Evidence-Based Neurology (eBook)

Management of Neurological Disorders

Bart Demaerschalk, Dean Wingerchuk (Herausgeber)

eBook Download: EPUB

2015 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-119-06733-7 (ISBN)

Infos

From an expert editor team drawn from the Cochrane Neurological Network, Evidence-Based Neurology provides specialists and those in training with the skills and knowledge to apply evidence-based practice in the clinical setting,

• fills the gap between guidelines and primary studies as well as between primary and secondary scientific medical literature
• summarizes the most recent and important findings on treatments for neurological patients
• measures the benefit and, when applicable, the risk of harm inherent in specific neurological interventions
• now includes new non-clinical topics of interest to neurologists such as education and research

Bart M, Demaerschalk, MD, MSc, FRCP(C), Professor of Neurology, Department of Neurology, Mayo Clinic, College of Medicine, Phoenix, AZ, USA

Dean M, Wingerchuk, MD, MSc, FRCP(C), Professor of Neurology, Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA

Inhalt

Contributors vii

Part 1 Evidence-based neurology: introduction

1 Evidence-based neurology in health education 3
Lawrence Korngut, Miguel Bussière and Bart M. Demaerschalk

2 Evidence-based medicine in health research 9
Dean M. Wingerchuk

3 Evidence and ethics 13
Joseph L. Verheijde

Part 2 Evidence-based neurology in the hospital

4 Thunderclap headache 23
Jonathan H. Smith and Todd J. Schwedt

5 Coma 33
Bappaditya Ray and Salah G. Keyrouz

6 Acute ischemic stroke and transient ischemic attack 53
Maria I. Aguilar

7 Spinal cord compression 67
Naresh P. Patel, Christopher A. Payne and Bhavesh M. Patel

8 Delirium 75
William D. Freeman

9 Status epilepticus 81
Kameshwar Prasad, Manya Prasad, Sridharan Ramaratnam and Anthony G. Marson

10 Raised intracranial pressure 87
William David Freeman

11 Traumatic brain injury 93
Miguel Arango, Walter Videtta and Corina Puppo

12 Myasthenia gravis 107
Brent P. Goodman

13 Acute visual loss 113
Byron Roderick Spencer

14 Secondary prevention of stroke 119
Gord Gubitz

Part 3 Evidence-based neurology in the clinic

15 Central nervous system infections 131
Gloria von Geldern and Avindra Nath

16 Evidence-based neuro-oncology 143
Michael G. Hart and Robin Grant

17 Epilepsy 153
Sridharan Ramaratnam and Anthony G. Marson

18 Cognitive disorders: mild cognitive impairment and Alzheimer's disease 173
Charlene H. Snyder, Bryan K. Woodruff and Richard J. Caselli

19 Evidence-based treatment of Parkinson's disease 191
Nicholas D. Child and Bryan T. Klassen

20 Therapies for multiple sclerosis 209
Greg Thaera and Dean M. Wingerchuk

21 Amyotrophic lateral sclerosis 219
Cumara B. O'Carroll, Amelia K. Adcock and Bart M. Demaerschalk

22 Peripheral nerve disorders 235
Jennifer A. Tracy and P. James B. Dyck

23 Critical illness neuromyopathy 243
Brent P. Goodman and Andrea J. Boon

24 Muscle disorders 249
Amelia K. Adcock, Cumara B. O'Carroll and Bart M. Demaerschalk

25 Sleep disorders 257
Joyce K. Lee-Iannotti

26 Acute migraine attacks 267
E. Anne MacGregor, Rashmi B. Halker and Bert B. Vargas

27 Therapy of vestibular disorders nystagmus and cerebellar ataxia 279
Michael Strupp and Thomas Brandt

28 Neuro-ophthalmology 291
Martin Sutton-Brown and Jason J. S. Barton

29 Therapeutic connection in neurorehabilitation: theory evidence and practice 303
Nicola M. Kayes, Kathryn M. McPherson and Paula Kersten

Part 4 Telemedicine feature

30 Evidence-based teleneurology practice 321
William D. Freeman, Kevin M. Barrett, Kenneth A Vatz and Bart M. Demaerschalk

Index 325

Textauszug

Chapter 1
Evidence-based neurology in health education

Lawrence Korngut1, Miguel Bussière2 and Bart M. Demaerschalk3

1Calgary ALS and Motor Neuron Disease Clinic, Clinical Neurosciences, South Health Campus, Calgary, AB, Canada

2Neurology and Interventional Neuroradiology, Division of Neurology, Grey Nuns Hospital, Edmonton, AB, Canada

3Department of Neurology, Mayo Clinic, Phoenix, AZ, USA

Introduction

Clinical neurology trainees undergo a lengthy and complex process requiring integration of many fundamental skills that coalesce into sound diagnosis and decision making. Beyond the core knowledge of anatomy, physiology, biochemistry, pathology, and the medical sciences, there is an essential requirement for the clinical student, in the arena of evidence-based clinical practice, to acquire skills and expertise in the principles and practice of critical appraisal and to have a working knowledge of the best evidence from the diverse multiple subspecialties that comprise neurology today. Maintaining competence in the current best evidence over a neurologist's career is essential to making accurate diagnoses, providing high-quality neurological care, and selecting appropriate tests and therapies.

Developing the skills necessary for critical appraisal is a difficult process, particularly when competing with the rigorous demands of a residency training program. An evidence-based curriculum in neurology education provides the opportunity for teaching the fundamentals of critical appraisal and engaging in discussion of current clinical questions, hot topics, and continued controversies. Fostering an understanding of what comprises an appropriately comprehensive rigorous literature search, the levels of evidence, the different types of studies, and the methodologies are difficult to consolidate outside of a formalized curriculum or graduate-level training in evidence-based medicine, health research methodology, and clinical epidemiology.

In this chapter, we discuss the development of an evidence-based neurology (EBN) curriculum in health education.

Objectives

Teaching and acquisition of critical appraisal skills is the primary objective of an evidence-based clinical practice curriculum. Fundamental critical appraisal skills include the following: awareness of a clinical knowledge gap, formulation of answerable questions based on clinical uncertainty, performance of a literature search, identification of the highest quality evidence from the search yield, and critical appraisal of the studies to address the original clinical question. Students should become familiar with the different classifications of clinical studies (e.g. prognosis, diagnosis, therapy or harm) and the main methodological and statistical questions that must be addressed in each type of study. The students should also be able to determine whether or not the study findings are worth considering given the methodological quality of the study and its generalizability in reference to the patient population in question.

Students should develop an understanding of both the importance and the limitations of clinical evidence. Emphasis should remain on high-quality patient care and the use of the current best evidence to guide clinical practice within the context of the patient's wishes and the clinician's judgment and reasoning. It must be emphasized that lack of evidence for efficacy does not necessarily mean lack of benefit with treatment, and vice versa for lack of evidence against certain therapies or diagnostic tests.

As a result of the evidence-based medicine, curriculum knowledge about best current evidence practices is accumulated and stored for future use. Owing to the discussion of common clinical scenarios and review of the relevant best evidence, the students develop a working knowledge of the current evidence (Table 1.1).

Table 1.1 Objectives of evidence-based neurology curriculum

Students of neurology should develop critical appraisal skills to formulate answerable questions based on clinical uncertainty perform an appropriate literature search identify the best quality evidence from the studies identified critically appraise the identified studies to answer the original clinical question be familiar with prognostic, diagnostic, and therapeutic clinical studies and the key methodological and statistical questions that should be addressed in each type of study determine whether the study findings are valid and useful, considering the methodological quality of the study and the applicability to a particular patient population Students of neurology should develop a working understanding of the importance of high-quality evidence and also realize its limitations Students should accumulate knowledge about best current evidence practices in neurology

The following sections describe an example of an EBN curriculum based on two longstanding, mature, and successful programs targeting clinical neurology residents: the EBN curriculum from the Western University (WU) in London, Canada [1–4]; and the Mayo Clinic Evidence-Based Clinical Practice, Research, Informatics, and Training (MERIT) Curriculum, Mayo Clinic, Phoenix, AZ [5, 6]. Another third valuable resource designed to help educators teach students of neurology to understand and use evidence-based medicine is the web-based American Academy of Neurology (AAN) Evidence-Based Medicine Curriculum [7].

Topic selection

Generating the clinical questions

Once annually EBN curriculum facilitators survey all neurology students and faculty members to generate a list of neurological questions for potential review. These clinical questions are then rank ordered by the trainees and facilitators according to multiple factors including clinical importance, relevance, frequency of occurrence, and interest. The most highly ranked questions are reviewed in the upcoming year. The topics are screened to ensure that they are congruent with the educational recommendations of the training program (post-graduate education committee): Royal College of Physicians and Surgeons of Canada Advisory Committee and/or Accreditation Council for Graduate Medical Education – Neurology Residency and American Board of Psychiatry and Neurology [1–6].

Preparing for the tutorial session

Students each select one or two clinical questions per academic year and prepare their critically appraised topic for general discussion with the group. For each clinical topic, a clinical scenario and a focused clinical question are formulated. A focused clinical question should include considerations of the specific patient group, the intervention or exposure, the method of comparison, and the outcome measures. The acronym PICO can serve as a helpful reminder [8] (Table 1.2).

Table 1.2 PICO acronym [8]

Patient or population

Intervention, prognostic factor or exposure

Comparison intervention

Outcome to measure or achieve

For a given clinical question, the presenting trainee performs a literature search and identifies studies representing the highest level of evidence [9]. Expert librarians and informatics specialists can be called upon to assist in efficient and comprehensive literature searching. Studies are evaluated according to the generally accepted hierarchy of clinical evidence. High-quality meta-analyses, systematic reviews, and randomized clinic trials are preferred over observational studies and case reports. One to four studies are selected for critical appraisal and discussion. A summary of this information is prepared in advance of the discussion in the form of a critically appraised topic (CAT) as described later. One week prior to the session, the presenting trainee circulates copies of the clinical scenario, focusing clinical question, search strategy, and articles for review to the participants. The pre-tutorial process is supervised by one of the facilitators. The faculty often provides instruction and advice on the search strategy and reasons for inclusion or exclusion of studies. Trainees are introduced to different search engines (e.g. PubMed [10], SUMSearch [11], Cochrane Library [12]). Discussions on Medical Subject Headings (MeSH headings), keywords, and their uses are helpful.

Flexibility is available to adjust the clinical topics to suit the needs and training level of the trainees. Semi-annual meetings of the curriculum trainees and facilitators allow for appropriate curriculum content changes and adjustment of group discussion objectives to cover specific epidemiological or biostatistical topics.

Tutorial

Each tutorial session focuses on a trainee presenting one clinical question. The session begins with a 5-min description of the clinical scenario and focused clinical question. This is followed by a 10-min presentation of the background topic including clinical information about the condition, treatment, or diagnostic test. The trainee then presents and discusses the search strategy for 5 min.

The following 45 min is dedicated to critical appraisal of the evidence.

The study type is identified (e.g. prognosis, diagnosis, therapy, or harm), and the appropriate rating scale or worksheet is utilized to assist the presenting trainee and faculty members guide the group through the...

Produkt-Details

• Erscheint lt. Verlag: 8.9.2015
• Reihe/Serie: Evidence-Based Medicine
• Reihe/Serie: Evidence-Based Medicine
• Reihe/Serie: Evidence-Based Medicine
• Mitarbeit: Berater: Livia Candelise
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Schlagworte: Cochrane Neurological NetworkEvidence-Based NeurologyClinical Evidence-based medicineNeurologyMethodologyNeurologistsBart DemaerschalkDean WingerchukLivia CandeliseEvidenceEthicsThunderclap headacheCritical Illness NeuromyopathyAcute Visual lossMyasthenia GravisTraumatic Brain InjuryRaised Intracranial PressureStatus EpilepticusDeliriumSpinal Cord CompressionAcute Ischemic StrokeTransient Ischemic AttackComaNeurorehabilitationNeuro-OphthalmologyVestibular disordersnystagmusHeadache DisordersSleep DisordersM • Medical Science • Medizin • Neurologie • Neurology
• ISBN-10: 1-119-06733-2 / 1119067332
• ISBN-13: 978-1-119-06733-7 / 9781119067337