Practice Point: Teleneurology | Figure 1

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Practice Point: Teleneurology

Teleneurology services have expanded in the era of COVID-19. As many regions of the country begin to lift pandemic restrictions, clinicians consider how they would like to incorporate telemedicine into their practices in the future.

Frequently cited benefits of teleneurology include:

1. Patient convenience and time savings. Neurological patients may have limitations to their mobility, and telemedicine can reduce burdensome travel.

2. Increased access to care. For patients living in remote areas, teleneurology allows for provision of care that was previously difficult to deliver.

3. Potential to decrease health care costs. Increasing the number of services within the patient’s home could allow for savings when compared to traditional models of health care delivery.

Key Questions on Teleneurology

• Have you incorporated teleneurology into your practice? What do you see as the pros and cons? Share your thoughts below.

• 65 years old female referred from health care center with this ECG for evaluation. Patient has no complaints and no chronic illness. What is your diagnosis and what can you do for more evaluation?

• @DrsWithoutBorders surgeons intervene to save the life of a pregnant woman with a complicated birth requiring obstetric surgery in Douentza, Mali. They support the Referral Health Centre (CSRef) in Douentza in nutrition, emergency surgery, care, and hospitalization for children aged 0-15, mental health, and transferring urgent cases to the city of Mopti.

Transitioning Patients

The needs of pediatric and adult patients can be quite different, and this potentially vulnerable population may experience challenges as they make the transition. Why talk about this? Eighty to ninety percent of patients with cerebral palsy live past age 30. The predicted survival for patients with cystic fibrosis increased from 25 years in 1985 to 46 years in 2019. It's becoming increasingly important that we think critically about how we approach transitioning patients from their pediatrician to their adult primary care provider.

What is your approach to the transition process within your practice? If you're a pediatrician, how do you prepare your medically complex patients for the transition to adult primary care? If you are an adult provider, how do you integrate patients with developmental disabilities or complex congenital conditions into your practice? If you're a family medicine provider, what aspects of care are important to you as your patient moves from adolescence to adulthood?

• A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

• A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

• A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

• A patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?