1150例神经内科会诊病例分析

目的了解神经内科会诊病例的科室分布、申请会诊方式以及疾病种类特点,探讨神经系统疾病与其他系统疾病的关系。方法对申请神经内科会诊病例的一般情况、疾病诊断以及神经系统疾病与其他系统疾病的关系等进行统计分析。结果会诊患者总数1150例,其中男性485例,女性665例,年龄分布7～95岁;平均年龄59.5±6.8岁。申请会诊科室以内科最多,共655例(56.9%)。急会诊例数285例(24.8%),常规会诊例数865例(75.2%)。531例(46.2%)继发于申请会诊科室所属的系统疾病,89例(7.7%)为医源性神经系统损害,75例(6.5%)为精神障碍性疾病。常规会诊以头晕/眩晕最多共243例,占常规会诊的25.5%;急会诊以急性脑血管病最多,共79例,占急会诊总数的39.9%。结论会诊病例神经系统损害多数与其他系统疾病有关;急会诊最常见的病种为急性脑血管病,常规会诊最常见的病种为头晕;部分神经系统损害与医源性因素有关;外科会诊主要目的为手术风险评估,内科会诊主要目的为脑血管病二级预防。     

副肿瘤性周围神经病15例临床分析

副肿瘤性周围神经病是指由癌肿引起的非转移性周围神经病变,在病变部位并无癌细胞可见[1]。约有50%患者神经系统症状早于肿瘤的发现[2],因而未发现癌肿之前患者常就诊于神经科。我科自2000年1月~2006年6月收治及会诊的该病患者15例,现分析如下。1临床资料1.1一般资料男9例,女6例;年龄50~74岁,平均62·5岁;发病至确诊时间4~16个月,平均10·5个月。6例曾误诊为Guillain-Barre综合征(GBS),9例为一般周围神经病。1.2临床表现1.2.1周围神经病表现均为隐匿或亚急性起病,均为首发周围神经病变症状,病情进行性发展。14例有四肢远端不适、刺痛、灼…     

国内神经内科住院总医师临床会诊文献回顾分析

目的总结国内神经内科会诊科室的分布特点及会诊疾病谱的构成,为科室医师临床与科研培训提供借鉴意义。方法通过检索国内文献数据库,检索2005-09—2015-09已发表关于神经内科会诊病例分析的报道,进行文献回顾性分析。结果共纳入研究报道7篇,会诊病例总数4 899例,男2 334例(47.6%),女2 565例(52.4%),年龄5个月~101岁。常规会诊3114例(63.32%),急会诊1 804例(36.68%)。会诊科室以内科最多。急会诊以急性脑血管病、昏迷!意识障碍、癫痫发作等常见,常规会诊以头晕!眩晕、头痛、陈旧性脑血管病、周围神经病变、精神障碍性相关疾病常见。结论会诊中应明辨神经系统疾病的症状及种类,详尽询问病史及体格检查,及时调整自身知识结构,掌握疾病谱系的演变,以辨证哲学思维指导临床医学发展。     

综合医院住院病人精神科会诊分析

目的了解综合医院精神科会诊的临床特点。方法将中南大学湘雅第二医院2001年4月至10月间申请精神科会诊的129例住院病人年龄、科室分布、会诊后诊断及治疗情况进行分析。结果总会诊率为1．67％，40岁以上年龄组申请会诊率较高，总会诊人数以内科最多(69例)，而会诊率以中医科最高(3．68％)，器质性精神障碍为会诊的主要精神科疾病，会诊后疗效(好转 痊愈)达89．9％。结论综合医院精神科医师协助处理临床各科疾病所伴／致精神障碍是十分必要的，且这种会诊作用正在不断加强。     

综合性医院住院病人的会诊精神病学

目的:探讨在综合医院设置精神科开放式病房后精神病学会诊的现状,方法:对我院近20年290例申请会诊的住院病人的科,地诊前后的论断对照,误诊情况及转科治疗情况进行分析.结果:总会诊率为1.38%,申请会诊的科室以内科最多138例(47.6%),会诊的精神科疾病中多见的是神经症84例(29.0%),躯体疾病致精神障碍60例20.7),器质性精神障碍50例(17.2%),精神分裂症37例(12.8%),误诊病例85例(29.3%),转科治疗64例(22.1%),结论:精神科会诊在综合医院呈增加趋势.综合设置精神科开放式病房既有利于精神科的发展,也有利于各类有精神障碍的患者得到及时妥善的治疗.     

综合医院精神科联络会诊分析

目的:探讨综合医院内精神科联络会诊的分布特征。方法:收集某综合医院1年内精神科联络会诊病例688例,完成自制调查问卷,使用SPSS统计软件进行描述性统计分析。结果:会诊病例最多分布在神经内科(19.3%),其次为心内科(9.7%)、骨科(9.3%)、消化内科(8.9%)、呼吸科(8.7%)以及脑外科(7.0%);患者年龄分布以40~69岁(53.2%)和20~29岁(13.5%)为多;会诊主要原因为急性脑病综合征(25.7%)、精神病性症状(22.8%)、不能解释的躯体症状(12.9%)和既往有精神障碍史而目前无明显症状者(13.8%);会诊诊断主要包括躯体疾病伴精神障碍(21.4%)、精神分裂症和其他精神病性障碍(20.9%)、脑器质性精神障碍(20.1%)等。结论:综合医院精神科联络会诊涉及各科室、各年龄段;主要会诊原因为急性脑病综合征和阳性精神病性症状,而抑郁、焦虑症状关注较少。     

269例周围神经病的初步分析

目的分析周围神经病的临床特点。方法收集2010年1月至2015年12月住院的具有完整临床资料的周围神经病患者269例。对疾病诊断、病因、起病形式、首发症状进行回顾性分析,并对3例典型病例(舌下"神经鞘瘤"、嗜伊红肉芽肿伴多血管炎、多灶性运动神经病)资料进行报道。结果 269例周围神经病患者中,男女比例为1.58:1。单根周围神经损害152例(56.51%),最常见为面神经麻痹;末梢神经损害94例(34.94%)。糖尿病引起的周围神经损害84例(31.23%),运动神经元病21例(7.81%)。急性起病多见147例(54.65%)。大部分以肌力减退为首发症状169例(62.82%)。结论糖尿病引起的周围神经损害发病率最高。     

以神经系统表现为首发症状的肺癌39例临床观察

我院自1985-01~2005-01共诊治肺癌231例,其中以神经系统表现为首发症状有39例,现分析报告如下。1资料与方法1·1一般资料本组39例中男31例,女8例,男女之比为3·88:1,年龄最小29·13岁,最大81·37岁,60岁以上37例,占大多数,31例有吸烟史,占79·49%。吸烟数大于400支/年。1·2临床表现以运动障碍为首发症状10例(25·64%),主要表现为单侧肢体无力或轻瘫等;以感觉障碍为首发症状12例(37·77%),表现为肢体麻木,刺痛11例,占28·21%;其他如头痛、眩晕7例(17·95%);声嘶3例(7·69%),Horner综合征3例(7·69%);腰痛、语言障碍、共济失调各2例,分别占5…     

神经科门诊患者的抑郁症状

对神经内科的门诊患者中具有抑郁症状进行调查。1对象和方法为2004年10月至11月我院神经科门诊患者,共221例,年龄14~82岁,平均(46·3±15·5)岁;男74例,女147例。采用抑郁自评量表(SDS),焦虑自评量表(SAS),Hamilton抑郁量表(HAMD,17项)进行评定。对临床资料进行分析。采用SAS8·2统计软件作χ2检验或t检验。2结果有36例(16·3%)SDS评分≥50分,平均(58·78±6·62)分,其中轻度抑郁(50~59分)22例,中度抑郁(60~69分)11例,重度抑郁(≥70分)3例。19例(8·6%)HAMD总分>17分,平均(21·79±3·28)分;其中轻中度抑郁(17~24分)13例,重度抑郁(…     

综合性医院精神科会诊178例分析

作者对综合性医院精神科会诊178例分析发现，会诊的主要原因是躯体疾病伴发精神障碍(38.2%）及原患精神疾病又患躯体疾病(32．0％)要求诊断和处理，内科会诊占首位(34.3％)，以器质性精神障碍(36．5％)最多见；其次为神经症(18．8％)，以癌症为多见，随后为精神障碍(8．4％)；会诊后44．8％病人转精神科治疗，未转科者使用精神活性药物治疗者占17.9％，综台治疗占11．8％，心理治疗占8．5%。作者建议，在综台性医院设置精神科，开展会诊一联络精神病学(CLP)工作甚为必要。     

Employment-seeking experiences of residents in 1996: a window into the neurology marketplace

OBJECTIVE: To assess career choice and employment-seeking experience of senior neurology residents in 1996. METHODS: Graduating residents in adult and pediatric neurology (n = 573) were surveyed to obtain career plans, initial job selection, health care attitudes, and demographic information. Results were compared with 1996 data on all United States neurologists and data from an American Medical Association (AMA) resident survey regarding the employment status of new physicians. RESULTS: Survey response rate was 71%. There was a significant increase in international medical graduates and women entering neurology compared with the current workforce. Seventy-four percent of graduates planned to enter a fellowship position; 19%, private practice; 5%, an academic position; and 2%, a career outside of clinical medicine. Neurology residents differ from aggregate national data because only 28% of residents responding to an AMA survey across all specialties applied to fellowships in 1996. Overall, 44% of neurology graduates planned an academic career. CONCLUSIONS: Changing demographics and career choice of recent graduates may require continued monitoring and could be important in neurology workforce planning. The high rate of fellowship training and plans for academic careers in 1996 is of interest and may reflect both resident response to new demands in the changing health care market and a need to modify residency programs to enhance academic training and competitiveness of neurology graduates.     

The academic half-day in Canadian neurology residency programs

BACKGROUND: The academic half-day (AHD) appears to have become widespread in Canadian neurology residency programs, but there is little published information about the structure, content, or impact of the AHD. METHODS: A written questionnaire was sent to the directors of all active Canadian adult and child neurology residency programs. RESULTS: All 21 program directors responded. An AHD was operating in 15/15 adult and 5/6 child neurology programs. The AHD typically lasts three hours, and occurs weekly, 10 months per year. Most of the weekly sessions are lectures or seminars, usually led by clinicians, with about 90% resident attendance. Course-like features (required textbook, examinations) are present in many AHDs. There is a wide range of topics, from disease pathophysiology to practice management, with considerable variation between programs. CONCLUSIONS: Almost all Canadian neurology programs now have an AHD. Academic half-days are broadly similar in content and format across the country, and residents now spend a substantial portion of their training attending the AHD. The impact of the AHD on how residency programs are organized, and on the learning, clinical work, and professional development of residents merits further study.     

Postgraduate education program in neurology at Iwate Medical University]

The major goal of the program is to provide residents with the opportunity to gain the knowledge, attitudes, and skills to enable them to provide exemplary health care to people with neurological disease. The program will facilitate learning through an atmosphere of collegiality and mutual respect that fosters active communication between residents and faculty. We will stress the pursuit of excellence in clinical neurology and encourage the development of a deeper interest in the academic aspects of the discipline. We will endeavor to create a level of excitement that will stimulate our residents to seek further education and pursue careers in academic neurology. Our program aims to serve both the present and future requirements of our patients and our discipline. The program consists of 24 months of internal medicine and other clinical rotations; 12 months of clinical and basic neuroscience research including neurophysiology, neurochemistry, neuroradiology, neuro-rehabilitation and neurogenetics; 24 months of clinical neurology including the primary care of inpatients on the neurology ward, the assessment of emergency department, and neurological consultation; and 12 months of residency as a senior neurology resident consultant in inpatient and outpatient settings with responsibility for teaching and supervising junior residents.     

Program Director Survey: Attitudes Regarding Child Neurology Training and Testing

BackgroundAs a result of major clinical and scientific advances and changes in clinical practice, the role of adult neurology training for Child Neurology and Neurodevelopmental Disability (NDD) certification has become controversial. The most recently approved requirements for board eligibility for child neurology and neurodevelopmental disability residents still include 12 months in adult neurology rotations. The objective of this study was to assess United States child neurology and neurodevelopmental disability residency program directors' opinions regarding optimal residency training.MethodsThe authors developed an 18-item questionnaire and contacted all 80 child neurology and neurodevelopmental disability program directors via e-mail, using SurveyMonkey.ResultsA total of 44 program directors responded (55%), representing programs that train 78 categorical and 94 total resident positions, approximately 70% of those filled in the match. Respondents identified multiple areas where child neurology residents need more training, including genetics and neuromuscular disease. A substantial majority (73%) believed child neurology and neurodevelopmental disability residents need less than 12 adult neurology training months; however, most (75%) also believed adult hospital service and man-power needs (55%) and finances (34%) would pose barriers to reducing adult neurology. Most (70%) believed reductions in adult neurology training should be program flexible. A majority believed the written initial certification examination should be modified with more child neurology and fewer basic neuroscience questions. Nearly all (91%) felt the views of child neurology and neurodevelopmental disability program directors are under-represented within the Accreditation Council for Graduate Medical Education Residency Review Committee.ConclusionsThe requirement for 12 adult neurology months for Child Neurology and Neurodevelopmental Disability certification is not consistent with the views of the majority of program directors, who favor more training in subspecialized fields of child neurology.     

The more things change the more they stay the same: a case report of neurology residency experiences

This study compared the neurology residency training experience for a single neurology resident at the University of Pennsylvania from the years 2002-2005. The prevalence of encounters seen during this residency was compared to the prevalence of neurological disorders typically observed by ambulatory neurologists in the United States (US). A total of 1,333 patients were evaluated during this residency. Ischemic stroke/transient ischemic accident, epilepsy, metabolic encephalopathy, peripheral neuropathy, and multiple sclerosis were the most common neurological disorders observed. The four most common reasons for an outpatient visit to a neurologist (i.e., headache/migraine, epilepsy, cerebrovascular disease, and peripheral neuropathy) typically account for approximately 49-55% of all appointments, but only contributed to approximately 40% of patient encounters during this neurology residency. While these results reflect the encounters of a single neurology resident, both the total number and distribution of neurological diagnoses were similar to previous experiences over two decades ago at US academic medical centers despite significant changes in health care delivery and policy. This case report demonstrates that neurology residency programs continue to overemphasize acute management of inpatient neurological disorders compared to outpatient care of more prevalent neurological complaints. Additional measures could be instituted to ensure a broader range of experiences during residency (i.e., online resident log). These methods could allow residency coordinators to identify certain areas of deficiency with regards to exposure to patients for a resident and ensure greater competency during residency.     

Residency training: developing a program of quality and safety to train resident neurologists for the future

Attention to quality and safety metrics is increasingly important for all physicians in practice due to mandates by governmental organizations, insurers, the public, and accreditation bodies. Neurology resident trainees need to acquire these skills, but little research in and outside of neurology provides guidance as to how to teach these important concepts. In the setting of new requirements mandating that training programs address these topics, we propose a number of strategies that can be implemented immediately in neurology residency training programs and call for increased investigation and sharing of best practices in order to adequately prepare neurology residents for the current and future environment of practice.     

Debate: is the neurology residency program of Japan to be standardized?: "Yes"]

Japanese Neurological Association (JNA) should establish the standardized nationwide neurology residency program, and JNA should disclose the minimal requirements of both knowledge and practice for the board of neurology to the public and guarantee the quality of the neurology specialists. Standardization of the residency program will facilitate not only standardization of the knowledge, skill and art of the neurology specialists but also inter-institutional cooperation among the individual teaching hospitals in completing the training programs for the residents. Neurology professionals whose quality is guaranteed by JNA will satisfy the demands of the patients who want excellent neurological services of high quality and safety, and will be favorably accepted by high level hospitals which supply medical services of high quality. Nationwide standardized neurology residency program will thus be welcomed by both residents who aim for the board of neurology and teaching hospitals which accept the residents. It will facilitate to efficiently educate neurology residents for specialists, and will benefit the patients and hospitals. JNA should establish the standardized neurology residency program as soon as possible and go to action to socially and economically improve the condition and treatment of the specialists (for example; approval of doctor's fee by the government).     

Sources and reasons for delays in the care of acute stroke patients

OBJECTIVE: This study aimed to identify sources and reasons for delays in the care of our acute stroke patients. METHODS: Data on time interval from symptom onset or awareness to initial presentation, to neurology assessment, to performance of cranial CT scan, and demographic and medical factors associated with delays among stroke patients admitted at St. Luke's Medical Center from May to October 2000 were obtained by interview and record review. RESULTS: Of 259 patients (mean age 61.5+/-13.6 years, 43% females), 63% had infarction (INF), 32% intracerebral hemorrhage (ICH) and 5% subarachnoid hemorrhage (SAH). Fifty-nine percent presented within 3 h of symptom onset or awareness, 73% within 6 h (median=2 h). Patients with ICH presented earlier than those with infarction. Reasons for delayed consultation included failure to recognize symptoms as serious and stroke-related. A non-neurologist was initially consulted in 97% of cases. Median delay from presentation to neurology evaluation was 7.5 h. Median time from presentation to brain imaging was significantly shorter for patients brought to CT-equipped facilities (2 h) than for those needing transfer to other hospitals (11.5 h). CONCLUSIONS AND RECOMMENDATIONS: Patient delay in presentation is only one cause of delay in acute stroke care. Longer delays arise from healthcare-related factors such as delays in neurologist referral and neuroradiologic diagnosis. Professional and public education on the necessity of early neurologic evaluation and patient transport to CT-equipped "Stroke Centers" is recommended.