Telehealth, which provides a means for long-distance clinical care, holds immense promise as a patient-centered care delivery model. This model has the potential to improve access to care in resource-limited settings (e.g., rural areas with few specialty providers) and for patients with limited mobility, transportation barriers, lack of caregivers and low funds. It may also improve the efficiency of a healthcare encounter by improving the timeliness and flexibility of visits. However, there are still several barriers to its widespread implementation. Beck and colleagues, through a randomized-controlled trial, test the feasibility and efficacy of adjunct telehealth visits with a movement disorders specialist compared to standard of care (as planned neurology visits) among participants with Parkinson’s disease to address one of these barriers. Namely, how does telehealth compare to what we currently do?
Eponyms are found all throughout medicine and perhaps there is no field more steeped in a rich collection of eponyms than neurology. As a young student I found eponymous signs and disease names to be antiquated and cumbersome to remember. When trying to learn the fundamentals of patient care, the names of historic clinicians seemed superfluous, and I held the belief that they had little to teach us about the practice of modern medicine.
Perspective is everything.
If you were around and interested in “Global Neurology” prior to 1994, then you felt mightily alone. The metric for assessing the burden or impact of a disease or health condition was essentially a body count. This rather primitive approach failed to capture at all the burden of diseases that devastate without necessarily causing rapid death. Think severe cerebral palsy. Untreated, primary progressive multiple sclerosis. Dementia. Treatment resistant epilepsy. You get the idea. So the development of the Disability Adjusted Life Year (DALY) and efforts to quantify this through the Global Burden of Disease work were transformative for global neurology.1, 2 Neuropsychiatric disorders rose out of oblivion to become recognized as one of the top causes of the global burden.3 Let’s call this “Transition in Perspective: Phase 1”
If you have not had an opportunity to attend a World Congress of Neurology, these are exciting and vibrant meetings well worth the travel. For a thorough overview of the September WCN in Kyoto, please check out Without Borders’ “On the Road” report from Steven Lewis and Wolfgang Griswold.
Travel can be illuminating. But perhaps none more so than the professional journey of Dr. Charles Hammond of Ghana who had to leave him home country for Child Neurology training in South Africa. Check out our Global Stuff You Should Know section to learn more about Dr. Hammond’s work as he settled back into “home” after years abroad.
The process of transitioning an adolescent with a neurologic condition from the pediatric to the adult health care system can be complex and seem daunting. It requires that the youth’s care team, including both the pediatric and adult neurologists involved, be aware of the medical, legal and financial implications of this transition and be able to use this information to support and guide the youth during the process. A smooth transition of care is likely to reduce youth and caregiver anxiety, prevent gaps in care, encourage youths to better understand and self-manage their own medical condition(s) and empower adult neurologists to feel more comfortable in taking care of young adults.
A challenge for the primary care medical home model (PCMH) is incorporating care from specialties. In this study, Elrashidi et al explored the impact of integrating a neurologist into the Mayo Clinic PCMH by comparing aspects of care delivered by the integrated neurologist with matched visits from the pre-integration time period. The integrated neurologist worked 0.6 FTE, had a staff of 3 FTE registered nurses, 3 clinical assistants, and a specified work plan — 3-4 scheduled patients per half day, in addition to curbsides, e-consults, follow-up, and additional acute same-day consults. Over a 12-month period of patient follow-up, patients seen by the integrated neurologist had fewer subsequent neurologist visits (0.62, p=0.001), EMGs (OR 0.64, p=0.009), and brain MRIs (0.60, p<0.001), but not total subsequent outpatient visits (0.92, p=0.21), ED visits (0.83, p=0.20), or hospitalizations (0.96, p=0.83) compared with the pre-integration visits. The integrated neurologist also did not lower the time to neurologist appointment (p=0.83), despite presumably reducing referrals because of curbsides and e-consults.
Burn-out is a phenomenon consisting of emotional exhaustion, feelings of cynicism/detachment, and a sense of being ineffective at one’s work, that threatens the well-being and safety of both physicians and the patients they treat. It is known to be a harbinger of work/home conflicts, health problems, and suicide among physicians.
In this issue of Neurology, Rubin and colleagues report disconcerting data from their analysis of the Women’s Interagency HIV Study database. In longitudinal assessments of cognitive and motor function in women with and without HIV infection, even among women with continuous viral suppression HIV-associated differences were evident. Perhaps even more disturbingly, in some domains women with continuous suppression performed more poorly than those with HIV who were not suppressed.
A newly published systematic review and meta-analysis in Neurology looks at the complications of sickle cell disease in Africa. In an accompanying editorial, Dr. Ralph Green and I consider the unmet challenges of these neurologic complications. As we note in the editorial, “Sometimes an important scientific report is more notable for what it cannot tell us than for what it can”.