No more neurophobia: welcome neurology in general practice

Ridsdale, Leone

doi:10.3399/bjgp09x453756

Cited by 12 publications

(13 citation statements)

References 9 publications

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“…172 Until recently there was no funding for epilepsy care in general practice to support systematic identification and monitoring. 173 We believe that there is a need for large-scale programme research to identify risk factors and service use across primary and secondary care, which may link up processes to the goal of reducing avoidable death. This will include large-scale epidemiological work linking data sets, the development and testing of interventions, and mixed quantitative, qualitative and economic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

Ridsdale

McCrone

Morgan

et al. 2013

Health Services and Delivery Research

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ObjectivesTo (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.DesignNon-randomised trial with nested qualitative study.SettingThe EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.ParticipantsAdults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.InterventionIntervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.Main outcome measuresThe primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.ResultsIn the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.ConclusionsAt baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.Trial registrationCurrent Controlled Trials ISRCTN06469947.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.

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Section: Discussionmentioning

confidence: 99%

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

Ridsdale

McCrone

Morgan

et al. 2013

Health Services and Delivery Research

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“…Three educational interventions that previous studies identified to be beneficial in improving neuroscience knowledge and decreasing neurophobia were studied: TBL, CBT, and PBL [ 4 – 6 , 8 , 10 – 13 , 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The number of new neurologists is growing at a much slower pace compared to other specialties, in both the United States (US) and Europe [ 8 ]. From 2010 to 2015, the growth in both the number of students applying for and the number of programs offering residencies in the US in neurology (+1.3%) has paled in comparison to surgery (+4.6%), psychiatry (+4.9%), family medicine (+11.6%), and internal medicine (+23.4%) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Medical student attitudes and educational interventions to prevent neurophobia: a longitudinal study

et al. 2017

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BackgroundWith an aging American population, the burden of neurologic disease is intensifying and the decline in neurology residents and practicing neurologists is leaving these patients helpless and unable to find care. ‘Neurophobia’, a chronic illness that begins early in medical school, has been identified as a cause for the low number of neurology residents.MethodsA longitudinal study surveyed medical students at the beginning of their first year (M1) and then again at the beginning of their second year (M2). Three neuroscience educational interventions were studied: team based learning (TBL), case based teaching (CBT), and problem based learning (PBL). Participants provided self-reported neurophobia levels, attitudes about neuroscience, and the effectiveness of educational interventions.ResultsA total of 446 students during M1 and 206 students during M2 participated in the survey. A significant change in self-reported neurophobia (p = 0.035) was observed from 19% in M1 to 26% in M2. Neuroscience knowledge and confidence managing a neurologic condition also significantly increased (p < 0.001 and p = 0.038 respectively). Perceived interest, difficulty, and desire to pursue a career in neuroscience did not a change significantly. Majority of students perceived CBT (76%), TBL (56%), and PBL (66%) beneficial. Only CBT demonstrated a statistical difference (p = 0.026) when stratified by self-reported change in neurophobia.ConclusionAn increase in neurophobia after completing a neuroscience was observed but the prevalence rate of 26% was lower than previous studies. Knowledge about neuroscience increased significantly and educational interventions were considered beneficial by students. Thus, interventions that increase knowledge and decrease neurophobia can lead to an increase in students pursuing neurology residencies.

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“…Por se tratar de um tema extenso, complexo e de integração de conhecimentos e saberes, demanda um maior esforço para a compreensão de todas as suas relações e aplicações envolvendo forma e função (ESTEVEZ et al, 2010 As aulas de neuroanatomia são consideradas mais complexas e de maior dificuldade de aprender quando comparadas as demais aulas das disciplinas de anatomia, tanto para os estudantes quanto para os profissionais já graduados (JOZEFOWICZ, 1994;SOLEY e KRAMER, 2001;SCHON et al, 2002;FOREMAN et al, 2005;RIDSDALE, 2009;JAVAID et al, 2018). Essa dificuldade leva à uma crescente preocupação com o grau de conhecimento de estudantes e profissionais recém-formados sobre o tema e sua consequente aplicação na neurologia (JOSEFOWICZ, 1994;JAVAID et al, 2018), especialmente levando-se em conta o suporte bibliográfico para seu estudo que é escasso.…”

Section: Revisão De Literaturaunclassified

>b<Elaboração de uma ferramenta de ensino-aprendizagem multidisciplinar de neuroanatomia do equino (>i<Equus caballus>/i<, Linneaus, 1758)>/b<

Cereta¹

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Among the topics of Animal Anatomy, neuroanatomy is presented as one of the most complex contents, in which traditional teaching methods don't allow students to have effective comprehension, and implies the need for complementary approaches to optimize their learning. This work aimed at the development of a teaching & learning tool for the study of neuroanatomy, using a collection of cross-sectional slides of the Central Nervous System (CNS) of the horse. Cross-sectional slides already prepared, stained with the modified Pal-Weigert staining technique, were used to identify neuroanatomic structures and to associate neuroanatomy with neurological syndromes of this species. In addition to this, schematic illustrations were performed to indicate the sites affected by neurological disorders and to represent the cross-sectional sections of the horse. A website prototype was also developed to exemplify the use of educational technologies, such as the use of softwares and computers as facilitators for the understanding of neuroanatomic structures and their clinical relationships. The use of the cross sectional slides of the CNS of the horse allowed the identification of anatomical structures, dividing their totality into sequential intervals to demonstrate the comprehensiveness and topography of CNS structures, as well as supporting the relationship between neuroanatomy and neurological syndromes. Furthermore, it was possible to maintain and preserve the collection of CNS sectional slides from the Laboratory of Comparative Neuroanatomy of the Department of Surgery of the Faculty of Veterinary Medicine and Animal Science of the University of São Paulo. Through this study we seek to broaden the discussions about the use of traditional techniques of study in animal anatomy, alliedto new educational technologies and complementary teaching methods, once teaching and learning tools can be developed aiming at undergraduate teaching, at a distance or faceto-face, or even through continuing education.

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No more neurophobia: welcome neurology in general practice

Cited by 12 publications

References 9 publications

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

Medical student attitudes and educational interventions to prevent neurophobia: a longitudinal study

>b<Elaboração de uma ferramenta de ensino-aprendizagem multidisciplinar de neuroanatomia do equino (>i<Equus caballus>/i<, Linneaus, 1758)>/b<

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