Evaluation of an Ambulatory Care Pathway for Patients with Nitrous Oxide-induced Myeloneuropathy

Overview

Journal BMJ Neurol Open

Specialty Neurology

Date 2024 Jun 5

PMID 38835539

Authors

Safiya A Zaloum

Alvar Paris

Devan Mair

Charles Gutteridge

Ruth M Ayling

Barbara L Onen

Joseph Walton

Anna Workman

Nelia Villanueva

Alastair J Noyce

Affiliations

Soon will be listed here.

Abstract

Introduction: Cases of nitrous oxide (NO)-induced myeloneuropathy are increasing at UK hospitals. At our centre, a dedicated ambulatory care pathway, endorsed nationally, was established to treat and monitor patients with NO-myeloneuropathy in 2021 and refined through three audit cycles. We analysed the outcomes of patients on this pathway to better understand factors associated with non-engagement. Alongside, a novel approach using WhatsApp for questionnaire delivery was trialled in an attempt to improve engagement with treatment.

Methods: Patients on the NO ambulatory care pathway were identified from MDT meeting lists from 9 September 2022 to 25 April 2023. Clinical data were collected via electronic clinical records, including the most recent neurological examination and reason for discharge from the pathway. Patients identified from MDT lists from 27 January 2023 to 14 March 2023 were approached to participate in weekly 12-item surveys, delivered via WhatsApp. This was approved as a service development project with approval for WhatsApp use given by the chief clinical information officer.

Results: 35/56 (62.5%) patients were discharged from ambulatory care due to non-attendance and 17/56 (30.4%) completed their treatment course. The median time from initial presentation to discharge was 49 days. 24/40 (60.0%) of patients with a final neurological examination documented had a residual deficit, with objective sensory deficits most common. 12 patients were approached to receive weekly questionnaires via WhatsApp. 5/8 who expressed interest returned a consent form. All participants were withdrawn due to non-response or participant choice. 1/5 returned more than two surveys.

Conclusion: Despite poor participation in surveys delivered via WhatsApp, novel approaches are needed to improve engagement with patients on the NO ambulatory care pathway.

Citing Articles

Enhancing Differential Diagnosis Related to Oxidative Stress, Nitrous Oxide, and Nutrition by Rapid Plasma Homocysteine Measurement.

Grzych G, Zerimech F, Touze B, Descamps C, Bout M, Joncquel M J Xenobiot. 2024; 14(4):1332-1342.

PMID: 39449416 PMC: 11503375. DOI: 10.3390/jox14040075.

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