SEARCH · PubMed Health

Results for “Neurologists”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMed2000

Shortening the time to the diagnosis of amyotrophic lateral sclerosis: role of the neurologist.

Early diagnosis is particularly relevant in the diagnosis of amyotrophic lateral sclerosis (ALS) as new therapies, which may have a direct impact on the outcome of the disease, are being developed. Many ALS patients go to non-neurological specialists rather than neurologists for their first consultation. Neurologists specialized in the field of neuromuscular diseases therefore have a duty to help general neurologists and other non-neurological specialists to recognize the disease. This may be achieved by disseminating the El Escorial/Airlie House clinical and electrophysiological criteria for the diagnosis of ALS as well as by emphasizing that ALS is a manageable condition. Neurologists should collaborate better with patient organizations as well as reinforce public awareness of ALS.

Diagnosis, Differential↗

PubMed2001

Are headache patients who initiate their referral to a neurologist satisfied with the consultation? A population study of 927 patients--the North Norway Headache Study (NNHS).

BACKGROUND: Headache is a common problem in primary care. Although most patients are treated by GPs, many are referred to specialist consultation. Knowledge of how the referrals can be improved is therefore an important issue. OBJECTIVES: The aim of this study was to determine the relationship between self-initiating referral to a neurologist and the patient's satisfaction with the specialist consultation. METHODS: All patients who had been examined by a neurologist for headache within a 2-year period from three neurological centres in North Norway completed a questionnaire. RESULTS: A total of 1052 patients from a population of 1403 headache patients (75%) returned the questionnaire while 927 patients answered questions about initiating the referral to the specialist. Two hundred and twenty patients (24%) initiated the referral to the neurologist themselves; 52% of those who self-initiated the referral were dissatisfied with the specialist consultation compared with 42% of those referred by the doctor, P = 0.002. Chronic headache, tension-type headache (TTH) and daily use of analgesic drugs were associated with dissatisfaction. CONCLUSIONS: Patients with headache who initiated the referral to a neurologist themselves were less satisfied with the specialist consultation. Selecting referrals containing proper medical information may improve satisfaction in severe headache patients treated in a neurological practice.

Adult↗

PubMed2007

Opinion of Belgian neurologists on antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET).

OBJECTIVES: To describe the choice of treatment in adult patients with epilepsy in Belgium, to detect the presence or absence of consensus among neurologists in epilepsy treatment, and to analyze the gaps between current guidelines and prescriptions. MATERIALS AND METHODS: Hundred Belgian neurologists were systematically interviewed between May and June 2003 using a structured questionnaire (modified Rand method). RESULTS: Initial monotherapy was the preferred treatment strategy. Valproate was the first choice in idiopathic generalized epilepsy (IGE) and carbamazepine in focal epilepsy (FE). The new antiepileptic drugs (AED) were usually recommended in second-line. However, in special treatment situations, they were considered first-line, e.g., lamotrigine in case of women of childbearing age. CONCLUSIONS: Neurologists reached consensus for most questions on epilepsy treatment. In 2003, monotherapy with valproate and carbamazepine was the common treatment strategy in Belgium, whereas lamotrigine and to a lesser extent levetiracetam, topiramate, and oxcarbazepine were predominantly prescribed in second-line. This is in agreement with the recently published UK epilepsy guidelines but not in agreement, however, with the US guidelines, that for new onset epilepsy, new and old drugs are equally effective. Belgian neurologists, except for some special situations still prefer old drugs as first line.

Adult↗

PubMed1989

Neurology in Gloucestershire: the clinical workload of an English neurologist.

Attempts to determine the ideal number of consultant neurologists that will be required in the United Kingdom in the future are hampered by a lack of information on a variety of topics, one of which concerns the workload of the average neurologist at the present time. This paper attempts to correct this deficiency by examining the clinical workload of a single handed neurologist practising in the south west of England. Diagnostic information is given on the 3020 new patients seen during 1984-1986 and is compared with similar data on 836 new patients seen in 1975. The pattern of diagnoses on these patients varies little from year to year, indicating a constancy of referral habit of those who seek neurological advice. However, the referral rates for different conditions do not correspond with what would be expected from epidemiological data, for when the incidence of particular conditions in the neurology clinic is compared with the calculated incidence in the community, very wide variations are noted. The implications of these data are discussed and it is suggested that further studies should be performed before detailed predictions are made on how many neurologists will be needed in this country in the future.

Cross-Sectional Studies↗

PubMed1995

Demographic differences in referral rates to neurologists of patients with suspected Parkinson's disease: implications for case-control study design.

Although patients with Parkinson's disease (PD) are often treated by neurologists, most are first diagnosed by a primary care physician. Epidemiologic studies which use PD cases from only neurology clinics may be subject to referral bias due to differential case selection in the referral process. To study this methodological issue, a historical cohort study of all outpatients with PD diagnosed by a non-neurologist from January 1, 1988 to June 1, 1992 at the Henry Ford Health System was conducted. This health system has specialty and primary care outpatient clinics located at the main facility in Detroit, Mich. and throughout the metropolitan area. The analysis included those who had at least one outpatient visit during the follow-up period from January 1, 1988 to June 30, 1993 (n = 588), of whom 183 (31.1%) were referred to a neurologist. The univariate analysis resulted in crude risk ratios for referral of 2.14 [95% confidence interval (CI) = 1.56-2.93] for age less than 70, 2.11 (95% CI = 1.57-2.84) for male sex, 1.64 (95% CI = 1.17-2.32) for nonwhite race, 2.48 (95% CI = 1.77-3.47) for private health insurance, 1.79 (95% CI = 1.32-2.43) for being married, 1.44 (95% CI = 1.08-1.92) for 10 or more health care visits per year and 2.27 (95% CI = 1.66-3.11) for having the initial visit for PD at the main Detroit clinic. In a Cox proportional hazards model which included all study variables, race and marital status were no longer statistically significant (p < 0.05), and no risk estimates were greater than 2.0. In summary, patients referred to neurologists in this study were more likely younger, male, to have private health insurance, frequent users of health care and to use hospital-based clinics for their primary health care. We suggest that future case-control studies of PD avoid potential referral bias by not using a study population comprised solely of patients referred to a neurology clinic or design studies which can estimate the potential effect of this bias.

Age Distribution↗

PubMed1977

Attitudes of departments of medicine in the United States toward provision of internal medicine training for prospective neurologists.

A questionnaire was sent to directors of training programs in internal medicine to assess attitudes towards providing a year of internal medicine training for prospecitve neurologists. Such applicants are handled in a variety of ways. Among the 92 responding institutions with neurology training programs, three were not willing to accept prospective neurologists for 1 year of internal medicine. Seventy-three percent would either reserve places for prospective neurologists, arrange with neurology for a position through the intern matching program, or arrange medical rotations for candidates accepted by neurology. Twenty-four percent would accept neurologists for a single year without specifying any special arrangement.

Attitude of Health Personnel↗

PubMed1986

On national needs for neurologists in the United States.

Estimates of the number of neurologists needed in the United States have been widely divergent. For direct patient care needs alone in a US population of 243.5 million, the Joint Commission on Neurology (ANA-AAN) estimate was 14,000 neurologist, the Delphi Panel median (Battelle/GMENAC) 11,200, and the Advisory Panel (Battelle/GMENAC) 6,200; our review suggests a need for 12,600. Total needs for clinical neurologists including faculty were 8,400 (Advisory Panel), 14,500 (Delphi Panel), and 16,500 (ours) for respective rates of 3.44, 5.96, and 6.76 neurologists per 100,000 population.

Humans↗

PubMed1989

Use of antithrombotic drugs in the treatment of acute ischemic stroke: a survey of neurologists in practice in the United States.

In an attempt to determine the opinions and practices of neurologists regarding the use of antithrombotic drugs in the treatment of acute ischemic stroke, we conducted a survey of 349 randomly selected neurologists from throughout the United States. Responses were received from 247 (71%), and 219 identified themselves as primary or consulting physicians for patients with acute ischemic stroke. During the previous 12 months, these 219 physicians estimated that they had seen a total of 14,636 patients within 24 hours of acute ischemic stroke, and 22% of these patients were treated with heparin. The most frequently reported indications were prevention of recurrent cerebral embolism (82% of physicians) and progressing stroke (70%). Despite the frequent use of heparin, only 6.4% of neurologists felt that it has been shown to be effective, and 16.4% felt that it has been shown to be of no value. The primary concern about the use of heparin was lack of proven efficacy in 48% and safety concerns in 41%. Results of a future trial testing the efficacy of antithrombotic drugs would be useful for most neurologists in their management of patients with acute or progressing ischemic stroke.

Acute Disease↗

PubMed1991

Neurologists--1990.

The American Medical Association Physician Masterfile for 1990 contains 13,705 physicians who consider neurology their primary, secondary, or tertiary specialty. Of these, 7,036 are board certified and 10,065 designated neurology as their primary specialty. Although there has been a steady increase in the number of women, the vast majority of neurologists are men and less than 50 years old. Two-thirds provide direct patient care as their major activity and 15% are in training. There are almost as many neurologists employed by hospitals, medical schools, and government entities (40%) as there are working alone or in group practice (48%). The actual number of neurologists is compared with earlier projections of neurology needs for 1990. Since forecasts, in the absence of more detailed information, can become the reality of public policy decisions, neurologists will need to become increasingly informed about the many unique benefits they provide to their patients.

Adult↗

PubMed2004

Migraine practice patterns among neurologists.

OBJECTIVE: To assess the attitudes, knowledge, and practice patterns of US neurologists regarding migraine management relative to the US Headache Consortium Guidelines (the Guidelines). METHODS: Two samples of 600 neurologists each were selected from the American Academy of Neurology membership database. The first group received a Migraine Attitudes, Knowledge, and Practice Patterns (MKAPP) Survey. The second group received a Clinical Vignette (CV) Survey, presenting two patient histories and correspondent questions. RESULTS: The MKAPP Survey showed that most neurologists felt that migraine was primarily a disease of the brain with a well-established neurobiological basis (69%) and an important part of their practice (60%). Most (53%) indicated that they routinely used neuroimaging in evaluating severe headache, an approach not recommended by the Guidelines. Most favored acute treatment limits, but 36% did not agree with the Guidelines that acute treatment should be limited to 2 or 3 days/week. In the CV Survey, for vignette 1, most (91%) correctly diagnosed migraine, 31% requested neuroimaging in the absence of indications, 64% appropriately recommended a triptan, and 45% recommended a preventive medication in the absence of indications. For vignette 2, 78% diagnosed migraine, 71% appropriately ordered neuroimaging, 80% appropriately recommended a preventive medication, and 38% prescribed a triptan in face of clear contraindication. CONCLUSIONS: Educational initiatives aiming to increase the awareness of the Guidelines among neurologists should highlight the full range of migraine symptoms that support the diagnosis, appropriate use of neuroimaging, indications for preventive treatments, issues of triptan cardiovascular safety, and preventing rebound headaches.

Adult↗

PubMed2001

Differences in knowledge, attitude and behavior with respect to hypertension among cardiologists, neurologists and other physicians in internal medicine.

It is known that the knowledge, attitude and behavior (KAB) of physicians with respect to hypertension directly affect the prevention of hypertension and associated cardiovascular diseases. To investigate the differences in KAB among cardiologists, neurologists and other physicians, 1,722 potential participants were selected by stratified random sampling. Among these, 1,609 participants took part in the present survey, and 948 of this group were eligible for the present analysis. The data were collected using a self-administrated questionnaire. Results showed that, with respect to knowledge and attitude regarding hypertension, 15.3% of cardiologists, 15.2% of neurologists and 7.2% of other internals selected the correct answers to all questions (p<0.05). The criteria of hypertension were not correctly understood by about two-thirds of physicians, including both cardiologists and neurologists. With regard to behavior, 16.5% of cardiologists, 17.9% of neurologists and 9.6% of other internals selected the correct answers to all questions (p<0.05). A majority of physicians considered that routine blood pressure measurements were not necessary in cases uncomplicated by cardiovascular disease and other disease, such as nephrotic disease, or diabetes mellitus. One-half to two-thirds of physicians did not believe that life style modifications reduce blood pressure. For each question, cardiologists showed the highest, and other internals the lowest, percentage of correct responses to all items in the questionnaire. These findings indicate that cardiovascular health education must be strengthened for all physicians, and not only for specialists.

Cardiology↗

PubMed1999

Access to multiple sclerosis diagnosis for Canadian neurologists.

BACKGROUND: Access to multiple sclerosis (MS) diagnosis in Canada has never been assessed. This study was designed to examine the pattern of MS diagnosis in Canada, including neurologists' diagnostic approach and waiting times for investigations. METHODS: A mail survey was forwarded to every registered neurologist in Canada (n = 479) in late 1996. Questions included their diagnostic approach to MS including perceived waiting times for various investigations including MRI. Actual MRI waiting periods were separately obtained from booking clerks or neuroradiologists from every MRI unit in Canada. RESULTS: 153 responses were received. Neurological assessment is obtained, on average, 1 month after referral. MRI is routinely ordered by 92% of neurologists for suspected MS followed by evoked potentials (EP) (36%) and lumbar puncture (LP) (17%). The perceived waiting period for EP and LP is less than one month but 3 months for MRI. This is very similar to the actual waiting periods obtained from the MRI units surveyed (mean of 101 days). There is a trend for longer waiting periods as one moved east to west (Eastern provinces--mean of 62 days, Ontario--95 days, Quebec--102 days and 122 days in the Western provinces). Private MRI units have appeared in the Western provinces and have the shortest waiting periods (2 weeks maximum). The current MRI/million population ratio in Canada is 1.8, far below the ratios of other developed nations. CONCLUSIONS: Canadian neurologists prefer MRI of the brain to confirm an MS diagnosis and desire greater access to it. Access to neurological assessment, EP and LP is probably adequate but the average wait for MRI of 3 months is relatively long. The perceived average waiting period for MRI is similar to the actual waiting times of 3 months, with the Western provinces of Canada having the longest waits. Canada continues to have one of the lowest MRI/population ratios in the developed world.

Adult↗

PubMed2000

Relationships between quantitative measures and neurologist's clinical rating of tremor and standing steadiness in two epidemiological studies.

OBJECTIVE: The purpose of the present investigation was to 1) compare a neurologist's physical examination (NPx) rating of severity of postural tremor to several summary measures derived from quantitative measurements of tremor and 2) compare a NPx rating of standing steadiness and related clinical findings to quantitative sway speed measurements. METHODS: Comparisons were performed on data obtained from two epidemiological field studies: 1) retired heavy industrial workers (n= 198, approximately half previously exposed to elemental mercury), and 2) small town residents (n=234, approximately 40% with environmental exposure to arsenic). A commercially available tremor measurement instrument was used in both studies. To obtain standing steadiness measures, a head position monitoring device was used in the mercury study, and a force platform was used in the arsenic study. The NPx included assessment of postural tremor, as well as evaluation of vibration perception and proprioception of the great toe, Achilles tendon reflex activity, Romberg test status, and tandem gait. One neurologist performed all the NPx in both studies and results were graded as normal, equivocal, or abnormal. The square root of the proportion of variance accounted for by a linear trend term in ANOVA models was used as an estimate of association between quantitative tests and clinical examination grade. An estimate of agreement, kappa, was also calculated after both NPx and quantitative test results were dichotomized. RESULTS: Most tremor summary measures varied monotonically with NPx tremor severity grade. Moderately good associations were observed between the tremor acceleration measure and NPx postural tremor grade (correlations up to approximately 0.5). Sway speed with eyes open and with eyes closed increased monotonically with NPx grade for most of the clinical signs. The NPx signs showing the strongest relationships with sway speed were Romberg test performance, tandem gait, and proprioception and vibration sensation of the great toe (correlations up to approximately 0.5). CONCLUSIONS: Quantitative tremor measurements were related to a neurologist's grading of postural tremor. Sway speed was associated with several NPx findings related to standing stability. Quantitative measurements of tremor and standing stability may provide more precise and objective measures of neurological function than NPx by a neurologist and are likely to be more consistent across times and examiners.

Adult↗

PubMed2003

[How should we establish professional education system for neurologists?].

A professional education system for neurologists has been provided at Department of Neurology, Niigata University, which includes neurophysiology, neuroradiology, and neuropathology (optional). A 6 month-course of "chief resident" has also been implemented in the program. Although these systems have functioned well, hospitals providing such education programs are limited. To encourage the education programs, various issues need to be discussed. 1. The number of staffs is limited in most of the hospitals, limiting the capacity for providing such programs. 2. We need to recruit at least a given number of neurologists to make such systems work properly. 3. We need to discuss on the relationship between professional education system for neurologists and programs in the graduate school. To establish standardized professional education system for neurologists in Japan, Japanese Society of Neurology is strongly encouraged to play major roles.

Curriculum↗

PubMed2006

[Neurologist regarding the dependence law].

INTRODUCTION: The approval of the "project of promotion of personal autonomy and care to people on dependence" situation law now opens the parliamentary process to the approval of the mentioned law around October- November 2006. Should the neurologist know its content and express his/her opinion about it? DEVELOPMENT: We analyze the role of neurological disorders as a cause of dependence, the law principles, the involvement of the neurologist in the social-health care coordination, the health administrations involved in the law development and the role of Spanish Neurological Society and regional societies as mediators with the different health administration, the involvement of the neurologist in accreditation, education, research and development, independence promotion, and dependence evaluation. CONCLUSION: Given that the project will be modified in the course of its parliamentary process, and the relevance of its reglamentary development, the door has been left open for the role of the neurologist to be accepted at the moment when the law is developed and applied. In any case, the well-being and quality of life of our patients should not be overlooked. We think that the Spanish Neurological Society will have an important role in this process.

Dependency, Psychological↗

PubMedDate not supplied

[Therapeutic strategies used by neurologists and primary care physicians in the symptomatic treatment of migraine. Findings from Strategia-I and Strategia-II opinion studies].

INTRODUCTION: Few studies have been carried out on the subject of stratification of medical care for migraines, and even fewer have been conducted with the aim of determining the attitudes adopted by physicians towards their patients when dealing with this issue. Strategia-I and II studies were designed for this purpose. SUBJECTS AND METHODS: The sample consisted of 162 neurologists and 3,168 Primary Care physicians (PCP). Participants in the studies filled out an opinion survey that was produced ad hoc and included the different possible strategies, namely a) Stepped care between attacks (the patient takes medication during several attacks and, if it is not effective, it is replaced by another in successive attacks); b) Stepped care within attacks (the patient treats his or her seizures with medication and, if it does not work, another is used as rescue medication); and c) Stratified care (the physician classifies the patient according to the degree of disability produced by the migraine and recommends the most appropriate drug at the start). RESULTS: Most participants in the study (90.7% of neurologists, 85.2% of PCP) reported using a single strategy. Stratified care was found to be the preferred choice by both collectives (67.6% of neurologists, 43.8% of PCP; p < 0.0001). Only 16% of the respondents admitted using some disability scale. Nonsteroidal antiinflammatory drugs are the medication chosen if disability is mild-moderate, while triptans are preferred if it is moderate-severe (92.9% of neurologists, 78.8% of PCP; p < 0.001). CONCLUSIONS: The strategy based on stratified care is the most widely used in visits to Neurology and Primary Care in Spain, although there are significant differences between the two collectives. Triptans are perceived as being the ideal medication in situations involving moderate-severe disability.

Clinical Protocols↗

PubMedDate not supplied

[Intake patterns of analgesics in patients with headache who came to the neurologist].

We have analysed the pattern of analgesic use in a group of patients that came for the first time to the neurologist. We have examined the first intention analgesic use in patients with headache, before the therapeutic intervention of the neurologist. During a month, we have followed a group of 40 patients. 20 of them were admitted as ambulatory patients at a Headache Unit at a Hospital and the other 20 were attended as outpatients by a general neurologist. 'Over-the-counter' analgesics were the most commonly used (paracetamol, acetylsalicylic acid and combinations of them with other products such as caffeine). More than a half of the patients had consumed a combination of analgesics. At the time of the investigation, the mean of analgesic use were greater in the group attended at the Headache Unit than in the one attended by the general neurologist. This could depend on the fact that chronic daily headache was more frequent in the first group and that they were older than the other group. These findings could be in relation with a larger evolution of their headache.

Acute Disease↗

PubMed1995

The teaching of bioethics to the health care team: the neurologist's role.

The term 'bioethics' connotes not only the complexity of the subject but also the importance of adopting an interdisciplinary approach to it. Any given bioethical issue should be considered from a biological as well as anthropological and social perspective. Treating and evaluating ethical ideas without regard for these three aspects means diminishing and limiting them. Owing to the progress in intensive care and thanks to our increased sensitivity towards patients affected by irreversible diseases, many ethical problems have emerged relating to new conditions (for instance persistent vegetative state) or to already known ones (for example the later stages of amyotrophic lateral sclerosis or dementias). In future, it is likely that neurologists will be called upon to address an increasing number of ethical concerns, as primary care givers, consultants or members of ethics consultative teams, given that they are the most qualified to throw light on individual cases with regard to their diagnostic and prognostic, as well as on ethical, rational and emotional aspects. Neurologists are eminently suitable to play a crucial part in medical decision making regarding issues such as the administration or withdrawal of life-sustaining treatment. Furthermore, neurologists have much to contribute to the education of the health care team. This is because they are used to formulating judgments grounded on their professional experience in dealing with problems both physical and psychological. On the basis of these considerations, the author believes that neurologists are among the most qualified to bridge the gap between the two major components of bioethics: natural and human science. These components should find their synthesis and completeness in the bioethical debate.

Coma↗