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.

The European Board of Neurology Examination--junior neurologists are eager to take the challenge.

BACKGROUND: The Union Européenne des Médecins Spécialistes Section of Neurology (UEMS SEN)/European Board of Neurology (EBN) examination was launched in 2009 to set standards in knowledge and skills for the next generation of European neurologists. METHODS: Stimulated by the low participation at the first examination, we conducted a survey amongst 76 junior colleagues to assess awareness, motivation and obstacles regarding this examination. RESULTS: Remarkably, junior neurologists indicated great interest in the examination and motivation to spend additional preparation time (up to 6months) with the aim to catch up with European standards and improve the care of patients. However, there are major issues, which detain our colleagues from taking the examination including the amount of the examination fee, the potential lack of language abilities and the varying usage of the recommended books for preparation. CONCLUSIONS: This survey highlights the positive attitude of junior neurologists regarding initiatives to improve clinical skills and knowledge. Moreover, this study delineated several factors, which may be considered in the future to increase participation and substantiate the significance of the examination.

Neurology residency training in Europe--the current situation.

INTRODUCTION: Little is known about neurological training curricula in Europe. A joint approach by the European Federation of Neurological Societies (EFNS), the Union of European Medical Specialists/European Board of Neurology and the European Association of Young Neurologist and Trainees was established to explore the spectrum of neurology training in Europe. METHODS: In 2006, a questionnaire-based survey on neurology curricula as well as demographic data was designed by WS and WG and distributed by the EFNS to the national delegates of the EFNS, which comprises all European countries and Israel. RESULTS: By 2009, delegates from 31 of 41 countries (representing 76% of 505 million) had returned the questionnaire. A total of 24,165 specialists (46% women) were registered in the 31 countries. This corresponds to an average of 6.6 neurologists per 100,000 inhabitants (range 0.9-17.4/100,000 inhabitants). Duration of training in Europe was on average 4.9,years, ranging from 3 to 6,years. The number of residents interested in neurological training exceeded the amount of available training positions. Performance of neurological trainees was regularly assessed in 26 countries (84%), usually by recurrent clinical evaluation. Board examinations were held in 23 countries (74%). Interim examinations were performed in three countries, exit examinations in 14 and both interim and exit examination in 6. Considerable differences were also found in manpower (0.9-17.4 neurologists/100,000 inhabitants) and working conditions (e.g. average weekly working hours ranging from 30-80 h/month). We found a significant positive correlation between manpower and theoretical training hours. CONCLUSION: Considerable differences exist in training curricula of European countries. These data might provide the basis for European training and quality assurance initiatives.

Reliability of the noninvasive sequence methods to estimate baroreflex function using the paradigm of brain death.

BACKGROUND: Various techniques have been developed to estimate spontaneous baroreflex sensitivity noninvasively. However, in the EuroBaVar study it has been shown that they yield differing results. AIM OF THE STUDY: To investigate the reliability of these methods further we compared the results of the most common sequence techniques. We used the paradigm of brain death with the absence of any baroreflex function. METHODS: In a prospective study we recorded breathing pattern, ECG and continuous blood pressure in 10 consecutive brain dead subjects of a neurointensive care unit. EuroBaVar sequence techniques 12-18 (ST12-ST18) were applied to the data sets and the number of sequences compared. RESULTS: Techniques which are based on thresholds in terms of blood pressure or R-R interval changes yielded the least false positive results: technique ST12, ST13, and ST14 detected very few sequences, while ST18 detected no sequence at all. Techniques using a correlation threshold (ST15-ST17) found a high number. CONCLUSION: This study demonstrates clearly that many of the sequence techniques used to estimate baroreflex sensitivity render false positive results in the unique paradigm of brain death. Thus, the method should be selected with regard to the biological signal and the pathophysiological background.

Peritumoral edema on MRI at initial diagnosis: an independent prognostic factor for glioblastoma?

BACKGROUND: Peritumoral brain edema in glioblastoma patients is a frequently encountered phenomenon that strongly contributes to neurological signs and symptoms. The role of peritumoral edema as a prognostic factor is controversial. MATERIALS AND METHODS: This multi-centre clinical retrospective study included 110 patients with histologically proven glioblastoma. The prognostic impact on overall survival of pre-treatment peritumoral edema detected on MRI-scans was evaluated. All patients had preoperative MRI, surgery, histology, and received standard treatment regimens. Edema on MRI-scans was classified as minor (<1 cm), and major (>1 cm). RESULTS: Our results confirm that peritumoral edema on preoperative MRI is an independent prognostic factor in addition to postoperative Karnofsky performance score (KPS), age, and type of tumor resection. Patients with major edema had significant shorter overall survival compared to patients with minor edema. CONCLUSION: This easily applicable early radiological characterization may contribute to a more subgroup oriented treatment in glioblastoma patients for future trials, as well as in clinical routine.

Stroke and cancer: a review.

Stroke is a disabling disease and can add to the burden of patients already suffering from cancer. Several major mechanisms of stroke exist in cancer patients, which can be directly tumour related, because of coagulation disorders, infections, and therapy related. Stroke can also occur as the first sign of cancer, or lead to its detection. The classical literature suggests that stroke occurs more frequently in cancer patients than in the average population. More recent studies report a very similar incidence between cancer and non-cancer patients. However, there are several cancer-specific types and causes of stroke in cancer patients, which need to be considered in each patient. This review classifies stroke into ischaemic, haemorrhagic, cerebral venous thrombosis and other rarer types of cerebrovascular disease. Its aim is to identify the types of stroke most frequently associated with cancer, and give a practical view on the most common and most specific types of stroke. The diagnosis of the cause of stroke in cancer patients is crucial for treatment and prevention. Management of different stroke types will be briefly discussed.

Desde el crecimiento a la realidad, ¿qué hacer con los neurólogos formados? / From expansion to reality, what to do with trained neurologists?

No disponible

No disponible

EFNS guidelines on the diagnosis and management of orthostatic hypotension.

Orthostatic (postural) hypotension (OH) is a common, yet under diagnosed disorder. It may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in primary and secondary autonomic disorders. These range from visual disturbances and dizziness to loss of consciousness (syncope) after postural change. Evidence based guidelines for the diagnostic workup and the therapeutic management (non-pharmacological and pharmacological) are provided based on the EFNS guidance regulations. The final literature research was performed in March 2005. For diagnosis of OH, a structured history taking and measurement of blood pressure (BP) and heart rate in supine and upright position are necessary. OH is defined as fall in systolic BP below 20 mmHg and diastolic BP below 10 mmHg of baseline within 3 min in upright position. Passive head-up tilt testing is recommended if the active standing test is negative, especially if the history is suggestive of OH, or in patients with motor impairment. The management initially consists of education, advice and training on various factors that influence blood pressure. Increased water and salt ingestion effectively improves OH. Physical measures include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise. Fludrocortisone is a valuable starter drug. Second line drugs include sympathomimetics, such as midodrine, ephedrine, or dihydroxyphenylserine. Supine hypertension has to be considered.

The influence of microgravity on memorized arm movements.

To investigate sensory and motor functions in microgravity, goal-oriented arm movements were performed by 9 cosmonauts in weightlessness. The ability to reproduce predefined motor patterns was examined pre-, in-, and post-flight under two different paradigms: In a first test, the cosmonaut had to reproduce passively learned movements with eyes closed, while in the second test, the cosmonaut learned the pattern with eyes open. The different learning paradigms effected the metric parameters of the memorized stimulus pattern while the influence of the different gravity levels resulted in significant offsets and torsions of the reproduced figures. In comparing the inflight condition with preflight, intact proprioceptive afference seemed to play an important role for reproducing movements from motor short-time memory correctly.

[Gastroduodenoscopy for screening of patients scheduled for oral anticoagulant therapy: incidence and age dependence for potentially bleeding pathologies]. / Die Gastroduodenoskopie als Screeninguntersuchung vor oraler Antikoagulationstherapie--Häufigkeit und Altersabhängigkeit blutungsrelevanter pathologischer Befunde.

UNLABELLED: This retrospective study was designed to shed light on the incidence and age-dependence of potentially bleeding pathologies in the upper gastrointestinal tract of asymptomatic patients scheduled for oral anticoagulant therapy. Gastroduodenoscopy was routinely performed during screening studies. The incidence of abnormalities was compared with gastroscopy findings of patients with epigastric symptoms. Only pathologies likely to bleed were considered. These included gastric ulcers, duodenal ulcers, esophageal varices, esophagitis, erosions, malformations and hemorrhages. RESULTS: 18.23% of the patients (n = 746) undergoing gastroscopy prior to scheduled oral anticoagulant therapy were found to present with abnormalities versus 18.44% of those with epigastric symptoms (n = 1,627). In the group scheduled for oral anticoagulant therapy, the rate of pathologies did not significantly increase with increasing age. CONCLUSIONS: The unexpectedly high incidence of potentially bleeding pathologies in asymptomatic patients scheduled for anti-coagulant therapy should prompt screening gastroduodenoscopies irrespective of the patients' age prior to instituting treatment.