关键词： 神经病学   BOPPPS教学模式   全科住院医师   临床教学  

摘要： 目的探讨BOPPPS(导入bridge-in、学习目标outcome、前测pre-test、参与式学习participation、后测post-test、总结summary)教学模式在全科住院医师神经内科临床教学中的应用。方法选取典型的动脉粥样硬化性脑梗死病例,以全科住院医师为对象,借助BOPPPS教学模式将课程设计为课前准备阶段、课堂阶段以及课后阶段3个环节。课堂阶段包含小视频观看、典型案例学习、角色扮演以及分组讨论等多种形式。结果BOPPPS教学模式将传统的“授之以鱼”转化成火车头带动车厢,并驾齐驱的形式,能最大程度激发住院医师的主观能动性,既有利于培养良好的临床思维,也强化了医患沟通能力。结论将BOPPPS教学模式灵活应用于神经病学等难度较大的学科,对于培养优秀的全科住院医师,推动全科医学事业具有重要意义。

关键词： MDT模式   PBL教学   神经病学   实习教学   效果分析  

摘要： 探讨MDT模式下PBL教学法在神经病学临床实习教学中的应用价值。方法:择取2017年3月—2019年6月,在本院神经病学临床实习的学生总计120名,以随机数字表法的分组模式,将60名实施LBL教学的设定为对照组,将基于MDT模式下PBL教学法的60名学生,设定为实验组。统计两组考核成绩、教学满意度和评判思维能力、核心能力评分。结果:实验组理论知识以及实践技能评分高于对照组,差异有统计学意义(P<0.05);实验组教学满意度显著高于对照组,差异有统计学意义(P<0.05);实验组评判思维能力的各项评分高于对照组,组间有差异性(P<0.05)。实验组临床实践能力、疑难病例讨论能力、健康教育能力、科研能力四个部分的核心能力评分高于对照组,组间有差异性(P<0.05)。结论:在神经病学临床实习教学中,MDT模式下PBL教学法的应用价值明显,可提升考核评分,且提升实习生的思维能力。

关键词： Clinical neuroscience   Education   Neurosurgery   Mentorship   Collaboration   NANSIG  

摘要： Collaboration and successful teamworking are important components of clinical practise, and these skills should be cultivated early in medical school. The breadth of current medical school curricula means that students often have limited exposure to clinical neurosciences. Since its inception in 2009, the Neurology and Neurosurgery Interest Group (NANSIG) has become a national (UK and Republic of Ireland) example of student and junior doctor synergistic collaboration to deliver educational materials, research, conferences, seminars and workshops, as well as advocating for diversity in this field. Recently, it has expanded to incorporate an international audience and cater for a larger group of young medical professionals. The organisation has overcome numerous challenges and is constantly innovating new approaches to harness the necessary knowledge, skills and network to succeed in a career in neurosciences, neurology and neurosurgery. This article summarises the initiatives undertaken by the group over its first 10 years of existence and its organisational structure, as well as its future plans.

关键词： Gastroesophageal reflux disease   Neurologically impaired patients   Laparoscopy-aided gastrostomy   Multichannel intraluminal impedance pH measurements  

摘要： Background Development of gastroesophageal reflux disease (GERD) after gastrostomy remains debatable. Therefore, this study aimed to evaluate whether laparoscopy-aided gastrostomy (LAG) influence on the occurrence of GERD in neurologically impaired (NI) patients. Furthermore, we investigated whether preoperatively excluding NI patients with GERD can reduce the number of patients requiring subsequent anti-reflux surgery (ARS) after LAG. Methods This retrospective study included 35 NI patients (median age: 11.0;interquartile range 5.0-23.5 years) who underwent LAG according to our criterion from October 2012 to June 2020 and MII-pH before and after LAG. MII-pH parameters were compared in all patients and among three age groups between before and after LAG. Results There were no significant differences in MII-pH parameters before and 1 year after LAG in all patients, and no patient underwent subsequent ARS. Only one paediatric patient with 64 number of reflux episodes before LAG required subsequent ARS 3 years after LAG. Conclusions Generally, LAG did not influence the postoperative GERD at 1 year after LAG, and our criteria could reduce the number of patients requiring subsequent ARS. However, paediatric NI patients with higher number of reflux episodes in preoperative MII-pH study may need careful long-term follow-up after LAG.

摘要： When parents were faced with the daunting reality that their children have been diagnosed with a rare and fatal neurological disease with no hope for a cure or treatment, what could they do? They could band together and join patient advocacy groups in search for researchers and clinicians willing to collaborate to help save these children. Families' determination, coupled with the knowledge and dedication of many stakeholders, led to a coveted miracle.

关键词： COVID-19   Neurological manifestation   PSQI   HADS   WHODAS-12  

摘要： Background Several people affected by COVID-19 experienced neurological manifestations, altered sleep quality, mood disorders, and disability following hospitalization for a long time. Objective To explore the impact of different neurological symptoms on sleep quality, mood, and disability in a consecutive series of patients previously hospitalized for COVID-19 disease. Methods We evaluated 83 patients with COVID-19 around 3 months after hospital discharge. They were divided into 3 groups according to their neurological involvement (i.e., mild, unspecific, or no neurological involvement). Socio-demographic, clinical data, disability level, emotional distress, and sleep quality were collected and compared between the three groups. Results We found that higher disability, depressive symptoms, and lower sleep quality in patients with mild neurological involvement compared to patients with unspecific and no neurological involvement. Differences between groups were also found for clinical variables related to COVID-19 severity. Conclusion After 3 months from hospital discharge, patients with more severe COVID-19 and mild neurological involvement experienced more psychosocial alterations than patients with unspecific or no neurological involvement. Both COVID-19 and neurological manifestations' severity should be considered in the clinical settings to plain tailored interventions for patients recovering from COVID-19.

关键词： Neurology   Radiotherapy   Leukoencephalopathy   Radionecrosis   Myelopathy   Plexopathy  

摘要： Radiation therapy (RT) is one of the main treatments administered to patients with cancer. The development of technology has improved RT accuracy by allowing more precise delivery of high doses to the target volumes with reduced exposure of healthy tissue. Life expectancy has increased due to these therapeutic advancements and the patients' quality of life remains a major concern. The adverse events related to RT are quite various and most likely will impair essential neurological functions, e.g. cognitive status. This literature review aims to describe the physiopathological processes, the neurological symptoms as well as the local modifications observed in magnetic resonance imaging following RT. The specific therapeutic options and preventive actions will also be discussed.

关键词： Cerebral small vessel disease   Magnetic resonance imaging   Fructosamine   Glycated albumin   Long-term glycemic fluctuations  

摘要： Aims To determine if medium- and long-term blood glucose control as well as glycemic variability, which are known to be strong predictors of vascular complications, are associated with underlying cerebral small vessel disease (cSVD) in neurologically asymptomatic individuals with type 1 diabetes. Methods A total of 189 individuals (47.1% men;median age 40.0, IQR 33.0-45.2 years) with type 1 diabetes (median diabetes duration of 21.7, IQR 18.3-30.7 years) were enrolled in a cross-sectional retrospective study, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. Glycated hemoglobin (HbA(1c)) values were collected over the course of ten years before the visit including a clinical examination, biochemical sampling, and brain magnetic resonance imaging. Markers of glycemic control, measured during the visit, included HbA(1c), fructosamine, and glycated albumin. Results Signs of cSVD were present in 66 (34.9%) individuals. Medium- and long-term glucose control and glycemic variability did not differ in individuals with signs of cSVD compared to those without. Further, no difference in any of the blood glucose variables and cSVD stratified for cerebral microbleeds (CMBs) or white matter hyperintensities were detected. Neither were numbers of CMBs associated with the studied glucose variables. Additionally, after dividing the studied variables into quartiles, no association with cSVD was observed. Conclusions We observed no association between glycemic control and cSVD in neurologically asymptomatic individuals with type 1 diabetes. This finding was unexpected considering the large number of signs of cerebrovascular pathology in these people after two decades of chronic hyperglycemia and warrants further studies searching for underlying factors of cSVD.

摘要： There are over 7,000 diseases that are individually rare, but collectively affect millions of people worldwide. They are very commonly neurologic single-gene disorders. Recent advances in recombinant adeno-associated virus vectors have enabled breakthroughs, including US Food and Drug Administration (FDA)-approved gene therapies for inherited retinal dystrophy due to RPE65 mutation and spinal muscular atrophy. A range of other gene therapies for rare neurologic diseases are at various stages of development. Future development of gene editing technologies promises further to broaden the potential for more patients with these disorders to benefit from innovative therapies.