The Medical journal of Australia
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There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults. ⋯ A brain health opportunity. We consider the discovery of incidental WMH on brain imaging to represent an opportunity to investigate for common cardiovascular risk factors and to optimise brain health. This can be commenced and monitored by the general practitioner or physician without delay in waiting for an outpatient neurology review.
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To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non-invasive ventilation guidelines, and their perspectives on delivering quality non-invasive ventilation services to people with neuromuscular disorders. ⋯ Systemic factors influence the needs-based provision of non-invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non-invasive ventilation care.