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J Daube

Publications and source records attributed to J Daube.

10 recordsLinked to original sources
PubMed1997

Quality improvement in neurology residency programs. Report of the Quality Improvement Committee of the Association of University Professors of Neurology.

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.

Academic Medical Centers↗
PubMed1986

Plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy.

Plasma exchange has been reported to be efficacious in chronic inflammatory demyelinating polyradiculoneuropathy. We performed a prospective double-blind trial in which patients with static or worsening disease were randomly assigned to plasma exchange (n = 15) or to sham exchange (n = 14) for three weeks. After three weeks, we observed statistically significant differences in combined measurements of nerve conduction (total, motor, proximal, velocity, and amplitude) favoring patients who had received plasma exchange. Improvement to a greater degree than for any patient receiving sham exchange was detected in the neurologic-disability score in five patients (P = 0.025) and in subset scores for weakness and reflex in four patients (P less than 0.057). We conclude that for some patients with chronic inflammatory demyelinating polyradiculoneuropathy, plasma exchange has an ameliorating effect on neurologic dysfunction and nerve conduction, but in others no improvement is observed. Because plasma was replaced with normal serum albumin, a humoral factor or factors may have a role in the neurologic deficit of this disorder.

Chronic Disease↗
PubMed1985

Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy.

Scored symptoms, neurological deficits, detection threshold of cutaneous sensation and parameters of nerve conduction were compared with quantitated neuropathological abnormalities in the sural nerve in 47 healthy subjects and 36 diabetic patients, 32 with and 4 without neuropathy. The fifth percentile line of a new Index of Pathology, which combines loss of myelinated fibres and abnormality of the remaining fibres, was found to provide a sensitive and reliable minimum neuropathological criterion for the diagnosis of polyneuropathy. Abnormality, as assessed by two clinical evaluations, similarly separated healthy subjects and diabetic patients into those with and without neuropathy. For the detection of diabetic polyneuropathy, vibration sense was more sensitive than touch-pressure or thermal cooling. Abnormalities of nerve conduction were found to be both sensitive and reliable in the detection of polyneuropathy. Velocity was most frequently abnormal, but only slightly more often than F wave latency and amplitude. We conclude that abnormality, as judged independently from two different types of evaluation, provides a sensitive and reliable minimal criterion for the diagnosis of neuropathy. Although symptoms, neurological deficits and abnormalities of nerve conduction are statistically associated, they should be evaluated separately to provide adequate characterization.

Adolescent↗
PubMed1982

The Mayo Clinic experience with plasma exchange in chronic inflammatory-demyelinating polyneuropathy (CIDP).

Fourteen patients with static or progressive CIDP with a neurologic disability score (NDS) greater than or equal to 50 were entered into a double-blind, stratified, 3-week trial of twice-weekly plasma exchange or sham plasma exchange. The end-points evaluated included the NDS, computer assisted sensory examination of the foot, and various attributes of nerve conduction of motor and sensory fibers of limb nerves. Of the 7 patients receiving plasma exchange, 4 improved by more than 10 points on the NDS (45, 32, 11, and 24 points) while 3 remained unchanged (2, -2, and -3 points). One patient, who did not appear to respond to either sham or plasma exchange, improved (100 points) with a 3 month alternate day course of prednisone. Of the 7 patients on sham exchange, 3 improved by more than 10 points (26, 15, and 16), 3 remained unchanged (-5, 4, and 8) and 1 was not able to complete the study due to cardiac tamponade. This preliminary trial will end with acquisition of 30 patients. It is too early to draw any conclusion from these studies other than that the double-blind study employed here is feasible and should provide information on the efficacy of plasma exchange in CIDP if its effect is prompt and large. The improvement which may be seen in the sham group appears to suggest that studies of efficacy require a double-blind design.

Adult↗