Insufficient global health education in European neurological post-graduate training: a European Association of Young Neurologists and Trainees survey.

BACKGROUND AND PURPOSE: The awareness of and demand for neurological expertise in global health (GH) have emerged over recent years and have become more relevant due to the increasing numbers of refugees from developing countries arriving in Europe. This study aimed to assess the provision of GH education and opportunities for international exchange during neurology post-graduate training with a focus on Europe. METHODS: We developed a questionnaire covering different aspects of and interest in GH education on behalf of the European Association of Young Neurologists and Trainees. Residents in neurology and junior neurologists (RJN) were approached to complete this survey. RESULTS: Completed questionnaires were returned by 131 RJNs, of whom 65.7% were women and 84.0% were between 26 and 35 years old. In total, almost one-third (29.0%) of RJNs reported that their residency programs offered training in GH. Limited education was reported for women's or children's health and neurological disorders of immigrants and refugees, as only 22.1%, 25.2% and 22.1% of RJNs reported that such training was offered, respectively. The curriculum rarely included coverage of the global impact of neurological disorders. Definite plans to volunteer in a developing country were reported by 7.6%. The majority of the participants acknowledged the importance of GH training and international exchange during post-graduate education. CONCLUSION: This survey corroborates the interest in and appreciation of GH education by European RJNs. However, there are shortcomings in training and opportunities for international exchange. Academic neurology and international bodies, including the European Academy of Neurology, are requested to address this.

European junior neurologists perceive various shortcomings in current residency curricula.

BACKGROUND: Whether residency programs in Europe and neighboring countries appropriately prepare one for clinical practice is a matter of discussion. AIMS OF THE STUDY: To assess perceived satisfaction and preparedness for clinical practice among residents and junior neurologists from Europe and neighboring countries. MATERIAL AND METHODS: We inquired about the level of satisfaction with the quality of teaching, rotations and research opportunities of their residency program with an anonymous paper-based questionnaire. We assessed different aspects of practical training including clinical examination, diagnostic procedures, and patient management. RESULTS: The survey revealed limited satisfaction with the overall training (47%). The quality of teaching was frequently perceived as good or excellent (73%), whereas supervision for patient care and diagnostic procedures was rated as improvable. Discontent related often to poor proficiency for neurological emergencies, diagnostic considerations, and therapeutic decisions. Whether the working time directive introduced by the European Union (EU) affected patient care or resident education or residents' quality of life remained ambiguous. CONCLUSIONS: This cross-sectional survey disclosed shortcomings in current residency curricula. These concerned diagnostic and therapeutic procedures as well as practical skills, regardless of country, region, or institutional background. Initiatives aimed to harmonize postgraduate neurology training across Europe will need to consider these findings.

Clinical significance of HPV-DNA testing for precancerous cervical lesions.

Cervical screening by using cytology was proven efficient in reducing the mortality secondary to cervical cancer, but this method has limitations. High risk HPV infection is essential for cervical cancer development so HPV testing is a new tool used for screening patients for cervical neoplasia. HPV testing was proven most useful for women over 30 years old, in cases in which cytology identified ASC-US and after treatment for CIN. This article outlines the clinical significance of HPV-DNA testing for precancerous cervical lesions and the evidence that stands behind these recommendations.

HPV-DNA testing for patients with ASC-US helps identify the women who have a high risk for precancerous cervical lesions.

BACKGROUND: The cytological interpretation of ASC-US represents a category of morphologic uncertainty. For patients with this result, other tests are necessary in order to determine the risk for cervical lesions. MATERIALS AND METHODS: 198 patients with ASC-US cytology have been analyzed between 2008 and 2013. All the patients included in the study have subsequently had a high oncogenic HPV testing and colposcopy risk. 103 (52%) patients tested positive for high risk HPV and 21 (10%) had associated colposcopy changes and precancerous and cancerous lesions identified through biopsy. 95 (48%) patients tested negative for HPV and none of these women had lesions at colposcopy. RESULTS AND DISCUSSION: High oncogenic risk HPV testing was proven useful in identifying the patients with ASC-US cytology who are at high risk for cervical lesions (100% sensibility). In this study, the HPV testing had a negative predictive value of 100%, which uselessly renders a further colposcopy evaluation. HPV testing for women with ASC-US is not specific in identifying women with cervical lesions (Specificity 53%) and this results from a high prevalence of limited HPV infections in an age group which is less than 30 years old. CONCLUSIONS: High risk HPV testing for women with ASC-US cervical cytology is useful in determining the risk for precancerous and cancerous cervical lesions. A positive result is associated with a high risk for cervical lesions (20%) and for these patients colposcopy is necessary. For women with a negative result, the risk for cervical lesions is practically null so colposcopy is not required.