Background: Telemedicine develops from technology that offers opportunities for knowledge transfer and information sharing and allows the provision of health services at a distance. Objective: To evaluate the number of publications on teleneurology in the last two decades in PubMed and the available evidence on the use of this technology in neurological clinical conditions. Methods: A quantitative assessment of publications related to telemedicine and neurology in the last two decades. A search was performed on the PubMed database for the descriptors ("Telemedicine"[Mesh]) AND "Neurology"[Mesh]). A review of the articles retrieved on the topic was carried out to evaluate the innovation processes used and applications in various clinical conditions involving teleneurology. Results: The search performed on March 14th 2022 resulted in 229 publications involving the topic of telemedicine and neurology between 1999 and 2022. Since 2000, there has been an increase in publications related to this topic, with a peak of 71 articles published in 2020, the year in which the World Health Organization defined the COVID-19 pandemic status. Conclusion: In the last two decades, teleneurology has been developing through the expansion of technological resources and the COVID-19 pandemic intensified this process. Different modalities of teleneurology are studied in several neurology subfields and include teleconsultation (between healthcare professionals or between healthcare professionals and patients), telerehabilitation, telemonitoring and tele-education. The advances achieved by teleneurology in this period encouraged technological innovations and health processes that developed opportunities to improve the care provided in a mechanism of constant evolution.

Introdução: o aumento da expectativa de vida da população brasileira associada a maior prevalência de doenças crônicas não transmissíveis promovem uma maior demanda de recursos assistenciais em saúde, dentre eles os cuidados paliativos (CP). Um serviço hospitalar de Cuidados Paliativos melhora os desfechos em saúde dos pacientes internados e facilita a discussão acerca dos valores dos pacientes, diagnóstico, prognóstico da doença e concordância sobre os objetivos do plano de cuidados, com evidências da redução de indicações de tratamentos não benéficos e até mesmo prejudiciais no final de vida.Metodologia:  relato de experiência da implementação das Linhas de Cuidados, para Cuidados Paliativos em hospital de retaguarda clínica e longa permanência de Porto Alegre, utilizando a proposta metodológica de Rosique estruturada em quatro etapas: seleção, desenvolvimento, implementação e avaliação/monitoramento de qualidade. Este processo foi realizado no período de outubro de 2018 a maio de 2019 para organização dos fluxos assistenciais e monitoramento da qualidade.Resultados: obtivemos um planejamento estruturado, com ações estratégicas para  implementar os Cuidados Paliativos. Os resultados são descritos nos fluxogramas assistenciais. A construção das LC facilitou a comunicação, coordenação de papéis, organização das atividades da equipe multidisciplinar de atendimento, o adequado registro, monitoramento, avaliação de variações, de resultados, indicadores de desfechos e identificação dos recursos apropriados.Conclusão: este processo qualificou a assistência com a capacitação dos recursos humanos, estabeleceu recursos tecnológicos disponíveis e materiais essenciais, possibilitou o desenvolvimento de protocolos e foi possível instituir indicadores para monitorar a qualidade da assistência aos pacientes e suas famílias.

Objective: to quantify the reasons for referrals of primary care physicians to neurology in Belo Horizonte, Brazil. Method: cross-sectional study evaluating referrals from Primary Care to the specialty of Neurology in Belo Horizonte, registered in the NOVO SISREG regulatory system, from March 2019 to July 2020. Neurologists or family physicians from the Regula Mais Brasil project, with experience in referral protocols for neurology, carried out the evaluation of the main diagnoses. Results: 13,844 referrals to neurology were identified, with an average of 814.35 referrals per month. Headache, epilepsy and cerebrovascular disorders were the most common reasons, accounting for 55.5% of referrals. Other neurological conditions identified less frequently were parkinsonism, tremor, syncope and vertigo, responsible for 10.9% of referrals. Conclusion: most referrals did not prioritize only neurology expertise. It is possible that cultural aspects and the routine of physicians, health services and the community itself determined these referrals, raising awareness about the high demand, waiting time and possible clinical conditions that are soon ceasing to be managed by other specialties that also share these skills.

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.