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Serôdio M, Magriço M, Sobral-Pinho A, Ventura R, Serrazina F, Cabral G, Meira B, Fernandes M, Salavisa M, Saraiva M, Marto JP, Sá F, Calado S, Viana-Baptista M. The Role of Neurohospitalism in a Specialized Cardiovascular Hospital. Eur Neurol 2024; 87:49-53. [PMID: 38382475 DOI: 10.1159/000537930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Cardiology and cardiothoracic surgery are among the specialties that most commonly require neurology inpatient consultations. We aimed to study the neurology referrals by the cardiovascular-specialized hospital included in our tertiary hospital center. METHODS Retrospective study of consecutive patients referred for neurology inpatient consultation between January 1, 2020, and December 31, 2022. We analyzed referrals, patients' characteristics, and the approach taken. A detailed subanalysis was performed for patients diagnosed with acute ischemic stroke (AIS). RESULTS 143 patients were observed (mean age 67.3 years, 46 [32.2%] females). Most frequent referral reasons were suspected AIS deficits (39.2%), altered mental status (19.6%), suspected seizures (13.3%), and neuroprognostication (11.9%). Mean referral-to-consult time was 2.7 days, and 117 (81.8%) consults were in-person. Additional investigation, treatment changes, and outpatient clinic referral were proposed, respectively, in 79.7%, 60.1%, and 19.6% of patients. Most common diagnoses were AIS (45.5%), hypoxic-ischemic encephalopathy (18.9%), and delirium (7.0%). Regarding patients with AIS (n = 62), most common stroke causes were post-cardiac procedure (44.6%), infective endocarditis (18.5%), aortic dissection (10.8%), acute myocardial infarction (10.8%), and anticoagulant withdrawal in patients with atrial fibrillation (6.2%). Thirty-four AIS patients were diagnosed less than 24 h since last seen well, of which four (6.2%) were treated (three with thrombolysis and one with mechanical thrombectomy). CONCLUSION AIS is the most common reason for referral in our cardiovascular hospital. Our results highlight the importance of the availability of a neurologist/neurohospitalist with stroke expertise for consultation of inpatients admitted in a specialized cardiovascular hospital.
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Affiliation(s)
- Miguel Serôdio
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marta Magriço
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - André Sobral-Pinho
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rita Ventura
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Filipa Serrazina
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Gonçalo Cabral
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Bruna Meira
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marco Fernandes
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Manuel Salavisa
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Marlene Saraiva
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Francisca Sá
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Sofia Calado
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Viana-Baptista
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Bradley M, Nursing M, Tacheva A, Chalissery A. Seizure management in a Model Three hospital: what does specialist neurology add? Ir J Med Sci 2022; 191:2729-2732. [PMID: 34988859 DOI: 10.1007/s11845-021-02676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The commonest reason for admissions to hospital in Ireland annually for patients with a neurological condition is due to convulsions/epilepsy and their care is often managed by Internal Medicine physicians. AIMS The study aims to evaluate the care provided for patients admitted with seizures in a Model Three hospital before and after the commencement of a specialist onsite neurology service. METHODS Retrospective chart review of patients admitted from Emergency Department (ED) with the term "seizure" during a 4-month period in 2018 and 2019 was undertaken. Charts evaluated for patient demographics, Length of Stay (LOS), driving and lifestyle advice offered, and rescue medications prescribed upon discharge. RESULTS In 2018, a total of 58 patients were admitted with a seizure over a period of 4 months of audit and the mean LOS was 4.25 days (SD = 4.43). Driving advice was documented in 9 patients and Buccal midazolam (Buccalam) for rescue therapy for prolonged seizures was prescribed once. Following the appointment of a neurologist, LOS for patients admitted with seizure dropped to 2.6 days (SD = 3.44, p < 0.05) in the same time frame in 2019. Driving status/recommendations were documented in 27(42%) and buccal midazolam was prescribed for 25 (39%) patients. CONCLUSION Access to expert neurology review in a Model Three hospital in Ireland not only improved the provision of safe, timely, and equitable care but also significantly reduced the LOS for patients admitted with seizures.
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Affiliation(s)
- Maeve Bradley
- Department of Neurology, Connolly and Beaumont Hospital (RCSI Hospital Group), Dublin, Ireland.
| | - Meenaski Nursing
- Department of Neurology, Connolly and Beaumont Hospital (RCSI Hospital Group), Dublin, Ireland
| | - Asya Tacheva
- Department of Neurology, Connolly and Beaumont Hospital (RCSI Hospital Group), Dublin, Ireland
| | - Albi Chalissery
- Department of Neurology, Connolly and Beaumont Hospital (RCSI Hospital Group), Dublin, Ireland
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Abstract
Liaison neurology (consulting with inpatient ward referrals) is the main way that most patients admitted with neurological disease will access neurology services. Most liaison neurology services are responsive, seeing referrals on request, but they also can be proactive, with a regular neurology presence in the acute medical unit. Fewer than half of hospitals in England have electronic systems, yet these can facilitate the process-allowing electronic responses to advise on investigations before seeing the patient, and arranging follow-up after-as well as prioritising referrals and documenting the process. In this time of COVID-19, there are additional benefits in providing prompt remote advice. Improving the way liaison neurology is delivered can improve patient outcomes and save money by shortening admissions. This hidden work of the neurologists needs to be recorded and recognised.
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Affiliation(s)
- Geraint N Fuller
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK .,Getting It Right First Time, Royal National Orthopaedic Hospital, Middlesex, UK
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Mors M, Bohr C, Fozo M, Shermetaro C. Consultation Intervention Rates for the Otolaryngology Service: A Large Metropolitan Hospital Experience. Spartan Med Res J 2020; 4:11596. [PMID: 33655167 PMCID: PMC7746046 DOI: 10.51894/001c.11596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/15/2019] [Indexed: 11/17/2022] Open
Abstract
CONTEXT The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital. METHODS The authors performed a retrospective review of the specific types of consultations received during calendar year 2016. RESULTS A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen ("earwax") removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available. CONCLUSIONS These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.
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Affiliation(s)
- Matt Mors
- McLaren Oakland Regional Medical Center
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5
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The urgent neurological consultation in the population of the province of Ferrara, Italy. Neurol Sci 2018; 39:1253-1259. [DOI: 10.1007/s10072-018-3424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
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Greene JG. Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center. Neurohospitalist 2018; 8:74-81. [PMID: 29623157 DOI: 10.1177/1941874417735173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality. Methods Cost and revenue associated with professional services was evaluated on a yearly basis. As part of ongoing quality improvement efforts, yearly surveys were administered to referring providers during the transition to a collaborative care model in which NHs and medicine hospitalists comanage neurology inpatients. Results Net operating loss was dramatically decreased upon transition to the new care model. Concomitantly, there was a robust positive impact on perception of overall quality, timeliness, and communication skills of neurology services. Conclusions Collaborative comanagement is an effective strategy to improve overall satisfaction with neurology services at a tertiary academic medical center while maintaining financial viability.
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Affiliation(s)
- James G Greene
- Department of Neurology, Emory University, Atlanta, GA, USA
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7
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Fu KA, Razmara A, Cen SY, Towfighi A, Mack WJ, Sanossian N. Hospital and demographic characteristics associated with inpatient neurological services in the United States. Clin Neurol Neurosurg 2018; 164:39-43. [DOI: 10.1016/j.clineuro.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
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Aller-Alvarez J, Quintana M, Santamarina E, Álvarez-Sabín J. Descriptive analysis of neurological in-hospital consultations in a tertiary hospital. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Moura LMVR, Price M, Cole AJ, Hoch DB, Hsu J. Accuracy of claims-based algorithms for epilepsy research: Revealing the unseen performance of claims-based studies. Epilepsia 2017; 58:683-691. [PMID: 28199007 PMCID: PMC6592609 DOI: 10.1111/epi.13691] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate published algorithms for the identification of epilepsy cases in medical claims data using a unique linked dataset with both clinical and claims data. METHODS Using data from a large, regional health delivery system, we identified all patients contributing biologic samples to the health system's Biobank (n = 36K). We identified all subjects with at least one diagnosis potentially consistent with epilepsy, for example, epilepsy, convulsions, syncope, or collapse, between 2014 and 2015, or who were seen at the epilepsy clinic (n = 1,217), plus a random sample of subjects with neither claims nor clinic visits (n = 435); we then performed a medical chart review in a random subsample of 1,377 to assess the epilepsy diagnosis status. Using the chart review as the reference standard, we evaluated the test characteristics of six published algorithms. RESULTS The best-performing algorithm used diagnostic and prescription drug data (sensitivity = 70%, 95% confidence interval [CI] 66-73%; specificity = 77%, 95% CI 73-81%; and area under the curve [AUC] = 0.73, 95%CI 0.71-0.76) when applied to patients age 18 years or older. Restricting the sample to adults aged 18-64 years resulted in a mild improvement in accuracy (AUC = 0.75,95%CI 0.73-0.78). Adding information about current antiepileptic drug use to the algorithm increased test performance (AUC = 0.78, 95%CI 0.76-0.80). Other algorithms varied in their included data types and performed worse. SIGNIFICANCE Current approaches for identifying patients with epilepsy in insurance claims have important limitations when applied to the general population. Approaches incorporating a range of information, for example, diagnoses, treatments, and site of care/specialty of physician, improve the performance of identification and could be useful in epilepsy studies using large datasets.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Maggie Price
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
- Departments of Health Care Policy and of Medicine, Harvard Medical School, Boston, Massachusetts, U.S.A
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Moura LM, Schwamm EL, Moura Junior V, Seitz MP, Hoch DB, Hsu J, Schwamm LH. Patient-reported financial barriers to adherence to treatment in neurology. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:685-694. [PMID: 27895506 PMCID: PMC5117903 DOI: 10.2147/ceor.s119971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective Many effective medical therapies are available for treating neurological diseases, but these therapies tend to be expensive and adherence is critical to their effectiveness. We used patient-reported data to examine the frequency and determinants of financial barriers to medication adherence among individuals treated for neurological disorders. Patients and methods Patients completed cross-sectional surveys on iPads as part of routine outpatient care in a neurology clinic. Survey responses from a 3-month period were collected and merged with administrative sources of demographic and clinical information (eg, insurance type). We explored the association between patient characteristics and patient-reported failure to refill prescription medication due to cost in the previous 12 months, termed here as “nonadherence”. Results The population studied comprised 6075 adults who were presented between July and September 2015 for outpatient neurology appointments. The mean age of participants was 56 (standard deviation: 18) years, and 1613 (54%) were females. The patients who participated in the surveys (2992, 49%) were comparable to nonparticipants with respect to gender and ethnicity but more often identified English as their preferred language (94% vs 6%, p<0.01). Among respondents, 9.8% (n=265) reported nonadherence that varied by condition. These patients were more frequently Hispanic (16.7% vs 9.8% white, p=0.01), living alone (13.9% vs 8.9% cohabitating, p<0.01), and preferred a language other than English (15.3% vs 9.4%, p=0.02). Conclusion Overall, the magnitude of financial barriers to medication adherence appears to vary across neurological conditions and demographic characteristics.
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Affiliation(s)
| | | | | | | | | | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital; Department of Medicine and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Ibrahim A, Owolabi LF, Musa BM, Aliyu S, Rabiu M, Yakasai AM. Pattern of in-patient neurologic review: An experience from a Tertiary Hospital North-Western Nigeria. Ann Afr Med 2016; 15:47-51. [PMID: 27044726 PMCID: PMC5402815 DOI: 10.4103/1596-3519.179734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Increase in neurologic diseases burden has increased the demand for neurology services globally, despite the shortcomings of shortage and maldistribution of neurologists worldwide, including Sub-Saharan Africa. This has placed significant pressure on the few available neurologists to provide optimal and effective services in our resource-challenged settings. Methods: Neurology referrals were prospectively reviewed over a period of 3 months. Sociodemographic characteristics of the patients, the initial diagnosis by the requesting team, the reasons for the consult/referral, the requesting personnel, duration of hospital stay before request, the time interval between receiving the request and review, the working and final diagnosis after the review, and the diagnostic outcome of neurologic review were analyzed using Predictive Analytics Software® version 18.0.0 for Windows (Chicago, Illinois, USA). Results: Fifty-three hand written in-patient requests were reviewed over the period of study given an average rate of 4.4/week. The mean age was 50.8 ± 16.1 years, and the median length of stay before a review was 1 day (interquartile range: 1–2.5 days). Diagnostic outcome of the reviews were; new diagnoses in 4 (11.3%), the incorrect diagnosis changed in 8 (15.1%), contribution to the differential diagnosis in 15 (28.3%), and contribution to management plans in 24 (45.3%) patients. The association between diagnostic outcomes and mortality in our study was not statistically significant (χ2 = 6.66, P = 0.08). Conclusion: Our study showed that in-patient neurologic reviews led to significant improvement in diagnostic and management plans. Appropriate policy guidelines should focus more on efficient ways of maximizing benefits of these reviews to patients without overburdening the few available neurologists in our environment.
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Affiliation(s)
- Aliyu Ibrahim
- Department of Medicine, Neurology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
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Aller-Alvarez JS, Quintana M, Santamarina E, Álvarez-Sabín J. Descriptive analysis of neurological in-hospital consultations in a tertiary hospital. Neurologia 2015; 32:152-157. [PMID: 26541696 DOI: 10.1016/j.nrl.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In-hospital consultations (IHC) are essential in clinical practice in tertiary hospitals. The aim of this study is to analyse the impact of neurological IHCs. PATIENTS AND METHOD One-year retrospective descriptive study of neurological IHCs conducted from May 2013 to April 2014 at our tertiary hospital. RESULTS A total of 472 patients were included (mean age, 62.1 years; male patients, 56.8%) and 24.4% had previously been evaluated by a neurologist. Patients were hospitalised a median of 18 days and 19.7% had been referred by another hospital. The departments requesting the most in-hospital consultations were intensive care (20.1%), internal medicine (14.4%), and cardiology (9.1%). Reasons for requesting an IHC were stroke (26.9%), epilepsy (20.6%), and confusional states (7.6%). An on-call neurologist evaluated 41.9% of the patients. The purpose of the IHC was to provide a diagnosis in 56.3% and treatment in 28.2% of the cases; 69.5% of the patients required additional tests. Treatment was adjusted in 18.9% of patients and additional drugs were administered to 27.3%. While 62.1% of cases required no additional IHCs, 11% required further assessment, and 4.9% were transferred to the neurology department. Of the patient total, 16.9% died during hospitalisation (in 37.5%, the purpose of the consultation was to certify brain death); 45.6% were referred to the neurology department at discharge and 6.1% visited the emergency department due to neurological impairment within 6 months of discharge. CONCLUSIONS IHCs facilitate diagnosis and management of patients with neurological diseases, which may help reduce the number of visits to the emergency department. On-call neurologists are essential in tertiary hospitals, and they are frequently asked to diagnose brain death.
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Affiliation(s)
- J S Aller-Alvarez
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - M Quintana
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Álvarez-Sabín
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
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Should we call the neurologist? The value and cost of a growing neurology consultation service. Ir J Med Sci 2015; 185:611-616. [DOI: 10.1007/s11845-015-1317-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
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Need for neurology specialists to be dedicated to hospital care in Italy. Neurol Sci 2013; 34:2193-8. [PMID: 23619531 DOI: 10.1007/s10072-013-1446-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Any patients admitted to healthcare facilities with a neurological diseases deserves to be managed by a neurologist. This is particularly important for acute onset neurological disorders, because of their severity and the requirement of early and appropriate diagnostic-therapeutic approach. In addition, this may reduce both unnecessary admissions and length of stay, with a significant saving of resources for the National Health System (NHS). To ensure this, it is important to evaluate predictable needs for hospital neurologists in Italy. The hospital discharges for neurological medical diseases of the Major Disease Category (MDC) 1 were 455,132 in 2009 and 491,836 in 2008, more than 50 % of which were acute neurological disorders. Stroke and transient ischemic attacks (TIA) accounted for about 170,000 per year. Currently available neurologists in Italian healthcare facilities are largely insufficient to assist such a large number of patients. The 270 Neurological Care Units in Italy (of which 243 open to the emergency care) are equipped with an average number of 7.7 neurologists per unit, inadequate to ensure on duty care 24 h a day, 7 days a week. In addition, the mean age of hospital neurologists is quite high, with provision for large retirement. It is therefore required to increase in the next few years the number of neurologists by at least 30 %, with an increase of 562 units. To meet the need for neurology specialists committed to hospital care in Italy is also necessary to increase the number of scholarships for residents in post-graduate schools.
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Omurtag A, Baki SGA, Chari G, Cracco RQ, Zehtabchi S, Fenton AA, Grant AC. Technical and clinical analysis of microEEG: a miniature wireless EEG device designed to record high-quality EEG in the emergency department. Int J Emerg Med 2012; 5:35. [PMID: 23006616 PMCID: PMC3552869 DOI: 10.1186/1865-1380-5-35] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND We describe and characterize the performance of microEEG compared to that of a commercially available and widely used clinical EEG machine. microEEG is a portable, battery-operated, wireless EEG device, developed by Bio-Signal Group to overcome the obstacles to routine use of EEG in emergency departments (EDs). METHODS The microEEG was used to obtain EEGs from healthy volunteers in the EEG laboratory and ED. The standard system was used to obtain EEGs from healthy volunteers in the EEG laboratory, and studies recorded from patients in the ED or ICU were also used for comparison. In one experiment, a signal splitter was used to record simultaneous microEEG and standard EEG from the same electrodes. RESULTS EEG signal analysis techniques indicated good agreement between microEEG and the standard system in 66 EEGs recorded in the EEG laboratory and the ED. In the simultaneous recording the microEEG and standard system signals differed only in a smaller amount of 60 Hz noise in the microEEG signal. In a blinded review by a board-certified clinical neurophysiologist, differences in technical quality or interpretability were insignificant between standard recordings in the EEG laboratory and microEEG recordings from standard or electrode cap electrodes in the ED or EEG laboratory. The microEEG data recording characteristics such as analog-to-digital conversion resolution (16 bits), input impedance (>100MΩ), and common-mode rejection ratio (85 dB) are similar to those of commercially available systems, although the microEEG is many times smaller (88 g and 9.4 × 4.4 × 3.8 cm). CONCLUSIONS Our results suggest that the technical qualities of microEEG are non-inferior to a standard commercially available EEG recording device. EEG in the ED is an unmet medical need due to space and time constraints, high levels of ambient electrical noise, and the cost of 24/7 EEG technologist availability. This study suggests that using microEEG with an electrode cap that can be applied easily and quickly can surmount these obstacles without compromising technical quality.
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Affiliation(s)
- Ahmet Omurtag
- Departments of Neurology, and Physiology & Pharmacology, State University of New York, Downstate Medical Center, Brooklyn, USA.
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Powers L, Shepard KM, Craft K. Payment reform and the changing landscape in medical practice: Implications for neurologists. Neurol Clin Pract 2012; 2:224-230. [PMID: 29443280 DOI: 10.1212/cpj.0b013e31826af252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The growth in health care spending in the United States, though slowed in the last few years, remains unsustainable. Since higher health care spending does not correlate with most measures of improved patient outcome, there are new attempts to define "value" in health care as the ratio of quality to cost. This article reviews newer proposed models for provider payment and organization and their possible effects on neurologic practice.
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Micieli G, De Falco FA, Consoli D, Inzitari D, Sterzi R, Tedeschi G, Toni D. The role of emergency neurology in Italy: outcome of a consensus meeting for a Intersociety position. Neurol Sci 2011; 33:297-304. [PMID: 22057314 PMCID: PMC3313019 DOI: 10.1007/s10072-011-0841-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/22/2011] [Indexed: 12/03/2022]
Abstract
A possible definition of clinical, educational and organizing aspects of emergency neurology in Italy is reported in this position paper of Emergency Neurology Intersociety Group, created in 2008 among the two neurological Societies in Italy: Società Italiana di Neurologia and Società di Neuroscienze Ospedaliere. The aim of this Group has been the evaluation of the role of neurologist in the emergency setting of Italian hospitals, as well as of the description of different scenarios in which a ward dedicated to a semi-intensive care of neurological emergencies could have a role in the actual organization of academic or general hospitals in our Country. The actual great relevance of neurologist activity in the inpatients treatment, in fact, is actually misleaded as it is the considerable significance of neurological expertise, techniques and support in hospital care pathways also involving neurological manifestations throughout the course of other diseases. Finally, the possible contents of educational programs orienting neurological specialty towards a better comprehension and management of emergency neurological problems either in terms of specific formation or of techniques to be learned by emergency neurologist, are reported as a results of the Consensus Workshop hold in Castiglioncello (LI) in September 12th, 2009.
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Affiliation(s)
- Giuseppe Micieli
- Dipartimento di Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy.
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Horgan F, McGee H, Hickey A, Whitford DL, Murphy S, Royston M, Cowman S, Shelley E, Conroy RM, Wiley M, O’Neill D. From Prevention to Nursing Home Care: A Comprehensive National Audit of Stroke Care. Cerebrovasc Dis 2011; 32:385-92. [DOI: 10.1159/000330640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022] Open
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Ali E, Chaila E, Hutchinson M, Tubridy N. The ‘hidden work’ of a hospital neurologist: 1000 consults later. Eur J Neurol 2009; 17:e28-32. [DOI: 10.1111/j.1468-1331.2009.02901.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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