bluuebunny/crossref_metadata_2025_split huggingface dataset:
167  A case of rapidly progressive meningoencephalitis caused by amoebae in the UK
Authors: Surendranathan Ajenthan , Qazi Hamood , Kumar Atul , Mattoscio Miriam , Chaudhuri Abhijit , Sinha Devesh 
Published: May 2022

BackgroundCases of Amoebic encephalitis have been reported in countries with tropical climates. Here we describe a rare adult case in the UK with a rapidly progressive history, which was confirmed at autopsy.Case PresentationA 77 year old lady, independent and still in employment, with a past medical history of Sjogren’s syndrome, presented with sudden onset of slurred speech, left facial twitching and facial droop. MRI showed a right frontal enhancing lesion with surrounding vasogenic oedema. Dexametha- sone was started for suspected high grade neoplasm. Nine days later she had a temperature of 37.7°C, with no apparent source of systemic infection. Despite empirical treatment with antibiotics, she became progressively unresponsive over the next 72 hours, developing dense left hemiplegia. Repeat MRI head showed large widespread multifocal T2/FLAIR signal changes. A lesional biopsy was planned but she deteriorated rapidly and died. Post mortem revealed disseminated collections of amoebae throughout the cerebral hemispheres, brain stem and cerebellum.Discussion andConclusionsAmoebic encephalitis, despite its rarity, should be a differential diagnosis in a rapidly progressive infective meningoencephalitis unresponsive to empirical therapy. Mortality is high, however early treatment based on clinical suspicion may improve survival rates.ajenthans@doctors.org.uk
170  Did the atraumatic lumbar puncture needle campaign have any effect?
Authors: Adegboyega Gideon , Lobo Rhannon , Alsousa Ines , Salman Reem , Lobo Sean , Uppal Encarl , Ali Shair , Schmierer Klaus , Giovannoni Gavin 
Published: May 2022

ObjectivesTo assess the impact of a national atraumatic lumbar puncture needle campaign on lumbar puncture needle usage across the United Kingdom. The campaign commenced in 2015, to increase usage of atraumatic needles to reduce complications associated with traumatic needles.DesignRetrospective cross-sectional auditMethodsWe requested procurement orders from all regional neuroscience centres in the United Kingdom, through freedom of information (FOI) requests to identify their lumbar puncture needle purchases over a four-year period (2015–2018). Of all sites, 20 centres provided usable datasets. Product codes were cross correlated to identify the type of lumbar puncture needle used. The procurement orders were used as a surrogate marker for lumbar puncture needle usage and to calculate a ratio of atraumatic: traumatic needles.ResultsIn total we analysed 739,209 procurement orders over the four-year period. The Atraumatic/Traumatic needle ratio was 0.244 ± 0.039 in 2015 and increased to 0.276 ± 0.046 in 2016 (p=0.05), witha subsequent decrease in 2017 to 0.252 ±0.042 (p=0.37) and 2018 to 0.256 ± 0.037 (p=0.93).ConclusionsDespite the increase between 2015 and 2016, the impact of the atraumatic lumbar puncture needle campaign has been marginal. Further efforts will be needed to effect a change in the ‘needle culture’ across neuroscience centres. Aside from the campaigning to highlight reduced complications and the cost-effectiveness of atraumatic needles, further initiatives such as a Delphi process should be considered.gideonadegboyega@gmail.com117
173  Does a post discharge phone follow up reduce readmission rates in patients with neurological conditions?
Authors: Shanmuganathan Sarah , Nitkunan Arani 
Published: May 2022

Early readmissions is an issue that not only drains NHS resources but also indicates failures of effective care of patients. Specifically, to neurological admissions, 6.5–11% of admissions are re-admitted within 30 days. We aimed to investigate whether post-discharge telephone calls prevented early readmissions in patients who had inpatient neurological reviews at a district general hospital. 235 inpatients seen by the neurology team at a district general hospital over a period of 2 months were reviewed. 76 were offered a follow up appointment. A significant proportion (45%) of patients were not contactable. When only the patients who were successfully contacted were assessed, there was a non-significant reduction in early readmission (38%). The introduction of post-discharge telephone intervention could be a cost effective method to reduce readmissions. This needs to be reassessed with a more robust method of contacting patients with clarity on when the appropriate time e.g. those at risk of re-admission, contact within 2 weeks and those not, contact at a clinically appropriate time.2236892s@student.gla.ac.uk
174  A career in neurology: How can we encourage medical students to think about it?
Authors: Gupta Dhruv , Poole Grace , Melamed Naomi 
Published: May 2022

IntroductionInterest in neurology is declining, reflected by reduced ST3 applications between 2016–2018. ‘Neurophobia’ and perceived lack of knowledge are possible explanations. Therefore, our aims were to identify factors that attract or deter students from neurology, and the impact of an extra-curricular careers event.Methods20 medical students attended a careers event organised by St George’s Clinical Neuroscience Society. A consultant neurologist discussed his experiences, recent neurological developments, and relevant training pathways. Attending students completed a questionnaire before and after the event, consisting of: motivating factors, deterrents, and utility of the event.Results45% of students were initially attracted to neurology due to the pathologies presenting in patients. After the talk, this significantly increased to 80% (p<0.05). 75% of students were initially deterred from neurology due to perceived lack of time with a future family. Following the event, this significantly decreased to 55% (p<0.01). 75% of students strongly agreed that similar events should be integrated into the curriculum.DiscussionFollowing a careers event, perceived insufficient time with family as a deterrent to entering neurology was attenuated. Such events are valuable in addressing misconceptions of students, and support an informed choice about the realities of a career in neurology.melamednaomi8@gmail.com
178  Atraumatic lumbar puncture campaign – effect on complications
Authors: Sousa Ines , Salman Reem , Lobo Rhannon , Adegboyega Gideon , Lobo Sean , Uppal Encarl , Ali Shair , Schmierer Klaus , Giovannoni Gavin 
Published: May 2022

AimsTo assess the impact of the usage of atraumatic lumbar puncture needles on lumbar puncture complications across the United Kingdom, following the national atraumatic lumbar puncture needle campaign which commenced in 2015DesignA retrospective cross-sectional audit of regional datasets was employed.SubjectsAll patients undergoing a lumbar puncture for both therapeutic and diagnostic purposes at regional neuroscience centres.MethodsWe requested hospital episode statistics (HES) from all regional neuroscience centres in the United Kingdom (32 sites). Through freedom of information (FOI) requests we asked the centres to provide the number of epidural blood patches procedures, post-lumbar puncture headaches and lumbar puncture needle procurement orders over a four-year period (2015–2018). A surrogate complication rate was cal- culated by the sum of the complications divided by the total procurement orders.ResultsOf all sites 32 sites, 16 centres provided usable datasets. Between the period of 2015–2018 there was a non-significant decrease in complication rates when using atraumatic lumbar puncture needles (p=0.14).ConclusionsThe study did not show a statistically significant decrease in the complication rates over the specified period, supported by previous work suggesting poor adherence to atraumatic needle usage.ines-alsousa@hotmail.com
181  Peer-to-peer teaching as a learning tool for SHOs working in a highly specialist centre
Authors: Fiorini Francesco , Cox Caitriona , Carr Aisling , Sayal Parag 
Published: May 2022

IntroductionNeurology can be challenging for SHOs working at highly specialist centres. Clinical exposure might be limited by firm-based systems and teaching, which is often targeted to more senior trainees, covers rare conditions. This is reflected in GMC survey data from IMT/CMT trainees, which has been poor at NHNN in recent years.MethodsWe developed a novel peer-teaching programme, which was open to SHOs and physician associates. It consisted of weekly sessions led by an SHO with a supervising SpR present. Data on the provision of teaching for SHOs, on learning about topics covered within and outside individual firms, and on teaching opportunities, was collected prior to the programme. We repeated data collection after a 3-month trial of the teaching programme.ResultsWe demonstrated significant improvements in trainee perception of overall SHO teaching provision (p=0.014) and in opportunities to develop their own teaching (p=0.01), as well as learning about neuro- logical conditions/topics outside of their own firms (p=0.011). Teaching was consistently well attended and received positive free text responses in the questionnaires.ConclusionNeurology SHO peer-teaching creates an effective learning environment to facilitate learning about neurological topics appropriate to training level, where trainees can also improve their own teaching skills.clc70@doctors.org.uk
182  Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do
Authors: Penn Dexter , Nicholls Jacqueline , Lanceley Anne , Petrie Aviva 
Published: May 2022

BackgroundThe Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment (MCAx).MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.dexter.penn.14@ucl.ac.uk
183  Safe neurological services: how should we best measure safety in neurology practice in the UK?
Authors: Kipps Christopher , Kinton Lucy , McCarron Mark , Nitkunan Arani , Petheram Kate , Ross-Russell Amy , Tripp Anand , Warner Graham , Zarkali Angelika 
Published: May 2022

Patient safety has been recognised as a top global priority. Safe neurological practice is crucial. Yet, how do we adequately measure safety in our services? A range of standpoints need to be considered including safety at clinician level, safety within a service and the organisational safety culture in which clinicians practice.The ABN is interested in understanding how best to benchmark safety in neurology practice across the UK. It aims to identify the range and extent of quality assurance and safety practice, and assess ways of presenting this data to inform efforts to maintain and improve safe practice at all levels.A series of questions have been formulated to address this issue, and will be circulated to ABN advisory groups for review. From this a comprehensive safety survey will be constructed and further refined. This will then be used to audit safety practice and attitudes at individual, service and organisational levels across the UK. We will present the results of the advisory group consultation and the intended question- naire to be used in the national survey. Presentation of this work will help raise awareness of the issue to ABN members, and further refine the national audit.ckipps@nhs.net
186  Published discussion of palliative care for patients with long term neurological conditions
Authors: Rees Richard , Alderman Bryony , Pigott Jen , Schrag Anette 
Published: May 2022

IntroductionThere is a growing recognition of the need for palliative care services for people with long-term neurological conditions (LTNC). However, in order to provide optimal treatment, there is a need for discussion and teaching within the relevant specialties, and research needs to provide evidence to inform provision of best medical practice.MethodsWe use number of abstracts from neurological, geriatric and palliative care conferences as a marker of the level of discourse at a clinical and academic levels. We searched ABN, BGS (British Geriatric Society), and APM (Association for Palliative Medicine) conference abstracts from 2014–2019 for neuro- logical and palliative search terms as appropriate.ResultsWe searched 3,750 abstracts over 21 conferences using the pre-specified search terms. Overall, only 2.19% out of these abstracts related to palliative issues in LTNC (ABN 21/1612 (1.3%), BGS 12/1017 (1.1%), APM 48/1121 (4.4%)) α2 p=3.2x10–8. ‘Dementia’ and ‘Parkinson’s’ were the most commonly identified LNTCs in BGS abstracts (each 4/12), with MND (14/48) and ‘dementia’ (10/48) dominating the APM abstracts.DiscussionThere is a dearth of published research and discussion at academic meetings related to the palliative needs of patients with LTNC. We believe these are necessary to inform best medical practice, and to establish policies and guidelines to serve this vulnerable group, or to inform the ongoing national debate.richard.n.rees@ucl.ac.uk
191  The neurology grand(ish) round
Authors: Adan Guleed , Kalam Sabrina 
Published: May 2022

Anecdotally the neurology grand round (NGR) is perceived as a beneficial learning opportunity but it is also an event that many trainees do not enjoy for a myriad of reasons. This project sought to explore these perceptions and uncover the beliefs that underpin them.All neurology trainees in a neuroscience centre were invited to take part in a semi-structured focus group. An inductive thematic analysis approach was used given the relative naivety of the phenomenon being studied.Eight participants consented to take part; two focus groups were conducted with four participants in each group. The data was analysed and divided into appropriately derived codes, themes and sub- themes. Main themes generated included; ‘learning environment’, ‘role of the consultant’, ‘questioning style, ‘learning format’, ‘future employment’ and ‘role of seniority’.Positive perceptions were based on the ability of the NGR to bring to life and contextualise theoretical prin- ciples in clinical neurology. Barriers to effective learning in the grand round included the anxiety inducing nature of the learning environment and the targeting of individual trainees for public questioning. Future NGRs should be designed to take these perceived barriers into account and improve the educational experience for all neurology trainees, regardless of level of experience.guleed.adan@liverpool.ac.uk
194  Improving the experience of core medical trainees and trust doctors at NHNN
Authors: Ceronie Bryan , Adams-Carr Kerala , Gration Betty , Yasar Binnaz , Mackay Katherine , Carr Aisling , Khaleeli Zhaleh 
Published: May 2022

IntroductionFeedback from core medical trainees and trust-grade doctors at the National Hospital for Neurology and Neurosurgery highlighted areas for improvement including induction, curriculum coverage and educational governance. A rolling programme of improvements since August 2017, facilitated by a consultant-appointed CMT Lead, was implemented in response to feedback.MethodsSpecific improvements included a paired colleague system to facilitate leave, dedicated firm timetables with clinic and acute neurology allowances, a new junior doctor handbook, overhaul of the induction programme, the appointment of clinical support workers and physician associates, daily safety huddles, regular team-building events and a case presentation competition.ResultsWe evaluated doctor satisfaction on a 6-monthly basis using an internal survey, from August 2017 to December 2019. Measures that demonstrated clear improvement included the proportion of doctors rating induction as good (14% to 83%), feeling valued as a team member (34 to 75%), deeming the job valuable for training (67% to 100%), attending teaching (39% to 50%), and those that were able to present to a consultant (41% to 58%).DiscussionThrough rolling improvements and regular feedback, job satisfaction has improved. More work remains to be done, in particular to improve attendance at protected teaching and facilitate contact with consultants.bryan.ceronie@gmail.com
198  Digital information for patients requiring inter-hospital transfers: benefits of co-production
Authors: Wu Kit , King Rachel , Ellis Cathy , Larcombe Karen , Dilley Michael 
Published: May 2022

IntroductionPatients admitted with neurological conditions often require transfer to a regional neuroscience centre for further investigations and management. For healthcare teams, inter-hos- pital transfer (IHT) is a complex process to coordinate. For patients and their families, it is a daunting experience with uncertain outcomes [Bosk et al, 2011]. Yet, there is no available digital information on the process of IHT for patients on the internet.AimTo produce publicly available digital patient information [leaflet] on the process of IHT in collaboration with patients.Method andResultsWe collaborated with patient representatives from key stakeholder organisa- tions and charities [South London Neuroscience Operational Delivery Network (ODN), King’s Health Partners (KHP), Neurological Alliance and the Brain and Spine Foundation] through co-production meetings set up jointly by ODN and KHP. Together, we defined the target service users and an outline of the content. Building on the digital capabilities of the charities, we defined the host site, its sustainability and maintenance. Thirdly, we defined how healthcare networks will facilitate the dissemination of information in reciprocity.ConclusionTo our knowledge, this is the first co-produced information leaflet for neurological patients on IHT available in a digital format. Providing written information is an important part of patient care which can reduce anxiety, manage expectations and improve patient satisfaction. Through collaboration, we, as healthcare organisations, can enable changes that benefit both the patients and the healthcare providers.kitwu@doctors.org.uk
199  Improving training in systems leadership management: a ‘Mini-Darzi’ approach
Authors: Wu Kit , Tahir Mehreen , Adams Sarah , Ellis Cathy , Larcombe Karen , King Rachel , Dilley Michael , Malby Rebecca 
Published: May 2022

IntroductionLeadership and management development is mandated by General Medical Council as core skills for all doctors [GMC, 2012]. Yet, the myriad of leadership courses for trainees are delivered by external organisations without opportunities for concrete applications in the NHS setting.AimsTo develop a short applied leadership and management course appropriate for doctors in training using peer-learning approach, and to review its impact through objective feedback from participants’ implementation of projects.Method andResultsA management and leadership course was developed using a peer-learning approach by three Darzi fellows participating in leadership development programme and project-based attachments to NHS organisations [Malby, 2018]. The course follows a three-stage approach: a one-day workshop to impart knowledge and skills in systems change; a quality improvement project in the par- ticipants’ workplace; finishing with a workshop for participants to showcase their project and feedback.Results and SummaryThe course educates participants in clinical leadership in the NHS and equip them with the tools to manage new challenges. The application of knowledge in the participants’ workplace through implementation of a systems change project allows for greater understanding of quality improve- ment within NHS healthcare. In turn, it will encourage participants to seek further opportunities to develop their skills and lead change projects in their future careers.kitwu@doctors.org.uk
210  Erenumab for the treatment of chronic migraine with idiopathic intracranial hypertension in ocular remission
Authors: Yiangou Andreas , Mitchell James , Vijay Vivek , Thomas Pravin , Fisher Claire , Edwards Julie , Alimajstorovic Zerin , Grech Olivia , Mollan Susan P , Sinclair Alexandra J 
Published: May 2022

Headache therapy is an unmet need in idiopathic intracranial hypertension (IIH).This was a prospective, real world, open-label cohort study over 9 months in the UK. Adult females with confirmed diagnosis of IIH now in ocular remission with chronic migraine (CM)-like headaches and failure of ≥3 preventative medications received Erenumab 70mg monthly. Clinical assessment was 3-monthly and primary endpoint was mean change in monthly migraine days (MMD) from baseline (30-day pre- treatment period) compared to 6 months.Study included 55 patients with mean(SD) age 35.3(9) years. Mean(SD) baseline monthly migraine days (MMD) was 16.1(4.7) and monthly headache days (MHD) was 29(2.3). MMD reduced significantly at 6 months by 10.3(4.8) (P<.001) and MHD reduced by 10.6 (8.7) (P<.001). Crystal clear days increased by 10.5(9) (P<.001) and monthly analgesic days reduced by 3.9(8.3) (P=.001). Significant improvements were also noted in patient reported outcomes. Results were consistent at 3 and 9 months.This prospective real world open-label study provides evidence for the efficacy of Erenumab for the treatment of headache in this population. It provides important mechanistic insights suggesting that CGRP is likely a key modulator driving headache in patients with IIH in ocular remission and worthy of evaluation in a future randomised trial.a.yiangou@bham.ac.uk137