusions: Remote examination via an audio-visual link produces comparable results to bedside performance even in acute patients of the emergency room. Compared to the scarce data available, inter-observer agreement is about the same as that between 2 examiners at bedside. However, more studies on reliability and validity of clinical neurological examination are required.

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Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital

Abstract: Audiovisual consultation seems to be a feasible and useful support in routine neurology back-up service of an acute care hospital. Better mobility of devices and flexibility of service is needed to improve availability and quality of this valuable tool.

Cited by 13 publications

References 19 publications

Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic

Emergency implementation of telemedicine for epilepsy in Spain: Results of a survey during SARS-CoV-2 pandemic

Multidisciplinary Approach and Outcomes of Tele-neurology: A Review

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine

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