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With the exponential growth of literature on coronavirus disease 2019 (COVID-19), we aimed to identify and characterize the 100 most cited COVID-19–related articles in neurology and neurosurgery. In March 2021, we performed a title-specific search of the Scopus database using ("neurology" or "neurologic" or "neurosurgery" or "neurosurgical") and "COVID" as our search query term without date restrictions. The top 100 most cited English-language articles were obtained and reviewed. Our search yielded 9648 articles published from December 2019 to March 2021. Bibliometric analysis of the top 100 articles found that the most cited article had a citation count of 1741 and was the first to report on the detailed neurologic manifestations of the disease; Neurology had the most number of publications; the majority of the primary authors were neurologists, but 35% were from nonneuroscience specialties; the United States, Italy, the United Kingdom, China, and Germany were the top contributors, with a combined total of 77%; most of the publications were correspondence or editorial articles; and most articles discussed the neurologic manifestations and complications of patients with COVID-19. This study identified the top 100 most cited neurologic or neurosurgical COVID-19–related articles published to date. This list can be used to identify high-impact studies that will help health care practitioners in clinical decision making and researchers in navigating key areas of study and guiding future research. [ABSTRACT FROM AUTHOR]

Francis Xavier Dercum (1856-1931) was a renowned clinician, teacher, and scientist. Although he is widely known as a prominent neurologist and remembered for his treatment of then-President Woodrow Wilson, he also had many contributions to the field of medicine. Specific to dermatology, he provided the first observations and descriptions of adiposis dolorosa, which laid the groundwork for further examination and research. He dedicated his life as a scholar to teaching others and furthering the field of medicine. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic enforced an almost complete switch from face-to-face clinical work to tele-neurology. This study explores neurologists' perceptions of telephone and videophone remote consultations.Methods: Semi-structured interviews were conducted with neurologists and a GP with a specialist interest (n = 22). Interviews were conducted remotely via Zoom®, audio-recorded, transcribed verbatim and analysed using the principles of thematic analysis.Results: Four main themes emerged: 'unknown unknowns (risks/uncertainties)', 'better service', 'challenges', and 'beyond the pandemic'. Thematic saturation was achieved by interview 19. Participants highlighted a number of benefits of remote consultations but over 80% also complained of a reduction in work satisfaction.Conclusion: The sudden introduction of tele-neurology is unlikely to be fully reversed when pandemic-related restrictions have been lifted. However, this study confirms tele-neurology cannot completely replace face-to-face consultations. Some patient groups and consultation types require direct contact. Moreover, significant administrative and infrastructural investment will be required to develop the full potential of tele-neurology.Practice Implications: Tele-medicine is capable of improving access and efficiency of specialist neurology services, but limited by lack of non-verbal communication and technical problems. It could enhance service provision with sufficient infrastructural and administrative investment, but may reduce neurologists' job statisfaction. [ABSTRACT FROM AUTHOR]

Dr. Lester Baker adopted my family during my internship at Children's Hospital of Philadelphia (CHOP), and with a firm hand he helped me to accept my limitations in the laboratory and guided me to a more fitting clinical academic career. The final mentor of my early career arrived later that year when Dr. Peter Berman, the Chief of Neurology, called me into his office. Caring for patients extends beyond the chief complaint The role of the child neurologist is more than counting seizures or addressing tic severity. [Extracted from the article]

The advent of targeted therapies has changed SMA's natural history. However, despite the emergence of new phenotypes, gastrointestinal symptoms (GIs) remain common in SMA patients. This study was conducted to evaluate the current medical approach and remaining unmet needs regarding this topic in France. In a second stage, we intend to develop national guidelines to ensure systematic follow-up to prevent GI complications. This observational study collected data from SMA healthcare professionals (child and adult neurologists and paedatricians) through an online questionnaire sent via the French neuromuscular network (FILNEMUS). It included short questions concerning the observed GIs, nutritional and metabolic complications, ancillary tests and global management. Especially, it was evaluated if the symptom was systematically sought out by the physician, or if only taken care of if advertised by the patients or their caregivers. Thirty-two medical doctors from Neuromuscular Reference Centers (FILNEMUS network) answered the questionnaire (59% of the French paediatric NM centers). The most common reported GIs were constipation and chewing difficulties. Concerning clinical practices, most of the specialists declared to systematically investigate swallowing (97%) and chewing disorders (87%), as well as gastric or abdominal complications. Interestingly, frequent symptoms as excessive burping, nausea, diarrhoea, and regurgitation were not regularly researched or explored by healthcare professionals, but in response to a complaint. This questionnaire has also shown that although the symptoms were surveyed, their follow-up was not systematically explored, in particular the limitation of mouth opening (danger of difficult intubation), the presence of abdominal bloating, and/or faecal incontinence. Preliminary results confirm the need for consensus on standards of care and systematic GI, nutritional and endocrine-metabolic surveillance in patients with SMA. Systematically evaluating and treating such symptoms could indeed ameliorate the patients' quality of life and potentially reduce the caregivers' burden. To improve the current situation and to ensure a proper clinical care for SMA patients, our study group will create a short questionnaire, easy to administer during multidisciplinary follow-up. Updated data will be provided at the congress. [ABSTRACT FROM AUTHOR]

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions. [ABSTRACT FROM AUTHOR]

Background The increasing stroke burden in sub-Saharan Africa far outstrips the availability of skilled human resource to provide timely and efficient acute, rehabilitative and preventive services. The objective of this study was to examine the impact of a short-term task-shifting stroke training program on the stroke knowledge of a cohort of Nigerian non-neurologist health workers (NNHWs). Methods Utilizing a quasi-experimental design, NNHWs drawn from 53 local government areas of Ogun and Oyo states participated in an intensive, multicomponent one-day stroke workshop. Stroke knowledge was evaluated before and after the training using a self-administered questionnaire. Results Out of a total of 210 NNHWs who participated in the session, 116 (55.2%) completed the pre-workshop questionnaire survey of stroke knowledge while 191 (91.0%) completed the post-workshop questionnaire survey. There were no statistically significant differences in the distribution of the age, gender and professional categories of the two groups. The participants' knowledge was significantly increased at the end of the training about stroke risk factors (p < 0.001), stroke symptoms (p < 0.001) and how stroke develops (p = 0.009). The proportion of respondents who understood the FAST mnemonic increased from 10.3% before the training to 90.6% at the end of the training (p < 0.001). The professional category of participants was associated with knowledge gain about swallowing test and thrombolysis. Conclusion Our data support the effectiveness of stroke-specific task-shifting training for non-neurologist health workers in a low resource setting. Interim studies with intermediate outcomes are needed to show that improved knowledge results in better care despite resource limitation. Randomized controlled trials will be useful to confirm findings and translate knowledge improvement into practical intervention. [ABSTRACT FROM AUTHOR]

Introduction: Results from a multi-factorial global survey regarding the awareness of, need for, and availability of Intraoperative Neurophysiological monitoring in a cross-section of populations and socio-economic conditions will be presented. A statistical analysis of the responses will be given. Conclusions from these data will be discussed. Intraoperative Neuromonitoring (IOM) is a proven technology for reducing iatrogenic sequelae and improving patient outcomes. Unfortunately, its availability is not universal, leaving many populations without access to this beneficial service. In order to target IOM resources most efficiently, thereby maximizing its availability to under-served patients, an understanding of the current state of IOM delivery in the global market is necessary. To establish a representative "cross-section" of respondents, we surveyed 12 countries across North and South America, Africa, Europe, and Asia. Respondents included surgeons, neurologists and clinical neurophysiologists. Of primary interest in the Survey was the demand for IOM, and the availability of trained Neurophysiology clinicians to meet that demand. Other critical factors examined included surgeon awareness of IOM, non-standardized delivery models, the relative paucity of education curricula or training resources for the IOM clinician, real-time physician oversight for the interpretation of the IOM data, and budgetary constraints related to reimbursement and capital equipment purchases. We are able to draw several conclusions from this survey. Demand for IOM far exceeds the available trained clinical staff, particularly in emerging economic regions. Increasing surgeon advocacy through awareness and education will drive improved opportunities to deliver this critical patient care. [ABSTRACT FROM AUTHOR]

Abstract: Falls in Parkinson's disease (PD) are common and frequently devastating. Falls prevention is an urgent priority, but there is no accepted program that specifically addresses the risk profile in PD. Therefore, we aimed to provide consensus-based clinical practice recommendations that systematically address potential fall risk factors in PD. We developed an overview of both generic (age-related) and PD-specific factors. For each factor, we specified: best method of ascertainment; disciplines that should be involved in assessment and treatment; and which interventions could be engaged. Using a web-based tool, we asked 27 clinically active professionals from multiple relevant disciplines to evaluate this overview. The revised version was subsequently reviewed by 12 experts. Risk factors and their associated interventions were included in the final set of recommendations when at least 66% of reviewing experts agreed. These recommendations included 31 risk factors. Nearly all required a multidisciplinary team approach, usually involving a neurologist and PD-nurse specialist. Finally, the expert panel proposed to first identify the specific fall type and to tailor screening and treatment accordingly. A routine evaluation of all risk factors remains reserved for high-risk patients without prior falls, or for patients with seemingly unexplained falls. In conclusion, this project produced a set of consensus-based clinical practice recommendations for the examination and management of falls in PD. These may be used in two ways: for pragmatic use in current clinical practice, pending further evidence; and as the active intervention in clinical trials, aiming to evaluate the effectiveness and cost-effectiveness of large scale implementation. [Copyright &y& Elsevier]

The majority of neurological disorders exist in low- and middle-income countries, but these nations have the fewest neurologists and neurological training opportunities worldwide. The objective of this study was to assess the effectiveness, relevance, and feasibility of a five-day neurocritical care course delivered online to African healthcare workers and to understand participants' prior neurological and neurocritical care training experiences. We offered the Neurocritical Care Society's Emergency Neurological Life Support (ENLS) course covering 14 neurocritical conditions via Zoom to 403 African healthcare workers over a 4-day period. An additional day was devoted to management of neurological emergencies in resource-limited settings. Participants completed pre- and post-course surveys to assess the effectiveness, relevance, and feasibility of the overall course to their settings. 318 participants (46% female; 56% residents; 24% neurologists; 9.0 ± 6.7 years practicing medicine) from 11 African countries completed the pre-course self-assessment, and 232 completed the post-course self-assessment. 97% reported prior experience caring for patients with neurological emergencies but only 35% reported prior neurology training and 9% prior neurocritical care training. Pre-course and post-course comfort levels showed statistically significant improvements (p < 0.001) across all fourteen neurocritical topics. 95% of participants found the course relevant to their current practice setting, 94% agreed the Zoom online platform was easy to use, and 93% reported it facilitated their learning. Suggestions for course improvement included addition of non-critical neurological conditions and inclusion of locally available diagnostics and treatment modalities. Study results suggest virtual platforms may offer a way to improve neurology training in areas with reduced neurological workforce. • A virtual neurocritical care course for African healthcare workers was effective. • Course could be improved by including locally available diagnostics and treatment. • Most participants regularly cared for patients with neurological emergencies. • Few participants had formal training in neurology or neurocritical care. • Virtual platforms could improve training in areas with few neurologists. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To check whether the use of an autoquestionnaire is adapted to obtain information about perceptions of multiple sclerosis (MS) patients concerning access to healthcare in the Pays de la Loire region of France. Patients and methods: Patients with MS were asked to complete a questionnaire concerning access to 31 healthcare professionals or social services. The questionnaires were anonymous and consisted of one page for the patient and one page for a member of his or her entourage. The questionnaires were returned in a prepaid stamped addressed envelope. The first 130 exploitable questionnaires were analysed. Results: Over 50% of patients with MS found access to general practitioners, neurologists, nurses and pharmacists useful, as well as access to less MS-specific specialists, for example, dentists, ophthalmologists or gynaecologists. Physical medicine and rehabilitation practitioners were not required until later in the course of the disease. Patients and their entourage rated the importance of access to care differently for bladder and sexual problems, and for support for cognitive and psychological problems. Conclusion: This study validates the use of a questionnaire to obtain information about patient perceptions of access to healthcare. The study also suggests a hierarchy of care needs, insufficient patient information, and disparities in access to care related to where the patients live. [Copyright &y& Elsevier]

Abstract: Alefacept is the first biologic agent approved by the US Food and Drug Administration for the treatment of psoriasis. To date, more than 1000 patients with moderate to severe psoriasis have been enrolled in phase III clinical trials of alefacept. More than 30% of patients treated with 2 courses of alefacept reached a Physician''s Global Assessment of clear to almost clear, and approximately 40% and 70% of patients achieved a Psoriasis Area Severity Index score of 75 and 50 after the same regimen. Alefacept is well tolerated, and there have been no reports of significant systemic toxicity or serious treatment-related adverse events. [Copyright &y& Elsevier]

Abstract: What leadership roles can transnational medical professional societies play in addressing the life long learning needs of health professionals in emerging world? The World Federation of Neurology (WFN) provides neurological education programme in countries with unmet neurological training needs, in an effort to improve the knowledge and skills of neurologists. The WFN''s experience provides a unique study to exemplify how global stakeholders collaborate with each other to deliver CME and to improve the quality of health care services. A multi-stage programme evaluation was undertaken to explore the WFN CME, in an effort to: a) understand how global CME programmes are organized, and b) understand the success factors and the challenges of delivering global CME. The programme evaluation was conducted between June 2005 and March 2006. The preliminary results were shared with the WFN education committee and national coordinators and international experts to check and confirm the findings from the study. The study results reveal that global CME programmes could be designed effectively with minimum costs. These programmes contribute to meeting the continued learning needs of neurologists in resource poor settings. Further, the WFN initiative provides, some initial evidence that these programs can contribute to systems level improvements. [Copyright &y& Elsevier]

In a multi-speciality rehabilitation centre, where child neuropsychiatrists, neurologists, physical rehabilitators, psychologists, nurses, therapists and other health care professionals actively care for patients, the moment will arrive when information security takes high priority on the chief medical officer (CMO) agenda. This has happened at the La Nostra Famiglia Institution. Local push to high priority arose from several concurrent forces, like privacy both on the patient and on the doctor side, legal and ethical aspects. Recommendations on the protection of medical data require appropriate technical and organisational measures to be taken to protect personal data against unauthorised access, alterations or any other form of inappropriate processing. In the same time quick and easy access to patient information should be granted to authorised personnel to ensure proper and in time treatment of patients. A long lasting sequence of co-operative negotiation meetings between the CMO and the chief information officer (CIO) led to appropriate outline of policies. We developed a suitable and modular architecture for designing systems that can simultaneously manage an increasing number of healthcare actors, objects and related access levels taking into account temporal conditions. Actions for keeping the prototype in use on an everyday basis are directly taken by the CMO. [Copyright &y& Elsevier]

Aim: To investigate how neurologists perceive the value of the radiology report and to analyse the relation with the neurologists own expertise in radiology and the level of subspecialisation of radiologists.Materials and Methods: A web-based survey was distributed to neurologists. The level of subspecialisation was assessed by the percentage of fellowship-trained radiologists and the percentage of radiologists that were members of the Dutch Society of Neuroradiology.Results: Most neurologists interpret all computed tomography (CT) and magnetic resonance imaging (MRI) studies themselves, and their self-confidence in making correct interpretations is high. Residents gave higher scores than neurologists for "Radiologist report answers the question" (p=0.039) and for "Radiologist reports give helpful advice" (p=0.001). Neurologists from university hospitals stated more frequently that the report answered their questions than neurologists from general hospitals (p=0.008). The general appreciation for radiology reports was higher for neurologists from university hospitals than from general hospitals (8.2 versus 7.2; p=0.003). Radiologists at university hospitals have a higher level of subspecialisation than those at general hospitals.Conclusion: Subspecialisation of radiologists leads to higher quality of radiology reporting as perceived by neurologists. Because of their expertise in radiology, neurologists are valuable sources of feedback for radiologists. Paying attention to the clinical questions and giving advice tailored to the needs of the referring physicians are opportunities to improve radiology reporting. [ABSTRACT FROM AUTHOR]