Do you want to perform endovascular therapy? Perspectives from neurology trainees across Europe.

BACKGROUND AND PURPOSE: Endovascular therapy (EVT) has become standard care for acute ischaemic stroke caused by large-vessel occlusion in the anterior circulation. However, access to this treatment in Europe remains poor. The lack of operators is a contributing factor and there is on-going discussion as to whether other specialists, including neurologists, could contribute to the EVT workforce. The question remains whether the next generation of neurologists want to become 'interventional neurologists'. The aim of this study was to address this question. METHODS: We conducted a short survey within the National Representatives Network (a division of the Resident and Research Fellow Section, European Academy of Neurology) in order to determine the interest of future neurologists in performing EVT. RESULTS: A total of 1218 responses from 27 European countries were received, with some variation in the number of respondents and results among individual countries. In total, 568 neurology trainees (47%) stated that they would want to be an 'interventional neurologist'. CONCLUSION: Our findings suggest that neurologists could make a significant contribution to the workforce performing EVT and have important implications for the development and uptake of training programmes in Europe.

Fabry disease mimicking multiple sclerosis: Lessons from two case reports.

Fabry disease is an X-linked lysosomal storage disorder that can mimic multiple sclerosis. We present two cases of heterozygous adult women where clinical and radiological features initially suggested a diagnosis of multiple sclerosis. This led us to review the early clinical course and neurological features of Fabry disease and highlight the importance of assessing non-neurologic (systemic) symptoms when considering a diagnosis of multiple sclerosis and the need for specialist interpretation of neuroradiological findings.

Direct communication with general practitioners improves management of infants at risk of hepatitis B.

The National Screening Committee has recommended that all women presenting for antenatal care be offered routine screening for hepatitis B by the year 2000. In a low prevalence area a survey of the management of neonates whose mothers were positive for hepatitis B surface antigen showed that management of this group was better among general practitioners who had received advice on treatment.

'Back to sleep': the position in Oxfordshire and Northampton.

We examined hospital and domestic infant care practices in Oxfordshire and Northampton Health Districts to measure changes in prevalence of sudden infant death syndrome (SIDS) risk factors, and to evaluate a specific educational intervention restricted to Oxfordshire. We sent a postal questionnaire to 2781 parents of babies newly born in January 1992, July 1992 and January 1993 and achieved an 88% response rate. Overall, in hospital a relatively constant proportion (81%) slept on their sides and few prone, whereas at home 52% (but increasing) slept supine and 8% prone part or all of the time. Significant differences existed by district, both in hospital and at home, with more sleeping supine in Oxfordshire and more side-sleeping/propping in Northampton. First-time parents were more receptive to safety guidelines about sleeping position and several other risk factors also. We detected no modifying effect of the Oxfordshire advice. Professional practice can influence parental behaviour but general media coverage may produce the biggest effects.

A new method of evaluating selective school entry medicals.

There is an ongoing debate about the relative value of selective vs routine entrant medicals. This paper describes a districtwide study of entrant medicals using the tracer method to assess the prevalence and detection rates of problems at school entry. Overall 57% of school entrants were selected for a medical but there was a significant difference in selection rates in urban and rural schools. This selection rate is higher than that reported by other authors. There was a trend for tracer conditions to be more prevalent in urban areas although this was not statistically significant. Prevalence rates suggest that the method of selection successfully detected children with problems. The tracer methodology provided useful information for service planning without the collection of large amounts of data and has not, to our knowledge, been used before in community child health. We recommended this methodology to other districts as a simple and effective method of assessing selective entrant medicals.

Efficacy of Haemophilus influenzae type b conjugate vaccine PRP-T.

Efficacy of the Haemophilus influenzae type b (Hib) conjugate vaccine PRP-T (Pasteur-Merieux) was evaluated in a controlled community intervention study in the Oxford region, UK. PRP-T was offered to infants from May 1, 1991 in three of the region's eight districts and from July 1, 1991, in a fourth district. It was given by separate injection in addition to the standard diphtheria, tetanus, and pertussis vaccine according to an accelerated 2, 3, and 4 month schedule without a booster dose in the second year of life. By October 1, 1992, more than 90% of infants in vaccine districts had received at least one dose of PRP-T. None of the infants given three doses had developed Hib infection, whereas 11 infections occurred in the control population (vaccine efficacy 100%, 95% CI 80-100%). Intention-to-treat analysis also showed a high estimate of efficacy for the vaccine (90%, 50-99%). Follow-up of study children until November 1, 1993, has shown only 1 vaccine failure in an infant, and no invasive infections in those older than 1 year (average age 22 months). PRP-T vaccine had high protective efficacy with an accelerated immunisation schedule. Furthermore, the vaccine appears to remain protective through the second year of life without a booster dose. These findings provide encouragement for use of PRP-T in the Expanded Programme of Immunisation.

Can retinoscopy be used to screen infants for amblyopia? A longitudinal study of refraction in the first year of life.

One hundred normal babies were refracted by two observers in a double-masked study within 24 hours of delivery and 30 minutes after instillation of 1% cyclopentolate. The procedure was repeated at 6 weeks, 3 months, 6 months and 1 year. At birth agreement between the two refractionists to within 1 dioptre spherical equivalent was 82%, rising to 94% at 1 year. Astigmatism of greater than 1 dioptre increased from 10% at birth to 42% at 6 months but decreased to 15% at 1 year. Myopia was uncommon (4%) but 80% of eyes were hypermetropic more than +2 dioptres and 25% more than +4 dioptres at birth, although these percentages decreased to 5% and 3% at 1 year. Anisometropia of more than 1 dioptre between the two eyes was uncommon but in the two cases where it persisted in the presence of high hypermetropia, reversible amblyopia was encountered in both cases.