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 109 records · Page 6Linked to original sources

PubMed2004

Perception of pediatric neurology among non-neurologists.

Pediatric neurology is considered a relatively new and evolving subspecialty. In Saudi Arabia, neurologic disorders in children are common, and the demand for trained pediatric neurologists is strong. The aim was to study the perception of the pediatric neurology specialty among practicing generalists and their referral practices. Attendees of a symposium on pediatric epilepsy comprehensive review for the generalist were included. A structured 25-item questionnaire was designed to examine their demographics, training, practice, and referral patterns. One hundred nineteen participants attended the symposium, and 90 (76%) questionnaires were returned. Attendees' ages were 22 to 70 years (mean 32 years), with 65.5% female physicians. There were 32% consultants, 51% trainees, and 17% students. Most physicians (67%) were practicing general pediatrics. Only 36% received a structured pediatric neurology rotation during training. Children with neurologic complaints constituted 28.5% of those seen in their practice, and they referred 32.5% of them to pediatric neurology. Only 32% were moderately or highly confident in making the diagnosis or providing the appropriate treatment. Those who received a structured pediatric neurology rotation felt more comfortable in their management (P = .03). Many physicians (38.5%) had no direct access to a pediatric neurologist for referrals. To conclude, pediatric neurologic disorders are common in daily practice. Most generalists did not receive a structured neurology rotation during their training and were not highly confident in diagnosing and treating these children. Given the limited number of pediatric neurologists, I highly recommend that generalists receive appropriate neurologic training.

Adult↗

PubMed1998

Child neurologist as expert witness: a report of the Ethics and Practice Committees of the Child Neurology Society.

A questionnaire was circulated to 1126 members of the Child Neurology Society to assess their opinions regarding the current medical-legal system and to determine the involvement of members of the Child Neurology Society as expert witnesses. Two-hundred eighty-five questionnaires were completed, corresponding to a response rate of 25.3%. Of the respondents, 52% were child neurologists in university-based, academic practices, whereas 32% were in private practice. Approximately 90% of the respondents reviewed cases for attorneys, and 37% of these reviewed five or more cases per year. The majority, 86%, had testified or been deposed as a treating physician, and 42% of the respondents had been the object of a medical liability lawsuit. Only 30% of the respondents believed that the current medical malpractice system was fair, and nearly 90% of the respondents indicated that the system should be reformed. Two thirds of the respondents indicated that there should be a mechanism for peer review and more than half believed that the Child Neurology Society should monitor the expert witness activities of its members. These results indicate that although child neurologists frequently participate as medical experts, the respondents have an unfavorable opinion of the current medical liability system. Based on the results of the questionnaire and the need for reform in the current system, monitoring of the expert witness activities of child neurologists should be considered.

Child↗

PubMed2001

Atherothrombosis--the neurologist's point of view.

Patients with peripheral arterial disease (PAD) have an increased risk of cerebral ischaemia, but many transient ischaemic attacks are not recognized by patients, or by physicians who are not neurologists. Similarly, PAD is common in stroke patients, but often remains unrecognized by neurologists. Major long-term risks in patients with cerebral ischaemia due to atherosclerosis are myocardial infarction and recurrence of stroke. Neurologists should consider concomitant PAD when choosing a treatment strategy. Patients with PAD need to be educated about their risk for cerebral ischaemic events, and physicians caring for PAD patients need to identify those individuals who may require carotid surgery. The appropriate strategy for prevention of stroke in PAD patients consists of optimal management of risk factors for stroke (smoking, arterial hypertension, hypercholesterolaemia), antiplatelet therapy with clopidogrel as first-choice treatment, and carotid surgery in patients with high-grade stenosis of the internal carotid artery who are at low risk for surgery.

Clopidogrel↗

PubMed2005

How treatment priorities influence triptan preferences in clinical practice: perspectives of migraine sufferers, neurologists, and primary care physicians.

BACKGROUND: In treating migraine sufferers, physicians can choose from among seven triptans with different attributes. OBJECTIVE: To develop a system for selecting an oral triptan based on treatment priorities of migraine sufferers, neurologists, and primary care physicians (PCPs) in the United States, and evidence-based performance of triptans in clinical trials. METHODS: The TRIPSTAR project combines data on the treatment preferences of migraineurs and physicians with results from a meta-analysis of individual triptans, which evaluated their effectiveness on various clinical endpoints. Telephone interviews with migraine sufferers, neurol ogists, and PCPs were conducted to elicit individual views on the relative importance of a prespecified set of acute treatment outcomes. Four hundred and fifteen migraine sufferers, both triptan-experienced and triptan-naive, were interviewed. Also, 200 board-certified neurologists and 200 PCPs provided information on migraine patients from their clinical practice. A multiattribute decision model for selecting an oral triptan was constructed using attribute importance weights collected at telephone interview and the meta-analysis data, which were drawn from 53 clinical trials of 6 oral triptans. RESULTS: Efficacy attributes were rated significantly more important than tolerability or consistency in selecting an oral triptan, according to migraine sufferers and physicians. Freedom from cardiovascular adverse events was the most important tolerability attribute, according to migraine sufferers and physicians alike. Pain free at 1 h was the most important lower-level efficacy attribute for migraine sufferers, while sustained pain free was most important for physicians. When weighted treatment attributes were combined with meta-analysis data in a multi-attribute decision model, almotriptan 12.5 mg, eletriptan 80 mg, and rizatriptan 10 mg were significantly closer to the hypothetical ideal triptan than was suma triptan 100 mg. Triptans selected by the model were generally closer to the patient-specific ideal triptan than were the triptans prescribed by physicians. CONCLUSIONS: Almotriptan, eletriptan, and rizatriptan were the three triptans closest to the ideal, from the perspectives of migraine sufferers, PCPs, and neurologists alike. The TRIPSTAR model may be a potentially useful decision-support tool to help physicians select the triptan most likely to produce a successful outcome in migraine sufferers.

Administration, Oral↗

PubMed1982

The continuing undersupply of neurologists in the 1980s: impressions based on data from three studies.

Current unmet needs for neurologists were estimated on the basis of a survey of the directors of all academic neurology programs in the United States and Puerto Rico, by a study of the state of Indiana, and a review of potential needs by the Veterans Administration Hospitals. The number of neurologists in 1990 were predicted from residency positions filled, the membership of the American Academy of Neurology, and the AMA Master File. From these analyses, the author concludes that a shortage of from 1,214 to 5,418 neurologists may exist in 1990.

American Medical Association↗

PubMed1984

Neurologists' knowledge of medication costs.

Using mailed questionnaires, neurologists were asked for (1) estimates of retail prices for 39 common drugs, (2) attitudes about drug costs, and (3) implications for clinical practice. Among these practitioners, (1) more product prices were overestimated than underestimated, (2) old products were as unfamiliar as new products, and (3) community practitioners were more aware of prices than academic neurologists and trainees, but still made errors. Future studies should also consider physician prescribing behavior in terms of adherence to recommended laboratory tests and patient inconvenience factors. Neurologists should be aware of alternative prescription outlets for patients.

Drug Prescriptions↗

PubMed1997

Attitudes of US neurologists concerning the ethical dimensions of managed care.

We surveyed attitudes of US neurologists about the ethical dimensions of managed care by administering a written instrument containing paradigmatic cases portraying conflicts of physicians, patients, and managed care organizations (MCOs). After each case, we assessed neurologists' attitudes by asking them their degree of agreement with a series of statements. We found that neurologists (1) generally were willing to follow clinical practice guidelines if they were created by medical societies; (2) experienced frequent conflicts of interest or conflicts of obligation in the care of their MCO patients; (3) feared legal ramifications of their clinical decisions on MCO patients; (4) were unwilling to employ deception or gaming to achieve what they perceived to be good patient care; (5) believed that their professional prerogatives and autonomy were under attack by MCOs; and (6) felt that the good of their patients should not be sacrificed for the good of society.

Attitude of Health Personnel↗

PubMed1999

Neuro@neurolist.mcg.edu: an e-mail discussion list for neurologists.

INeuro@neurolist.mcg. edu: An e-mail discussion list for neurologists Neuro@neurolist.mcg.edu (Neurolist) is a discussion list for neurologists. This Internet tool, established in 1994, allows the worldwide community of neurologists to communicate quickly and efficiently using e-mail, web browsers, and newsreaders. Neurolist currently has 584 members in 51 countries. Between June 1997 and October 1998, 6179 messages were transmitted by Neurolist. Most of the list's posts (70%) concerned patient care and neurologic diseases. Users may subscribe at the web site: . The service is free.

Communication↗

PubMed2001

Neurologists' use of ICD-9CM codes for dementia.

Neurologists' use of ICD-9CM codes in a sample of 181 consecutive, new patients evaluated for dementia by 48 of all 49 neurologists from the Rochester, NY, area over a 1-year period was examined. The specific code for AD, 331.0, was used for only 36.5% of patients judged by the neurologist to have AD as the most likely diagnosis. Other codes used were not inaccurate but would result in lower reimbursement. Variation in coding could affect validity of dementia research using claims data.

Dementia↗

PubMed1981

Computer assisted diagnosis and computer consultation in neurology: preliminary testing of diagnostic accuracy for the neurologist system.

The Neurologist system is a computer program for consultation in clinical neurology which employs human-like reasoning in diagnosis, covers a broad diagnostic domain, has the capacity to explain strategies and conclusions and is readily expandable. Neurologist employs the strategy of first localizing a neurologic disease, then uses these data as well as mode of disease onset, rapidly to focus on a limited number of diagnostic possibilities which are then sequentially investigated. This paper presents the results of the preliminary assessment of Neurologist's diagnostic accuracy. For a set of 30 test cases, the system's leading diagnosis was correct in 77%, and separation of correct and incorrect diagnostic hypotheses was excellent. Further evaluations of the system are in progress.

Brain Diseases↗

PubMed2003

Evolving role of the neurologist in the diagnosis and treatment of chronic noncancer pain.

The neurologist has become increasingly involved in the multidisciplinary treatment of patients with chronic noncancer pain (CNP). Chronic noncancer pain affects a diverse patient population with multiple underlying diagnoses and associated therapies. Following the model of the American Board of Anesthesiology and the American Society of Anesthesiologists for practice guidelines and subspecialty requirements, neurologic pain management is now recognized as a subspecialty of neurology by the American Academy of Neurology and the American Board of Psychiatry and Neurology. Current basic and clinical research into the neuropathology, neurophysiology, neurochemistry, and neuropharmacology of chronic pain continues to expand diagnostic and therapeutic options. Informed regulatory agencies and professional organizations such as the American Academy of Neurology recognize the undertreatment of patients with CNP and provide clear recommendations to help neurologists in the ethical and effective treatment of patients with pain. Improved education of neurologists, other health care professionals, patients, and the media about evolving standards of pain care and therapy will produce a more supportive environment for the compassionate and ethical treatment of patients with CNP.

Analgesics, Opioid↗

PubMed2005

Historical comments on tardive dyskinesia: a neurologist's perspective.

This article was undertaken to review the history of professional awareness of tardive dyskinesia (TD) and to address reasons for the delay in such recognition. The literature was reviewed, and selections are included to highlight some of the major issues. Personal recollections are deliberately emphasized since they may reflect the phenomenon of personal discovery familiar to others and the now widespread professional awareness of TD. TD is indeed well recognized by psychiatrists and neurologists, and most general practitioners are also aware that the syndrome exists. Physicians were once unfamiliar with the concept of a drug reaction that was so long delayed as is possible with TD, nor did they know that a drug side effect could present in this manner. The historical delay in initial recognition of TD, and the reason for such delay, remain of interest. The lack of a perfect therapy and the uncertainty regarding the precise pathophysiologic basis of TD remain as challenges. Most psychiatrists, and many neurologists, probably have vivid memories of specific patients with TD. This author, a neurologist, was blessed to work with George Crane and other investigators in the early days of TD and was witness to some of the original uncertainty regarding what seemed to be a new phenomenon. TD has reshaped our concepts of disease and our awareness that diseases can originate from deleterious late effects of beneficial agents.

Antipsychotic Agents↗

PubMedDate not supplied

UK neurologists and the care of adults with acute neurological problems.

In the UK, most patients admitted to hospital with acute neurological problems are not looked after or even seen by a consultant neurologist. As a result, the outcome of their care may be suboptimal. The Association of British Neurologists believes that, in order to provide a reasonable service, the number of consultant neurologists will have to increase more than threefold, to about 1,400. This should be achievable in the next 10-15 years and would bring UK neurological services up to the standards that already obtain in comparable European countries.

Clinical Competence↗

PubMed2006

[Postgraduate education for neurologists in hospitals authorized by the Japanese Society of Neurology].

To evaluate postgraduate education for neurologists, we performed a questionnaire-based investigation in hospitals authorized by the Japanese Society of Neurology. The response rate to the questionnaire was 91%. The number of board-certified neurologists is usually less than 5, even in the authorized teaching hospitals. Most respondents thought that the postgraduate training programs already existing in many teaching hospitals are insufficient, but nevertheless useful. More staff may be needed for postgraduate education in neurology. The respondents considered that neurological education has generally functioned well, except in certain areas such as brain death judgment. On the other hand, the rotation of training in neurosurgery, psychiatry and child neurology is still inadequate. The problem of devising a suitable training rotation system in postgraduate education for neurologists has not yet been solved.

Curriculum↗

PubMed2006

[Clinical neurologists' views on measures influencing the quality of acute stroke care].

BACKGROUND: Legislation, professional medical societies and health care providers urge neurological departments to increase focus on more effective structures and processes. This, however, depends on the appreciation of quality features by the physicians involved. GOAL: The present study aimed to identify neurologists' subjective quality criteria, the analysis of influential factors, and a comparison with existing guidelines. METHOD: In a multicentre survey, 99 registrars and senior registrars from 30 clinical departments of neurology were interviewed. The data were analysed both quantitatively and qualitatively. RESULTS: In the participants' view, the quality of acute stroke care depends upon access to competent care, optimal acute management and the presence of trained and experienced personnel. Some subjective dimensions of service quality are dependent upon the interviewed neurologist's board certification status and the features of the respective department (stroke caseload, implementation of a stroke guideline). In comparison to national guidelines, early secondary prevention is underreported. Interviewed neurologists and guidelines agree on the importance of rapid diagnostic procedures and continuous monitoring. CONCLUSIONS: The focus upon early and rapid diagnosis and treatment underlines the importance of optimal emergency organisation for acute stroke patients. Early secondary prophylaxis, the prevention of complications and rehabilitation management are underestimated as relevant fields of action. Empirical research and medical education should address possible deficits concerning these aspects.

Certification↗

PubMed1994

Role of neurologists in the pharmaceutical industry.

Important advances in the field of clinical neuropharmacology have created an increasing demand by the pharmaceutical industry for neurologists. As recently as a decade ago, neurologists were relatively rare in the pharmaceutical industry. I describe the roles played by industrial neurologists and review both the opportunities and risks in this career path.

Clinical Competence↗

PubMed1993

How Twin Cities neurologists treat ischemic stroke. Policies and trends.

OBJECTIVE: To examine community practices. DESIGN: Physician practice policies were surveyed using case vignettes in which evaluation for carotid endarterectomy or use of anticoagulation therapy was at issue. Virtually the same group was surveyed in 1988 and again in 1991, after publication of carotid endarterectomy trials in symptomatic patients. SETTING: Greater Metropolitan Minneapolis-St. Paul, Minnesota. PARTICIPANTS: Community and academic neurologists in practice of general adult neurology. MEASUREMENT: Percentage of respondents who would recommend the management option in question for each vignette. RESULTS: Ninety-eight percent favored evaluation for carotid endarterectomy in appropriately symptomatic "good risk" patients in 1988 before proof of efficacy became available. Proof increased the percentage (from 67% to 92%) favoring evaluation in older, sicker, symptomatic patients but not the percentage of those favoring evaluation of bruit patients (1988: 33%; 1991: 24%). In 1991, a lower percentage recommended warfarin therapy after noncardioembolic transient ischemic attack; this was especially apparent in the vertebrobasilar case (1988: 59%; 1991: 37%). Both years, nine of 10 neurologists recommended heparin therapy for progressing stroke, while half to three-fourths used it after partial stroke or transient ischemic attack. Almost all would use anticoagulants for secondary prophylaxis after suspected cardioembolic stroke. CONCLUSION: The results reflect a treatment-oriented empirical approach in this community and document quick clinical application of scientific evidence when it became available.

Aged↗

PubMed2006

Results of the management of atherothrombosis with clopidogrel in high-risk patients trial: implications for the neurologist.

The secondary prevention of ischemic stroke is aided by the use of antiplatelet therapy, and the predominant current choices are aspirin, aspirin plus extended-release dipyridamole, and clopidogrel. The potential utility of combining platelet antiaggregants with different mechanisms of action proved successful with aspirin plus extended-release dipyridamole, and this approach has been explored with the combination of clopidogrel and aspirin. In the Management of Atherothrombosis With Clopidogrel in High-Risk Patients trial, this combination was compared with clopidogrel alone for secondary prevention in patients with transient ischemic attack and stroke in a high-risk population with a high prevalence of other vascular risk factors. A nonsignificant trend for a reduction of the combined endpoint of ischemic stroke, myocardial infarction, vascular death, and rehospitalization was observed in the combination therapy group (P = .24). The frequency of serious, life-threatening bleeding adverse effects was almost doubled in the combination arm. Neurologists need to be aware of these results and avoid the use of clopidogrel plus aspirin in patients with stroke or transient ischemic attack until evidence that the combination is safe in this population is provided. Neurologists faced with patients who have had a stroke or transient ischemic attack and are receiving this combination of antiplatelet agents after coronary stenting should inform their cardiology colleagues of the reported bleeding risk, and they should encourage the use of the combination for as short a time period as possible after such coronary intervention.

Brain Ischemia↗