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Management of optic neuritis in Canada: survey of ophthalmologists and neurologists.

https://arctichealth.org/en/permalink/ahliterature156525
Source
Can J Neurol Sci. 2008 May;35(2):179-84
Publication Type
Article
Date
May-2008
Author
Edward J Atkins
Carolyn D Drews-Botsch
Nancy J Newman
Olivier Calvetti
Seegar Swanson
Valérie Biousse
Author Affiliation
Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada.
Source
Can J Neurol Sci. 2008 May;35(2):179-84
Date
May-2008
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health Surveys
Humans
Neurology - methods - statistics & numerical data
Ophthalmology - methods - statistics & numerical data
Optic Neuritis - diagnosis - epidemiology - therapy
Physician's Practice Patterns - statistics & numerical data
Abstract
Acute isolated optic neuritis is often the first manifestation of multiple sclerosis (MS), and its management remains controversial. Over the past decade, with the advent of new disease-modifying agents, management of isolated optic neuritis has become more complicated.
To evaluate the current practice patterns of Canadian ophthalmologists and neurologists in the management of acute optic neuritis, and to evaluate the impact of recently published randomized clinical trials.
Mail survey.
All practicing ophthalmologists and neurologists in Canada were mailed a survey evaluating the management of isolated acute optic neuritis and familiarity with recent clinical trials. Surveys for 1158 were mailed, and completed surveys were collected anonymously through a datafax system. Second and third mailings were sent to non-respondents 6 and 12 weeks later.
The final response rate was 34.5%. Although many acute optic neuritis patients initially present to ophthalmologists, neurologists are the physicians primarily managing these patients. Ordering magnetic resonance imaging, and treating with high dose intravenous steroids has become the standard of care. However, 15% of physicians (14% of ophthalmologists and 16% of neurologists) continue to prescribe low dose oral steroids, and steroids are being given for reasons other than to shorten the duration of visual symptoms by 73% of ophthalmologists and 50% of neurologists. More neurologists than ophthalmologists are familiar with recent clinical trials involving disease-modifying agents.
Although the management of acute optic neuritis has been evaluated in large clinical trials that were published in major international journals, some ophthalmologists and neurologists are not following evidence-based recommendations.
Notes
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PubMed ID
18574931 View in PubMed
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Management of optic neuritis and impact of clinical trials: an international survey.

https://arctichealth.org/en/permalink/ahliterature91617
Source
J Neurol Sci. 2009 Jan 15;276(1-2):69-74
Publication Type
Article
Date
Jan-15-2009
Author
Biousse Valérie
Calvetti Olivier
Drews-Botsch Carolyn D
Atkins Edward J
Sathornsumetee Busaba
Newman Nancy J
Author Affiliation
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA. vbiouss@emory.edu
Source
J Neurol Sci. 2009 Jan 15;276(1-2):69-74
Date
Jan-15-2009
Language
English
Publication Type
Article
Keywords
Clinical Trials as Topic
Female
Health Surveys
Humans
International Cooperation
Magnetic Resonance Imaging
Male
Neurology - methods - statistics & numerical data
Ophthalmology - methods - statistics & numerical data
Optic Neuritis - diagnosis - therapy
Outcome Assessment (Health Care)
Questionnaires
Abstract
OBJECTIVE: 1) To evaluate the management of acute isolated optic neuritis (ON) by ophthalmologists and neurologists; 2) to evaluate the impact of clinical trials; 3) to compare these practices among 7 countries. METHODS: A survey on diagnosis and treatment of acute isolated ON was sent to 5,443 neurologists and 6,099 ophthalmologists in the southeast-USA, Canada, Australia/New Zealand, Denmark, France, and Thailand. USA data were compared to those of other countries. RESULTS: We collected 3,142 surveys (1,449 neurologists/1,693 ophthalmologists) (29.8% response rate). In all countries, ON patients more frequently presented to ophthalmologists, and were subsequently referred to neurologists or subspecialists. Evaluation and management of ON varied among countries, mostly because of variations in healthcare systems, imaging access, and local guidelines. A brain MRI was obtained for 70-80% of ON patients; lumbar punctures were obtained mostly in Europe and Thailand. Although most patients received acute treatment with intravenous steroids, between 14% and 65% of neurologists and ophthalmologists still recommended oral prednisone (1 mg/kg/day) for the treatment of acute isolated ON. In all countries, steroids were often prescribed to improve visual outcome or to decrease the long-term risk of multiple sclerosis. INTERPRETATION: Although recent clinical trials have changed the management of acute ON around the world, many neurologists and ophthalmologists do not evaluate and treat acute ON patients according to the best evidence from clinical research. This confirms that evaluation of the impact of major clinical trials ("translational T2 clinical research") is essential when assessing the effects of interventions designed to improve quality of care.
PubMed ID
18926549 View in PubMed
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100 years after Alzheimer: contemporary neurology practice assessment of referrals for dementia.

https://arctichealth.org/en/permalink/ahliterature153508
Source
Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):516-27
Publication Type
Article
Author
Tiffany W Chow
Carin Binder
Steven Smyth
Sharon Cohen
Alain Robillard
Author Affiliation
Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Source
Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):516-27
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Dementia - diagnosis - psychology - therapy
Humans
Neurology - methods - statistics & numerical data
Physician's Practice Patterns
Practice Guidelines as Topic
Primary Health Care - methods - statistics & numerical data
Psychiatric Status Rating Scales - statistics & numerical data
Questionnaires
Referral and Consultation - standards - statistics & numerical data
Abstract
The prevalence of dementia is placing an increased burden on specialists.
Canadian neurologists responded to a structured questionnaire to assess reasons for referral and services provided as well as to compare the neurologists' perceptions of their practice characteristics against cases seen over a 3-month period.
The audit confirmed the participants' perception that family practitioners are the main referral source (358/453, 79%). Sixty-two percent of patients had undergone clinical investigation for dementia prior to being seen by the neurologist; 39% (177/453) were on pharmacotherapy at the time of referral, 68% were initiated on pharmacotherapy by the neurologist. A fifth of the referrals did not meet clinical criteria for dementia, which may be directly related to the prevalence of prior workup that did not include mental status testing.
Neurologists currently treat patients referred for dementia who may already have been adequately evaluated and treated by primary care providers.
Notes
Comment In: Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):513-519222144
PubMed ID
19106275 View in PubMed
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Outpatient practice patterns after stroke hospitalization among neurologists.

https://arctichealth.org/en/permalink/ahliterature157895
Source
Stroke. 2008 Jun;39(6):1850-4
Publication Type
Article
Date
Jun-2008
Author
Bruce Ovbiagele
Oksana Drogan
Walter J Koroshetz
Pierre Fayad
Jeffrey L Saver
Author Affiliation
Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
Source
Stroke. 2008 Jun;39(6):1850-4
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Ambulatory Care - statistics & numerical data - trends
Canada
Cardiovascular Diseases - diagnosis - prevention & control - therapy
Counseling - statistics & numerical data - trends
Data Collection
Hospitalization - statistics & numerical data - trends
Humans
Neurology - methods - statistics & numerical data - trends
Outpatients - statistics & numerical data
Patient compliance
Physician's Practice Patterns - statistics & numerical data - trends
Physician-Patient Relations
Risk Reduction Behavior
Stroke - nursing - prevention & control - therapy
United States
Abstract
Care after stroke hospitalization can provide several opportunities to optimize vascular risk reduction. However, not much is known about poststroke practice patterns among neurologists. Such knowledge may help direct specific efforts to improve the impact of practicing neurologists on clinical outcomes after stroke.
A survey soliciting information on processes of care in the outpatient setting after recent hospitalization for ischemic stroke or transient ischemic attack was mailed to a random sample of 833 US and Canadian neurologist-members of the American Academy of Neurology.
A total of 475 (57%) responses were received. Practice demographics of survey responders and nonresponders were largely similar. Fourteen percent of respondents identified themselves as vascular neurologists. Overall, respondents reported frequently checking for medication adherence and counseling patients on lifestyle modification. However, neurologists reported screening more frequently for diabetes, hypertension, and dyslipidemia than actually treating these conditions (all P
PubMed ID
18388342 View in PubMed
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