A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

A neuroradiology e-mail service for a district general hospital in the COVID-19 era

BACKGROUND

Hospital care for most neurological patients occurs in district general hospitals (DGHs). The COVID-19 pandemic displaced our DGH weekly neuroradiology meeting to an email service.

METHODS

Neuroradiological discrepancies among selected neurological patients were compared between face-to-face (f2f) meetings and an e-mail service.

RESULTS

Among 734 consecutively selected patients there was no statistically significant differences in outcomes - frequency of clinically unimportant discrepancies (10.3% e-mail vs 12.8% f2f, p = 0.300) or frequency of clinically important discrepancies (16.0% e-mail vs 15.6% f2f, p = 0.889). Among all imaged patients assessed by a neurologist, clinically important discrepancies were estimated to be 4.2% (95% CI: 3.5%-5.0%), with little annual variation (Chi-square for trend, p = 0.156).

CONCLUSION

This study shows that DGH general radiology provides good quality reporting of neuroimaging, and neurologists provide a pivotal role in identifying patients who require neuroradiology second opinions. During the COVID-19 pandemic, an e-mail service maintained neuroimaging quality assurance in a DGH.

Empathy as a crucial skill in disrupting disparities in global brain health

Brain health refers to the state of a person's brain function across various domains, including cognitive, behavioral and motor functions. Healthy brains are associated with better individual health, increased creativity, and enhanced productivity. A person's brain health is intricately connected to personal, social and environmental factors. Racial, ethnic, and social disparities affect brain health and on the global scale these disparities within and between regions present a hurdle to brain health. To overcome global disparities, greater collaboration between practitioners and healthcare providers and the people they serve is essential. This requires cultural humility driven by empathy. Empathy is a core prosocial value, a cognitive-emotional skill that helps us understand ourselves and others. This position paper aims to provide an overview of the vital roles of empathy, cooperation, and interdisciplinary partnerships. By consciously integrating this understanding in practice, leaders can better position themselves to address the diverse challenges faced by communities, promote inclusivity in policies and practices, and further more equitable solutions to the problem of global brain health.

Clinical autonomic nervous system laboratories in Europe: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

BACKGROUND AND PURPOSE

Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences.

METHODS

We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey.

RESULTS

We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021).

CONCLUSIONS

This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.