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Penner IK, Heras VDL, Jones E, Hetherington S, Karu H, Chetlangia R, Biswas S, Castro PD, Lines C. The presence and burden of cognitive issues: discordance between the perception of neurologists and people living with multiple sclerosis. Eur J Neurol 2024:e16234. [PMID: 38500270 DOI: 10.1111/ene.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a common symptom of multiple sclerosis (MS) and occurs in more than 40% of people living with MS (plwMS). No real-world study has assessed the perception of neurologists and plwMS on cognitive issues. METHODS Using data from the 2011-2019 Adelphi MS Disease Specific Programme database, this real-world, retrospective, cross-sectional multi-cohort study included people aged ≥18 years with relapsing-remitting MS and secondary progressive MS from the United States, UK and the EU. Neurologists provided data on the patient record form for plwMS, with the same plwMS invited to voluntarily complete a patient self-completion form: a questionnaire about their experiences with MS. RESULTS Of 25,374 plwMS, 4817 who provided information on cognitive and mood symptoms were included in the analysis. Of the plwMS, 68% and 59% reported feeling 'mentally fatigued' and having 'difficulty concentrating', respectively. Neurologists reported only 27% of plwMS as having 'difficulty concentrating' and 15% of plwMS as having 'short-/long-term memory problems'. Neurologists reported cognitive or mood symptoms as 'not experienced' by a higher percentage of participants with relapsing-remitting MS than secondary progressive MS. Of the plwMS who experienced 'difficulty concentrating', most had a concomitant feeling of being 'mentally fatigued' (52%), followed by 'feeling anxious or tense' (49%) and 'feeling depressed' (44%). In plwMS, caregivers reported 'difficulty concentrating' (16%) as the most common cognitive issue. CONCLUSION A clear discordance was observed between neurologists and plwMS regarding the perception of the cognitive and neuropsychiatric issues. These results underline the under-perception of cognitive and emotional affective symptoms in plwMS during neurological consultations.
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Affiliation(s)
- Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Watt JK, Quinn TJ. Critical Look at the NIHSS Visual Stimuli. Stroke 2024; 55:452-453. [PMID: 38252749 DOI: 10.1161/strokeaha.123.045806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Jodi Karlyn Watt
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
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Jagolino-Cole AL, Brown DL, Chiota-McCollum N, Southerland AM, Liebeskind DS. Optimizing Educational Environments in Stroke and Neurovascular Fields. Stroke 2024; 55:e12-e16. [PMID: 38037224 DOI: 10.1161/strokeaha.123.041019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Amanda L Jagolino-Cole
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (A.L.J.-C.)
| | - Devin L Brown
- Department of Neurology, The University of Michigan, Ann Arbor (D.L.B.)
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Lidonnici D, Brambilla P, Ravasio R, Zozulya-Weidenfeller A, Beiderbeck A, van Aswegen M, Oliveira R, Sansone VA. Expert Insights from a Delphi-driven Neurologists' Panel: Real-world Mexiletine use in Patients with Myotonic Disorders in Italy. J Neuromuscul Dis 2024; 11:411-423. [PMID: 38306059 DOI: 10.3233/jnd-230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background Myotonic disorders, such as non-dystrophic myotonias (NDMs) and myotonic dystrophies (DMs) are characterized by a delay in muscle relaxation after a contraction stimulus. There is general consensus that protocols to treat myotonia need to be implemented. Objective Mexiletine is the only pharmacological agent approved for the symptomatic treatment of myotonia in adult patients with NDM and is considered to be the first-line treatment for DMs; however, its production in Italy was halted in 2022 making its availability to patients problematic. Methods A panel of 8 Italian neurologists took part in a two-round Delphi panel between June and October 2022, analyzing the current use of mexiletine in Italian clinical practice. Results The panelists assist 1126 patients (69% DM type1, 18% NDM and 13% DM type2). Adult NDM patients receive, on average, 400-600 mg of mexiletine hydrochloride (HCl) while adult DM patients receive 100-600 mg, per day in the long-term. The severity of symptoms is considered the main reason to start mexiletine treatment for both NDM and DM patients. Mexiletine is reckoned to have a clinical impact for both NDM and DM patients, but currently drug access is problematic. Conclusions Mexiletine treatment is recognized to have a role in the reduction of the symptomatic burden for NDM and DM patients. Patient management could be improved by facilitating access to therapy and developing new drug formulations.
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Affiliation(s)
| | | | | | | | | | | | | | - Valeria A Sansone
- The NEMO Center, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
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Bryarly MA, Rubin MA, Stuve O. Perspective: Industry-patient relationships for the promotion of pharmaceutical agents. Ther Adv Neurol Disord 2023; 16:17562864231207560. [PMID: 37920862 PMCID: PMC10619335 DOI: 10.1177/17562864231207560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Meredith A. Bryarly
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O’Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A. Rubin
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O’Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olaf Stuve
- Department of Neurology, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, Dallas, TX 75390-8813, USA
- Neurology Section, VA North Texas Health Care System, Dallas, TX, USA
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Gude M, Kirkegaard H, Blauenfeldt R, Behrndtz A, Mainz J, Riddervold I, Simonsen CZ, Hjort N, Johnsen SP, Andersen G, Valentin JB. Inter-Rater Agreement on Cincinnati Prehospital Stroke Scale (CPSS) and Prehospital Acute Stroke Severity Scale (PASS) Between EMS Providers, Neurology Residents and Neurology Consultants. Clin Epidemiol 2023; 15:957-968. [PMID: 37700930 PMCID: PMC10494913 DOI: 10.2147/clep.s418253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Objective To examine the agreement between emergency medical service (EMS) providers, neurology residents and neurology consultants, using the Cincinnati Prehospital Stroke Scale (CPSS) and the Prehospital Acute Stroke Severity Scale (PASS). Methods Patients with stroke, transient ischemic attack (TIA) and stroke mimic were included upon primary stroke admission or during rehabilitation. Patients were included from June 2018 to September 2019. Video recordings were made of patients being assessed with CPSS and PASS. The recordings were later presented to the healthcare professionals. To determine relative and absolute interrater reliability in terms of inter-rater agreement (IRA), we used generalisability theory. Group-level agreement was determined against a gold standard and presented as an area under the curve (AUC). The gold standard was a consensus agreement between two neurology consultants. Results A total of 120 patient recordings were assessed by 30 EMS providers, two neurology residents and two neurology consultants. Using the CPSS and the PASS, a total of 1,800 assessments were completed by EMS providers, 240 by neurology residents and 240 by neurology consultants. The overall relative and absolute IRA for all items combined from the CPSS and PASS score was 0.84 (95% CI 0.80; 0.87) and 0.81 (95% CI 0.77; 0.85), respectively. Using the CPSS, the agreement on a group-level resulted in AUCs of 0.83 (95% CI 0.78; 0.88) for the EMS providers and 0.86 (95% CI 0.82; 0.90) for the neurology residents when compared with the gold standard. Using the PASS, the AUC was 0.82 (95% CI 0.77; 0.87) for the EMS providers and 0.88 (95% CI 0.84; 0.93) for the neurology residents. Conclusion The high relative and absolute inter-rater agreement underpins a high robustness/generalisability of the two scales. A high agreement exists across individual raters and different groups of healthcare professionals supporting widespread applicability of the stroke scales.
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Affiliation(s)
- Martin Gude
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region; and Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region; and Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rolf Blauenfeldt
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Behrndtz
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jeppe Mainz
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claus Z Simonsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Hjort
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Amiri P, Pirnejad H, Bahaadinbeigy K, Baghini MS, Khazaee PR, Niazkhani Z. A qualitative study of factors influencing ePHR adoption by caregivers and care providers of Alzheimer's patients: An extension of the unified theory of acceptance and use of technology model. Health Sci Rep 2023; 6:e1394. [PMID: 37425233 PMCID: PMC10323167 DOI: 10.1002/hsr2.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/06/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Aims As the nowadays provision of many healthcare services relies on technology, a better understanding of the factors contributing to the acceptance and use of technology in health care is essential. For Alzheimer's patients, an electronic personal health record (ePHR) is one such technology. Stakeholders should understand the factors affecting the adoption of this technology for its smooth implementation, adoption, and sustainable use. So far, these factors have not fully been understood for Alzheimer's disease (AD)-specific ePHR. Therefore, the present study aimed to understand these factors in ePHR adoption based on the perceptions and views of care providers and caregivers involved in AD care. Methods This qualitative study was conducted from February 2020 to August 2021 in Kerman, Iran. Seven neurologists and 13 caregivers involved in AD care were interviewed using semi-structured and in-depth interviews. All interviews were conducted through phone contacts amid Covid-19 imposed restrictions, recorded, and transcribed verbatim. The transcripts were coded using thematic analysis based on the unified theory of acceptance and use of technology (UTAUT) model. ATLAS.ti8 was used for data analysis. Results The factors affecting ePHR adoption in our study comprised subthemes under the five main themes of performance expectancy, effort expectancy, social influence, facilitating conditions of the UTAUT model, and the participants' sociodemographic factors. From the 37 facilitating factors and 13 barriers identified for ePHR adoption, in general, the participants had positive attitudes toward the ease of use of this system. The stated obstacles were dependent on the participants' sociodemographic factors (such as age and level of education) and social influence (including concern about confidentiality and privacy). In general, the participants considered ePHRs efficient and useful in increasing neurologists' information about their patients and managing their symptoms in order to provide better and timely treatment. Conclusion The present study gives a comprehensive insight into the acceptance of ePHR for AD in a developing setting. The results of this study can be utilized for similar healthcare settings with regard to technical, legal, or cultural characteristics. To develop a useful and user-friendly system, ePHR developers should involve users in the design process to take into account the functions and features that match their skills, requirements, and preferences.
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Affiliation(s)
- Parastoo Amiri
- Student Research CommitteeKerman University of Medical SciencesKermanIran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Mahdie Shojaei Baghini
- Medical Informatics Research Center, Institute of Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | | | - Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Clinical Research InstituteUrmia University of Medical SciencesUrmiaIran
- Health Care Governance, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
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Comer AR, Templeton E, Glidden M, Bartlett S, D'Cruz L, Nemati D, Zabel S, Slaven JE. National Institutes of Health Stroke Scale (NIHSS) scoring inconsistencies between neurologists and emergency room nurses. Front Neurol 2023; 13:1093392. [PMID: 36712449 PMCID: PMC9875120 DOI: 10.3389/fneur.2022.1093392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background Little is known about the consistency of initial NIHSS scores between neurologists and RNs in clinical practice. Methods A cohort study of patients with a code stroke was conducted at an urban academic Primary Stroke Center in the Midwest between January 1, 2018, and December 31, 2019 to determine consistency in National Institutes of Health Stroke Scale Scores (NIHSS) between neurologists and registered nurses (RNs). Results Among the 438 patients included in this study 65.3% (n = 286) of neurologist-RN NIHSS scoring pairs had congruent scores. One-in-three, (34.7%, n = 152) of neurologist-RN NIHSS scoring pairs had a clinically meaningful scoring difference of two points or greater. Higher NIHSS (p ≤ 0.01) and aphasia (p ≤ 0.01) were each associated with incongruent scoring between neurologist and emergency room RN pairs. Conclusions One-in-three initial NIHSS assessed by both a neurologist and RN had a clinically meaningful score difference between providers. More severe stroke, as indicated by a higher NIHSS was associated with scoring inconsistency between neurologist-RN pairs. Subjective scoring measures, especially those involving a patient having aphasia, was associated with greater score incongruency. Score differences may be attributed to differences in NIHSS training requirements between neurologists and RNs.
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Affiliation(s)
- Amber R. Comer
- Indiana University School of Health and Human Sciences, Indianapolis, IN, United States,Indiana University School of Medicine, Indianapolis, IN, United States,*Correspondence: Amber R. Comer ✉
| | - Evan Templeton
- Indiana University School of Medicine, Indianapolis, IN, United States,Eskenazi Health, Indianapolis, IN, United States
| | | | - Stephanie Bartlett
- Indiana University School of Health and Human Sciences, Indianapolis, IN, United States
| | - Lynn D'Cruz
- Indiana University School of Health and Human Sciences, Indianapolis, IN, United States
| | - Donya Nemati
- Indiana University School of Health and Human Sciences, Indianapolis, IN, United States
| | - Samantha Zabel
- Indiana University School of Health and Human Sciences, Indianapolis, IN, United States
| | - James E. Slaven
- Indiana University School of Medicine, Indianapolis, IN, United States
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Fortea J, García-Arcelay E, Terrancle Á, Gálvez B, Díez-Carreras V, Rebollo P, Maurino J, Garcia-Ribas G. Attitudes of Neurologists Toward the Use of Biomarkers in the Diagnosis of Early Alzheimer's Disease. J Alzheimers Dis 2023; 93:275-282. [PMID: 36970902 DOI: 10.3233/jad-221160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) biomarkers reflect key elements of pathophysiology and improve the diagnostic process. However, their use in routine clinical practice is still limited. OBJECTIVE We aimed to assess neurologists' barriers and enablers to early AD diagnosis using core AD biomarkers. METHODS We conducted an online study in collaboration with the Spanish Society of Neurology. Neurologists answered a survey exploring their attitudes towards AD diagnosis using biomarkers in mild cognitive impairment (MCI) or mild AD dementia. Multivariate logistic regression analyses were conducted to determine the association between neurologists' characteristics and diagnostic attitudes. RESULTS We included 188 neurologists with a mean age (SD) of 40.6 (11.3) years, 52.7% male. Most participants had access to AD biomarkers, mainly in cerebrospinal fluid (CSF) (89.9%,#x0025;, n = 169). The majority of participants (95.2%,#x0025;, n = 179) considered CSF biomarkers useful for an etiological diagnosis in MCI. However, 85.6% of respondents (n = 161) used them in less than 60% of their MCI patients in routine clinical practice. Facilitating patients and their families to plan for the future was the most frequent enabler for the use of biomarkers. Short consultation time and practicalities associated with the programming of a lumbar puncture were the most common barriers. A younger neurologist age (p = 0.010) and a higher number of patients managed weekly (p = 0.036) were positively associated with the use of biomarkers. CONCLUSION Most neurologists had a favorable attitude to the use of biomarkers, especially in MCI patients. Improvements in resources and consultation time may increase their use in routine clinical practice.
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Affiliation(s)
- Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | | | | | - Blanca Gálvez
- Medical Department, Roche Diagnostics, Barcelona, Spain
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Hmoud M, Salamatullah HK, Faidah DE, Makkawi S. Experience and perception of utilizing virtual clinic in neurological assessment in Saudi Arabia. Front Neurol 2023; 14:1111254. [PMID: 36873439 PMCID: PMC9983690 DOI: 10.3389/fneur.2023.1111254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction The World Health Organization defined electronic health as "the unified usage of information technology and electronic communications in the health sector." In the Kingdom of Saudi Arabia, outpatient encounters were largely shifted to virtual clinics due to the crisis caused by COVID-19. This study aimed to evaluate the neurology consultants', specialists', and residents' experience and perception of utilizing virtual services for neurological assessment in Saudi Arabia. Methods This cross-sectional study was conducted by sending an anonymous online survey to neurologists and neurology residents in Saudi Arabia. The survey was developed by the authors and contained three main sections: demographics, subspecialty and years of experience after residency, and virtual clinics during the coronavirus disease 2019 (COVID-19) pandemic. Result A total of 108 neurology-practicing physicians in Saudi Arabia responded to the survey. Overall, 75% experienced virtual clinics, and 61% of them used phones for consultation. In neurology clinical practice, there was a significant difference (P < 0.001) regarding the teleconsultations for follow-up patients compared to the newly referred patients, being more suitable for the follow-up cases. Additionally, most neurology practicing physicians showed more confidence in performing history-taking tasks virtually (82.4%) than in physical examination. However, it was found that consultants were significantly (P < 0.03) more confident to virtually perform the cranial nerve, motor, coordination, and extrapyramidal assessments than the neurology residents. Physicians deemed it more suitable to conduct teleconsultations for patients with headaches and epilepsy than for those with neuromuscular and demyelinating diseases/multiple sclerosis. Furthermore, they agreed that patients' experiences (55.6%) and physicians' acceptance (55.6%) were the two main limitations to implementing virtual clinics. Discussion This study revealed that neurologists were more confident in performing history-taking in virtual clinics than in physical exams. On the contrary, consultants were more confident in handling the physical examination virtually than the neurology residents. Moreover, the most accepted clinics to be handled electronically were the headache and epilepsy clinics in comparison to the other subspecialties, being mainly diagnosed using history. Further studies with larger sample sizes are warranted to observe the level of confidence in performing different duties in neurology virtual clinics.
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Affiliation(s)
- Mohammed Hmoud
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Hassan K Salamatullah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Dania E Faidah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Pruzin JJ, Brunton S, Alford S, Hamersky C, Sabharwal A, Gopalakrishna G. Medical Journey of Patients with Mild Cognitive Impairment and Mild Alzheimer's Disease Dementia: A Cross-sectional Survey of Patients, Care Partners, and Neurologists. J Prev Alzheimers Dis 2023; 10:162-170. [PMID: 36946442 DOI: 10.14283/jpad.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive, neurodegenerative disease presenting along a continuum ranging from asymptomatic disease to mild cognitive impairment (MCI), followed by dementia characterized as mild, moderate, or severe. OBJECTIVES To better understand the medical journey of patients with all-cause MCI or mild AD dementia from the perspective of patients, care partners, and physicians. DESIGN Cross-sectional study. SETTING Online surveys in the United States between February 4, 2021, and March 1, 2021. PARTICIPANTS 103 patients with all-cause MCI or mild AD dementia and 150 care partners participated in this survey. 301 physicians (75 of whom were neurologists) completed a survey. MEASUREMENTS The surveys included questions regarding attitudes, experiences, and behaviors related to diagnosis and management of MCI and mild AD dementia. For the patient and care partner surveys, questions regarding healthcare received for MCI and mild AD dementia were only asked of care partners. RESULTS Most patients (73%) had a similar medical journey. The majority (64%) initially consulted a primary care physician on average 15 months after symptom onset, with symptoms primarily consisting of forgetfulness and short-term memory loss. About half (51%) of patients in the typical medical journey were diagnosed by a neurologist. Upon diagnosis, most neurologists reported having discussions with patients and care partners about the potential causes of MCI or mild AD dementia (83%); of these physicians, 83% explained the effect other conditions have on the risk of the diagnoses and symptom progression. Neurologists (52%) consider themselves the coordinator of care for patients with MCI or mild AD dementia. Amongst patients and care partners, about one-third (35%) perceive the neurologists to be the coordinating physician. CONCLUSIONS Neurologists commonly diagnose MCI and mild AD dementia but are typically not the first point of contact in the medical journey, and patients do not consult with a physician for over a year after symptom onset. Neurologists play a key role in the medical journey for patients and care partners, and could help ensure earlier diagnosis and treatment, and improve clinical outcomes by coordinating MCI and mild AD dementia care and collaborating with primary care physicians.
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Affiliation(s)
- J J Pruzin
- Jeremy Pruzin, MD, Banner Alzheimer's Institute, 901 E. Willetta St, Phoenix, AZ 85006, USA, Telephone number: 520-909-5590,
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Muacevic A, Adler JR, Aldharman SS, Alburayman MZ, Alrashed MH, Al-Sultan AA, Alrahil R. Approach and Clinical Practice of Functional Movement Disorders Among Neurologists in Saudi Arabia. Cureus 2022; 14:e32770. [PMID: 36694532 PMCID: PMC9858697 DOI: 10.7759/cureus.32770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Functional movement disorders (FMDs) are neurological disorders that consist of abnormal and involuntary movements that have no specific organic cause. Given the prevalence of FMDs and the scarcity of information on neurologists' approaches to FMDs, we aimed to assess the neurologists' approaches and clinical practice in managing FMDs in Saudi Arabia. Methods A validated online questionnaire in English was used. The data were collected through a self-reported questionnaire. The data were analyzed using the statistical software IBM SPSS version 22 (SPSS, Inc., Armonk, NY). Results A total of 231 neurologists completed the study survey. A total of 129 (55.8%) were males. Regarding the predictors for a diagnosis other than FMD, the highest rating predictor was for evidence of physical injury and lack of psychiatric history of psychological stressors, while the lowest rating was for the male gender. Regarding the effective treatment strategies of FMD, the most effective treatment strategy reported by the clinicians was patient education, while the least was alternative or complementary medicine. The management ability of clinicians was generally restricted by cultural beliefs about psychological illnesses and the availability of referral services. The reported predictors by clinicians for a better prognosis of FMD include acceptance of the diagnosis by the patient followed by identification and management of psychological stressors and concurrent psychiatric disorder and a supportive social network. Generally, the most used terminology in this study was "functional movement disorder". Conclusions There is a variation in the approach and clinical practice of FMD among neurologists in Saudi Arabia. Shared knowledge regarding diagnosis and effective management is crucial. Collaborative efforts are required to establish practice guidelines in the future.
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Ramachandran D, George GB, Panicker P, Aravind R, Suresh MK, Iype T. COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience. Neurol India 2022; 70:1942-1946. [PMID: 36352591 DOI: 10.4103/0028-3886.359188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases. METHODOLOGY A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality. RESULTS Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months. CONCLUSION Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.
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Affiliation(s)
- Dileep Ramachandran
- Departments of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Githin Benoy George
- Departments of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Praveen Panicker
- Departments of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - R Aravind
- Department of Infectious Disease, Government Medical College, Thiruvananthapuram, Kerala, India
| | - M K Suresh
- Department of General Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Thomas Iype
- Departments of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
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14
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Kim BK, Chu MK, Yu SJ, Dell'Agnello G, Hundemer HP, Panni T, Alonso SP, Roche SL, Han JH, Cho SJ. Prevalence Rates of Primary Headache Disorders and Evaluation and Treatment Patterns Among Korean Neurologists. J Clin Neurol 2022; 18:571-580. [PMID: 36062775 PMCID: PMC9444561 DOI: 10.3988/jcn.2022.18.5.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Several studies have found that the prevalence of migraine is higher among healthcare professionals than in the general population. Furthermore, several investigations have suggested that the personal experiences of neurologists with migraine can influence their perception and treatment of the disease. This study assessed these relationships in Korea. Methods A survey was used to investigate the following characteristics among neurologists: 1) the prevalence rates of migraine, primary stabbing headache, and cluster headache, and 2) their perceptions of migraine and the pain severity experienced by patients, diagnosing migraine, evaluation and treatment patterns, and satisfaction and difficulties with treatment. Results The survey was completed by 442 actively practicing board-certified Korean neurologists. The self-reported lifetime prevalence rates of migraine, migraine with aura, primary stabbing headache, and cluster headache were 49.8%, 12.7%, 26.7%, and 1.4%, respectively. Few of the neurologists used a headache diary or validated scales with their patients, and approximately half were satisfied with the effectiveness of preventive medications. Significant differences were observed between neurologists who had and had not experienced migraine, regarding certain perceptions of migraine, but no differences were found between these groups in the evaluation and preventive treatment of migraine. Conclusions The high self-reported lifetime prevalence rates of migraine and other primary headache disorders among Korean neurologists may indicate that these rates are underreported in the general population, although potential population biases must be considered. From the perspective of neurologists, there is an unmet need for the proper application of headache diaries, validated scales, and effective preventive treatments for patients. While the past experiences of neurologists with migraine might not influence how they evaluate or apply preventive treatments to migraine, they may influence certain perceptions of the disease.
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Affiliation(s)
- Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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15
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Nitrini R. Training of neurologists for the 21st century: cultural and professional skills. Arq Neuropsiquiatr 2022; 80:1-6. [PMID: 35976294 PMCID: PMC9491433 DOI: 10.1590/0004-282x-anp-2022-s104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Training of neurologists for the near future is a challenge due to the likely advances in neuroscientific methods, which will change much of our knowledge on diagnosis and treatment of neurological diseases. OBJECTIVE to comment on what may be more likely to be a constant in the very near future and to recommend how to prepare the neurologist for the 21st century. METHODS through a critical review of recent articles on the teaching of Neurology, to present a personal view on the subject. RESULTS Diagnostic methods and therapeutic resources in Neurology will be greatly improved, but the central core of teaching young neurologists will continue to be the clinical/anatomical correlation. The neurologist must be prepared to be the primary physician in the care of patients with neurological disorders, although the roles of consultant and clinical neuroscientist must also be considered. In addition to technical knowledge, the neurologist must be prepared to discuss not only distressing issues related to the specialty, such as the risks of genetic diseases for family members of their patients, the inexorable progression of some diseases and the need for palliative care, but also problems not directly related to Neurology that cause anxiety and depression in the patient or that are the main reason for the initial consultation. CONCLUSION neurology will be an even more important area of medicine and the neurologist must be well prepared to be the primary doctor to diagnose, treat and follow the patient with neurological disorders. In addition to technical knowledge, training in doctor-patient relations should be highlighted.
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Affiliation(s)
- Ricardo Nitrini
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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16
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Weinstein DR, Owens GM, Gandhi A. Multiple Sclerosis: Systemic Challenges to Cost-Effective Care. Am Health Drug Benefits 2022; 15:13-20. [PMID: 35586614 PMCID: PMC9038003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disorder of the central nervous system characterized by symptoms including reduced mobility, pain, fatigue, and spasticity. MS affects nearly 1 million people in the United States, with significant negative impact on a patient's quality of life, and an average lifetime cost of care in excess of $4 million. The cost-effective management of patients with MS faces several challenges. OBJECTIVE To review the challenges to the cost-effective management of patients with MS, and to offer healthcare stakeholders a roadmap to address them. DISCUSSION The cost-effective management of patients with MS, which is driven largely by how quickly a patient receives effective medication therapy, is challenged by a paucity of between-office-visit clinical data, variability of provider expertise with magnetic resonance imaging (MRI), MRI machine quality, lack of standards for MRI machines and reports, misaligned financial incentives, the limited number of available Current Procedural Terminology (CPT) codes for brain MRI, the complexity of disease-modifying therapy (DMT) selection, poor patient adherence to treatment plans, poor communication among providers, and a lack of objective measures of disease progression. CONCLUSION Insurers, neurologists, researchers, and patient advocacy groups must address the needs of patients with MS holistically. These efforts should include establishing standards for MRI machines and reports, matching patients with MS specialists, aligning financial incentives, including creating a new CPT code for complex brain MRI, streamlining prior authorization processes of DMTs, using technology to gather patient data and improve coordination of care, and developing better measurement tools of disease activity.
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Affiliation(s)
| | - Gary M Owens
- President, Gary Owens Associates, Ocean View, DE
| | - Ankit Gandhi
- Clinical Trials Results Analyst, National Institutes of Health, Bethesda, MD
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17
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Li Y, Chu L, Zha Z. Job stress and satisfaction in southwest Chinese hospitals: A cross-sectional study. Medicine (Baltimore) 2022; 101:e28562. [PMID: 35060515 PMCID: PMC8772665 DOI: 10.1097/md.0000000000028562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
This paper discusses the job characteristics, satisfaction, and stress levels experienced by clinical neurologists in Guizhou Province, China.A questionnaire survey was conducted associated with the 2021 Annual Meeting of Neurology in Guizhou province. After obtaining ethical approval to conduct the study, the target group was asked to complete an anonymous online survey that included sociodemographic data, followed by questions related to job stress and satisfaction as well as future aspirations.Four hundred sixty people participated in the study, including 179 (38.9%) men and 281 (61.1%) women. About 407 (88.5%) felt stress in their job. Three hundred and seventeen (68.9%) experienced depression, 307 (66.7%) experienced anxiety, and 273 (59.3%) had some degree of sleep disturbance. Three hundred fifty-three (76.7%) were disappointed with their wages, 239 (52.0%) were bored with their jobs, and 353 (76.7%) considered their jobs to be somewhat dangerous. Interestingly, 250 (54.3%) would consider becoming doctors again, but 354 (77.0%) preferred their child not to become doctors. While 338 (73.5%) said they were proud to be a neurologist, only 123 (26.7%) indicated they were optimistic concerning doctor-patient relationships.Neurologists have significant emotional factors associated with their careers, which are more likely to lead to job burnout and decreased job satisfaction. Attention should be paid to these stresses to improve the retention and job satisfaction of neurologists.
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Affiliation(s)
- Yuan Li
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Lan Chu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zongyi Zha
- Department of Neurology, Guizhou Medical University, Guiyang, Guizhou, China
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18
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Qureshi AI, Rheaume C, Huang W, Lobanova I, Govindarajan R, French BR, Siddiq F, Gomez CR, Sahota PK. COVID-19 Exposure During Neurology Practice: Results of American Academy of Neurology Survey. Neurologist 2021; 26:225-230. [PMID: 34734898 PMCID: PMC8575116 DOI: 10.1097/nrl.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the exposure risk for coronavirus 2019 (COVID-19) during neurology practice. Neurological manifestations of COVID-19 are increasingly being recognized mandating high level of participation by neurologists. METHODS An American Academy of Neurology survey inquiring about various aspects of COVID-19 exposure was sent to a random sample of 800 active American Academy of Neurology members who work in the United States. Use of second tier protection (1 or more including sterile gloves, surgical gown, protective goggles/face shield but not N95 mask) or maximum protection (N95 mask in addition to second tier protection) during clinical encounter with suspected/confirmed COVID-19 patients was inquired. RESULTS Of the 81 respondents, 38% indicated exposure to COVID-19 at work, 1% at home, and none outside of work/home. Of the 28 respondents who did experience at least 1 symptom of COVID-19, tiredness (32%) or diarrhea (8%) were reported. One respondent tested positive out of 12 (17%) of respondents who were tested for COVID-19 within the last 2 weeks. One respondent received health care at an emergency department/urgent care or was hospitalized related to COVID-19. When seeing patients, maximum protection personal protective equipment was used either always or most of the times by 16% of respondents in outpatient setting and 56% of respondents in inpatient settings, respectively. CONCLUSIONS The data could enhance our knowledge of the factors that contribute to COVID-19 exposure during neurology practice in United States, and inform education and advocacy efforts to neurology providers, trainees, and patients in this unprecedented pandemic.
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Affiliation(s)
| | - Carol Rheaume
- Insights, American Academy of Neurology, Minneapolis, MN
| | - Wei Huang
- Zeenat Qureshi Stroke Institute and Department of Neurology
| | - Iryna Lobanova
- Zeenat Qureshi Stroke Institute and Department of Neurology
| | | | | | - Farhan Siddiq
- Division of Neurosurgery, University of Missouri, Columbia, MO
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19
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Saposnik G, Bueno-Gil G, Sempere ÁP, Rodríguez-Antigüedad A, Del Río B, Baz M, Terzaghi M, Ballesteros J, Maurino J. Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol. Front Neurol 2021; 12:675520. [PMID: 34234734 PMCID: PMC8256155 DOI: 10.3389/fneur.2021.675520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS). Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: "regret and decision," "regret and physicians," and "regret and nurses." An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports-recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty. Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals. Spanish National Register (SL42129-20/598-E).
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Affiliation(s)
- Gustavo Saposnik
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Beatriz Del Río
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mar Baz
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - María Terzaghi
- Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada
| | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of the Basque Country (UPV/EHU), Leioa, Spain
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20
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Lin CC, Hill CE, Burke JF, Kerber KA, Hartley SE, Callaghan BC, Skolarus LE. Primary care providers perform more neurologic visits than neurologists among Medicare beneficiaries. J Eval Clin Pract 2021; 27:223-227. [PMID: 32754960 DOI: 10.1111/jep.13439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Little is known about which medical providers, other than neurologists, are involved in the care of neurologic conditions. We aimed to describe the current distribution of outpatient neurologic care by provider type. METHODS We conducted a restrospective, cross-sectional analysis using a 20% national sample claims database that contains information on medical care utilizations from adult Fee-for-Service Medicare beneficiaries in 2015. We identified patient visits for evaluation and management services for common neurologic conditions and by medical provider type. The main outcome was the proportion of visits for neurologic conditions by medical provider type, both in aggregate and across neurologic conditions. RESULTS 40% of neurologic visits were performed by primary care providers (PCPs) and 17.5% by neurologists. The most common neurologic conditions were back pain (49.3%), sleep disorders (8.0%), chronic pain/abnormality of gait (6.4%), peripheral neuropathy (5.9%), and stroke (5.5%). Neurologists cared for a large proportion of visits for Parkinson's disease (75.6% vs 20.8%), epilepsy (70.9% vs 26.6%), multiple sclerosis (63.9% vs 26.2%), other central NS disorders (54.2% vs 24.9%), and tremor/RLS/ALS (54.0% vs 31.2%) compared to PCPs. PCPs provided a greater proportion of visits for dizziness/vertigo (57.8% vs 9.3%) and headache/migraine (50.4% vs 35.0%) compared to neurologists. CONCLUSIONS PCPs perform more neurologic visits than neurologists. With the anticipated increased demand for neurologic care, strategies to optimize neurologic care delivery could consider expanding access to neurologists as well as supporting PCP care for neurologic conditions.
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Affiliation(s)
- Chun Chieh Lin
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chloe E Hill
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James F Burke
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kevin A Kerber
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah E Hartley
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Brian C Callaghan
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lesli E Skolarus
- Health Services Research Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Abstract
The year 2020 has undoubtedly made Digital Health a necessity and no longer an exception. Many technological advances that seemed futuristic became a reality in a few months due to the pandemic's needs. Stroke was one of the diseases that most benefited from the digital health revolution. Due to the need for immediate care and a shortage of neurologists worldwide, telestroke has revolutionized the acute care of cerebrovascular diseases in many areas based on strong scientific evidence. In this brief article, we have tried to summarize all we have experienced in 2020, the year which irreversibly transformed the practice of medicine.
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Affiliation(s)
- Gisele Sampaio Silva
- Universidade Federal de São Paulo-UNIFESP and Academic Research Organization, Hospital Israelita Albert Einstein, Brazil (G.S.S.)
| | - Lee H Schwamm
- C. Miller Fisher Chair of Vascular Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.)
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22
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Kutlu S, Harris WB, Tse CE, Anzai NE, Miura H, Chang BK, Miles JD. Neurologist Attitudes on Practicing in Hawai'i. Hawaii J Health Soc Welf 2020; 79:340-346. [PMID: 33313515 PMCID: PMC7726617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a shortage of neurologists nationwide, and the demand for neurologists is expected to increase in the upcoming years while the pool of practicing neurologists dwindles. Per Hawai'i Neurological Society, there were 44 practicing neurologists in the state of Hawai'i in 2019, representing a shortage of approximately 28 neurologists. Considering that Hawai'i is geographically, demographically, and culturally distinct compared to other states, a concern is that practicing neurology in Hawai'i poses unique challenges that may contribute to the low numbers of neurologists. An anonymous online survey was sent via email to all members of the Hawai'i Neurological Society from February 2019 to June 2019, inquiring about aspects of their practice they considered unique to Hawai'i. Twenty-three neurologists completed the survey, representing 52% of Hawai'i's neurology workforce. One neurologist completed a portion of the survey. Twenty-five percent of participants were born and raised or completed their medical education in Hawai'i. Self-reported reasons for practicing in Hawai'i included family, lifestyle, and patient population despite financial challenges and limited resources and opportunities. Participants suggested introducing a mandatory neurology rotation for Hawai'i medical students and creating an instate neurology residency program to combat the growing neurologist shortfall in Hawai'i. This survey identified local strengths and challenges in the field of neurology, potential ways to improve the practice environment in Hawai'i, and neurologists' perspectives on ways to address the neurology shortage.
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Affiliation(s)
- Selin Kutlu
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - William B. Harris
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Christina E. Tse
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Nicole E. Anzai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Heather Miura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Bryce Kalei Chang
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - J. Douglas Miles
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Torkildsen Ø, Linker RA, Sesmero JM, Fantaccini S, Sanchez-de la Rosa R, Seze JD, Duddy M, Chan A. Living with secondary progressive multiple sclerosis in Europe: perspectives of multiple stakeholders. Neurodegener Dis Manag 2020; 11:9-19. [PMID: 33234006 DOI: 10.2217/nmt-2020-0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The transition from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS) remains a clinical challenge owing to the heterogeneous course of the disease, indistinct disease progression and lack of availability of validated biomarkers and diagnostic tools. This article summarizes the outcomes from an international expert group meeting conducted to validate the preliminary research findings gathered through interviews with primary healthcare stakeholders and pharmaceutical representatives, and to understand the current and future patient journey of SPMS across seven European countries. We highlight the uncertainty in SPMS diagnosis and management and, consequently, the need for uniform assessment guidelines, enhanced awareness and a collaborative effort between the stakeholders associated with SPMS patient care and the pharmaceutical industry.
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Affiliation(s)
- Øivind Torkildsen
- Department of Neurology, Haukeland University Hospital, 5020, Bergen, Norway
| | - Ralf A Linker
- Department of Neurology, University Hospital, 93053, Regensburg, Germany
| | | | | | | | - Jerome de Seze
- University Hospital of Strasbourg, 67200, Strasbourg, France
| | - Martin Duddy
- Department of Neurology, The Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
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Gocan S, Fitzpatrick T, Wang CQ, Taljaard M, Cheng W, Bourgoin A, Dowlatshahi D, Stotts G, Shamy M. Diagnosis of Transient Ischemic Attack: Sex-Specific Differences From a Retrospective Cohort Study. Stroke 2020; 51:3371-3374. [PMID: 32993462 DOI: 10.1161/strokeaha.120.031510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Research suggests that women and men may present with different transient ischemic attack (TIA) and stroke symptoms. We aimed to explore symptoms and features associated with a definite TIA/stroke diagnosis and whether those associations differed by sex. METHODS We completed a retrospective cohort study of patients referred to The Ottawa Hospital Stroke Prevention Clinic in 2015. Exploratory multinomial logistic regression was used to evaluate candidate variables associated with diagnosis and patient sex. Backwards elimination of the interaction terms with a significance level for staying in the model of 0.25 was used to arrive at a more parsimonious model. RESULTS Based on 1770 complete patient records, sex-specific differences were noted in TIA/stroke diagnosis based on features such as duration of event, suddenness of symptom onset, unilateral sensory loss, and pain. CONCLUSIONS This preliminary work identified sex-specific differences in the final diagnosis of TIA/stroke based on common presenting symptoms/features. More research is needed to understand if there are biases or sex-based differences in TIA/stroke manifestations and diagnosis.
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Affiliation(s)
- Sophia Gocan
- Champlain Regional Stroke Network (S.G., A.B., G.S.)
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
| | - Tess Fitzpatrick
- Division of Neurology, The Ottawa Hospital (T.F., D.D., G.S., M.S.)
- Department of Medicine (T.F., C.Q.W., D.D., G.S., M.S.), University of Ottawa, Ontario, Canada
| | - Chu Qi Wang
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
- Department of Medicine (T.F., C.Q.W., D.D., G.S., M.S.), University of Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health (M.T.), University of Ottawa, Ontario, Canada
| | - Wei Cheng
- Clinical Epidemiology Program (M.T., W.C.), Ottawa Hospital Research Institute, Ontario, Canada
| | - Aline Bourgoin
- Champlain Regional Stroke Network (S.G., A.B., G.S.)
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
| | - Dar Dowlatshahi
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
- Division of Neurology, The Ottawa Hospital (T.F., D.D., G.S., M.S.)
- Department of Medicine (T.F., C.Q.W., D.D., G.S., M.S.), University of Ottawa, Ontario, Canada
| | - Grant Stotts
- Champlain Regional Stroke Network (S.G., A.B., G.S.)
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
- Division of Neurology, The Ottawa Hospital (T.F., D.D., G.S., M.S.)
- Department of Medicine (T.F., C.Q.W., D.D., G.S., M.S.), University of Ottawa, Ontario, Canada
| | - Michel Shamy
- Neuroscience Program (S.G., C.Q.W., A.B., D.D., G.S., M.S.), Ottawa Hospital Research Institute, Ontario, Canada
- Division of Neurology, The Ottawa Hospital (T.F., D.D., G.S., M.S.)
- Department of Medicine (T.F., C.Q.W., D.D., G.S., M.S.), University of Ottawa, Ontario, Canada
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Demergazzi S, Pastore L, Bassani G, Arosio M, Lonati C. Information Needs and Information-Seeking Behavior of Italian Neurologists: Exploratory Mixed Methods Study. J Med Internet Res 2020; 22:e14979. [PMID: 32181742 PMCID: PMC7177431 DOI: 10.2196/14979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/22/2019] [Accepted: 02/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background Current medical professions involve an extensive knowledge of the latest validated scientific data to implement disease diagnosis, therapeutic strategies, and patient care. Although clinicians can refer to a growing number and type of information sources to keep current with new scientific achievements, there are still various concerns about medical information validity, quality, and applicability into clinical practice. Novel strategies are required to identify physicians’ real-life needs with the final aim to improve modern medical information delivery. Objective Our research used an innovative tool to collect real-time physician queries in order to investigate information needs and seeking behavior of Italian neurologists treating patients with multiple sclerosis (MS) and migraine. Methods The study was designed as an exploratory mixed methods (ie, qualitative and quantitative) study involving 15 consecutive days of observation. A total of 50 neurologists (n=25 MS and n=25 migraine specialists) were recruited. Data were collected using an instant messaging mobile app designed for this research. At each information-seeking event, moderators triggered a computer-assisted personal interview including both semistructured interview and close-ended questions. Interactions and physician queries collected using the mobile app were coded into emerging themes by content analysis. Results Neurologist queries were relevant to the following major themes: therapy management (36/50, 71%) and drug-related information (34/50, 67%), followed by diagnostic strategies and procedures (21/50, 42%). Quantitative analysis indicated online resources were preferentially used by clinicians (48/50, 96%) compared with offline sources (24/50, 47%). A multichannel approach, in which both online and offline sources were consulted to meet the same need, was adopted in 33% (65/198) of information-seeking events. Neurologists more likely retrieved information from online relative to offline channels (F=1.7; P=.01). MS specialists were 53% more likely to engage in one information-seeking event compared with migraine neurologists (risk ratio 1.54; 95% CI 1.16-2.05). MS specialists tended to be more interested in patient-related content than migraine clinicians (28% [7/25] vs 10% [2/25], P=.06), who conversely more likely sought information concerning therapy management (85% [21/25] vs 60% [15/25], P=.05). Compared with MS clinicians, migraine specialists had a harder time finding the required information, either looking at online or offline channels (F=12.5; P=.01) and less frequently used offline channels (30% [8/25] vs 60% [15/25] of information-seeking events, P=.02). When multiple sources needed to be consulted to retrieve an information item, a reduced satisfaction rate was observed both among migraine and MS specialists (single source vs multiple sources P=.003). Conclusions This study provides a detailed description of real-life seeking behavior, educational needs, and information sources adopted by Italian MS and migraine neurologists. Neurologist information needs and seeking behavior reflect the specific characteristics of the specialty area in which they operate. These findings suggest identification of time- and context-specific needs of clinicians is required to design an effective medical information strategy.
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Affiliation(s)
| | - Luca Pastore
- Medical Information Department, Teva Italia Srl, Assago, Italy
| | | | - Marco Arosio
- Research Department, Doxa Pharma Srl, Milan, Italy
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Shen J, Xia Y, Cao S, Lu Z, He Q, Li M, Wang H, Bi Y, Chen S, Hu B, Cao F. Knowledge, attitude, and practice regarding atrial fibrillation among neurologists in central China: A cross-sectional study. Clin Cardiol 2020; 43:639-646. [PMID: 32208538 PMCID: PMC7298974 DOI: 10.1002/clc.23361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/12/2020] [Indexed: 01/22/2023] Open
Abstract
Background Physicians' knowledge and practice of atrial fibrillation (AF) are determinants of the efficacy of thromboprophylaxis. Hypothesis This study aimed to investigate physicians' knowledge, attitude, and practice toward AF, to analyze the influencing factors, and to provide data to support departments that develop health policies. Methods A cross‐sectional study was carried out from October 1, 2016, to March 31, 2018. A standard‐structured anonymous questionnaire was completed by each participant through face‐to‐face interviews. Results A total of 611 doctors from 38 hospitals were responded to this survey. The mean of the total score of the questionnaire was 21.59 ± 3.559 (total score of the questionnaire was 36), and the mean scores of knowledge, attitude, and practice were 6.86 ± 1.70, 6.13 ± 1.35, and 8.59 ± 2.21, respectively. The doctor' s knowledge, practice scores, and total scores were positively correlated with the education level and the workplace. The influencing factors that affect doctors' knowledge, attitudes, and practice scores including education level, professional title, working years, hospital grade, and hospital location. Conclusions There was still a big gap in neurologists' knowledge and practice about AF. It is necessary to strengthen the continuous improvement of doctor training to improve the management of AF.
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Affiliation(s)
- Jing Shen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Neurology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Wang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ying Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Roux J, Guilleux A, Lefort M, Leray E. Use of healthcare services by patients with multiple sclerosis in France over 2010-2015: a nationwide population-based study using health administrative data. Mult Scler J Exp Transl Clin 2019; 5:2055217319896090. [PMID: 31903222 PMCID: PMC6923529 DOI: 10.1177/2055217319896090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background Most of the knowledge about people with multiple sclerosis (PwMS) in France
comes from cohorts, which may suffer from recruitment bias or from the
unique registry located in Lorraine, East France. Objective To describe use of care in the French population of PwMS, over 2010–2015. Methods All PwMS in the French national health data system (97% of the general
population covered) were included. Demographics, and use of care were
described (visits with general practitioners (GPs), neurologists, nurses,
physiotherapists and hospitalisations). A focus on the neurological
follow-up was also conducted. Results A total of 112,415 PwMS were identified (sex ratio F:M = 2.4, median age 46),
of whom 5005 died during follow-up. The median numbers of visits with GPs
and neurologists were 6.6 and 1.3 respectively per patient-year. Moreover,
53,457 (47.6%) received multiple sclerosis (MS) treatments; about 13% of
patients had no neurological follow-up, and 81.8% had at least one
hospitalisation. Conclusions For the first time in France, this exhaustive dataset offered the opportunity
to provide objective figures regarding care practices for MS at the national
level, without any selection bias. It also allowed description of patients
with MS according to their neurological follow-up, especially those who were
absent from cohorts led by neurologists.
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Affiliation(s)
- J Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - A Guilleux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - M Lefort
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
| | - E Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and health services research-EA 7449), Rennes, France
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Vahidy FS, Sozener CB, Meeks JR, Chhatbar PY, Ramos-Estebanez C, Ayodele M, Richards RJ, Sharma R, Wilbrand SM, Prabhakaran S, Bregman BS, Adams HP, Jordan LC, Liebeskind DS, Tirschwell D, Janis LS, Marshall RS, Kleindorfer D. National Institutes of Health StrokeNet Training Core. Stroke 2019; 51:347-352. [PMID: 31795907 DOI: 10.1161/strokeaha.119.027946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The National Institutes of Health (NIH) StrokeNet provides a nationwide infrastructure to advance stroke research. Capitalizing on this unique opportunity, the NIH StrokeNet Training Core (NSTC) was established with the overarching goal of enhancing the professional development of a diverse spectrum of professionals who are embedded in the stroke clinical trials network of the NIH StrokeNet. Methods- This special report provides a descriptive account of the rationale, organization, and activities of the NSTC since its inception in 2013. Current processes and their evolution over time for facilitating training of NIH StrokeNet trainees have been highlighted. Data collected for monitoring training are summarized. Outcomes data (publications and grants) collected by NSTC was supplemented by publicly available resources. Results- The NSTC comprises of cross-network faculty, trainees, and education coordinators. It helps in the development and monitoring of training programs and organizes educational and career development activities. Trainees are provided directed guidance towards their mandated research projects, including opportunities to present at the International Stroke Conference. The committee has focused on developing sustainable models of peer-to-peer interaction and cross-institutional mentorships. A total of 124 professionals (43.7% female, 10.5% underrepresented minorities) have completed training between 2013 and 2018, of whom 55% were clinical vascular neurologists. Of the total, 85% transitioned to a formal academic position and 95% were involved in stroke research post-training. Altogether, 1659 indexed publications have been authored or co-authored by NIH StrokeNet Trainees, of which 58% were published during or after their training years. Based on data from 109 trainees, 33% had submitted 72 grant proposals as principal or co-principal investigators of which 22.2% proposals have been funded. Conclusions- NSTC has provided a foundation to foster nationwide training in stroke research. Our data demonstrate strong contribution of trainees towards academic scholarship. Continued innovation in educational methodologies is required to adapt to unique training opportunities such as the NIH StrokeNet.
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Affiliation(s)
- Farhaan S Vahidy
- From the Department of Neurology, Institute for Stroke and Cerebrovascular Diseases, The University of Texas Health Science Center, Houston (F.S.V., J.R.M.)
| | - Cemal B Sozener
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor (C.B.S.)
| | - Jennifer R Meeks
- From the Department of Neurology, Institute for Stroke and Cerebrovascular Diseases, The University of Texas Health Science Center, Houston (F.S.V., J.R.M.)
| | - Pratik Y Chhatbar
- Department of Neurology, Duke University Medical Center, Durham, NC (P.Y.C.)
| | - Ciro Ramos-Estebanez
- Department of Neurology, Case Western Reserve University, Cleveland, OH (C.R.-E.)
| | - Maranatha Ayodele
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA (M.A.)
| | - Rebekah J Richards
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (R.J.R.)
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, CT (R.S.)
| | | | - Shyam Prabhakaran
- Department of Neurology, Pritzker School of Medicine, University of Chicago, IL (S.P.)
| | - Barbara S Bregman
- Department of Neuroscience, Georgetown University Medical Center, Washington DC (B.S.B.)
| | - Harold P Adams
- Department of Neurology, University of Iowa Carver College of Medicine (H.P.A.)
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles (D.S.L.)
| | | | - L Scott Janis
- Division of Clinical Research, National Institute of Neurological Diseases and Stroke, National Institutes of Health (L.S.J.)
| | - Randolph S Marshall
- Department of Neurology, New York Presbyterian and Columbia University Medical Center, New York, NY (R.S.M.)
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.K.)
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Manabe Y, Odawara T, Konishi O. Fact-finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies. Psychogeriatrics 2019; 19:345-354. [PMID: 30784148 PMCID: PMC6850325 DOI: 10.1111/psyg.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/22/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND We performed a questionnaire survey of medical doctors engaged in the management of dementia to identify the actual status of treatment for dementia with Lewy bodies (DLB) in Japan. METHODS Among participating medical doctors, we selected neurologists (Group N) and psychiatrists (Group P) because these physicians are usually involved in the management of DLB patients. The two groups were compared based on their diagnosis and treatment of DLB and in particular, parkinsonism. RESULTS Neurological examinations and biomarker tests were less frequently performed by Group P than Group N. Antipsychotics and other psychotropics excluding anti-dementia drugs were significantly more frequently administered by Group P than Group N. The proportion of physicians who selected L-dopa as a first-line therapy for parkinsonism was significantly higher in Group N than in Group P. Despite these between-group differences, the following findings were common to the two groups: there was a discrepancy between the symptom that patients expressed the greatest desire to treat, and the awareness of physicians regarding the treatment of these symptoms; the initial agent was L-dopa; and physicians exercised caution against the occurrence of hallucinations, delusions, and other adverse drug reactions. CONCLUSIONS The results of the present survey offer valuable insight for the formulation of future DLB therapeutic strategies.
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Affiliation(s)
- Yuta Manabe
- Department of Dementia and Geriatric Internal Medicine, Kanagawa Dental University Hospital, Yokosuka-shi, Japan.,Department of Emergency and General Internal Medicine, Fujita Health University Hospital, Toyoake-shi, Japan
| | - Toshinari Odawara
- Health Management Center, Yokohama City University, Yokohama-shi, Japan
| | - Osamu Konishi
- Medical Affairs, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
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30
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Dolmans LS, Lebedeva ER, Veluponnar D, van Dijk EJ, Nederkoorn PJ, Hoes AW, Rutten FH, Olesen J, Kappelle LJ. Diagnostic Accuracy of the Explicit Diagnostic Criteria for Transient Ischemic Attack: A Validation Study. Stroke 2019; 50:2080-2085. [PMID: 31693449 PMCID: PMC6661246 DOI: 10.1161/strokeaha.119.025626] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The clinical diagnosis of a transient ischemic attack (TIA) can be difficult. Evidence-based criteria hardly exist. We evaluated if the recently proposed Explicit Diagnostic Criteria for TIA (EDCT), an easy to perform clinical tool focusing on type, duration, and mode of onset of clinical features, would facilitate the clinical diagnosis of TIA. Methods— We used data from patients suspected of a TIA by a general practitioner and referred to a TIA service in the region of Utrecht, the Netherlands, who participated in the MIND-TIA (Markers in the Diagnosis of TIA) study. Information about the clinical features was collected with a standardized questionnaire within 72 hours after onset. A panel of 3 experienced neurologists ultimately determined the definite diagnosis based on all available diagnostic information including a 6-month follow-up period. Two researchers scored the EDCT. Sensitivity, specificity, and predictive values of the EDCT were assessed using the panel diagnosis as reference. A secondary analysis was performed with modified subcriteria of the EDCT. Results— Of the 206 patients, 126 (61%) had a TIA (n=104) or minor stroke (n=22), and 80 (39%) an alternative diagnosis. Most common alternative diagnoses were migraine with aura (n=24; 30.0%), stress related or somatoform symptoms (n=16; 20.0%), and syncope (n=9; 11.3%). The original EDCT had a sensitivity of 98.4% (95% CI, 94.4–99.8) and a specificity of 61.3% (49.7–71.9). Negative and positive predictive values were 96.1% (86.0–99.0) and 80.0% (75.2–84.1), respectively. The modified EDCT showed a higher specificity of 73.8% (62.7–83.0) with the same sensitivity and a similar negative predictive value of 96.7%, but a higher positive predictive value of 85.5% (80.3–89.5). Conclusions— The EDCT has excellent sensitivity and negative predictive value and could be a valuable diagnostic tool for the diagnosis of TIA.
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Affiliation(s)
- L Servaas Dolmans
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Elena R Lebedeva
- Department of Neurology, Ural State Medical University, Yekaterinburg, Russia (E.R.L.).,International Headache Center 'Europe-Asia', Yekaterinburg, Russia (E.R.L., J.O.)
| | - Dinusha Veluponnar
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands (E.J.v.D.)
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (P.J.N.)
| | - Arno W Hoes
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Frans H Rutten
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jes Olesen
- International Headache Center 'Europe-Asia', Yekaterinburg, Russia (E.R.L., J.O.).,Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Denmark (J.O.)
| | - L Jaap Kappelle
- Department of Neurology (L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Salazar AJ, Useche N, Granja MF, Morillo AJ, Bermúdez S, Sossa D, Ortiz CJ, Torres OJ, Ropero B. Mobile device for thrombolysis decisions for telestroke. Colomb Med (Cali) 2018; 49:254-260. [PMID: 30700917 PMCID: PMC6342084 DOI: 10.25100/cm.v49i4.3921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study compares the reliability of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer in a telestroke context. Methods: A factorial design with 1,452 interpretations was used. Reliability was evaluated using the Fleiss’ kappa coefficient on the agreements of the interpretation results on the lesion classification, presence of imaging contraindications to the intravenous recombinant tissue-type plasminogen activator (t-PA) administration, and on the Alberta Stroke Program Early CT Score (ASPECTS). Results: The intra-observer agreements were as follows: good agreement on the overall lesion classification (κ= 0.63, p<0.001), very good agreement on hemorrhagic lesions (κ= 0.89, p<0.001), and moderate agreements on both without acute lesion classification and acute ischemic lesion classification (κ= 0.59 and κ= 0.58 respectively, p<0.001). There was good intra-observer agreement on the dichotomized-ASPECTS (κ= 0.65, p<0.001). Conclusions: The results of our study allow us to conclude that the reliability of the mobile solution for interpreting brain CT images of patients with acute stroke was assured, which would allow efficient and low-cost telestroke services.
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Affiliation(s)
- Antonio J Salazar
- Universidad de los Andes, Laboratorio de Telemedicina y Electrofisiología. Bogotá, Colombia
| | - Nicolás Useche
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Manuel F Granja
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville. FL, USA
| | - Aníbal J Morillo
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Sonia Bermúdez
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Didier Sossa
- Universidad El Bosque, Facultad de Medicina. Bogotá, Colombia
| | - Claudia J Ortiz
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Oscar J Torres
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Brenda Ropero
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
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Huang WC, Kuo CH, Wu JC, Chen YC. Higher Risk of Intervertebral Disc Herniation among Neurosurgeons Than Neurologists: 15 Year-Follow-Up of a Physician Cohort. J Clin Med 2018; 7:jcm7080198. [PMID: 30072677 PMCID: PMC6111668 DOI: 10.3390/jcm7080198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022] Open
Abstract
High physical activity or workload has been associated with intervertebral disc degeneration. However, there is little data on physicians' risks of disc disease. The study aimed to investigate the incidences of spinal problems among neurologists and neurosurgeons. A cohort of neurologists and neurosurgeons was derived from Taiwan's national research database. During the study period, the incidences of intervertebral disc herniation or spondylosis among these specialists were calculated. Another one-to-one by propensity score matched cohort, composed of neurologists and neurosurgeons, was also analyzed. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were conducted to compare the risks and incidences. The entire cohort comprised 481 and 317 newly board-certified neurologists and neurosurgeons, respectively. During the 15 years of follow-up, neurosurgeons were approximately six-fold more likely to develop disc problems than neurologists (crude HR = 5.98 and adjusted HR = 6.08, both p < 0.05). In the one-to-one propensity-score matched cohort (317 neurologists versus 317 neurosurgeons), there were even higher risks among neurosurgeons than neurologists (crude HR = 8.15, and adjusted HR = 10.14, both p < 0.05). Neurosurgeons have a higher chance of intervertebral disc disorders than neurologists. This is potentially an occupational risk that warrants further investigation.
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Affiliation(s)
- Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans' General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans' General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans' General Hospital, Taipei 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Family Medicine, Taipei Veterans' General Hospital, Taipei 11217, Taiwan.
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan.
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O'Connor M, Aoun SM, Breen LJ. Australian family carer responses when a loved one receives a diagnosis of Motor Neurone Disease-"Our life has changed forever". Health Soc Care Community 2018; 26:e415-e421. [PMID: 29359485 DOI: 10.1111/hsc.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 06/07/2023]
Abstract
While the experiences of family members supporting a person with a terminal illness are well documented, less is known about the needs of carers of people with neurological diseases, in particular, Motor Neurone Disease (MND). This paper describes the qualitative data from a large Australian survey of family carers of people with MND, to ascertain their experiences of receiving the diagnosis. The aim of the study was to describe the experiences of family carers of people with MND in receiving the diagnosis in order to inform and improve ways in which the diagnosis is communicated. Anonymous postal surveys were sent to people with MND in Australia and their family carers respectively. The perceived ability/skills of neurologists was assessed using a five-point scale from excellent to poor. Attributes of communication of bad news was measured by the SPIKES protocol. Each survey question invited further written responses. Eight hundred and sixty-four questionnaires were posted to people with MND and their family carers, with assistance from MND associations. One hundred and ninety-six family carers submitted responses, of which 171 (88%) were patient-carer dyads. Analyses were conducted on 190 family carers. Five themes emerged from reading and re-reading written responses: frustrations with the diagnosis; giving information; family carer observations of the neurologist; the setting; and what would have made the diagnosis easier? The delivery of the diagnosis is a pivotal event in the MND trajectory. Satisfaction for patients and their family carers is related to the neurologists showing empathy and responding appropriately to their emotions, exhibiting knowledge and providing longer consultations. Neurologists may benefit from education and training in communication skills to adequately respond to patients' and families' emotions and development of best practice protocols.
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Affiliation(s)
- Margaret O'Connor
- Nursing & Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Samar M Aoun
- Curtin University, Perth, WA, Australia
- La Trobe University, Melbourne, Victoria, Australia
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Sung VW, Iyer RG, Gandhi SK, Shah-Manek B, DiBonaventura M, Abler V, Claassen DO. Physician perceptions of pharmacologic treatment options for chorea associated with Huntington disease in the United States. Curr Med Res Opin 2018; 34:643-648. [PMID: 29383957 DOI: 10.1080/03007995.2018.1435518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To survey neurologists and obtain clinical perceptions of tetrabenazine for the treatment of chorea in patients with Huntington disease (HD). METHODS Board-certified/board-eligible neurologists, in practice for ≥5 years, who had treated treat ≥3 HD patients in the past 2 years, were recruited from an online physician panel to participate in a cross-sectional, web-based survey. Respondents provided information about themselves, their practice, approaches to HD chorea management and perceptions of available treatments. RESULTS Two hundred neurologists responded to the survey. Based on clinician responses, the most common reasons to treat chorea are impairment in activities of daily living (54%) and quality of life (41%). Although tetrabenazine was the only approved treatment for chorea in HD patients at the time of this analysis, it was only prescribed to ∼50% of patients with HD-related chorea. More than half of physicians perceive tetrabenazine as having minimal or no effectiveness in improving chorea. More than 40% of physicians consider tetrabenazine to be a non-optimal treatment, and 51% of physicians agree that they are unable to titrate to efficacious doses due to adverse side effects or tolerability concerns. Physicians report that side effects leading to dose interruptions (33%) and reductions (30%) occur in their patients "often" or "almost always". The most common side effects that led to insufficient dosing and disruptions in titration were sedation and somnolence (41%), depression (24%) and anxiety (22%). CONCLUSIONS Many physicians who treat HD-related chorea report that tolerability issues with tetrabenazine impact their ability to effectively use tetrabenazine in their clinical practice.
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Affiliation(s)
- Victor W Sung
- a University of Alabama School of Medicine , Birmingham , AL , USA
| | - Ravi G Iyer
- b Teva Pharmaceutical Industries , Frazer , PA , USA
| | | | | | | | - Victor Abler
- b Teva Pharmaceutical Industries , Frazer , PA , USA
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Affiliation(s)
- Mark R Etherton
- From the Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston.
| | - Lee H Schwamm
- From the Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
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Wang MD, Yin XX, Yang TT, Wang Y, Zhu YY, Zhou YF, Lu ZX, Hu B. Chinese neurologists' perspective on intravenous thrombolysis for acute ischemic stroke. Brain Behav 2018; 8:e00882. [PMID: 29568683 PMCID: PMC5853636 DOI: 10.1002/brb3.882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study examined the neurologists' perspective toward intravenous thrombolysis for the treatment of acute ischemic stroke and the influencing factors in a Chinese Province. METHODS A cross-sectional study was conducted from 1 October 2014 to 31 January 2015. A total of 719 neurologists from 66 hospitals in Hubei Province were included. A questionnaire was designed, and multivariable logistic regression models were used to identify the factors associated with the neurologists' perspective toward intravenous thrombolysis. RESULTS Among the responding neurologists, 67.3% reported using intravenous thrombolysis and 32.9% believed the treatment was unsafe. Approximately 51.4% reported deficits in their knowledge of intravenous thrombolysis and 45.8% felt unconfident about their ability to employ the treatment. The majority (90.1%) supported hospitals in performing intravenous thrombolysis for eligible patients. Their safety concern was associated with hospital grade (odds ratio[OR] = 2.3; 95% confidence interval [CI], 1.4-3.7) and previous experiences with thrombolysis (OR = 3.1; 95% CI, 2.1-4.6). Their confidence was associated with their educational background (OR = 2.5; 95% CI, 1.3-4.5), knowledge mastery (OR = 10.4; 95% CI, 6.6-16.3), and previous experiences with thrombolysis (OR = 3.3; 95% CI, 2.1-5.3). Their attitudes were associated with gender (OR = 0.6; 95% CI, 0.3-1.0) and previous experiences with thrombolysis (OR = 4.9; 95% CI, 2.5-9.4). CONCLUSIONS Most neurologists in Hubei Province, China, identified with intravenous thrombolysis for the treatment of acute ischemic stroke. However, they were weak in knowledge and lack confidence. Therefore, training, especially practical training, is needed to promote the use of thrombolysis in the region.
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Affiliation(s)
- Meng-Die Wang
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Xiao-Xv Yin
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Ting-Ting Yang
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Yong Wang
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yi-Yi Zhu
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yan-Feng Zhou
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Zu-Xun Lu
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Bo Hu
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,The Stroke Quality Control Center of Hubei Province Wuhan Hubei China.,Key Laboratory of Neurological Disease Ministry of Education Tongji Medical College Huazhong University of Science and Technology Wuhan China
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Fahed R, Lecler A, Sabben C, Khoury N, Ducroux C, Chalumeau V, Botta D, Kalsoum E, Boisseau W, Duron L, Cabral D, Koskas P, Benaïssa A, Koulakian H, Obadia M, Maïer B, Weisenburger-Lile D, Lapergue B, Wang A, Redjem H, Ciccio G, Smajda S, Desilles JP, Mazighi M, Ben Maacha M, Akkari I, Zuber K, Blanc R, Raymond J, Piotin M. DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates: An Intrarater and Interrater Agreement Study. Stroke 2017; 49:223-227. [PMID: 29191851 DOI: 10.1161/strokeaha.117.019508] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/05/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. METHODS Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. RESULTS Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. CONCLUSIONS Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.
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Affiliation(s)
- Robert Fahed
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.).
| | - Augustin Lecler
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Candice Sabben
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Naim Khoury
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Célina Ducroux
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Vanessa Chalumeau
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Daniele Botta
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Erwah Kalsoum
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - William Boisseau
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Loïc Duron
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Dominique Cabral
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Patricia Koskas
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Azzedine Benaïssa
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Hasmik Koulakian
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Michael Obadia
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Benjamin Maïer
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - David Weisenburger-Lile
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Bertrand Lapergue
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Adrien Wang
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Hocine Redjem
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Stanislas Smajda
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Mikaël Mazighi
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Malek Ben Maacha
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Inès Akkari
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Kevin Zuber
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Raphaël Blanc
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Jean Raymond
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
| | - Michel Piotin
- From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.)
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Grotta JC, Lyden P, Brott T. Rethinking Training and Distribution of Vascular Neurology Interventionists in the Era of Thrombectomy. Stroke 2017; 48:2313-2317. [PMID: 28706124 DOI: 10.1161/strokeaha.116.016416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/21/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- James C Grotta
- From the Clinical Innovation and Research Institute Memorial Hermann Hospital - Texas Medical Center, Houston (J.C.G.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA (P.L.); and Department of Neurology, Mayo Clinic, Jacksonville, FL (T.B.).
| | - Patrick Lyden
- From the Clinical Innovation and Research Institute Memorial Hermann Hospital - Texas Medical Center, Houston (J.C.G.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA (P.L.); and Department of Neurology, Mayo Clinic, Jacksonville, FL (T.B.)
| | - Thomas Brott
- From the Clinical Innovation and Research Institute Memorial Hermann Hospital - Texas Medical Center, Houston (J.C.G.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA (P.L.); and Department of Neurology, Mayo Clinic, Jacksonville, FL (T.B.)
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Elkind MSV. Introducing InterSECT: The International Stroke Early Career and Training Section. Stroke 2017; 48:1715-1716. [PMID: 28611084 DOI: 10.1161/strokeaha.117.017626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitchell S V Elkind
- From the Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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Abstract
Flatau, Goldflam and Babinski originated from the Russian area of partitioned Poland in the 19th century and knew each other. Each contributed significantly to neurology at a time of adversity in Polish academic life because of the political situation. This paper in the main is centred on Flatau and Goldflam; Babinski, the most recognised of the three, is included for comparison. They all died in 1932, when Poland had been an independent sovereignty since the end of the First World War in 1918.
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Abstract
This essay explores the impact of 'generalism' and 'general practice' on the specialisation of British medicine using the case of neurology in Britain to reveal characteristics of British 'generalist medical culture' from 1870 to 1990. It argues that 'generalism' represented a particular epistemological position in Victorian medicine, one that then created a natural bridge between science and medicine over which almost all physicians and scientists were comfortable walking. The legacies of that Victorian 'generalist preference' exerted an enduring impact on the specialisation process as physicians experienced it in the twentieth century and as this case of neurology reveals so clearly. Neurologists and general physicians would still be arguing about the relative merits of a general medical education into the 1980s. By then, however, the emergence of government bodies promoting specialist labour conditions would have rendered the process seemingly inexorable.
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Affiliation(s)
- Stephen T. Casper
- Clarkson University, 8 Clarkson Avenue, Box 5650, Potsdam, NY 13699 USA.
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Schröder S, Kuessner D, Arnold G, Zöllner Y, Jones E, Schaefer M. Do neurologists in Germany adhere to the national Parkinson's disease guideline? Neuropsychiatr Dis Treat 2011; 7:103-10. [PMID: 21552312 PMCID: PMC3083983 DOI: 10.2147/ndt.s8895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Indexed: 11/23/2022] Open
Abstract
Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson's disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson's disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II-V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline.
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Affiliation(s)
- Sabrina Schröder
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
| | | | - Guy Arnold
- Department of Neurology, Sindelfingen-Böblingen Hospital, Sindelfingen, Germany
| | | | | | - Marion Schaefer
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
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