European journal of neurology : the official journal of the European Federation of Neurological Societies
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Observational Study
Structured education to improve primary-care management of headache: how long do the benefits last? A follow-up observational study.
Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here the duration of this effect was assessed. ⋯ Improvements in GPs' practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of a decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years.
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Multicenter Study
Predictors of symptomatic intracranial haemorrhage in off-label thrombolysis: an analysis of the Safe Implementation of Treatments in Stroke registry.
Intravenous thrombolysis (IVT) is the only approved pharmacological treatment for acute ischemic stroke. Off-label IVT for ischemic stroke is common. We aimed to analyse its safety in a large database. ⋯ Thrombolysis appears to be safe with regard to SICH for most of the off-label criteria, especially for minor stroke, but is risky in patients with high blood pressure. Individual risk-benefit evaluation should be performed.
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There are numerous grading scales to describe the severity of aneurysmal subarachnoid hemorrhage (aSAH) and to predict outcome. Historically, outcome measures are heterogeneous and the comparability of grading scales is therefore limited. We designed this study to compare radiographic, clinical and combined grading systems in aSAH. ⋯ Knowledge of the merits and limitations of clinical, radiographic and combined scores is necessary in routine clinical practice. The new combined grading systems (HAIR, VG) showed no superiority compared with the established clinical measures (WFNS, HH) in predicting CI and unfavorable patient outcome.
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Observational Study
Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study.
The aim was to determine differences of clinical, treatment and outcome characteristics between patients with in-hospital and out-of-hospital status epilepticus (SE). ⋯ Patients with in-hospital SE had more fatal aetiologies and comorbidities, refractory SE, less return to functional baseline, and increased mortality compared to patients with out-of-hospital SE. Whilst the STESS was a robust predictor for death in both groups, the association between continuous anaesthesia and death was limited to out-of-hospital SE.
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A 1988 pilot study in Peru suggested an association between migraine and chronic exposure to high altitude. This study provides epidemiological evidence corroborating this. ⋯ Dwelling at high altitudes increases not only migraine prevalence but also the severity of its symptoms.