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1
Moré, Jayaji M., Justin A. Miller, and Mill Etienne. "Disaster Neurology Update." Neurology: Clinical Practice 11, no. 2 (January 25, 2021): 175–78. http://dx.doi.org/10.1212/cpj.0000000000001042.
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In 2013, the term disaster neurology was introduced to describe a new practice opportunity for neurologists interested in providing needed, nonsurgical neurologic care in regions affected by natural or human-influenced disasters. Although previously presented as an option for interested neurologists, the coronavirus disease 2019 (COVID-19) pandemic has made it clear that every neurologist should be prepared to take on the unique challenges of disaster neurology. Examining the role of neurologists on the frontlines of the COVID-19 pandemic response represents an opportunity to review and apply key features of disaster neurology, including recognizing the categories of neurologic cases expected to be seen during a disaster, adapting inpatient and outpatient workflows, and accommodating the needs of vulnerable populations. Relating principles of disaster neurology to the response of neurologists to the current pandemic informs best practices for neurologic care as COVID-19 cases continue to surge throughout the United States and abroad.
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Saadi, Altaf, David U. Himmelstein, Steffie Woolhandler, and Nicte I. Mejia. "Racial disparities in neurologic health care access and utilization in the United States." Neurology 88, no. 24 (May 17, 2017): 2268–75. http://dx.doi.org/10.1212/wnl.0000000000004025.
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Objective:To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States.Methods:We analyzed nationally representative data from the 2006–2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy). To assess disparities in neurologic care utilization, we performed logistic regression analyses of outpatient department neurologic care visit rates and expenditures for each racial ethnic group controlling for age, sex, health status, socioeconomic characteristics, and geographic region of care.Results:Of the 279,103 MEPS respondents, 16,936 (6%) self-reported a neurologic condition; 5,890 (2%) received a total of 13,685 outpatient neurology visits. Black participants were nearly 30% less likely to see an outpatient neurologist (odds ratio [OR] 0.72, confidence interval [CI] 0.64–0.81) relative to their white counterparts, even after adjustment for demographic, insurance, and health status differences. Hispanic participants were 40% less likely to see an outpatient neurologist (OR 0.61, CI 0.54–0.69). Among participants with known neurologic conditions, blacks were more likely to be cared for in the emergency department, to have more hospital stays, and to have higher per capita inpatient expenditures than their white counterparts.Conclusions:Our findings highlight racial and ethnic inequalities in the utilization of neurologic care in the United States.
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Kremenchutzky, Marcelo, and Len Walt. "Perceptions of Health Status in Multiple Sclerosis Patients and Their Doctors." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 40, no. 2 (March 2013): 210–18. http://dx.doi.org/10.1017/s0317167100013755.
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Objective:To compare neurologist and patient perceptions of multiple sclerosis (MS)-related health status.Methods:MS patients (n=99) were recruited from six sites in Canada. Following a consultation with their neurologist, patients estimated their relapse frequency, rated their general health and quality of life (QoL), reviewed descriptions of eight health domains and selected the three most important, and completed a utility assessment using the standard gamble (SG). Concurrently, neurologists independently used the same instruments to rate their patients' health status. Assessments were compared on the basis of paired mean values of both groups and the degree of exact agreement quantified by intraclass coefficient (ICC) and kappa analyses, which yield values of 1.0 with 100% agreement.Results:There were significant differences (p<0.001) between patient and neurologist ratings for relapses in the last year (0.86 vs. 0.4, respectively), QoL (61.2 vs. 69.7 (maximum score = 100) and utility (0.864 vs. 0.971); ICC analysis revealed moderate to poor levels of agreement (0.56 for QoL to 0.03 for SG). There was little concordance in identification of important health domain and the only significant associations were in bodily pain and social functioning (kappa statistic = 0.24, p = 0.026 for both). Neurologists identified physical functioning domains as important, while patients placed more emphasis on mental health domains.Conclusions:Discrepancies between neurologist and patient perceptions of MS were observed. The study identifies a need to educate neurologists on the recognition of MS health domains that are important in the definition of patient QoL.
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Sacchetti, Daniel C., Ajay Gupta, Caroline D. Chung, Abhinaba Chatterjee, Yi Zhang, Babak B. Navi, Alan Z. Segal, and Hooman Kamel. "Vascular Neurologists’ Involvement in the Care of Medicare Patients With Ischemic Stroke." Neurohospitalist 10, no. 3 (February 11, 2020): 181–87. http://dx.doi.org/10.1177/1941874420902951.
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Background and Purpose: We sought to determine the proportion of patients with ischemic stroke evaluated by vascular neurologists in the United States. Methods: Using 2009 to 2015 claims from a 5% nationally representative sample of Medicare beneficiaries, we identified patients ≥65 years of age who were hospitalized for ischemic stroke. We ascertained the proportion of patients evaluated during the hospitalization or within 90 days of discharge by nonvascular and vascular neurologists. We assessed the relationship between county-level socioeconomic status and the likelihood of neurologist evaluation and between neurologist evaluation and diagnostic testing. Results: Among 66 989 patients with ischemic stroke, 37 820 (56.5%) were evaluated by a nonvascular neurologist and 11 700 (17.5%) by a board-certified vascular neurologist. Across increasing quartiles of county socioeconomic advantage, the proportion of patients evaluated by a vascular neurologist was 12.2%, 16.5%, 19.8%, and 23.0%. Relative to evaluation by a nonvascular neurologist, evaluation by a vascular neurologist was associated with a higher likelihood of postdischarge heart rhythm monitoring (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.9), echocardiography (OR, 1.4; 95% CI, 1.3-1.4), cervical vessel imaging (OR, 1.3; 95% CI, 1.2-1.3), and intracranial vessel imaging (OR, 2.1; 95% CI, 2.0-2.2). Conclusions: In a nationally representative cohort of Medicare beneficiaries, we found that about three quarters of patients with ischemic stroke were evaluated by a neurologist, and about one-sixth were evaluated by a vascular neurologist. Patients who were evaluated by a vascular neurologist were significantly more likely to undergo diagnostic testing.
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Rahmayanti, Rahmayanti, Retnaningsih Retnaningsih, and Muchlis AU Achsan Udji Sofro. "Manifestasi Klinik Gangguan Neurologis Terkait HIV." Medica Hospitalia : Journal of Clinical Medicine 6, no. 2 (November 25, 2019): 100–106. http://dx.doi.org/10.36408/mhjcm.v6i2.390.
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Latar Belakang: Komplikasi neurologis terjadi pada lebih dari 40% pasien dengan infeksi HIV. Kelainan neurologis yang terkait dengan infeksi HIV meliputi infeksi sistem saraf pusat, neoplasma, komplikasi vaskular, neuropati perifer, dan miopati.Penelitian ini bertujuan untuk mengetahui manifestasi klinis gangguan neurologis terkait HIV pada pasien terdiagnosis HIV yang dirawat di RSUP Dr. Kariadi Semarang tanggal 1 Januari 2014- 31 Desember 2016.
Metode: Penelitian ini adalah studi deskriptif retrospektif observasional yang dilakukan di Rumah Sakit Umum Dr. Kariadi, Semarang, Jawa Tengah. Data diambil dari Rekam medis, dianalisis manifestasi neurologis terkait HIV.
Hasil: Subyek adalah 115 pasien dengan HIV-AIDS, 64 laki-laki (56%) dan 51 perempuan (44%). Usia rata-rata 32,06 tahun (4 sampai 68 tahun). Dari 115 kasus, 40 subyek (34,78%) memiliki manifestasi neurologis terkait HIV. Manifestasi neurologis terkait HIV meliputi toksoplasmosis otak (60%), meningoencephalitis(20%), st non hemoragik (5%),abses serebral (5%) dan vertigo (5%).
Kesimpulan. Infeksi HIV dan kaitannya dengan tingkat keparahan imunodefisiensi bertanggung jawab atas sejumlah besar gangguan neurologis. Analisis faktor risiko serta status imunitas harus dilakukan pada semua pasien dengan gangguan neurologis untuk tujuan penyaringan hiv.
Kata kunci: HIV, AIDS, Kelainan neurologis
Background: Neurologic complications occur in more than 40% of patients with HIV infection. Neurologic disorders associated with HIV infection include central nervous system infections, neoplasms, vascular complications, peripheral neuropathies, and myopathies. This study was aimed to identify clinical manifestation of HIV-associated neurologic disorders in Patients with AIDS treated in Dr. Kariadi General Hospital from 1 January 2014 to 31 December 2016.
Methods: This is a descriptive retrospective observational study conducted in neurology clinic,Dr. Kariadi General Hospital, Semarang,between 1 January 2014 and 31 December 2016.Each patient”s medical record was studied in detail and then analyzed specifically in regard to the clinical manifestation of HIV-associated neurologic disorders.
Results: One hundred fifteen patients were included, 64 males (56%) and 51 females (44%). The average age was 32,06 years (4 to 68 years). Of the 115 cases, 40 (34,78 %) had neurologic manifestation.The manifestation include brain toxoplasmosis (60%), meningoencephalitis (20%), non hemorragic stroke (5%),cerebral abces (5%) and vertigo (5%).
Conclusions. HIV infection and their association with the severity of immunodeficiency is responsible for a large number of neurologic disorders. Analysis of risk factors as well as imunnological status should be made in all patients with neurologic disorders for the purpose of hiv screening.
Keywords: HIV, AIDS, neurologic disorders
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Stern, John M., Fernando Cendes, Frank Gilliam, Patrick Kwan, Philippe Ryvlin, Joseph Sirven, Brien Smith, Aleksandra Adomas, and Lauren Walter. "Neurologist–patient communication about epilepsy in the United States, Spain, and Germany." Neurology: Clinical Practice 8, no. 2 (March 14, 2018): 93–101. http://dx.doi.org/10.1212/cpj.0000000000000442.
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BackgroundEffective communication between patients and their health care providers is recognized as critically important to improve the quality of health services for individuals with epilepsy. We aimed to describe in-office neurologist–patient conversations about epilepsy and focus on disease identification, shared decision-making, and care planning.MethodsTranscripts and audio recordings of conversations between patients and neurologists in the United States, Spain, and Germany were analyzed linguistically in the topic areas of epilepsy identification and diagnosis, disease education, treatments, and care planning. Analyses included word-level assessments, topic switching, strategies of information elicitation, identification of topics discussed, quantification of questions asked, and assessment of types of questions asked.ResultsConversations of 17 neurologists in the United States, 12 in Spain, and 6 in Germany, with 50, 20, and 16 patients, respectively, were analyzed. Neurologists tended to utilize an event-based, patient-friendly vocabulary to refer to seizures, and in the United States, they avoided using the term “epilepsy.” Regardless of who initiated the treatment discussion, the neurologists in all 3 countries were unilaterally responsible for the treatment decision and choice of medication. When describing a new medication, neurologists most often discussed potential side effects but did not review potential benefits. Neurologists rarely defined seizure control and did not ask patients what seizure control meant to them.ConclusionsWe identified opportunities related to vocabulary, decision-making, and treatment goal setting that could be targeted to improve neurologist–patient communication about epilepsy, and ultimately, the overall treatment experience and outcomes for patients.
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Zeiger, William, Scott DeBoer, and John Probasco. "Patterns and Perceptions of Smartphone Use Among Academic Neurologists in the United States: Questionnaire Survey." JMIR mHealth and uHealth 8, no. 12 (December 24, 2020): e22792. http://dx.doi.org/10.2196/22792.
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Background Smartphone technology is ubiquitous throughout neurologic practices, and numerous apps relevant to a neurologist’s clinical practice are now available. Data from other medical specialties suggest high utilization of smartphones in routine clinical care. However, the ways in which these devices are used by neurologists for patient care–related activities are not well defined. Objective This paper aims to characterize current patterns of smartphone use and perceptions of the utility of smartphones for patient care–related activities among academic neurology trainees and attending physicians. We also seek to characterize areas of need for future app development. Methods We developed a 31-item electronic questionnaire to address these questions and invited neurology trainees and attendings of all residency programs based in the United States to participate. We summarized descriptive statistics for respondents and specifically compared responses between trainees and attending physicians. Results We received 213 responses, including 112 trainee and 87 attending neurologist responses. Neurology trainees reported more frequent use of their smartphone for patient care–related activities than attending neurologists (several times per day: 84/112, 75.0% of trainees; 52/87, 59.8% of attendings; P=.03). The most frequently reported activities were internet use, calendar use, communication with other physicians, personal education, and health care–specific app use. Both groups also reported regular smartphone use for the physical examination, with trainees again reporting more frequent usage compared with attendings (more than once per week: 35/96, 36.5% of trainees; 8/58, 13.8% of attendings; P=.03). Respondents used their devices most commonly for the vision, cranial nerve, and language portions of the neurologic examination. The majority of respondents in both groups reported their smartphones as “very useful” or “essential” for the completion of patient care–related activities (81/108, 75.0% of trainees; 50/83, 60.2% of attendings; P=.12). Neurology trainees reported a greater likelihood of using their smartphones in the future than attending neurologists (“very likely”: 73/102, 71.6% of trainees; 40/82, 48.8% of attendings; P=.005). The groups differed in their frequencies of device usage for specific patient care–related activities, with trainees reporting higher usage for most activities. Despite high levels of use, only 12 of 184 (6.5%) respondents reported ever having had any training on how to use their device for clinical care. Regarding future app development, respondents rated vision, language, mental status, and cranial nerve testing as potentially being the most useful to aid in the performance of the neurologic examination. Conclusions Smartphones are used frequently and are subjectively perceived to be highly useful by academic neurologists. Trainees tended to use their devices more frequently than attendings. Our results suggest specific avenues for future technological development to improve smartphone use for patient care–related activities. They also suggest an unmet need for education on effectively using smartphone technology for clinical care.
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Falet, JR, S. Deshmukh, M. Babinski, G. Sigler, A. Al-Jassim, and F. Moore. "P.031 A qualitative study of patient perspectives regarding the role of the neurologist in advanced Multiple Sclerosis." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (June 2018): S24. http://dx.doi.org/10.1017/cjn.2018.133.
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Background: With few evidence-based disease-modifying therapies being available for patients with progressive multiple sclerosis (PMS), how can neurologists best care for their patients? Little is known about the perspectives of patients with respect to the role they would like their neurologist to play in their care. We hereby report an update to our abstract presented at the Canadian Neurological Sciences Federation’s annual congress in 2016. Methods: Patients with PMS having an Expanded Disability Status Scale (EDSS) score of 6 or more were invited to participate. Semi-structured interviews were conducted with patients and their caregivers, and written questionnaires were completed by all participants. Collected data was subjected to thematic coding. Results: We have now interviewed a total of 18 patients (compared to 10 in 2016) and have reached thematic saturation. The majority of patients identified the neurologist as a useful figure in their care. Three main reasons were identified: (1) The neurologist provides information about new research and therapies (2) The neurologist educates patients about their disease and available services (3) The neurologist is viewed as an important supportive figure. Conclusions: Despite a lack of disease-modifying treatments for progressive multiple sclerosis, patients with PMS view the neurologist as an essential provider of care.
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Sandrone, Stefano, Jimmy V. Berthaud, Miguel Chuquilin, Jacquelyne Cios, Pritha Ghosh, Rachel J. Gottlieb-Smith, Hani Kushlaf, et al. "Neurologic and neuroscience education." Neurology 92, no. 4 (December 19, 2018): 174–79. http://dx.doi.org/10.1212/wnl.0000000000006716.
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Neurologic disorders are among the most frequent causes of morbidity and mortality in the United States. Moreover, the current shortfall of neurologists is expected to worsen over the coming decade. As a consequence, many patients with neurologic disorders will be treated by physicians and primary care providers without formal neurologic training. Furthermore, a pervasive and well-described fear of neurology, termed neurophobia, has been identified in medical student cohorts, residents, and among general practitioners. In this article, members of the American Academy of Neurology A.B. Baker Section on Neurological Education review current guidelines regarding neurologic and neuroscience education, contextualize the genesis and the negative consequences of neurophobia, and provide strategies to mitigate it for purposes of mentoring future generations of health care providers.
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Hill, Jeoffrey, and Daniel Alford. "Prescription Medication Misuse." Seminars in Neurology 38, no. 06 (December 2018): 654–64. http://dx.doi.org/10.1055/s-0038-1673691.
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AbstractIn the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pain, seizures, spasticity) where the prescriptions of medications with misuse potential are indicated. It is therefore imperative that neurologists understand which medications are liable to misuse and institute strategies to minimize the harm associated with these medications. The authors review the most common medications prescribed by neurologist with misuse potential, and briefly discuss the behaviors that are suggestive of medication misuse and tools for monitoring patients to minimize medication-related harm from misuse.
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Nalleballe, Krishna, Sen Sheng, Chenghui Li, Ruchira Mahashabde, Amarnath R. Annapureddy, Kamran Mudassar, Krishna Pothineni, et al. "Industry Payment to Vascular Neurologists." Stroke 51, no. 4 (April 2020): 1339–43. http://dx.doi.org/10.1161/strokeaha.119.027967.
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Background and Purpose— Industry payments to physicians raise concerns regarding conflicts of interest that could impact patient care. We explored nonresearch and nonownership payments from industry to vascular neurologists to identify trends in compensation. Methods— Using Centers for Medicare and Medicaid Services and American Board of Psychiatry and Neurology data, we explored financial relationships between industry and US vascular neurologists from 2013 to 2018. We analyzed payment characteristics, including payment categories, payment distribution among physicians, regional trends, and biomedical manufacturers. Furthermore, we analyzed the top 1% (by compensation) of vascular neurologists with detailed payment categories, their position, and their contribution to stroke guidelines. Results— The number of board certified vascular neurologist increased from 1169 in 2013 to 1746 in 2018. The total payments to vascular neurologist increased from $99 749 in 2013 to $1 032 302 in 2018. During the study period, 16% to 17% of vascular neurologists received industry payments. Total payments from industry and mean physician payments increased yearly over this period, with consulting fee (31.1%) and compensation for services other than consulting (30.7%) being the highest paid categories. The top 10 manufacturers made the majority of the payments, and the top 10 products changed from drug or biological products to devices. Physicians from south region of the United States received the highest total payment (38.72%), which steadily increased. Payments to top 1% vascular neurologists increased from 64% to 79% over the period as payments became less evenly distributed. Among the top 1%, 42% specialized in neuro intervention, 11% contributed to American Heart Association/American Stroke Association guidelines, and around 75% were key leaders in the field. Conclusions— A small proportion of US vascular neurologists consistently received the majority of industry payments, the value of which grew over the study period. Only 11% of the top 1% receiving industry payments have authored American Heart Association/American Stroke Association guidelines, but ≈75% seem to be key leaders in the field. Whether this influences clinical practice and behavior requires further investigation.
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Triono, Agung, and Elisabeth Siti Herini. "Faktor Prognostik Kegagalan Terapi Epilepsi pada Anak dengan Monoterapi." Sari Pediatri 16, no. 4 (November 9, 2016): 248. http://dx.doi.org/10.14238/sp16.4.2014.248-53.
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Latar belakang. Epilepsi merupakan salah satu penyakit neurologi utama pada anak. Banyak faktor yangmemengaruhi kegagalan monoterapi epilepsi pada anak sehingga akan berdampak pada keberhasilan terapiepilepsi secara keseluruhan.Tujuan. Mengetahui faktor prognostik yang dapat digunakan untuk memprediksi kegagalan monoterapiepilepsi pada anakMetode. Penelitian kasus-kontrol pada pasien epilepsi usia 6 bulan sampai dengan 18 tahun yang berobatke Poli Anak RSUP Dr. Sardjito tahun 2009. Kasus adalah pasien epilepsi yang gagal dengan monoterapidan kontrol adalah pasien epilepsi yang berhasil dengan monoterapi.Hasil. Didapat 120 pasien dengan 60 pasien kelompok kontrol dan 60 kelompok kasus. Dilakukan analisisunivariat pada masing-masing faktor prognostik. Berdasarkan analisis univariat didapatkan beberapa faktorprognostik kegagalan monoterapi, yaitu terapi epilepsi yang tidak segera, frekuensi serangan kejang sebelumterapi, status epileptikus, adanya defisit neurologis, dan adanya kelainan neurologi penyerta. Setelah dianalisissecara multivariat, faktor frekuensi serangan kejang sebelum terapi >10 kali (OR 14,196, IK95%:3,576-56,348; p<0,01) dan adanya kelainan neurologi penyerta (OR 18,977, IK95%:3,159-113,994; p<0,01 )merupakan faktor prognostik kegagalan monoterapiKesimpulan. Hasil penelitian ini menunjukkan bahwa anak epilepsi dengan serangan kejang lebih darisepuluh kali sebelum terapi dan adanya kelainan neurologi penyerta merupakan faktor prognostik kegagalanmonoterapi.
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Gillum, Leslie A., and S. Claiborne Johnston. "Are Outcomes of Ischemic Strokes Improved When a Neurologist is Attending?" Stroke 32, suppl_1 (January 2001): 383. http://dx.doi.org/10.1161/str.32.suppl_1.383.
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P239 BACKGROUND: Whether admission of stroke patients to neurologists is associated with improved outcomes is uncertain. Though prior studies suggested ischemic stroke patients under the care of neurologists had lower rates of in-hospital mortality than those treated by internists, these studies were uncontrolled for the possibility that patients with better prognosis were admitted to neurologists. METHODS: The University HealthSystem Consortium administrative database contains patient information from 84 large academic health centers and associates. Discharge abstracts for ischemic strokes admitted through emergency rooms 1997–1999 were obtained. Database variables were validated by comparison with a detailed chart review of 927 patients at 36 institutions. Attending physician specialty was evaluated as a predictor of in-hospital mortality using chi-square statistics and multivariable logistic regression. To determine whether hospital rates of stroke admission to neurologists were predictive of in-hospital mortality, generalized estimating equations (GEE) were used. This multivariable method accounts for clustering of observations at institutions, which broadens confidence intervals (CI). All multivariable analyses were adjusted for age, gender, race, admission status, and treatment volume. RESULTS: Of 28,571 ischemic strokes admitted through the emergency department, 58% were admitted to neurologists. Univariate analyses demonstrated a lower risk of in-hospital mortality in cases admitted to neurologist (4.7%) compared to non-neurologists (9.4%; p<0.001). Adjustment for case-mix did not alter the association (odds ratio, 0.48; 95% CI, 0.43–0.53; p<0.001). However, risk of death was not lower at hospitals admitting a larger portion of ischemic stroke cases to neurologists (p=0.54) as would be expected if admission to neurologists led to improved outcomes. CONCLUSIONS: In academic medical centers, ischemic stroke patients admitted to neurologists are less likely to die in the hospital compared to those admitted to other services. However, this may be due to selection of patients with better prognosis for admission to neurologists.
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Archer, Trevor. "Neurologic disruption arising from Immunologic Aberration." Neuroscience and Neurological Surgery 4, no. 4 (September 20, 2019): 01–05. http://dx.doi.org/10.31579/2578-8868/084.
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Interactions between neurodegenerative states and immune system dysregulations may underlie several diseases that induce problems for neuropsychological and physical health. It seems increasingly evident that process of apoptosis, a central issue for health and well-being, is associated to greater or lesser extents with the balance and ongoing regulation of immune system proclivities. One key contributor to the regulation of structure and function of brain and behaviour has emerged to be the gastrointestinal microbiome, not least in the context of the neurodegenerative disorders. Certain genes identified in in these disorders encode for proteins with directly-acting immunoactive/immunoreactive roles, which when mutated lead to dysregulations in immune functions, thereby affecting the disease states; yet accumulating evidence implies direct malfunctions of immune ells in the brain and CNS as well as at the periphery of the nervous system. Remarkably, the therapeutic effects of anti-tumor, immune system-enhancing agents are emerging to awaken the necessity for consideration of immune system-nervous system interactions as reciprocal determinants of both neurodegenerative and inflammatory disorders.
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Hasan, Tasneem F., Marion T. Turnbull, Kenneth A. Vatz, Maisha T. Robinson, Elizabeth A. Mauricio, and William D. Freeman. "Burnout and attrition." Neurology 93, no. 23 (November 5, 2019): 1002–8. http://dx.doi.org/10.1212/wnl.0000000000008583.
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Neurology faces an increasing shortage of neurologists in the United States due to a growing demand for neurologic services. A 7% increase in the supply of neurologists is predicted from 2012 to 2025, whereas the demand will rise by 16%. An increase in the neurology workforce is critical to meet the demands, and a significant gender gap remains within the workforce that must be addressed to further ease the discrepancy between supply and demand. Individual, institutional, and societal factors contribute to this gender discrepancy and potentially result in the burnout or soft attrition of women from neurology. These factors, including earning disparity between male and female neurologists, one of the largest gaps in pay for any medical specialty, and the lack of representation at higher academic levels with only 12% (14 of 113) of neurology department chairs at academic medical centers being women, could lead to increased attrition of women from neurology. Identifying and mitigating these factors may help narrow the gender gap and increase the supply of neurologists to better meet future demand.
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Freedman, Daniel A., and Dara V. F. Albert. "Opinion and Special Articles: Neurology education at US osteopathic medical schools." Neurology 89, no. 24 (December 11, 2017): e282-e283. http://dx.doi.org/10.1212/wnl.0000000000004750.
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Osteopathic medical schools have a longstanding tradition of training primary care physicians (PCP). Neurologic symptoms are common in the PCP's office and there is an undersupply of neurologists in the United States. It is therefore crucial for osteopathic medical students to have a strong foundation in clinical neurology. Despite the importance, a mere 6% of osteopathic medical schools have required neurology clerkships. Furthermore, exposure to neurology in medical school through required clerkships has been correlated with matching into neurology residency. As osteopathic medical schools continue to expand, it will become increasingly important to emphasize the American Academy Neurology's published guidelines for a core clerkship curriculum. Practicing neurologists should take an active role in encouraging osteopathic medical schools to adopt these guidelines.
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Ahlawat, Aditi, and Pushpa Narayanaswami. "Financial relationships between neurologists and industry." Neurology 92, no. 21 (May 20, 2019): 1006–13. http://dx.doi.org/10.1212/wnl.0000000000007640.
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ObjectiveTo analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments Database.MethodsIn this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce Data Book, 2015.ResultsIn 2015, approximately 96% of US neurologists received nonresearch payments totaling $93,920,993. The median payment per physician was $407. The highest proportion of neurologists (24%) received between $1,000 and $10,000. Food and beverage was the most frequent category (83% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (49%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($16,461,055; 17.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%).ConclusionsThe Open Payments program was established to foster transparent disclosure of physician compensations from industry, in response to legislative and public concerns of the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.
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Ahlawat, Aditi, and Pushpa Narayanaswami. "Financial relationships between neurologists and industry." Neurology 90, no. 23 (May 4, 2018): 1063–70. http://dx.doi.org/10.1212/wnl.0000000000005657.
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ObjectiveTo analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments database.MethodsIn this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce data book, 2015.ResultsIn 2015, approximately 51% of US neurologists received nonresearch payments totaling $6,210,414. The median payment per physician was $81. Payments to the top 10% of compensated neurologists amounted to $5,278,852 (84.5%). Food and beverage was the most frequent category (86.5% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (58%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($1,162,900; 18.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%).ConclusionsThe Open Payments program was established to foster transparent disclosure of physician compensation from industry, in response to legislative and public concerns over the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.
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Johnston, S. Claiborne, and Leslie A. Gillum. "Characteristics of Academic Medical Centers Associated with Ischemic Stroke Outcome." Stroke 32, suppl_1 (January 2001): 382. http://dx.doi.org/10.1161/str.32.suppl_1.382-a.
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P235 Background: Data supporting the efficacy of stroke center characteristics are limited. Methods: A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium participating in a quality improvement project. In-hospital mortality of all emergency-department admissions for ischemic stroke at these institutions was evaluated in a large administrative database from 1997 through 1999. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Using this technique, institutional characteristics were evaluated as predictors of in-hospital mortality after adjusting for age, gender, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Results: Thirty-two institutions completed the questionnaire and 29 of these were included in the administrative database. In-hospital deaths occurred in 758 (7.0%) of the 10,880 ischemic strokes admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.36–0.74, p<0.001), and at those with guidelines stating that only neurologists could administer tPA (OR 0.65, 95% CI 0.49–0.88, p=0.004). There was a trend toward fewer deaths at hospitals with a dedicated stroke team available by pager (OR 0.76, 95% CI 0.56–1.04, p=0.09). The presence of a dedicated neurological intensive care unit, stroke unit, and written clinical pathway for stroke were not significantly associated with in-hospital death. Conclusions: Academic medical centers with a vascular neurologist and those with written guidelines limiting tPA administration to neurologists had lower rates of in-hospital mortality for ischemic stroke patients.
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Ravnborgl, M., M. Grønbech-Jensen, and A. Jønsson. "The MS impairment scale: a pragmatic approach to the assessment of impairment in patients with multiple sclerosis." Multiple Sclerosis Journal 3, no. 1 (February 1997): 31–41. http://dx.doi.org/10.1177/135245859700300104.
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We developed a measurement scale for assessment of impairment in MS patients (MSIS) in accordance with the recommandations of WHO. The items were kept close to a standard neurologic examination, and a short battery of cognitive tests was added. Normality was assigned to the value, zero, and the theoretical maximum score was 204. Two-hundred and ten multiple sclerosis (MS) patients were rated by one neurologist on the MS Impairment Scale (MSIS), the Extended Disability Status Scale (EDSS), and the Ambulation Index (AI). The median MSIS score was 52 (5- 147), the median EDSS 6.5 (1 - 9.5), and the median Al 5 (1-5). The relation between the MSIS scores and the EDSS was best described by an exponential function (non-linear regression coefficient, R=0.87). Sixty-two of the patients were reexamined and rated by another neurologist The interrater reliability coefficient (R) of the MSIS was 0.95, of the EDSS 0.91, and of the Al 0.94. Forty patients were examined twice by the first neurologist The intrarater reliability coefficient was 0.97 for the MSIS, 0.95 for the EDSS, and 0.98 for the Al. The MSIS is easy to use and is robust to observer dissimilarities. It has a monomodal univariate distribution and has a better discriminatory power than the EDSS, especially in the EDSS range 6 - 9, while the interrater reliability of the MSIS is at least as good as that of the EDSS and the Al.
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Ettlin, Th. "Status of Neurologic Rehabilitation in Switzerland." Neurorehabilitation and Neural Repair 12, no. 3 (January 1, 1998): 93. http://dx.doi.org/10.1177/154596839801200302.
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Fee, Susan C., Kathleen Malee, Ruth Deddish, John P. Minogue, and Michael L. Socol. "Severe acidosis and subsequent neurologic status." American Journal of Obstetrics and Gynecology 162, no. 3 (March 1990): 802–6. http://dx.doi.org/10.1016/0002-9378(90)91014-4.
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Goetz, Christopher G. "Poor Beard!!" Neurology 57, no. 3 (August 14, 2001): 510.1–514. http://dx.doi.org/10.1212/wnl.57.3.510.
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Objective: To analyze the role of the seminal 19th-century neurologist, Jean-Martin Charcot, in the internationalization of neurasthenia, previously known as “the American disease.”Background: The New York neurologist, George Beard, first described neurasthenia in 1869 and considered it a disorder related to the particular stress of modern civilization, most typified in the United States.Methods: Charcot’s personal files on neurasthenia from the Bibliothèque Charcot, Salpêtrière Hospital, Paris, were studied and his teaching lessons and lectures were examined.Results: Charcot presented numerous cases of neurasthenia, always crediting Beard with the original name and description. Calling Beard’s 1880 work a “remarkable monograph,” Charcot emphasized that patients with neurasthenia also comprised the bulk of his own private practice. Focusing on the signs of sexual impotency, fatigue, and a tight band of pressure around the head, Charcot categorically distinguished patients with neurasthenica from patients with hysteria. Like Beard, Charcot concluded that the origin of neurasthenia was psychological stress and felt the European society also fostered the environment to precipitate the disease. Charcot adamantly opposed extrapolations that called for early childhood educational reforms to reduce current classroom stress. Charcot sympathized more with the treating physician than the patient, calling neurasthenics insufferable (insupportables). On the front sheet of his neurasthenia file, he wrote in large script, “Poor Beard!!”Conclusion: By emphasizing the prevalence of neurasthenia and extending Beard’s observations, Charcot internationally legitimized the new diagnosis. Adding neurasthenia to the other neurologic descriptions from the United States by Hammond, Mitchell, and Dana, Charcot helped to foster the recognition of the American Neurologic School.
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Giebler, Reiner M., Ralf U. Scherer, and Jurgen Peters. "Incidence of Neurologic Complications Related to Thoracic Epidural Catheterization." Anesthesiology 86, no. 1 (January 1, 1997): 55–63. http://dx.doi.org/10.1097/00000542-199701000-00009.
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Background Due to potential neurologic sequelae, the risk:benefit ratio of thoracic epidural analgesia is controversial. Surprisingly, however, few available data address neurologic complications. The incidence of neurologic complications occurring after thoracic epidural catheterization was studied in patients scheduled for abdominal or abdominothoracic surgery. Methods A total of 4,185 patients were studied, including 2,059 during the prospective phase of the study and 2,126 during the retrospective phase. After thoracic epidural catheterization, all patients received general anesthesia. Patients' neurologic status was assessed by an anesthesiologist using clinical criteria after operation and after epidural catheter removal. If neurologic complications were suspected, a neurologist was consulted. The incidence of specific complications was compared for different thoracic puncture sites: upper (T3/4-6/7), mid (T7/8-8/9), and lower (T9/10-11/12) catheter insertion levels. Results The overall incidence of complications after thoracic epidural catheterization was 3.1% (n = 128). This included dural perforation (0.7%; n = 30); unsuccessful catheter placement (1.1%; n = 45); postoperative radicular type pain (0.2%; n = 9), responsive to catheter withdrawal in all cases; and peripheral nerve lesions (0.6%; n = 24), 0.3% (n = 14) of which were peroneal nerve palsies probably related to surgical positioning or other transient peripheral nerve lesions (0.2%; n = 10). No signs suggesting epidural hematoma were recognized, and there were no permanent sensory or motor defects attributable to epidural catheterization. Unintentional dural perforation was observed significantly more often in the lower (3.4%) than in the mid (0.9%), or upper (0.4%) thoracic region. A single patient experienced severe respiratory depression after receiving epidural buprenorphine but recovered without sequelae. Conclusions Thoracic epidural catheterization for abdominal and thoracoabdominal surgery is not associated with a high incidence of serious neurologic complications. In fact, the incidence of puncture- and catheter-related complications is less in the mid and upper than in lower thoracic region, and the predicted maximum risk for permanent neurologic complications (upper bound of the 95% confidence interval) is 0.07%.
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Polyak, Alexander, Serguei Bannykh, Andrew Klein, and Vinay Sundaram. "Neurologic Imaging in a Patient with Cirrhosis and Altered Mental Status: To CT or Not to CT." Case Reports in Gastrointestinal Medicine 2021 (July 30, 2021): 1–3. http://dx.doi.org/10.1155/2021/5588208.
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Hepatic encephalopathy represents a continuum of neuropsychiatric symptoms among patients with end-stage liver disease. When a patient with cirrhosis presents with altered mental status (AMS), routine neurologic imaging is not typically recommended, due to low diagnostic yield. Guidance from the American Association for the Study of Liver Disease states that, on initial presentation, brain imaging is not required unless there are other signs of intracranial pathology, including focal neurologic deficits. We present a case of a 61-year-old female with cirrhosis presenting with AMS without focal deficits, in whom neurological imaging revealed a meningioma and subsequent resection led to symptom improvement.
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Salam, Adil, Lisa Tilluckdharry, Yaw Amoateng-Adjepong, and Constantine A. Manthous. "Neurologic status, cough, secretions and extubation outcomes." Intensive Care Medicine 30, no. 7 (March 4, 2004): 1334–39. http://dx.doi.org/10.1007/s00134-004-2231-7.
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Ames, D., W. C. Wirshing, B. Waters, R. Mohgimi, and M. A. Berisford. "Neurologic deficits, Tardive dyskinesia, and medication status." Biological Psychiatry 35, no. 9 (May 1994): 715. http://dx.doi.org/10.1016/0006-3223(94)91018-9.
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Ceccarelli, Brindisino, Salomon, Heick, and Maselli. "A Rare Consequence after Shoulder Dislocation in a Professional Cyclist: A Case Report." Medicina 55, no. 9 (August 25, 2019): 529. http://dx.doi.org/10.3390/medicina55090529.
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Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist’s differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient’s psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient’s neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.
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Packer, Greg, Dan White, Tom Hayton, Julian Bion, and Tonny Veenith. "PO053 Status epilepticus – do neurologists and intensivists differ?" Journal of Neurology, Neurosurgery & Psychiatry 88, Suppl 1 (December 2017): A25.4—A26. http://dx.doi.org/10.1136/jnnp-2017-abn.86.
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Claassen, Jan, Lawrence J. Hirsch, and Stephan A. Mayer. "Treatment of status epilepticus: a survey of neurologists." Journal of the Neurological Sciences 211, no. 1-2 (July 2003): 37–41. http://dx.doi.org/10.1016/s0022-510x(03)00036-4.
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Ichord, Rebecca, Faye S. Silverstein, Beth S. Slomine, Russell Telford, James Christensen, Richard Holubkov, J. Michael Dean, and Frank W. Moler. "Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials." Neurology 91, no. 2 (June 8, 2018): e123-e131. http://dx.doi.org/10.1212/wnl.0000000000005773.
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ObjectiveTo implement a standardized approach to characterize neurologic outcomes among 12-month survivors in the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials.MethodsTwo multicenter trials enrolled children age 48 hours to 18 years who remained comatose after cardiac arrest (CA) occurring out-of-hospital (THAPCA-OH, NCT00878644) or in-hospital (THAPCA-IH, NCT00880087); patients were randomized to therapeutic hypothermia or therapeutic normothermia. The primary outcome, survival with favorable 12-month neurobehavioral outcome (Vineland Adaptive Behavior Scales [VABS-II]), did not differ between treatment groups in either trial. Neurologists examined 181 12-month survivors, described findings using the novel semi-quantitative Pediatric Resuscitation after Cardiac Arrest (PRCA) form, and rated findings in 6 domains; scores ranged from 0 (no deficits) to 21 (maximal deficits). PRCA scores were compared with 12-month VABS-II scores and cognitive scores.ResultsNeurologic outcome PRCA scores were classified as no/minimal impairment, PRCA 0–3, 81/179 (45%); mild impairment, PRCA 4–7, 24/179 (13%); moderate impairment, PRCA 8–11, 15/179 (8%); severe impairment, PRCA 12–16, 20/179 (11%); profound impairment, PRCA 17–21, 39/179 (21%) (2/181 incomplete). VABS-II scores correlated strongly with PRCA category (r = −0.88, p < 0.0001, Pearson correlation coefficient) and cognitive scores (r = −0.72, p < 0.0001). Factors associated with poor outcomes included out-of-hospital CA, seizure recognition in the early postarrest period, and poor neurologic status at hospital discharge.ConclusionThe PRCA provides a robust method for depicting neurologic outcomes after acute encephalopathy caused by CA in children. It provides a global semiquantitative rating of neurologic impairment and domain-specific impairment. The strong correlation with well-established neurobehavioral outcome measures supports its validity over a broad age range and wide spectrum of outcomes.
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Smith, Maiya, Christina Tse, Nicholas Fancher, Ryoko Hiroi, William Harris, Selin Kutlu, Nicole Anzai, Heather Miura, Bryce Chang, and Douglas Miles. "Lack of Native Hawaiian Neurologists and Disparities in Care for Native Hawaiians in Hawaiʻi." Pacific Health Dialog 21, no. 7 (June 22, 2021): 415–20. http://dx.doi.org/10.26635/phd.2021.108.
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Introduction: In Hawaiʻi, there are 367,000 Native Hawaiian and Pacific Islanders. Native Hawaiians experience health disparities in a variety of conditions, including stroke, diabetes, and cancer. Ethnic minorities are underrepresented among physicians; this lack of physician-patient racial concordance may contribute to the disparities, as recent studies suggest that racial discordance resulted in poorer healthcare quality. This study aims to assess the current status of neurological health disparities in the Native Hawaiian population in Hawaiʻi, with a focus on identifying neurologist ethnic representation, neurological diseases, and healthcare-related challenges disproportionately affecting Native Hawaiians. Methods: An anonymous survey on physician’s attitudes and practice was emailed to all neurologists in the Hawaiʻi Neurological Society from February 2019 to June 2019. Findings: Twenty-three full responses and one partial response was received. No participants self-identified as Native Hawaiian nor did they know of any Native Hawaiian neurologists in Hawaiʻi, yet all who completed the survey reported treating Native Hawaiians in their practice (n = 23), which identifies a gap in Native Hawaiian representation in the field of neurology in Hawaiʻi. In addition, majority of participants perceived that Native Hawaiians are disproportionately affected by neurological diseases and have difficulty accessing neurology services and obtaining quality care. Conclusions: Future focus on creating opportunities to improve racially discordant physician-patient relationships and to increase Native Hawaiian representation in neurology may help narrow the gap in health disparities experienced by Native Hawaiians.
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Reza Mohebbi, Mohammad. "Becoming a Child Neurologist in the United States." Journal of Child Neurology 24, no. 4 (January 23, 2009): 514. http://dx.doi.org/10.1177/0883073808331346.
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Durkin, Maureen S., and Marshalyn Yeargin-Allsopp. "Socioeconomic Status and Pediatric Neurologic Disorders: Current Evidence." Seminars in Pediatric Neurology 27 (October 2018): 16–25. http://dx.doi.org/10.1016/j.spen.2018.03.003.
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Cheng, E. M., R. D. Hays, L. W. Myers, G. W. Ellison, M. Beckstrand, and B. G. Vickrey. "Factors related to agreement between self-reported and conventional Expanded Disability Status Scale (EDSS) scores." Multiple Sclerosis Journal 7, no. 6 (December 2001): 405–10. http://dx.doi.org/10.1177/135245850100700610.
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Background: Although the Expanded Disability Status Scale (EDSS) remains a widely used scale for evaluating impairments in people with multiple sclerosis (MS), EDSS assessments are infeasible in certain situations. A self-administered version of the EDSS would be potentially usefulif it yielded similar results as the conventional physician-based version. Methods: We developed a self-administered patient questionnaire to obtain ratings of neurologic impairments, and developed algorithms to estimate EDSS scores. We mailed the questionnaires to all new consecutive patients scheduled to be seen at an MS clinic. Questionnaires were completed prior to the visit, and traditional EDSS ratings were made by one of two neurologists at the visit. One hundred and forty-six pairs of patient questionnaires and physician EDSS assessments were obtained. Results: Kappa values for agreement between the physician's EDSS scores and the questionnaire-derived scores were 0.13 (for exact agreement), 0.39 (+0.5 EDSS steps), and 0.56 (+1.0 EDSS steps). A scatterplot showed that agreement was best at EDSS scores 53.0 and 45.0. Better agreement was obtained when patients had a higher level of education, and when the physician was more certain of the diagnosis of MS. Conclusions: While the self-assessed EDSS scores do not agree highly enough to take the place of conventional EDSS scores, they may be sufficient for MS trial screening or for assessing outcomes across broad categories of disability.
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Bradley, W. G., J. Daube, J. R. Mendell, J. Posner, D. Richman, B. T. Troost, and T. R. Swift. "Quality improvement in neurology residency programs." Neurology 49, no. 5 (November 1997): 1205–7. http://dx.doi.org/10.1212/wnl.49.5.1205.
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The neurology residency programs in the United States are facing a crisis of quality. The Association of University Professors of Neurology (AUPN) approved the Quality Improvement Committee to examine this situation and make recommendations, which have been accepted by the AUPN. The recommendations are (1) that the educational goals of neurology residency training be dissociated from patient-care needs in academic medical centers and (2) that minimum levels of quality be applied to residents in neurology residency programs and to these programs themselves. These minimum criteria should include minimum educational criteria for entry into the program, minimum criteria for advancement from one year to the next in the program, and minimum criteria for performance of the graduates of neurology residency programs for program accreditation. The implementation of these recommendations will require a shift of funding of the care of indigent patients from the graduate medical education budget to direct patient-care sources. These recommendations will significantly improve the quality of neurologists and neurologic care in the United States.
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Johnson, B. E., N. Patronas, W. Hayes, J. Grayson, B. Becker, D. Gnepp, J. Rowland, A. Anderson, E. Glatstein, and D. C. Ihde. "Neurologic, computed cranial tomographic, and magnetic resonance imaging abnormalities in patients with small-cell lung cancer: further follow-up of 6- to 13-year survivors." Journal of Clinical Oncology 8, no. 1 (January 1990): 48–56. http://dx.doi.org/10.1200/jco.1990.8.1.48.
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To determine the subsequent evolution of neurologic, neuropsychologic, and intracranial anatomic findings in long-term survivors of small-cell cancer, we repeated an evaluation done 4 years previously in patients 6 to 13 years after treatment. Fifteen patients were reevaluated with a history and physical examination, mental status examination, neuropsychologic testing, computed cranial tomographic (CCT) scans, and magnetic resonance imaging (MRI). All but one was ambulatory and none were institutionalized. Thirteen of 15 had neurologic complaints, 10 of 15 had an abnormal neurologic examination, seven of 14 had an abnormal mental status examination, 12 of 14 had abnormal neuropsychologic testing, 12 of 15 had abnormal CCT scans, and seven of 15 had white-matter abnormalities on MRI scans. No dramatic decline in performance status, functional status, neurologic symptoms, or neurologic examination occurred in these patients with 4 years of additional follow-up. More patients showed a decline in mental status examinations and neuropsychologic testing than demonstrated improvement. Anatomic studies showed no dramatic changes in the CCT scans and MRI confirmed these findings. From these data we conclude that there is a slow decline in neuropsychologic function in some of the patients surviving more than 6 years from a diagnosis of small-cell lung cancer. The anatomic abnormalities documented by CCT scans and MRI are more frequent in patients with abnormal neuropsychologic function.
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Di Battista, G., A. Bertolotto, C. Gasperini, A. Ghezzi, D. Maimone, and C. Solaro. "Multiple Sclerosis State of the Art (SMART): A Qualitative and Quantitative Analysis of Therapy’s Adherence, Hospital Reliability’s Perception, and Services Provided Quality." Multiple Sclerosis International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/752318.
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The purpose of this study was to assess the adherence to therapy in patients with relapsing remitting multiple sclerosis (RR-MS) and to analyze the possible influence of factors such as hospital care and patients socioeconomic status. Two hundred eighty-five patients with RR-MS according to Mc Donald’s criteria and naïve disease-modifying drugs (DMDs) naïve were enrolled. Two self-administered questionnaires addressing the management of patients at therapy prescription and the personal perception of the daily life changes caused by DMDs were administered at months 3 and 12. Full adherence, considered as correct use of the therapy prescribed, was observed in a very high percentage of subjects (97.3% and 93.9% at 3 and 12 months). The main cause for reduced adherence was single dose forgetfulness, followed by anxiety, pain at the injection site, and tiredness of “doing all injections.” Nurses and neurologists of MS Center were identified as the major resource in coping with the disease at 3 and 12 months by patients. The neurologist was the health professional involved in MS management in 95% of cases and the nurse appeared to play a central role in patient training and drug administration management (50.3%).
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Nelson, Sarah. "Confusional State in HaNDL Syndrome: Case Report and Literature Review." Case Reports in Neurological Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/317685.
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The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.
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Socol, Michael L., Patricia M. Garcia, and Susan Riter. "Depressed Apgar scores, acid-base status, and neurologic outcome." American Journal of Obstetrics and Gynecology 170, no. 4 (April 1994): 991–99. http://dx.doi.org/10.1016/s0002-9378(94)70092-3.
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Drislane, Frank W. "Evidence Against Permanent Neurologic Damage From Nonconvulsive Status Epilepticus." Journal of Clinical Neurophysiology 16, no. 4 (July 1999): 323–31. http://dx.doi.org/10.1097/00004691-199907000-00004.
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SOCOL, MICHAEL L., PATRICIA M. GARCIA, and SUSAN RITER. "Depressed Apgar Scores, Acid-Base Status, and Neurologic Outcome." Survey of Anesthesiology 39, no. 1 (February 1995): 51. http://dx.doi.org/10.1097/00132586-199502000-00060.
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SOCOL, M. L., P. M. GARCIA, and S. RITER. "Depressed Apgar Scores, Acid-Base Status, and Neurologic Outcome." Survey of Anesthesiology 39, no. 3 (June 1995): 150. http://dx.doi.org/10.1097/00132586-199506000-00013.
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Mahakul, Dibya Jyoti, Ramesh Doddamani, Rajesh Meena, and Deepak Agrawal. "Analysis of Surgical Outcome in Patients with Firearm Injury to Spine." Indian Journal of Neurotrauma 15, no. 02/03 (August 2018): 051–56. http://dx.doi.org/10.1055/s-0039-1677669.
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Abstract Aim of Study To see whether surgical intervention in gunshot injuries to the spine leads to recovery in neurologic status. Methods It is a retrospective study conducted at the Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institutes of Medical Sciences (AIIMS), New Delhi, where case records of 20 patients with gunshot injury to the spine, admitted between January 2013 to March 2018, were analyzed. Result Out of 20 patients, 17 underwent surgical intervention. Entry wound was most common on the back, with the thoracic vertebrae being the most common segment involved. Nine patients had complete spinal cord injury (SCI) at the time of presentation and seven of them underwent surgery. However, only one of these patients showed neurologic improvement at follow-up. Seven patients with canal compromise underwent surgery, and only two of them showed improvement in neurologic status at follow-up. Early surgery was done in 8 out of 16 patients. All 16 patients underwent decompressive procedure, and 3 underwent additional stabilization procedure. Bullet was removed in nine cases. Intraoperative blood loss was minimal in 9 cases, and dural breach was noticed in 14 cases. At follow-up, 56.25% patients showed improvement in neurologic status. Conclusion Surgical intervention, timing of surgery, amount of intraoperative blood loss, and dural breach had no significant impact on the overall surgical outcome. Neurologic status at the time of presentation is the single most important factor that determines the ultimate outcome. Indication and type of surgical intervention is still an ambiguous topic. Owing to lack of conclusive evidence, we believe that there is role for surgery when it is done with an intention to restore the neurologic function.
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Kirschen, Matthew P., Josh Blinder, Aaron Dewitt, Megan Snyder, Rebecca Ichord, Robert A. Berg, Vinay Nadkarni, and Alexis Topjian. "Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units." Cardiology in the Young 28, no. 12 (October 16, 2018): 1457–62. http://dx.doi.org/10.1017/s1047951118001634.
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AbstractIntroductionNeurodevelopmental disabilities in children with CHD can result from neurologic injury sustained in the cardiac ICU when children are at high risk of acute neurologic injury. Physicians typically order and specify frequency for serial bedside nursing clinical neurologic assessments to evaluate patients’ neurologic status.Materials and methodsWe surveyed cardiac ICU physicians to understand how these assessments are performed, and the attitudes of physicians on the utility of these assessments. The survey contained questions regarding assessment elements, assessment frequency, communication of neurologic status changes, and optimisation of assessments.ResultsSurveys were received from 50 institutions, with a response rate of 86%. Routine clinical neurologic assessments were reported to be performed in 94% of institutions and standardised in 56%. Pupillary reflex was the most commonly reported assessment. In all, 77% of institutions used a coma scale, with Glasgow Coma Scale being most common. For patients with acute brain injury, 82% of institutions reported performing assessments hourly, whereas assessment frequency was more variable for low-risk and high-risk patients without overt brain injury. In all, 84% of respondents thought their current practice for assessing and monitoring neurologic status was suboptimal. Only 41% felt that the Glasgow Coma Scale was a valuable tool for assessing neurologic function in the cardiac ICU, and 91% felt that a standardised approach to assessing pre-illness neurologic function would be valuable.ConclusionsRoutine nursing neurologic assessments are conducted in most surveyed paediatric cardiac ICUs, although assessment characteristics vary greatly between institutions. Most clinicians rated current neurologic assessment practices as suboptimal.
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Sadikin, Cindy, Meryana Meryana, Valentinus Besin, and Yanna Saelan. "Neuroimaging Findings in Patients with Covid-19 in Indonesia." Medica Hospitalia : Journal of Clinical Medicine 8, no. 1 (March 23, 2021): 69–73. http://dx.doi.org/10.36408/mhjcm.v8i1.509.
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Background: Covid-19 caused by the SARS-CoV-2 virus has spread worldwide, including Indonesia. Neurological manifestations has also been reported in Covid-19 positive patients. Yet documentation of their neuroimaging findings are lacking, especially in Indonesia. Objective: To understand neuroimaging findings in Covid-19 positive patients
Methods: An observational study from medical record of Covid-19 positive patients in our hospital who developed abnormal neurologic manifestations and were followed up by neuroimaging examination from May to August 2020. Covid-19 positive diagnosis was confirmed from nasopharyngeal swab using the Real Time Polymerase Chain Reaction (RT-PCR). Neurological examination was performed by a neurologist, who then referred patients for neuroimaging examination using CT or MRI. Radiological expertise was performed by a radiologist.
Results: A total of 288 patients who are Covid-19 positive from nasopharyngeal RT-PCR swab admitted to our hospital from May to August 2020. Ten patients (3.5%) had abnormal neurologic manifestations and further neuroimaging examination follow up. Range of age 33-72 years old and slight male predominance (60%). Frequent clinical symptoms were decreased consciousness (40%), altered mental status (30%) and tremors (20%). Neuroimaging findings were large vessel occlusion (30%), vasculitis (20%), post hipoxic leucoencephalopathy (10%), basal ganglia encephalopathy (10%), non specific small vessel ischemia changes and negative findings (30%). Most patients were discharged with clinical improvement (60%), while 40% mortality rate were seen in patient with large vessel occlusion (30%) and vasculitis (10%).
Conclusion: Neuroimaging findings in Covid-19 positive patients were large vessel occlusion (LVO), vasculitis, post hipoxic leucoencephalopathy and basal ganglia encephalopathy Keywords: Covid-19, neurological, manifestation, neuroimaging
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Sigsbee, Bruce, and Orly Avitzur. "Upcoming Challenges for Neurologists in the United States." JAMA Neurology 70, no. 9 (September 1, 2013): 1097. http://dx.doi.org/10.1001/jamaneurol.2013.3299.
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Agarwal, Sonika, Jake R. Keller, Chloe E. Nunneley, Eyal Muscal, Michael C. Braun, Poyyapakkam Srivaths, and Timothy E. Lotze. "Therapeutic Plasma Exchange Use in Pediatric Neurologic Disorders at a Tertiary Care Center: A 10-Year Review." Journal of Child Neurology 33, no. 2 (January 16, 2018): 140–45. http://dx.doi.org/10.1177/0883073817749368.
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Pediatric neurologic conditions requiring therapeutic plasma exchange are rare in children and literature is sparse. The study aims to determine the outcomes, safety, and feasibility of therapeutic plasma exchange treatment in pediatric neurologic disorders. This retrospective analysis looked at the outcomes and safety of therapeutic plasma exchange in children (n = 50) with neurologic conditions. Patient age ranged <1 to 19 years old with a mean of 10.35 years. Of the 50 children treated with plasmapheresis, 26 patients received inpatient rehabilitation. At discharge, functional status can be summarized as follows: 24 (48%) with mental status impairment, 10 (20%) with vision impairment, 19 (38%) with bladder incontinence, and 37 (74%) with motor impairment. Three-month follow-up: 30% with mental status impairment, 10% with vision impairment, 18% with bladder incontinence, and 52% with motor impairment. Therapeutic plasma exchange is an effective and safe therapy for neurological conditions in the pediatric population.
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Pawloski, Jacob, Hassan Fadel, Sam Haider, Lisa Rogers, Ian Lee, and Adam Robin. "SURG-14. Laser Ablation for Brain Metastases: Risk Factors for Neurologic Complication." Neuro-Oncology Advances 3, Supplement_3 (August 1, 2021): iii26. http://dx.doi.org/10.1093/noajnl/vdab071.107.
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Abstract Introduction Laser interstitial thermal therapy (LITT) is a routinely used in treatment of recurrent brain metastases following SRS or open craniotomy. While considered safer than craniotomy, patients do experience neurologic decline following LITT. Identifying which patients are at risk for neurologic deterioration can help better advise patients on the most appropriate treatment options for their tumor. Objective The objective of the present study was to assess the frequency and identify risk factors for neurologic decline following LITT. Methods Data was gathered on patients who underwent LITT for ablation of metastatic brain tumors at our institution between 2014–2019. These cases were analyzed retrospectively and data was collected on patient demographics, tumor characteristics, procedural details, and post-operative complications and outcomes. Pre-operative neurologic function was compared to neurologic status at the 6–12 week post-op visit. Results 16 patients underwent LITT of a total of 18 metastatic lesions during the study time period and were included in the analysis. 7/16 patients demonstrated reduced KPS or worse neurologic function at 6–12 week follow up. 4 patients (25%) demonstrated neurologic deficits that were attributable to the laser ablation procedure, and each of these 4 patients had lesions in eloquent areas. Comparatively, none of the other 12 patients analyzed had eloquent lesions (p = 0.002). The presence of a pre-op neurologic deficit was not predictive of worsening neurologic function following LITT (p = 0.35). Average lesion size in patients who experienced neurologic deficit was 5.69cm3 compared to 3.15cm3 in those that did not (p = 0.1). Conclusion Our complications rate is similar to other published case series (15–44%). LITT, while better tolerated than standard craniotomy, can lead to neurologic decline in patients with brain metastases regardless of lesion size or pre-operative functional status. Eloquence is a significant predictor of neurologic complications following laser ablation.
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Sarnat, Harvey B., and Laura Flores-Sarnat. "Survey on Olfactory Testing by Pediatric Neurologists: Is the Olfactory a “True” Cranial Nerve?" Journal of Child Neurology 35, no. 5 (January 8, 2020): 317–21. http://dx.doi.org/10.1177/0883073819896513.
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Background: The olfactory nerve was conceptualized in the 4th century BC by Alcmaeon and described anatomically by Winslow in 1733. Cranial nerves (CNs) were named and numbered by Soemmerring in 1791. Notions still prevail that the olfactory (CN1) is not a “true” cranial nerve. Methods: To confirm our impression that the olfactory nerve is infrequently tested by North American pediatric neurologists, a survey was distributed to members of national pediatric neurology societies in Mexico, Canada, and the United States. A total of 233 responses were received to 6 multiple-choice questions regarding practice patterns examining CN1 in neonates and children and in metabolic, endocrine, and genetic disorders and cerebral malformations. Two of the questions addressed familiarity with neonatal olfactory reflexes and asked whether the olfactory is a “true” cranial nerve. Results: Only 16% to 24% of North American pediatric neurologists examine CN1 in neonates, even in conditions in which olfaction may be impaired. About 40% of respondents were aware of olfactory reflexes. A minority 15% did not consider CN1 as a “true” cranial nerve. Conclusions: Olfactory evaluation in neonates is simple, rapid, and inexpensive. It tests parts of the brain not otherwise examined. It may assist diagnosis in cerebral malformations; metabolic, endocrine, and hypoxic encephalopathies; and some genetic diseases, including chromosomopathies. CN1 is neuroanatomically unique and fulfills criteria of a true sensory cranial nerve. We recommend that olfaction be routinely or selectively included during neurologic examination of neonates and children.