Use of telemedicine in managing deep brain stimulation for movement disorders

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES BMJ Innovations Pub Date : 2022-01-01 DOI:10.1136/bmjinnov-2021-000735
M. Paranathala, U. Brechany, Russell Mills, C. Nicholson, Alistair J. Jenkins, M. Hussain
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Abstract

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION During the global COVID19 pandemic, there has been a move towards ‘remote’ healthcare and minimising nonessential traffic through primary and secondary care to minimise the spread of the virus. Studies have shown that patients with deep brain stimulators (DBSs) have a high requirement for input regarding programming and maintenance of their systems. 2 Patients with neuromodulators for movement disorders are usually seen by specialist nurses for followup. One component of assessment is checking the implantable pulse generators (IPGs) which are the batteries for the stimulation, and planning surgery for replacement in a timely manner. If this is not done, it can lead to clinical crises for the patient, emergency admission and longer stays in hospital while they wait for emergency surgery and recover from the episode leading to significant mental and physical impact. Monitoring of recharging patterns, where the IPG is rechargeable, is valuable in highlighting any problems. To maintain clinical care during the pandemic, there was a move towards video and audio conferencing of outpatient appointments for new and followup patients within neurosurgery. 4 Studies suggest that this method of clinical followup is acceptable to patients with DBS. 5 Other options for telemedicine are secure interactive software for communication with the patient via their own devices such as laptop, tablets and mobile telephones. Reminders and notifications can be sent securely via this medium between clinicians and patients. Such telemedicine allows management of IPGs to be done remotely. Use of telemedicine can be technically and logistically challenging due to cost and hardware required, so it is important to understand its utility, as well as patient experience, tolerability and impact on clinical resources. Studies during COVID19 suggest its use in managing DBS for Parkinson’s disease (PD) was effective. If valuable then its use may be continued beyond the COVID19 pandemic to reduce the workload on clinical staff and enable contemporaneous monitoring of patients. We reviewed our experience with telemedicine in managing our cohort of patients with DBS for movement disorder.
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远程医疗在治疗运动障碍的深部脑刺激中的应用
©作者(或其雇主)2022。禁止商业重用。请参阅权利和权限。英国医学杂志出版。在2019冠状病毒病全球大流行期间,人们开始转向“远程”医疗保健,并通过初级和二级医疗尽量减少不必要的交通,以尽量减少病毒的传播。研究表明,使用深部脑刺激器(DBSs)的患者对其系统的编程和维护有很高的输入要求。使用神经调节剂治疗运动障碍的患者通常由专科护士随访。评估的一个组成部分是检查可植入脉冲发生器(IPGs),它是刺激的电池,并及时计划更换手术。如果不这样做,可能会导致患者的临床危机,紧急入院,并在等待紧急手术和从发作中恢复期间延长住院时间,从而导致严重的精神和身体影响。监测充电模式(IPG是可充电的)对于突出任何问题都是有价值的。为了在大流行期间维持临床护理,对神经外科的新患者和随访患者门诊预约采取了视频和音频会议的做法。4研究表明,这种临床随访方法对于DBS患者是可以接受的。远程医疗的其他选择是安全的交互式软件,用于通过患者自己的设备(如笔记本电脑、平板电脑和移动电话)与患者进行通信。提醒和通知可以通过这种媒介在临床医生和患者之间安全地发送。这种远程医疗允许远程管理ipg。由于成本和所需硬件,远程医疗的使用在技术上和后勤上都具有挑战性,因此了解其效用以及患者体验、耐受性和对临床资源的影响非常重要。2019冠状病毒病期间的研究表明,将其用于治疗帕金森病(PD)的DBS是有效的。如果有价值,可以在covid - 19大流行之后继续使用,以减少临床工作人员的工作量,并实现对患者的同步监测。我们回顾了远程医疗在治疗运动障碍DBS患者队列中的经验。
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来源期刊
BMJ Innovations
BMJ Innovations Medicine-Medicine (all)
CiteScore
4.20
自引率
0.00%
发文量
63
期刊介绍: Healthcare is undergoing a revolution and novel medical technologies are being developed to treat patients in better and faster ways. Mobile revolution has put a handheld computer in pockets of billions and we are ushering in an era of mHealth. In developed and developing world alike healthcare costs are a concern and frugal innovations are being promoted for bringing down the costs of healthcare. BMJ Innovations aims to promote innovative research which creates new, cost-effective medical devices, technologies, processes and systems that improve patient care, with particular focus on the needs of patients, physicians, and the health care industry as a whole and act as a platform to catalyse and seed more innovations. Submissions to BMJ Innovations will be considered from all clinical areas of medicine along with business and process innovations that make healthcare accessible and affordable. Submissions from groups of investigators engaged in international collaborations are especially encouraged. The broad areas of innovations that this journal aims to chronicle include but are not limited to: Medical devices, mHealth and wearable health technologies, Assistive technologies, Diagnostics, Health IT, systems and process innovation.
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