Department of Neurology, University Hospitals, Cleveland VA Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
Division of Brain Sciences, Imperial College, London, UK.
Cerebellum. 2021 Feb;20(1):4-8. doi: 10.1007/s12311-020-01178-8.
The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged by the novel coronavirus pandemic (COVID19). The social distancing measures and lockdowns imposed in many countries left medical care providers with limited options in evaluating ambulatory patients, pushing the rapid transition to assessments via virtual platforms. In this novel arena of medical practice, which may form new norms beyond the current pandemic crisis, we found it critical to define guidelines on the recommended practice in neurotology, including remote methods in examining the vestibular and eye movement function. The proposed remote examination methods aim to reliably diagnose acute and subacute diseases of the inner-ear, brainstem, and the cerebellum. A key aim was to triage patients into those requiring urgent emergency room assessment versus non-urgent but expedited outpatient management. Physicians who had expertise in managing patients with vestibular disorders were invited to participate in the taskforce. The focus was on two topics: (1) an adequate eye movement and vestibular examination strategy using virtual platforms and (2) a decision pathway providing guidance about which patient should seek urgent medical care and which patient should have non-urgent but expedited outpatient management.
虚拟实践在我们照顾现代患者的方式上取得了重大进展。虚拟实践、咨询和远程医疗文化几年前就已经开始了,随着新型冠状病毒肺炎(COVID-19)的挑战,它加速飞跃。许多国家实施的社交距离措施和封锁,使得医疗保健提供者在评估门诊患者时选择有限,促使快速过渡到通过虚拟平台进行评估。在这个新的医学实践领域,它可能会在当前的大流行危机之外形成新的规范,我们发现有必要定义神经耳科学推荐实践的指南,包括前庭和眼动功能的远程检查方法。提出的远程检查方法旨在可靠地诊断内耳、脑干和小脑的急性和亚急性疾病。一个主要目标是将患者分诊为需要紧急急诊评估的患者与非紧急但需要加急门诊管理的患者。邀请了在管理前庭障碍患者方面具有专业知识的医生参与工作组。重点关注两个主题:(1)使用虚拟平台进行充分的眼动和前庭检查策略,(2)提供指导患者应寻求紧急医疗护理和患者应进行非紧急但加急门诊管理的决策途径。