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To identify factors that patients consider when choosing between future in-person, video, or telephone visits.Telemedicine has been rapidly integrated into ambulatory neurology in response to the COVID-19 pandemic.Ambulatory neurology patients at a single center were contacted via telephone to complete: (1) a survey quantifying likelihood of scheduling a future telemedicine visit, and (2) a semi-structured qualitative interview following their visit in March 2021. Data were processed using the principles of thematic analysis.Of 2493 visits, 39% assented to post-visit feedback; 74% were in-person visits and 13% video and telephone. Patients with in-person visits were less likely than those with video and telephone visits to "definitely" consider a future telemedicine visit (36 vs. 59 and 62%, respectively; p 0.001). Patients considered five key factors when scheduling future visits: "Pros of Visit Type," "Barriers to Telemedicine," "Situational Context," "Inherent Beliefs," and "Extrinsic Variables." Patients with telemedicine visits considered convenience as a pro, while those with in-person visits cited improved quality of care. Accessibility and user familiarity were considered barriers to telemedicine by patients with in-person and telephone visits, whereas system limitations were prevalent among patients with video visits. Patients agreed that stable conditions can be monitored via telemedicine, whereas physical examination warrants an in-person visit. Telemedicine was inherently considered equivalent to in-person care by patients with telephone visits. Awareness of telemedicine must be improved for patients with in-person visits.Across visit types, patients agree that telemedicine is convenient and effective in many circumstances. Future care delivery models should incorporate the patient perspective to implement hybrid models where telemedicine is an adjunct to in-person visits in ambulatory neurology.

ObjectiveTo describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States.MethodsA retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call.ResultsOf 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years,p< 0.001), more likely to be female (63% vs 55%,p< 0.007), be White or Caucasian (p= 0.024), and not have Medicare or Medicaid insurance (p< 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%,p= 0.05).ConclusionRapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.

Objective:To assess patient experiences with rapid implementation of ambulatory telehealth during the COVID-19 pandemic.Methods:A mixed methods study was performed to characterize the patients’ experience with neurology telehealth visits during the first eight weeks of the COVID-19 response. Consecutive patients who completed a telehealth visit were contacted by telephone. Assenting patients completed a survey quantifying satisfaction with the visit followed by a semi-structured telephone interview. Qualitative data were analyzed using the principles of thematic analysis.Results:2,280 telehealth visits were performed, 753 patients (33%) were reached for post-visit feedback. Of these, 47% of visits were by video and 53% by telephone. Satisfaction was high with 77% of patients reporting that all needs were met though only 51% would consider telehealth in the future. Qualitative themes emerged suggesting that positive patient experiences were associated with elimination of commute time and associated costs as well as a positive physician interaction. Negative patient experiences were associated with the inability to complete the neurologic examination. Overall, patients tended to view telehealth as a tool that should augment, and not replace, in-person visits.Conclusion:In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed.

OBJECTIVE: Examine the prevalence of sarcopenia (low muscle mass) and osteosarcopenia (low bone density and muscle mass) in older motor vehicle crash (MVC) occupants, and the relationship of these musculoskeletal conditions with age, sex, and injury. METHODS: Sarcopenia and osteopenia was assessed from abdominal computed tomography (CT) scans of 61 seriously injured MVC occupants over age 50 in the Crash Injury Research and Engineering Network (CIREN) database. RESULTS: The prevalence was 43% for sarcopenia, 25% for osteopenia, and 15% for osteosarcopenia in the CIREN occupants. The Injury Severity Score (ISS) was higher in those with only sarcopenia (mean ± standard error: 22.4 ± 2.3), followed by those with osteosarcopenia (17.9 ± 2.4) and only osteopenia (12.8 ± 1.5). More total fractures were observed in occupants with sarcopenia alone (7.6 ± 1.5) or osteosarcopenia (7.0 ± 2.1) compared to non-sarcopenic occupants with osteopenia (4.0 ± 2.5). CONCLUSIONS: Sarcopenia and osteosarcopenia may be associated with more serious injuries and fractures in MVCs.

The glutamatergic neurotransmitter system may play an important role in attention-deficit hyperactivity disorder (ADHD). This 5-week, open-label, single-blind, placebo-controlled study reports the safety, pharmacokinetics and responsiveness of the metabotropic glutamate receptor (mGluR) activator fasoracetam (NFC-1), in 30 adolescents, age 12–17 years with ADHD, harboring mutations in mGluR network genes. Mutation status was double-blinded. A single-dose pharmacokinetic profiling from 50–800 mg was followed by a single-blind placebo at week 1 and subsequent symptom-driven dose advancement up to 400 mg BID for 4 weeks. NFC-1 treatment resulted in significant improvement. Mean Clinical Global Impressions-Improvement (CGI-I) and Severity (CGI-S) scores were, respectively, 3.79 at baseline vs. 2.33 at week 5 (P, Stimulant drugs are most commonly used to treat ADHD. Here, the authors demonstrate that in adolescents with ADHD who also have genetic variation in genes impacting metabotropic glutamate signaling, the non-stimulant mGluR activator fasoracetam is well tolerated and may be beneficial in alleviating symptoms of this disease.

Child psychiatric disorders do not follow a simple linear gene–phenotype, rendering the quest for gene discovery challenging. The rapidly expanding field of epigenetics, which focuses on the regulation of gene activity and expression, may provide the missing components that may explain some of the complexity. Numerous environmental factors such as maternal stress, hypoxia, and nutritional deficiencies, among others, are being consistently associated with increased risk for several of the major child psychiatric disorders, and some with small effect have been shown to have a significant effect within the context of a positive family history. The mechanisms by which epigenetic factors silence or enhance gene expression in child psychiatric disorders remains to be discovered. Recent advances in the role of microRNAs and epigenetic reconfiguration in normal brains, where over 50% of methylation was discovered to occur in non-CpG nucleotides, will undoubtedly accelerate discoveries.