Number Of Neurologists Research Articles

World Federation of Neurology Needs Registry Survey 2021

The WFN Needs Registry survey was developed and conducted over two and a half years commencing in 2020 to investigate the accessibility and affordability of neurological services and therapeutics and the most urgent needs. Method: An experienced neurologist responded in each of 118 societies to an online electronic survey comprising 13 questions. General data sought comprised the respondent's training, place of practice, duration in practice, number of neurologists in the society, health care system and types of neurological practice available. Specific data collected comprised neurological facilities, specialist services available, resources, therapeutics accessibility, challenges and three most urgent needs. ResultsResponding neurologists spent a median of 26 years in practice and represented a median of 225 neurologists per society. Of 13 classes of neuromedicines deemed readily available to 70% of the population, 41 societies listed ≥1 and 14 societies ≥3 unavailable. The three most frequent unavailable neuromedicines were second level AEDs, Dopamine agonists and MS DMTs. Of 14 neurological services, 15 societies had all services accessible and affordable, 13 had none and 72 had ≥1 services either inaccessible or unaffordable. EEG, Epilepsy, Headache and EMG services were most available; Neurogenetics, Neuropsychology, Neurorehabilitation and Neurodevelopmental services were least available. Of 13 specified challenges, lack of subspecialists and specialty centers were both identified by 61% of societies followed by costs of neurological care, neuromedicines availability and stigma. Ten societies had no challenges. ConclusionA unique insight into the inequities of neurological care globally and a potential tool to assist their remedy.

Tele-stroke services in rural areas of Nepal: a dire need

With the increasing burden of non-communicable diseases in South Asian countries, Nepal also holds a pertinent position with the rapidly increasing prevalence of non-communicable diseases. Among the South Asian countries with the least developed health infrastructure in Nepal, the hurdles of providing equal health services to all demographic and geographic groups of people had always been a matter of serious concern. Moreover, the citizens of rural Nepal had always been kept at a distance from even minor to several major healthcare services for decades and stroke-related illness falls under one of those major diseases with spiking rates of hypertension and diabetes mellitus. Traditional risk factors, lifestyle and feeding practices of those regions combined with arduous transportation facilities barring the rural citizens from getting health care services from tertiary care centers have increased morbidity rates as well. Along with it the numbers of neurologists and stroke centers providing specialist services are not in par with the burden of stroke-related illness. Adding to it such stroke care services are below scarce level and completely devoid in most of the areas of rural Nepal which is a matter of global health concern. Telestroke service if properly implemented can act a modern solution to provide access to such special health care services preventing rural citizens from lifelong disability and dependence.

A Bibliometric Analysis on Viral Central Nervous System Infection Research Productivity in Southeast Asia.

Research productivity on viral infections of the nervous system in Southeast Asia (SEA) is unknown. We aimed to determine the research productivity of SEA in terms of bibliometric indices and PlumX metrics and their correlation with socioeconomic factors. A comprehensive search of major electronic databases was done to identify studies on viral infections of the nervous system with at least one author from SEA. Socioeconomic factors and collaborations outside SEA were determined. Correlational analysis was done on bibliometric indices and socioeconomic factors. A total of 542 articles were analyzed. The majority came from Thailand (n = 164, 30.2%). Most articles used a descriptive study design (n = 175, 32.2%). The most common topic was Japanese encephalitis (n = 170, 31.3%). The % gross domestic product allotted for research, number of neurologists, and number of collaborations outside SEA correlated with the bibliometric indices and PlumX metrics. In conclusion, the number of research from SEA was low but the quality was comparable to the global benchmark. Improving resource allocation and collaboration between SEA nations and other countries may support this endeavor.

Factors influencing medication adherence among U.S. Medicare beneficiaries with Alzheimer’s disease and related dementia (ADRD)

AbstractBackgroundFor persons with ADRD, access to specialist physicians facilitates appropriate medication use and adherence with treatment. Our objective was to ascertain whether system‐level factors, including availability of specialty physicians predicts ADRD medication adherence among community‐dwelling older adults.MethodWe conducted secondary analyses of claims data for Medicare beneficiaries with ADRD in 2013‐2015. Medication adherence was measured using the proportion of days covered (PDC); i.e., ratio of days with ADRD prescriptions over total days of follow‐up. Adherence was defined as PDC >=0.8. Multivariable‐adjusted Modified Poisson regression was used to examine associations of adherence with physicians' availability (defined as number of neurologists and psychiatrist per 1K county population from Area Health Resources File [AHRF]). Analyses adjusted for predisposing factors (sex, race, and age); enabling factors (Medicare/Medicaid dual eligibility, Area Deprivation Index), need factors Alzheimer's disease vs. other) and comorbidities. Context level characteristics from AHRF included county‐level education, urban/rural residence, income/poverty indicator, and mental health professionals shortage area. Because the “Deep South” (DS) region of the US has a shortfall of specialists, we also considered geographic location.ResultWe identified 54,194 Medicare Beneficiaries. The race/ethnicity distribution of the sample was 81.44% white, 9.17 % black, 6.24 % Hispanic, 2.25 % Asian, and 1% other; 71.8 % were female, and 42.36% were >85 years. Bivariate analyses revealed significant differences between DS and non‐DS in all individual and contextual characteristics except sex and comorbidities. Specialists' availability was not significantly associated with adherence to ADRD medication: Neurologists RR: 1.0080, CI (0.9789‐1.0380) and Psychiatrists RR: 1.0066 CI (0.9948‐1.0186). Age, dual eligibility, and living in non‐large metropolitan areas were associated with a higher probability of adherence. Race, comorbidities, having ≥1 visit with specialists, and context factors such as living in deprived and lower education areas were associated with a lower probability of adherence.ConclusionAdherence to ADRD medications was not associated with specialist availability but was related to individual and socioeconomic context factors in community‐dwelling older individuals with ADRD. Research should continue ascertaining factors that may influence medication adherence, particularly communities with a higher prevalence of ADRD risk factors, a greater proportion of minorities and socially at‐risk people, and health disparities.

Associations of motor neuron disease research productivity and socioeconomic factors in Southeast Asia: a bibliometric analysis.

Scientific productivity on motor neuron disease (MND) research has been hypothesized to be low in Southeast Asia (SEA). To investigate the scientific productivity of SEA countries on MND and the associations between research metric indices and various country-specific socioeconomic parameters. We searched electronic databases for relevant articles from SEA on MND from the earliest indexed record to June 30, 2020. We obtained the following research productivity indices: bibliometric (number of publications in journals with impact factor (IF) and Scopus citations) and altmetric indices (PlumX metrics). We also collected data from published literature and reliable sources on the following socioeconomic variables: population, gross domestic product (GDP), GDP per capita, %GDP allocated for research and development (R&D) and the number of neurologists per country. We included 196 articles that satisfied our inclusion criteria. Amyotrophic lateral sclerosis studies comprised the majority of the articles (n = 112; 57.1%). The top three countries in terms of the numbers of publications in journals with IF and in PlumX metrics were Singapore (n = 129), Malaysia (n = 26), and Thailand (n = 18). GDP per capita, %GDP for R&D and number of neurologists per one million population had strong positive correlations with the bibliometric and altmetric indices. This study highlights that although the scientific productivity of MND research in SEA has been low, it is continuously growing. This also emphasizes the imperative to improve economic indices and the number of neurologists in SEA to enhance scientific output on MND.

Bibliometric analysis of bacterial central nervous system infection research in Southeast Asia

BackgroundThe status of research and scientific outputs with regards to bacterial central nervous system (CNS) infection in southeast Asia (SEA) is unknown. This study aimed to analyze and compare bacterial CNS infection research output of SEA countries in terms of bibliometric indices.MethodsThe major electronic databases (MEDLINE, Scopus, Embase, CENTRAL, Clinicaltrials.gov and WPRIM) were searched for studies on bacterial CNS infection in SEA until August 31, 2020. Frequencies, percentages and Spearman’s rho correlations were used.ResultsThere was a total of 648 unique studies on bacterial CNS infection in SEA and it was 657 when double-counted (collaborative studies between SEA countries). Thailand (n=148, 22.5%) and Vietnam (n=142, 21.6%) had the highest number of publications. The most common type of research publication was the case report / case series (n=160, 24.7%). Tuberculous meningitis/tuberculoma (n=176, 26.7%) was the most common topic. This study showed that the %GDP for research and development (R&D) was associated with a higher number of research output. However, the GDP per capita was not associated with any of the bibliometric indices. The total number of neurologists was associated with all of the bibliometric analysis.ConclusionBacterial CNS infection research output in SEA countries was low in terms of quantity. The %GDP for R&D was associated with the number of research publications. The total number of neurologists was associated with all of the bibliometric indices.

STROKE REHABILITATION SERVICES IN PAKISTAN: CURRENT STATUS AND FUTURE DIRECTIONS

Stroke is a leading cause of adult mortality and morbidity worldwide. The incidence of stroke is falling in developed countries, while on the rise in developing countries.1 Pakistan is a low middle-income country with an underdeveloped health care system whose major focus is on the management of communicable diseases.2 Epidemiological data on stroke in Pakistan is limited, based mostly on small samples reported from hospital data.3 Due to the combined efforts of the Pakistan Society of Neurology, Pakistan Stroke Society and the Faculty of Neurology at the College of Physicians and Surgeons of Pakistan (CPSP), the number of neurologists and stroke medicine physicians in the country has increased in the last decade.4 Diagnosis, acute evaluation and management of stroke has also improved. Areas of noted progress include early recognition of signs and symptoms of stroke, timely evacuation to a hospital, early neurology consult, availability of brain imaging (Computed Tomographic scan and Magnetic Resonance Imaging) and access to treatments including tissue plasminogen activator and endovascular procedures.4 At present, this is available only in major cities and hospitals. Despite such improvements in acute stroke management, functional outcomes and community reintegration for stroke patients in Pakistan is generally inadequate, due largely in part to the lack of multi-disciplinary stroke rehabilitation services. We aim to describe the current status of stroke rehabilitation services in Pakistan and discuss the main challenges and barriers towards providing multi-disciplinary stroke rehabilitation. Recommendations to overcome these challenges are also provided.

Stroke Research Disparity in Southeast Asia: Socioeconomic Factors, Healthcare Delivery, and Stroke Disease Burden

BackgroundCerebrovascular disease is the second leading cause of death worldwide and provides a heavy burden of disease in Southeast Asia (SEA). Contribution to the collective knowledge of this disease is necessary to address practice and treatment disparities. There is limited data on research productivity in the region. This study aimed to determine research productivity on stroke and other cerebral and spinal vascular diseases among the SEA countries and determine its relationship with bibliometrics, socioeconomic parameters, healthcare delivery indices, and burden of disease. MethodsA comprehensive literature search was conducted using five major healthcare databases. We included studies published until June 2020 on cerebral and spinal vascular disease with at least one author from SEA. Country-specific socioeconomic parameters, the burden of disease, healthcare delivery indices, and the number of neurologists were collected from international databases and published data. Correlational analysis was done on bibliometric indices and collected data. ResultsA total of 2577 articles were included. Singapore had the most publications (n=1095, 42.5%) and citations (PlumX n=16,592, 55.2%; Scopus n=22,351, 56.7%). Gross domestic product per capita, percent gross domestic product for research and development, universal health care effective coverage index overall and for stroke treatment, and the number of neurologists had a positive correlation to bibliometric indices. ConclusionsThere is a disparity in stroke research productivity among high-income and low-income countries in SEA. Priority must be given to scientific research output and its role in socioeconomic development and policy formulation.

A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

Determinants of specialist physician ambulatory visits: a neurology example

Background: Economic theory argues that specialization in medicine improves efficiency. Current literature suggests that access to and utilization of specialist care vary widely based on many determinants. Thus, understanding the determinants of specialist physician ambulatory care utilization is integral to healthcare policy. Objectives: The objective is to investigate the individual and community determinants of specialist ambulatory care utilization—specifically neurologists. The aim was to find predictors of specialist utilization and to identify the particular determinants that can be modified by regulatory or legislative action. Methods: A large claims database, Truven Health Analytics™ Marketscan data, was used from 2007–2010 as the sample. These data are supplemented with data from the American Academy of Neurology (for geographic distribution of neurologists) and the US Census American FactFinder (for community demographic factors). Multivariate regression analysis was run to test the hypotheses. Several robustness tests of our models were included. Results: Most importantly, neurologists per capita has a meaningful impact on utilization. Additionally, the difference in neurologist usage by neurological condition is an important factor. It was also found that union status, age, comorbidities, and diagnosis are significant individual level determinants, and that the percentage of Hispanic residents and median income are significant community level determinants. Conclusions: There are two predictors believed to be the most important. The first is the unique neurologists per 1,000 capita variable, which shows a small increase in the number of neurologists would be correlated with a small increase in the probability of seeing a neurologist. We suggest that this is within policymakers’ control, and policymakers should consider this action in the face of the predicted shortage. The second is what appears to be possible sorting by neurologists of patients based on diagnosis – the large difference in the fraction of patients seeing a neurologist by disease.

Current amyotrophic lateral sclerosis management at the neurology department of a regional core hospital in Aomori prefecture

Background: In Aomori prefecture, the numbers of neurologists are so small to provide a sufficient medical services.

The professional practice and training of neurology in the Asian and Oceanian Region: A cross-sectional survey by the Asian and Oceanian Association of Neurology (AOAN)

ObjectiveTo survey AOAN member countries regarding their organizational structure, postgraduate neurology training program, and resources for neurological care provision. MethodologyA cross-sectional survey using a 36-item questionnaire was conducted among country representatives to AOAN from August 2015 to August 2016. ResultsA total of 18/20 AOAN member countries participated in the survey. All the countries have organized association with regular meetings, election of officers and neurology training program. In 9/18 countries, professionals other than neurologists were eligible for affiliation. In 11/18 countries, prior Internal medicine training (or equivalent postgraduate housemanship) is prerequisite to neurology program. Recertification examination is not a practice, but submission of CME is required in 7/18 countries to maintain membership. 12/18 countries publish peer-reviewed journals with at least 1 issue per year. Subspecialty training is offered in 14/18 countries. The ratio of neurologist to population ranges from 1:14,000 to as low as 1:32 million with 9/18 having <1 neurologist per 100,000 population. 6/18 countries have at least 1 specialized center solely for neurological diseases. In government-funded hospitals, the lag time to be seen by a neurologist and/or obtain neuroimaging scan ranges from 1day to 3months. All except one country have several medical- and lay- advocacy or support groups for different neurological conditions. ImplicationsThe data generated can be used for benchmarking to improve neurological care, training, collaborative work and research in the field of neurosciences among the AOAN member countries. The paper presented several strategies used by the different organizations to increase their number of neurologists and improve the quality of training. Sharing of best practices, academic networking, exchange programs and use of telemedicine have been suggested.

Brazilian Academy of Neurology (2006 – 2016)

Brazil is a heterogeneous country with continental dimensions. The different characteristics of cultural, socioeconomic, and demographic status of the population drive different strategies for neurological care. This knowledge helps the understanding of the current scenario with the consequent possibility of preparing for future challenges. We used data from annual internal forms of the Brazilian Academy of Neurology (BAN) since 2006 and the survey for all BAN members (3,240) in 2016. The geographic distribution of BAN members in Brazil follows the demographic concentration of the population. Participation of members from big cities was the most prevalent, 18.7% of participants were young neurologists, and 36.7% of neurologists had more than of 20 years of neurological practice. The improvement of knowledge of neurological practice in Brazil will be useful for BAN leadership in planning future actions. The BAN must make an effort to aggregate a greater number of neurologists, offering updating support contributing to health policies to disseminate neurological care in Brazil.

The assessment of headaches on the acute medical unit: is it adequate and how could it be improved?

Neurological emergencies represent 15-25% of the medical take, second only to cardiac and respiratory cases. However, the UK's number of neurologists is lower than that of other developed nations. This quality improvement project aimed to develop a guideline to optimise acute headache management by non-specialists, informed by the findings of a survey and audit of doctors' knowledge and practice. In total, 62 doctors responded to our survey. 53/56 (94.6%) agreed a guideline would be useful. Knowledge of some important causes of headache was high, but was lower for others, including cerebral venous sinus thrombosis and cervical artery dissection. A consultant neurologist deemed 14/27 (51.9%) of acute headache presentations audited pre-guidelines to have had appropriate management. After guideline launch, a re-audit demonstrated this proportion was 18/22 (81.8%) (p=0.04). We conclude the investigation and management of acute headache requires optimisation and a guideline may help to achieve this.

Why neurology? Factors which influence career choice in neurology

Objective: To evaluate the factors which influence the decision to pursue a career in neurology.Methods: An anonymous survey was developed using a Likert scale to rate responses. The survey was sent to adult and child neurology faculty, residents and fellows, as well as medical students applying for neurology. Descriptive statistics were used to analyse the factors of influence. Respondents were subsequently categorized into pre-neurology trainees, neurology trainees, child neurologists and adult neurologists, and differences between the groups were analysed using Pearson’s chi-square test.Results: One hundred and thirty-three anonymous responses were received. The respondents were neurologists across all levels of training and practice. Across all respondents, the most common factor of high importance was intellectual content of specialty, challenging diagnostic problems, type of patient encountered and interest in helping people. Responses were similar across the groups; however, the earliest trainees cited interest in helping people as most important, while those in neurology training and beyond cite intellectual content of the specialty as most important.Discussion: As trainees transition from their earliest levels of clinical experience into working as residents and faculty, there is a shift in the cited important factors. Lifestyle and financial factors seem to be the least motivating across all groups. Encouragement from peers, mentors, faculty and practicing physicians is considered high influences in a smaller number of neurologists. This may present an opportunity for practicing neurologists to make connections with medical students early in their education in an effort to encourage and mentor candidates.

Multiples sclerosis in India.

The chosen subject of discussion for this supplement of Annals of Indian Academy of Neurology is multiple sclerosis and related disorders in India. It is the initiative of the President, Dr. Arabinda Mukharjee, and comes at a time when a lot is happening in the field in general and in our country as well. From a time when early Indian practitioners of neurology wondered about the existence of multiple sclerosis in India, perceptions have changed much in recent years. While India still appears to be a low-risk zone for multiple sclerosis based on our geographical location, cases are seen regularly in all parts of India, rural and urban. In the absence of robust epidemiological data, it is very difficult to have accurate perceptions of the incidence and prevalence of multiple sclerosis in India. Increasing numbers of neurologists and the uniform availability of diagnostic tools such as magnetic resonance imaging have helped increase the detection and diagnosis of cases. On the other hand, the possibility that the incidence is increasing cannot be denied, and this has been shown to happen in other Asian countries, such as Japan. From the initial documentation of Indian patients with demyelinating disease, it was thought that the clinical pattern tended to be somewhat different in India, the optic nerves and spinal cord being affected more often: the “Asian MS.” Recent clinical and radiological studies on large cohorts of Indian multiple sclerosis patients have confirmed that their clinical profiles are similar to those seen in other parts of the world. The concept of Asian MS has given way to the recognition of neuromyelitis optica (NMO) as a distinct disease spectrum, and information is now available about NMO among Indians. The antibody detection rates in NMO spectrum disorders have increased in India, probably as test methodologies have improved. With the availability of tests throughout the country, the differential diagnosis between multiple sclerosis and NMO has become easier and therapies have improved. The increasing role of vitamin D in the causation of immunological disorders assumes importance in India, as large sections of the population are deficient in vitamin D, for unclear reasons. This issue of Annals of Indian Academy of Neurology covers some of these aspects. Singhal, our senior neurologist with long-term experience in treating demyelinating disorders, gives an overview of multiple sclerosis in India with comments on local therapy issues. Bhatia et al. present information on the epidemiological and genetic aspects of multiple sclerosis in India. As can be seen, the available reports are few, and there is a clear need for multicenter efforts spread across the country. There are two papers on NMO. Pandit, with her special expertise in this condition, covers many aspects of the disease in India, and Biswas and Mukharjee deal with the therapeutic aspects of NMO. As radiology forms the mainstay of the diagnosis, Katdare and Ursekar discuss this important aspect of diagnosis in modern times, covering differential diagnosis. The subject of therapy for multiple sclerosis is presented in two parts. Coles discusses the conventional and the newer agents in the treatment of multiple sclerosis and Shah discusses the symptomatic therapies. Surya gives an overview of the rehabilitative measures for these diseases, an aspect that requires much attention in our local situation. As can be seen from these papers, the diagnostic aspects of the disease have improved in India, but challenges face us in terms of the availability and affordability of therapies. As many Indians still bear medical expenses out of their own pocket, the feasibility of purchasing medicines becomes remote. There is a clear need for efforts toward subsidizing the drug costs and, possibly, evolving locally suitable treatment paradigms. The Multiple Sclerosis Society of India is an active and vibrant organization. Initially started in Mumbai, it now has many branches throughout India, and volunteers are involved in rehabilitation and counselling work, arranging medical camps, and spreading awareness. Having been associated with them for over two decades, I have witnessed their dedicated work. Support from neurologists and cohesive work with such organizations can further the documentation of data on multiple sclerosis and create a stronger platform for the sufferers.

Need for neurology specialists to be dedicated to hospital care in Italy

Any patients admitted to healthcare facilities with a neurological diseases deserves to be managed by a neurologist. This is particularly important for acute onset neurological disorders, because of their severity and the requirement of early and appropriate diagnostic-therapeutic approach. In addition, this may reduce both unnecessary admissions and length of stay, with a significant saving of resources for the National Health System (NHS). To ensure this, it is important to evaluate predictable needs for hospital neurologists in Italy. The hospital discharges for neurological medical diseases of the Major Disease Category (MDC) 1 were 455,132 in 2009 and 491,836 in 2008, more than 50 % of which were acute neurological disorders. Stroke and transient ischemic attacks (TIA) accounted for about 170,000 per year. Currently available neurologists in Italian healthcare facilities are largely insufficient to assist such a large number of patients. The 270 Neurological Care Units in Italy (of which 243 open to the emergency care) are equipped with an average number of 7.7 neurologists per unit, inadequate to ensure on duty care 24 h a day, 7 days a week. In addition, the mean age of hospital neurologists is quite high, with provision for large retirement. It is therefore required to increase in the next few years the number of neurologists by at least 30 %, with an increase of 562 units. To meet the need for neurology specialists committed to hospital care in Italy is also necessary to increase the number of scholarships for residents in post-graduate schools.

Abstract TP341: Nursing Impact on the Acute Stroke Team - Driving Practice in a Collaborative Environment

Background /Purpose: In 2005 a community hospital began the journey to Primary Stroke Center. One aspect was to develop a stroke response team. The acute stroke team must provide neurologist expertise at bedside, be cost neutral, compliment the workflow in the Emergency Department, and maximize the limited number of neurologists on staff. Stroke unit nurses were identified as neurological experts in the hospital. After intense training, Stroke Alert went live in October of 2007. The nurse led acute stroke team (AST) collaborated with the medical staff to increase the total volume of stroke patients receiving t-PA. With additional training, the nurse led team assisted in the identification and transfer of patients for endovascular therapy. Method: A group of 12 nurses were trained by the stroke medical director to complete a stroke assessment, then to communicate those findings to the neurologist on call and the Emergency Department physicians. The nurse responders and the Emergency Department nurses were trained to mix and calculate the doses for t-PA. In 2010 the nurse responders were educated on the criteria for endovascular therapy, including time frames, patient assessment, and key CT results. In 2011, the nurse responders were re-educated on the golden hour of stroke. Results: Since 2008, over 450 stroke alerts have been activated each year. The administration of t-PA increased from 4 patients in 2007 to 43 patients in 2011; an additional 9 patients were sent to another facility for endovascular therapy. In the first 6 months of 2012, over 50% of patients receive t-PA in less than 60 minutes and Gold plus from the AHA was achieved. Conclusion: Nurses can be a vital asset to the AST by providing neurological expertise, collaborating with physicians, and driving the stroke protocols.

The Nationwide Prevalence of Multiple Sclerosis in Iran (P01.143)

Objective: This study was designed to determine the epidemiologic indices of MS and to investigate the presence of a north-south gradient. Background There is not a nationwide MS prevalence study in Iran assessing the epidemiological aspects of the disease including geographical features and latitude. Design/Methods: The data for this cross-sectional survey was gathered from the MS Societies in different provinces of Iran.For this purpose, the number of MS patients before 2011 on the prevalence date (01/January/2011) were obtained. The relationship between MS risk and latitude, number of available MRI machines and number of neurologists were studied with regard to the population of each province data using univariate Spearman Correlation analysis. Results: Data of 12 active MS Societies in 12 different major provinces of Iran were recruited in this survey. The total number of all registered MS patients till 2010 was 19524 out of 46695319 Iranian population living in these 12 provinces resulting in an overall MS prevalence rate of 41.81/100000 .A significant correlation was found between MS prevalence and the number of neurologists (r=0.657, P =0.020) and the opening date of MS Societies (r= -0.676, P =0.016).There isn9t any relationship between geographical latitude and the prevalence of MS (r= -0.271, P=0.395). While the highest MS prevalence rate belonged to Esfahan at the center of the country (83.3/100000), the Northern provinces of Mazandaran (33.32/100000) had lower prevalence rate. Conclusions: The MS prevalence rate of 41.81/100000 in Iran is markedly higher than what was estimated before. It seems that, in spite of common point of view, there isn9t relationship between the MS prevalence and north-south gradient in Iran. Some most important epidemiologic factors for differences in MS prevalence in Iran were the opening year of MS Society, the number of neurologists and the number of active MRI centers leading to the higher recognition of MS cases in these areas. Disclosure: Dr. Heydari has nothing to disclose. Dr. Heydari has nothing to disclose. Dr. Heydari has nothing to disclose. Dr. Heydari has nothing to disclose.

脳卒中を診る神経内科医の育て方：卒前・卒後（研修医）教育に関する提言

Neurologists play a central role in management of stroke patients. However, in Japan, the number of neurologists who are interested in stroke management is not sufficient. In this paper, to raise stroke-conscious neurologists, i.e., neurologists who willingly take care of stroke patients, the roles of undergraduate medical education and postgraduate neurological training are discussed. The key points in neurological education are that stroke provides the best source of brain diseases, symtomatology, and neuroimaging, the best material for understanding of evidence-based medicine, and the model of comprehensive continuous practice from neurological emergency to neurorehabilitation.