Referral management: Which patients are deemed not appropriate for neurologic consultation, and what happens to them?

Objective: In many if not most institutions in the US, demand for neurology services exceeds the supply, resulting in poor access. This study examines whether the use of a limited resource - time for outpatient neurology consultation - can be optimized by screening referrals for appropriateness and whether it is safe to do so.

Patients And Methods: An established triage activity at an academic outpatient clinic - experienced nurses flagging possibly inappropriate outpatient referrals and a group of neurologists triaging them - was examined by obtaining referral characteristics and detailed one year follow up for patients that were referred but not scheduled, over a period of 6 months.

Do Headache Patients Require More Care in Between Visits Than Other Neurology Outpatients?

Background: There is evidence that time spent in patient care in between patient visits is increasing and a contributor to physician burnout. The extent of this work on providers in the field of headache medicine is unknown.

Objectives: To establish whether headache outpatients require a high level of care in addition to clinic visits, based on the quantity of remote encounters per patient (phone calls and secure email communication to the clinics), in comparison to other neurologic clinics.

Hemicrania continua in carotid artery dissection - symptomatic cases or linked pathophysiology?

Background Hemicrania continua (HC) -like headaches have been rarely reported as symptomatic headaches, including cases secondary to cervical artery dissection. Case series We present five cases of HC-like headaches following cervical artery dissection, in three cases with specific indomethacin response. In two cases, comorbidity of fibromuscular dysplasia (FMD) was noted.

Are neurology residents in the United States being taught defensive medicine?

Objective: To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes.

Methods: Neurology residents in the US (n=25) and, as a control group, Neurology residents training in Germany (n=42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.

Middle ear fluid Streptococcus pneumoniae serotype distribution in Costa Rican children with otitis media.

Background: Streptococcus pneumoniae conjugate vaccine became available in Costa Rica in 2004. Previous S. pneumoniae middle ear fluid (MEF) data obtained during the period 1999-2001 from Costa Rican children indicated that serotype 19F was the most common type (75%), but more recently other serotypes have become more prevalent.

In vitro activities of levofloxacin and comparable agents against middle ear fluid, nasopharyngeal, and oropharyngeal pathogens obtained from Costa Rican children with recurrent otitis media or failing other antibiotic therapy.

This study analyzes the in vitro activities of levofloxacin and other commonly used antimicrobials against middle ear fluid, nasopharyngeal, and oropharyngeal pathogens obtained from children with otitis media at risk of having a resistant pathogen. Levofloxacin proved to be very active against these pathogens and had intermediate activity against Streptococcus pyogenes.

Introducing new technology: handheld computers and drug databases. A comparison between two residency programs.

There have been numerous efforts to introduce and increase the use of handheld computers, also called personal digital assistants (PDA), in health care, one of which is the distribution of PDAs to Neurology residents at the University of Illinois at Chicago. The authors examined the success of this intervention by comparing PDA use and user attitudes between residents of the intervention group and residents in another residency program where the use of PDAs is neither encouraged nor discouraged. The authors examined in particular the use of drug databases on the PDA as its currently most popular application in health care.

Clinical and neuroradiologic features of 39 consecutive cases of West Nile Virus meningoencephalitis.

Background: West Nile Virus (WNV) is a flavivirus WNV that has spread westwards across North America in recent years. It can cause a febrile illness and infection of the central nervous system, which is associated with poor outcome.

Methods: We retrospectively studied the clinical and neuroradiologic features of 39 consecutive patients admitted during summer of 2002 that had IgM in the cerebrospinal fluid positive for WNV.

Prostaglandin analog mechanisms are not effective in refractory chronic cluster headache.

Prostaglandin E analogs have been shown to be effective in the treatment of refractory trigeminal neuralgia in patients with multiple sclerosis. Prostaglandin E inhibits the functions of T lymphocytes which are involved in the pathophysiology of cluster headache. Therefore, a double-blind, placebo-controlled, crossover study on the efficacy of misoprostol in chronic refractory cluster headache was performed.

The impact of HIV infection on primary headache. Unexpected findings from retrospective, cross-sectional, and prospective analyses.

Headache is one of the most important factors influencing the quality of life in patients infected with the human immunodeficiency virus type 1 (HIV). However, only symptomatic headache but not changes or primary headache types during HIV infection have been studied to date. Therefore, we aimed to determine the impact of an HIV infection on frequency and semiology of different primary headache types.

Cerebral vasculopathy in HIV infection revealed by transcranial Doppler: A pilot study.

Background And Purpose: There is growing evidence for affection of cerebral vessels during human immunodeficiency virus (HIV) infection. We prospectively evaluated cerebrovascular reserve capacity (CRC) in HIV-seropositive patients by transcranial Doppler sonography (TCD) after systemic administration of acetazolamide. We hypothesized that a disturbed vasoreactivity would reflect the cerebral arteries' involvement in HIV infection.

Cluster headache after orbital exenteration.

A 37-year-old man developed an ipsilateral headache which fulfilled the criteria for cluster headache after orbital extenteration because of a traumatic lesion of the bulb. The headache could be treated successfully by drugs usually applied in the therapy of cluster headache. Six similar cases of cluster headache after orbital exenteration could be identified in the literature suggesting that the eye itself is not necessarily part of the pathogenesis of cluster headache.