Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study

Donno, Antonio De; Acella, Adriano; Angrisani, Carmelinda; Gubinelli, Giulia; Musci, Gianluca; Gravili, Gianluca; Ciritella, Chiara; Santamato, Andrea

doi:10.3389/fmed.2021.754456

Cited by 9 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Current studies highlighted that the cessation of certain health services may lead to a decline in patients’ quality of life. Additionally, the healthcare system may incur higher costs in the future to regain the loss of benefits from previous therapies due to their discontinuation ( 30 , 31 ). Thus, to reduce the unessential visits to hospitals and insure basic health services, the government implemented a series of policies including prompting pharmacy delivery services and telemedicine.…”

Section: Discussionmentioning

confidence: 99%

Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

Yang

Huang

Yan

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

ObjectiveThe COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing’s 2020–2021 pandemic relative to the 2017–2019 pre-COVID-19 benchmark period.MethodsHospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing’s HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included.ResultsIn the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017–2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5.ConclusionThe HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.

show abstract

Section: Discussionmentioning

confidence: 99%

Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

Yang

Huang

Yan

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Moreover, in one case, we highlight how discontinuation of treatment for prolonged periods can negatively impact on maintenance of achieved abilities. A clear deterioration during the COVID-19 pandemic owing to the inability to continue usual treatments has been reported in both pediatric and adult populations [39,40].…”

Section: Discussionmentioning

confidence: 99%

From Feeding Challenges to Oral-Motor Dyspraxia: A Comprehensive Description of 10 New Cases with CTNNB1 Syndrome

Onesimo,

Sforza,

Trevisan

et al. 2023

Genes

View full text Add to dashboard Cite

CTNNB1 syndrome is an autosomal-dominant neurodevelopmental disorder featuring developmental delay; intellectual disability; behavioral disturbances; movement disorders; visual defects; and subtle facial features caused by de novo loss-of-function variants in the CTNNB1 gene. Due to paucity of data, this study intends to describe feeding issues and oral-motor dyspraxia in an unselected cohort of 10 patients with a confirmed molecular diagnosis. Pathogenic variants along with key information regarding oral-motor features were collected. Sialorrhea was quantified using the Drooling Quotient 5. Feeding abilities were screened using the Italian version of the Montreal Children’s Hospital Feeding Scale (I-MCH-FS). Mild-to-severe coordination difficulties in single or in a sequence of movements involving the endo-oral and peri-oral muscles were noticed across the entire cohort. Mild-to-profuse drooling was a commonly complained-about issue by 30% of parents. The mean total I-MCH-FS t-score equivalent was 43.1 ± 7.5. These findings contribute to the understanding of the CTNNB1 syndrome highlighting the oral motor phenotype, and correlating specific gene variants with clinical characteristics.

show abstract

“…Kim et al discovered that the agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial (kappa = 0.643) and fair (kappa = 0.308), respectively ( 110 ). De Donno et al showed that tele-evaluation of spasticity is inadequate and only 7.3% of patients can be accessed, as it involves a lot of ethical, medico-legal and technical issues ( 111 ).…”

Section: Telemedicine Based Spasticity Assessmentmentioning

confidence: 99%

Quantitative assessment of spasticity: a narrative review of novel approaches and technologies

Luo

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

Spasticity is a complex neurological disorder, causing significant physical disabilities and affecting patients' independence and quality of daily lives. Current spasticity assessment methods are questioned for their non-standardized measurement protocols, limited reliabilities, and capabilities in distinguishing neuron or non-neuron factors in upper motor neuron lesion. A series of new approaches are developed for improving the effectiveness of current clinical used spasticity assessment methods with the developing technology in biosensors, robotics, medical imaging, biomechanics, telemedicine, and artificial intelligence. We investigated the reliabilities and effectiveness of current spasticity measures employed in clinical environments and the newly developed approaches, published from 2016 to date, which have the potential to be used in clinical environments. The new spasticity scales, taking advantage of quantified information such as torque, or echo intensity, the velocity-dependent feature and patients' self-reported information, grade spasticity semi-quantitatively, have competitive or better reliability than previous spasticity scales. Medical imaging technologies, including near-infrared spectroscopy, magnetic resonance imaging, ultrasound and thermography, can measure muscle hemodynamics and metabolism, muscle tissue properties, or temperature of tissue. Medical imaging-based methods are feasible to provide quantitative information in assessing and monitoring muscle spasticity. Portable devices, robotic based equipment or myotonometry, using information from angular, inertial, torque or surface EMG sensors, can quantify spasticity with the help of machine learning algorithms. However, spasticity measures using those devices are normally not physiological sound. Repetitive peripheral magnetic stimulation can assess patients with severe spasticity, which lost voluntary contractions. Neuromusculoskeletal modeling evaluates the neural and non-neural properties and may gain insights into the underlying pathology of spasticity muscles. Telemedicine technology enables outpatient spasticity assessment. The newly developed spasticity methods aim to standardize experimental protocols and outcome measures and enable quantified, accurate, and intelligent assessment. However, more work is needed to investigate and improve the effectiveness and accuracy of spasticity assessment.

show abstract

Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study

Cited by 9 publications

References 25 publications

Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

Coping with COVID: Performance of China’s hierarchical medical system during the COVID-19 pandemic

From Feeding Challenges to Oral-Motor Dyspraxia: A Comprehensive Description of 10 New Cases with CTNNB1 Syndrome

Quantitative assessment of spasticity: a narrative review of novel approaches and technologies

Contact Info

Product

Resources

About