关键词： acute coronary syndrome   airway management   emergency medical services   resuscitation  

摘要： Objective: To describe the association between prehospital airway management and neurological outcomes in patients transferred by the ambulance service directly to a heart attack centre (HAC) post-return of spontaneous circulation (ROSC). Methods: A retrospective observational cohort study in which ambulance records were reviewed to determine prehospital airway management strategy and collect physiological and demographic data. HAC notes were obtained to determine in-hospital management and quantify neurological outcome via the cerebral performance category (CPC) scale. Statistical analyses were performed via chi(2)-test, Mann-Whitney U-test, odds ratios and binomial logistic regression. Results: Two hundred and twenty patients were included between August 2013 and August 2014, with complete outcome data obtained for 209. Median age of patients with complete outcome data was 67 years and 71.3% were male (n = 149). Airway management was provided using a supraglottic airway (SGA) in 72.7% of cases (n = 152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients who had a good neurological outcome (CPC 1 and 2) at discharge between the SGA and ETI groups (P = 0.29). Binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference in neurological outcomes between the SGA and ETI groups (adjusted OR 0.73, 95% CI 0.34-1.56). Conclusion: In this observational study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest and in the postROSC transfer phase. Further research is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest.

关键词： Academic neurosurgery   Academic orthopedic surgery   Bibliometrics   Gender   h-Index   Spine surgery   Workforce analysis  

摘要： OBJECTIVE: Spinal surgery is taught and practiced within 2 different surgical disciplines: neurological surgery and orthopedic surgery. We have provided a unified analysis of spine-focused faculty at U.S. residency programs. METHODS: A total of 278 Accreditation Council for Graduate Medical Education training programs were assessed to identify 923 full-time faculty members with a spinal surgery designation, defined by spine fellowship training or surgeon case volume >75% spine surgeries. Faculty were assessed with respect to parent discipline, years of fellowship training, academic rank, gender, and academic productivity (h-index). RESULTS: The spine-teaching workforce contains 55% orthopedic surgeons and 45% neurosurgeons with wide gender asymmetry overall and at all faculty ranks. Of the female spine surgeons, those with neurosurgical training (64.44%) nearly doubled the number with orthopedic training (35.56%). Academic productivity increased with academic rank similarly for both genders and subspecialties. Orthopedic spine surgeons had a greater mean fellowship number compared with the neurological spine surgeons. Fellowship time of completion (intraresidency/infolded vs. postresidency) did not significantly affect the h-indexes. Addition of fellowship conferred academic productivity benefit for orthopedic surgeons only. CONCLUSIONS: Neurological and orthopedic spine surgery showed similar patterns for the spread of faculty across academic ranks and trends in academic productivity. Marked gender disparity was seen in both neurosurgical and orthopedic surgery, with fewer female spine surgeons seen at every academic rank. Orthopedic spine surgeons had a greater mean fellowship number than did their neurosurgical counterparts, and a lack of fellowship correlated with lower academic productivity in orthopedic, but not neurological, spine surgery.

关键词： Psychiatry   neurology  

摘要： Over the past three decades, there has been an increase in residency training emphasis on neuroscience, “a broad discipline encompassing the study of the nervous system and behavior using cellular and molecular biology, animal models, neuroanatomy, neuroimaging, genetics, neuropsychology, and basic pharmacology (as opposed to clinical pharmacology)” [3]. Since 2006, there has been a boom in neuroscience education with the rapidly developing National Neuroscience Curriculum Initiative [4], but the challenge of clinical application remains [5]. The State of Neurology Training and Evaluation for Psychiatry Residents Since 1987, psychiatry trainees have been mandated by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Psychiatry and Neurology (ABPN) to complete two months of full-time clinical neurology training [7]. [...]in 2016 neurology made up 15–20% of the Psychiatry Resident-In-Training Examination (PRITE), an in-service exam used by residency programs to evaluate the medical knowledge and board-readiness of residents [12]. Based on the milestones, training goals established at this forum included neurologic exam skills, diagnosis and initial management of neurologic issues relevant to psychiatry, and recognition of need for neurologic consultation.

摘要： .

关键词： Emergency department   Syncope   Neuroimaging   Cranial CT   Cranial MRI  

摘要： Objectives: Diagnostic tests are widely used for patients with syncope in the emergency department (ED). This study aimed to determine the diagnostic yield of neuroimaging in patients with syncope without high-risk symptoms. Methods: Adult patients who presented to the ED with syncope in 2016 were screened retrospectively. Patients who suffered from mild head trauma due to syncope were also included. Patients with neurological examination findings (confusion, amnesia, focal neurological deficit, severe headache, dizziness, nausea and vomiting), patients on anticoagulants, patients with known intracranial malignancies and those whose loss of consciousness was attributed to reasons other than syncope were excluded from the study. Results: A total of 1114 patients were included in the study. The median age was 48 years (IQR 34-66 years) and 576 (51.7%) of the patients were male. The neuroimaging tests performed were cranial computerized tomography (Cr) in 694 (623%) cases and magnetic resonance imaging (MRI) in 114 (102%) cases. Mild head trauma due to syncope was observed in 116 (10.4%) patients. None of the neuroimaging studies revealed any clinically significant findings. Conclusion: Neuroimaging is not beneficial in patients whose medical history and physical examination do not indicate neurogenic syncope, even if the patient has mild head trauma. (C) 2018 Elsevier Inc. All rights reserved.

关键词： androstenedione   aromatization   estradiol   estrone   mortality   steroidogenesis   traumatic brain injury  

摘要： Early declines in gonadotropin production, despite elevated serum estradiol, among some individuals with severe traumatic brain injury (TBI) suggests amplified systemic aromatization occurs post-injury. Our previous work identifies estradiol (E2) as a potent mortality marker. Androstenedione (A), a metabolic precursor to E2, estrone (E1), and testosterone (T), is a steroid hormone substrate for aromatization that has not been explored previously as a biomarker in TBI. Here, we evaluated serum A, E1, T, and E2 values for 82 subjects with severe TBI. Daily hormone values were calculated, and E2:A and E1:T ratios were generated and then averaged for days 0-3 post-injury. After data inspection, mean E2:A values were categorized as above (high aromatization) and below (low aromatization) the 50th percentile for 30-day mortality assessment using Kaplan-Meier survival analysis and a multivariable Cox proportional hazard model adjusting for age, and Glasgow Coma Scale (GCS) to predict 30-day mortality status. Daily serum T, E1, and E2 were graphed by E2:A category. Serum E1 and E2 significantly differed over time (p<0.05);the high aromatization group had elevated levels and a significantly lower probability of survival within the first 30 days (p=0.0274). Multivariable Cox regression showed a significant E2:A*GCS interaction (p=0.0129), wherein GCS predicted mortality only among those in the low aromatization group. E2:A may be a useful mortality biomarker representing enhanced aromatization after TBI. E2:A ratios may represent non-neurological organ dysfunction after TBI and may be useful in defining injury subgroups in which GCS has variable capacity to serve as an accurate early prognostic marker.

关键词： Zika virus infection   Infant   Newborn   Microcephaly   Congenital   Calcification   Retinal abnormalities   Hydrocephalus  

摘要： BACKGROUND: In utero Zika virus infection resulted in many newborns with congenital defects;this public health issue was followed by unprecedented scientific productivity in this field. Many questions remain about congenital Zika virus infection and its maternal transmission, pathogenesis, clinical events, and the resulting neurological damage. There are few review articles that synthesize the current knowledge of congenital neurological complications as well as the gaps in the pediatric literature. OBJECTIVE: We review the full range of data on neurological complications in the newborns and infants born to Zika virus-infected women. METHODS: A research question (PCC: Population, newborns and infants of infected mothers;Concept, neurological outcomes at birth;Context, congenital Zika virus infection) was created to guide our review in searching several databases: PubMed, Lilacs, CINAHL, Cochrane Library, and OpenGrey literature. A total of 34 articles were included in the final review. RESULTS: Central nervous system calcifications, mainly at the cortical-subcortical junction, were the most prevalent neurological birth defects related to Zika infection (104/112, 92.9% from seven studies). Also, microcephaly occurred in 39.7% of all infected infants (1561/3931 patients in all the studies) and ventriculomegaly and/or hydrocephalus occurred in 63.1% (157/249 patients analyzed in 12 studies). A total of 10 articles detailed ocular findings, including macular lesions, focal pigment mottling of the retina, chorioretinal atrophy, optic nerve abnormalities, cataract, microphthalmia, and strabismus, among others. CONCLUSIONS: Neurological and related malformations are common lesions in individuals with congenital Zika syndrome. Long-term follow-up studies in this field are lacking. (C) 2018 Elsevier Inc. All rights reserved.

关键词： Out-of-hospital cardiac arrest   Health insurance   Post-resuscitation care  

摘要： Background: We investigated the association of health insurance status with post-resuscitation care and neurological recovery in out-of-hospital cardiac arrest (OHCA) and whether the effects changed with age or gender. Methods: Adult OHCAs with presumed cardiac etiology who had sustained ROSC from 2013 to 2016 were enrolled from the nationwide OHCA registry of Korea. Insurance status was categorized into 2 groups: National Health Insurance (NHI) and Medical Aid (MA). The endpoints were post-resuscitation coronary reperfusion therapy (CRT), targeted temperature management (TTM), and good neurological recovery (cerebral performance category of 1 or 2). Multivariable logistic regression models and interaction analyses (insurance x age and insurance x gender) were conducted for adjusted odds ratios (aORs) and 95% confidence intervals (CI). Results: Of a total of 19,865 eligible OHCA patients, 18,119 (91.2%) were covered by NHI and 1746 (8.8%) by MA. The MA group was less likely to receive post-resuscitation CRT and TTM (aOR (95% CI): 0.75 (0.59-0.96) for CRT;0.71 (0.57-0.89) for TTM) and had worse neurological outcomes (0.71 (0.57-0.89)) compared with the NHI group. In the interaction analyses, MA was associated with less CRT and good neurological recovery in the 4564 year old group (0.54 (0.37-0.77) for CRT;0.70 (0.51-0.95) for neurological outcome) and in the male group (0.69 (0.52-0.91) for CRT;0.77 (0.61-0.97) for TTM;0.70 (0.53-0.92)) for neurological outcome). Conclusions: There were disparities in post-resuscitation care and substantial neurological recovery by health insurance status, and the disparities were prominent in middle-aged adults and males. Increasing health insurance coverage for post-resuscitation care should be considered.

关键词： child neurology   palliative care   interdisciplinary care   barriers to care  

摘要： It has long been recognized that patients with neurological conditions, and particularly pediatric neurology patients, are well suited for palliative care because they frequently have a high symptom burden and variable prognoses. In 1996, the American Academy of neurology formally recognized a need for neurologists to "understand and apply the principles of palliative medicine." Subsequently, some reviews have proposed a simultaneous care model in which palliative care is integrated for all neurology patients from the time of diagnosis. This article will review the current status of palliative care in pediatric neurology and discuss barriers to its integration.