关键词： Burnout   Compassion fatigue   Narrative medicine  

摘要： Objective Aim of the research was to define the quality of life of Italian neurologists and nurses' professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. Material and methods One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. Results Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. Conclusion The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.

关键词： Clinical historian   diagnosis   history   MRCP   neurology   sources   story  

摘要： If clinicians are considered the historians, and patients the story-tellers, the approach to the task of taking ‘the’ history can usefully be informed by the work of academic historians who make explicit the importance of the historian's own views and expertise in their writing of history, and of the ways in which they consult and scrutinize sources. For any bedside diagnosticians – depicted here as clinical historians – their possible sources include the patient, relatives and witnesses, and other healthcare professionals. The information provided needs to be filtered and distilled, like any historical account of a series of events, but is done – typically – in 20–30 minutes in a hospital environment, not over months and years on location or in a university library. This platform of thinking may help to align and enrich the standardized approach to compiling the clinical history, and informs the role – one of many – of the physician as historian. © 2020

摘要： In response to the coronavirus disease 2019 (COVID-19) pandemic, the scientific community has accelerated its process for knowledge synthesis and dissemination at multiple levels, from creating pathways for expedited journal peer review to establishing specialty task forces that curate information most relevant to individual fields of expertise. We describe our experience engaging with the latter to fill a gap in knowledge. At our institution, we established a group of fifteen neurologists from six subspecialties that created protocols on managing inpatients with concurrent neurological disorders and COVID-19, using best available evidence and expert opinion. These protocols were disseminated online at *** on April 3, 2020, and have been updated continuously based on emerging literature and frontline clinical experience. We evaluated utility using data analytics, characterizing the number of unique visitors over a week of "normal" usage and the demographic data of visitors. We discuss here the limitations of this imperfect method of knowledge synthesis and dissemination, and acknowledge our peers nationwide who have provided feedback to greatly enhance the quality of these protocols. We believe that our experience highlights the need for exceptionally high levels of collaboration in these unprecedented times. This article is protected by copyright. All rights reserved.

关键词： Dizziness   migraine   MRCP   Ménière's disease   stroke   vertigo   vestibular disorders  

摘要： Dizziness and vertigo are common symptoms. Because there are effective treatments for vestibular disorders, it is always important to make an accurate diagnosis. In acute vertigo, expert clinical assessment is critically important in discerning stroke from non-stroke causes because results of stroke-protocol brain magnetic resonance imaging, including diffusion-weighted imaging, can be falsely negative in the first 24 hours. It follows that acute medical services must have access to clinicians expert in assessing acute vertigo. Expertise in clinical examination and interpretation of findings requires appropriate training, but here we outline the basic diagnostic and therapeutic approach to patients with dizziness. Appropriate early management of these conditions is part of prevention of disabling chronic functional dizziness. © 2020

关键词： continuing professional development   health coaching   person-centred care   realist evaluation   self-management  

摘要： Background Supporting people to self-manage their long-term conditions is a UK policy priority. Health coaching is one approach health professionals can use to provide such support. There has been little research done on how to train clinicians in health coaching or how to target training to settings where it may be most effective. Objective To develop theories to describe how training health professionals in health coaching works, for whom and in what circumstances, with a focus on those working with people with progressive neurological conditions. Design Realist evaluation using mixed methods (participant observation, pre- and post-training questionnaires, and telephone interviews with participants and trainers). Realist data analysis used to develop and refine theories. Intervention Two 1-day face-to-face training sessions in health coaching with 11 weeks between first and second days. Setting and participants Twenty health-care professionals who work with people with neurological conditions in the UK, two training facilitators. Results Four theories were developed using context-mechanism-outcome configurations to describe how training triggers critical reflection;builds knowledge, skills and confidence;how participants evaluate the relevance of the training;and their experiences of implementing the training. Some participants reported a major shift in practice, and others implemented the training in more limited ways. Discussion Fully embracing the role of coach is difficult for health professionals working in positions and settings where their clinical expertise appears most highly valued. Conclusions Training should address the practicality of using coaching approaches within existing roles, while organizations should consider their role in facilitating implementation.

关键词： Principal component analysis  

摘要： In this work we report for the first time surface functionalization of 2D MoS(2)with X (metals: Al, Cu, Sn, Ti) to develop a low-cost, ultra-selective biosensor array based Electronic Tongue (E-Tongue) for the detection of 4 vital neurological drugs in human saliva. The hydrothermally grown surface functionalized X-MoS(2)was integrated onto a single 1 x 1 cm aluminium foil and contacts were defined using Cr electrodes. Detailed characterization revealed the formation of 2-H MoS(2)and metal-X (Al, Cu, Sn, Ti)-functionalized MoS(2)nanoflower like morphology decorated with nanoflake, nanorod, nanocube and nanostick structures, respectively. The response of the sensor array was recorded for aspirin, nicotine, caffeine and tramadol. Principal Component Analysis (PCA) was performed to reduce the dimension of numerous response data sets from all sensors and predict the likely possible response from various neurological drugs towards each sensor. Pattern-recognition analysis confirmed a definite pattern in response to respective functionalization and could efficiently differentiate neurological drugs from one another. Real-time analysis was performed using saliva samples for monitoring the therapeutic neurological drug concentration in the human body. Furthermore, the biosensor array was exposed to respective neurological drugs to study their sensitivity, selectivity, stability, reproducibility and adhesion onto the device. The strategy outlined can be used to develop lab-on-a-chip devices for the real-time detection of numerous bioanalytes in body fluids.

关键词： Relaxation training   rehabilitation   anxiety   depression   long-term neurological conditions  

摘要： Purpose:The present study investigated the effects of a relaxation training program on self-reported depression and anxiety in participants living with long-term neurological conditions, including acquired brain injury, stroke, Parkinson's disease, and multiple sclerosis. Materials and methods: A five-session relaxation training program, plus a follow-up session was offered to people living with a long-term neurological condition as part of routine clinical practice, and was delivered in their own homes. A self-report measure (Hospital Anxiety and Depression Scale) was administered at the pre- and post-intervention time points and at follow-up, around 5 weeks after the final session. Participants also completed an individual assessment of change questionnaire at follow-up, reporting on subjective views of observed changes. Results:Statistically significant improvements were found on measures of both anxiety and depression following completion of the relaxation program. Scores at follow-up (mean = 5 weeks) revealed the improvement was maintained for anxiety, and there was further significant improvement for depression. Reliable change analyses from pre- to post-intervention demonstrated a clinically significant decrease in anxiety scores for 47% of participants and in depression scores for 30% of participants. No clinically significant increase in depression and anxiety was identified from pre- to post-intervention, and this was generally maintained at follow-up. Conclusion:Relaxation training is proposed as a clinically effective treatment for anxiety and depression in people living with long-term neurological conditions, which could in turn lead to better functional outcomes of neurorehabilitation. The program investigated here has additional benefits of being delivered in people's own homes, which overcomes barriers to attending hospital, and is consistent with trends towards home as opposed to hospital care. This program may also be less costly to administer as i

关键词： Superficial siderosis   Oxidative stress   Ascorbate   Folate   Pterin   Antioxidant