27 results on '"Struhal W"'
Search Results
2. Clinical autonomic nervous system laboratories in Europe: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies.
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Habek M, Leys F, Krbot Skorić M, Reis Carneiro D, Calandra-Buonaura G, Camaradou J, Chiaro G, Cortelli P, Falup-Pecurariu C, Granata R, Guaraldi P, Helbok R, Hilz MJ, Iodice V, Jordan J, Kaal ECA, Kamondi A, Pavy Le Traon A, Rocha I, Sellner J, Senard JM, Terkelsen A, Wenning GK, Berger T, Thijs RD, Struhal W, and Fanciulli A
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- Humans, Laboratories, Autonomic Nervous System, Surveys and Questionnaires, Autonomic Nervous System Diseases, Neurology
- Abstract
Background and Purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences., Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey., Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021)., Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
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- 2022
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3. Evaluation of the 2020 European Academy of Neurology virtual congress: transition from a face-to-face to a virtual meeting.
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Stamelou M, Struhal W, Ten Cate O, Matczak M, Çalışkan SA, Soffietti R, Marson A, Zis P, di Lorenzo F, Sander A, Deuschl G, de Visser M, and Bassetti CLA
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- Europe, Humans, Pandemics, SARS-CoV-2, COVID-19, Neurology
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Background and Purpose: Due to the COVID-19 pandemic, scientific congresses are increasingly being organized as virtual congresses (VCs). In May 2020, the European Academy of Neurology (EAN) held a VC, free of charge. In the absence of systematic studies on this topic, the aim of this study is to evaluate the attendance and perceived quality of the 2020 EAN VC compared to the 2019 EAN face-to-face congress (FFC)., Methods: An analysis of the demographic data of participants obtained from the online registration was done. A comparison of the two congresses based on a survey with questions on the perception of speakers' performance, quality of networking and other aspects was made., Results: Of 43,596 registered participants, 20,694 active participants attended the VC. Compared to 2019, the number of participants tripled (6916 in 2019) and the cumulated number of participants attending the sessions was five times higher (169,334 in 2020 vs. 33,024 in 2019). Out of active participants 55% were from outside Europe, 42% were board-certified neurologists (FFC 80%) and 21% were students (FFC 0.6%). The content of the congress was evaluated as 'above expectation' by 56% of the attendees (FFC 41%). Of the respondents who had been exposed to earlier EAN congresses 73% preferred the FFC compared to the VC (17%)., Conclusion: The VC fulfilled the main mission of organizing high quality EAN congresses despite the restrictions of the impersonal format. The geographical distribution of the participants proves the expected higher inclusivity of a VC. The large participation of students and neurologists in training opens new educational potentials for the EAN., (© 2021 European Academy of Neurology.)
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- 2021
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4. Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN).
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Thijs RD, Brignole M, Falup-Pecurariu C, Fanciulli A, Freeman R, Guaraldi P, Jordan J, Habek M, Hilz M, Pavy-LeTraon A, Stankovic I, Struhal W, Sutton R, Wenning G, and van Dijk JG
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- Consensus, Humans, Tilt-Table Test, Unconsciousness, United States, Neurology, Postural Orthostatic Tachycardia Syndrome
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An expert committee was formed to reach consensus on the use of Tilt Table Testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous ones. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to perform (1) additional provocation tests, such as the active standing test carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO
2 or neuro-endocrine tests; (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2021
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5. Insufficient global health education in European neurological post-graduate training: a European Association of Young Neurologists and Trainees survey.
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Sauerbier A, Macerollo A, Györfi O, Balicza P, Moarcas M, Papp V, Zis P, Klingelhoefer L, Saifee T, Struhal W, and Sellner J
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- Europe, Humans, Internship and Residency, Curriculum, Education, Medical, Graduate, Global Health, Health Education, Neurologists, Neurology education
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Background and Purpose: The awareness of and demand for neurological expertise in global health (GH) have emerged over recent years and have become more relevant due to the increasing numbers of refugees from developing countries arriving in Europe. This study aimed to assess the provision of GH education and opportunities for international exchange during neurology post-graduate training with a focus on Europe., Methods: We developed a questionnaire covering different aspects of and interest in GH education on behalf of the European Association of Young Neurologists and Trainees. Residents in neurology and junior neurologists (RJN) were approached to complete this survey., Results: Completed questionnaires were returned by 131 RJNs, of whom 65.7% were women and 84.0% were between 26 and 35 years old. In total, almost one-third (29.0%) of RJNs reported that their residency programs offered training in GH. Limited education was reported for women's or children's health and neurological disorders of immigrants and refugees, as only 22.1%, 25.2% and 22.1% of RJNs reported that such training was offered, respectively. The curriculum rarely included coverage of the global impact of neurological disorders. Definite plans to volunteer in a developing country were reported by 7.6%. The majority of the participants acknowledged the importance of GH training and international exchange during post-graduate education., Conclusion: This survey corroborates the interest in and appreciation of GH education by European RJNs. However, there are shortcomings in training and opportunities for international exchange. Academic neurology and international bodies, including the European Academy of Neurology, are requested to address this., (© 2016 EAN.)
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- 2016
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6. European junior neurologists perceive various shortcomings in current residency curricula.
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Györfi O, Moarcas M, Balicza P, Macerollo A, Struhal W, and Sellner J
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- Adult, Europe, Humans, Personal Satisfaction, Curriculum standards, Internship and Residency standards, Neurologists standards, Neurology education
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Background: Whether residency programs in Europe and neighboring countries appropriately prepare one for clinical practice is a matter of discussion., Aims of the Study: To assess perceived satisfaction and preparedness for clinical practice among residents and junior neurologists from Europe and neighboring countries., Material and Methods: We inquired about the level of satisfaction with the quality of teaching, rotations and research opportunities of their residency program with an anonymous paper-based questionnaire. We assessed different aspects of practical training including clinical examination, diagnostic procedures, and patient management., Results: The survey revealed limited satisfaction with the overall training (47%). The quality of teaching was frequently perceived as good or excellent (73%), whereas supervision for patient care and diagnostic procedures was rated as improvable. Discontent related often to poor proficiency for neurological emergencies, diagnostic considerations, and therapeutic decisions. Whether the working time directive introduced by the European Union (EU) affected patient care or resident education or residents' quality of life remained ambiguous., Conclusions: This cross-sectional survey disclosed shortcomings in current residency curricula. These concerned diagnostic and therapeutic procedures as well as practical skills, regardless of country, region, or institutional background. Initiatives aimed to harmonize postgraduate neurology training across Europe will need to consider these findings., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2016
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7. Voice of young neurologists around the world.
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Rakusa M, Struhal W, Gak S, Tanprawate S, Balicza P, Khawaja AM, and Schneider LD
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- Humans, Neurology education, Organizations, Nonprofit, Neurology organization & administration, Physicians organization & administration
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- 2016
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8. International issues: an international survey of young neurologists' perceptions of future health care and neurology.
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Macerollo A, Róna-Vörös K, Struhal W, Kobeleva X, and Sellner J
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- Adult, Delivery of Health Care standards, Europe, Global Health, Humans, Neurology standards, Delivery of Health Care trends, Neurology trends, Physicians psychology
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- 2015
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9. International Issues: Cross-border mobility of junior neurologists within and to the European Union.
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Macerollo A, Varga ET, Struhal W, Györfi O, Kobeleva X, and Sellner J
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- Adult, Education, Medical, Graduate statistics & numerical data, Employment statistics & numerical data, European Union, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Emigration and Immigration statistics & numerical data, Neurology education, Physicians statistics & numerical data
- Abstract
Objective: To assess the general interest in and motivation for cross-border mobility among residents and junior neurologists from member states of the European Union and neighboring countries., Methods: Questionnaire-based paper survey among 118 participants of a neurology course., Results: Ninety-seven (82%) participants returned the survey. Most of them had at one point considered relocating within or to the European Union for postgraduate education (87%) or employment (71%). Common motivations were superior prospects for clinical training (85%), resources at work and academic environment (both 80%), and remuneration (70%). Barely half of the surveyed intended to return to their home country. The attractiveness of Europe as a destination for migration was ranked over other continents. The most common reasons that reduce enthusiasm for relocation were the loss of family connection (55%) and uncertain future prospects (41%), whereas language barriers were less relevant (21%)., Conclusion: There is keen interest of the upcoming generation of neurologists to relocate within and to the European Union. The motives include regional differences in training and career opportunities as well as economic welfare. Appropriate steps toward the harmonization of educational and career prospects are urgently required to ensure adequate provision of neurology service and patient care throughout Europe., (© 2014 American Academy of Neurology.)
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- 2014
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10. International issues: Obtaining an adult neurology residency position in the United States: an overview.
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Jordan JT, Sellner J, Struhal W, Schneider L, and Mayans D
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- Humans, Internal Medicine, Schools, Medical, United States, Workforce, Career Choice, Education, Medical, Graduate, Internship and Residency, Neurology
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Around the world, there are marked differences in neurology training, including training duration and degree of specialization. In the United States, adult neurology residency is composed of 1 year of internal medicine training (preliminary year) and 3 years of neurology-specific training. Child neurology, which is not the focus of this article, is 2 years of pediatrics and 3 years of neurology training. The route to adult neurology residency training in the United States is standardized and is similar to most other US specialties. Whereas US medical graduates often receive stepwise guidance from their medical school regarding application for residency training, international graduates often enter this complex process with little or no such assistance. Despite this discrepancy, about 10%-15% of residency positions in the United States are filled by international medical graduates.(1,2) In adult neurology specifically, 35% of matched positions were filled by international graduates in 2013, 75% of whom were not US citizens.(1) In an effort to provide a preliminary understanding of the application process and related terminology (table 1) and thereby encourage international residency applicants, we describe the steps necessary to apply for neurology residency in the United States.
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- 2014
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11. The European Association of Young Neurologists and Trainees: the scent of freedom.
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Rakusa M, Struhal W, and Sellner J
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- Europe, History, 20th Century, History, 21st Century, Humans, Medical Staff, Hospital education, Neurology history, Neurology education, Societies, Medical history
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- 2014
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12. The global perspective on neurology training: the World Federation of Neurology survey.
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Steck A, Struhal W, Sergay SM, and Grisold W
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- Data Collection, Humans, Workforce, Education, Medical, Graduate trends, Internship and Residency trends, Neurology education, Societies, Medical
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This World Federation of Neurology (WFN) study aimed to characterize the status quo of post-graduate neurology training throughout the world and enable a better orientation on global training in neurology. Basic data on training curricula and working conditions of neurology residents and neurologists in 39 countries worldwide were evaluated. Our data show considerable differences in manpower and training, but a continuous improvement within the last 10 years of observation. Worldwide a spread of interim evaluations and final examinations of different types are used. Online resources will undoubtedly profoundly change skill and knowledge acquisition and training practices in Neurology in the coming years., (© 2013 Elsevier B.V. All rights reserved.)
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- 2013
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13. Harmonization of European neurology education: the junior doctor's perspective.
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Macerollo A, Struhal W, and Sellner J
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- European Union, Humans, Education, Medical, Graduate, Neurology education, Physicians
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The objective of this article, written by executives of the European Association of Young Neurologists and Trainees (EAYNT), is to illustrate the status quo of neurology training in Europe and give an outlook on ongoing efforts and prospects for junior neurologists. The European Union is an economic and political union that currently encompasses 27 member states with more than 500 million inhabitants (or 7.3% of the world population) (interested readers are referred to http://en.wikipedia.org/wiki/European_Union). Countries of the European Union act as a single market with free movement of citizens, goods, services, and finances. As a consequence, a diploma and postgraduate training obtained in one EU country will be automatically recognized by all other EU member states. At the Lisbon European Council in March 2000, the Heads of State or Government signed a treaty that expresses their ambition of making Europe "the most competitive and dynamic knowledge-based economy in the world, capable of sustainable economic growth with more and better jobs and greater social cohesion" (www.en.wikipedia.org/wiki/Lisbon_Strategy). More than 1.6 million physicians in all the different medical specialties are represented by the European Union of Medical Specialists (UEMS). The UEMS was founded in 1958 and the objectives include the study, promotion, and harmonization of the highest level of training of medical specialists, medical practice, and health care within the European Union. The European Board of Neurology (UEMS-EBN; www.uems-neuroboard.org) is in charge of the implementation of the UEMS policy regarding neurology.
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- 2013
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14. Three important steps to European neurology harmonization: core curriculum, visitation program, European board examination.
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Struhal W, Mellgren SI, and Grisold W
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- Curriculum, Europe, Neurology economics, Specialization, Neurology education, Neurology standards, Specialty Boards standards
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- 2013
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15. The Open Facilities for Training in European Neurology (OFTEN): an emerging pan-European exchange programme for junior neurologists.
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Sellner J, Schirmer L, Erik Gilhus N, Grisold W, and Struhal W
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- Education, Medical, Europe, Humans, Physicians, Workforce, Education, Medical, Graduate, Neurology education
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- 2012
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16. The European Board of Neurology Examination--junior neurologists are eager to take the challenge.
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Struhal W, Rakusa M, Grisold W, and Sellner J
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- Attitude of Health Personnel, Certification methods, Clinical Competence standards, Europe, Female, Health Surveys, Humans, Internship and Residency standards, Male, Professional Competence standards, Certification standards, Education, Medical, Graduate standards, Neurology education, Neurology standards, Specialty Boards standards
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Background: The Union Européenne des Médecins Spécialistes Section of Neurology (UEMS SEN)/European Board of Neurology (EBN) examination was launched in 2009 to set standards in knowledge and skills for the next generation of European neurologists., Methods: Stimulated by the low participation at the first examination, we conducted a survey amongst 76 junior colleagues to assess awareness, motivation and obstacles regarding this examination., Results: Remarkably, junior neurologists indicated great interest in the examination and motivation to spend additional preparation time (up to 6months) with the aim to catch up with European standards and improve the care of patients. However, there are major issues, which detain our colleagues from taking the examination including the amount of the examination fee, the potential lack of language abilities and the varying usage of the recommended books for preparation., Conclusions: This survey highlights the positive attitude of junior neurologists regarding initiatives to improve clinical skills and knowledge. Moreover, this study delineated several factors, which may be considered in the future to increase participation and substantiate the significance of the examination., (© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.)
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- 2011
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17. Neurology residency training in Europe--the current situation.
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Struhal W, Sellner J, Lisnic V, Vécsei L, Müller E, and Grisold W
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- Certification standards, Europe, Female, Humans, Male, Education, Medical, Graduate methods, Education, Medical, Graduate standards, Neurology education
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Introduction: Little is known about neurological training curricula in Europe. A joint approach by the European Federation of Neurological Societies (EFNS), the Union of European Medical Specialists/European Board of Neurology and the European Association of Young Neurologist and Trainees was established to explore the spectrum of neurology training in Europe., Methods: In 2006, a questionnaire-based survey on neurology curricula as well as demographic data was designed by WS and WG and distributed by the EFNS to the national delegates of the EFNS, which comprises all European countries and Israel., Results: By 2009, delegates from 31 of 41 countries (representing 76% of 505 million) had returned the questionnaire. A total of 24,165 specialists (46% women) were registered in the 31 countries. This corresponds to an average of 6.6 neurologists per 100,000 inhabitants (range 0.9-17.4/100,000 inhabitants). Duration of training in Europe was on average 4.9,years, ranging from 3 to 6,years. The number of residents interested in neurological training exceeded the amount of available training positions. Performance of neurological trainees was regularly assessed in 26 countries (84%), usually by recurrent clinical evaluation. Board examinations were held in 23 countries (74%). Interim examinations were performed in three countries, exit examinations in 14 and both interim and exit examination in 6. Considerable differences were also found in manpower (0.9-17.4 neurologists/100,000 inhabitants) and working conditions (e.g. average weekly working hours ranging from 30-80 h/month). We found a significant positive correlation between manpower and theoretical training hours., Conclusion: Considerable differences exist in training curricula of European countries. These data might provide the basis for European training and quality assurance initiatives., (© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.)
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- 2011
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18. International Issues: the EAYNT: ten years of unifying European junior neurologists.
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Struhal W, Sztriha LK, Rejdak K, Petzold A, and Sellner J
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- Adult, Education, Medical statistics & numerical data, Europe, Humans, International Educational Exchange statistics & numerical data, Practice Guidelines as Topic, Quality of Health Care standards, Education, Medical trends, International Educational Exchange trends, Neurology education, Societies, Medical organization & administration
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- 2011
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19. European Association of Young Neurologists and Trainees: position paper on teaching courses for Generation Y.
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Struhal W, Falup-Pecurariu C, Sztriha LK, Grisold W, and Sellner J
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- Adult, Education, Medical, Graduate, Europe, Female, Humans, International Educational Exchange, Male, Neurology trends, Teaching methods, Teaching trends, Neurology education, Physicians trends, Societies, Medical organization & administration
- Abstract
The European Association of Young Neurologists and Trainees (EAYNT) is a non-profit organization which acts on behalf of young neurologists in Europe and concertedly exerts influence on the formation of a new generation of neurologists [Struhal et al.: Eur J Neurol 2009;16:e146-e148]. This concerns particularly the Generation Y (Gen Y), also known as Millennial Generation, Digital Natives or Generation Next, a demographic cohort defined by birth between 1981 and 1999 [Elkind: Neurology 2009;72:657-663]. A unifying feature is the increased use and familiarity with online media and digital technologies. Online social networks and interactive communication have not only shaped this cohort but necessitate a different approach towards educational matters. This position paper aims to address the changing needs for Gen Yers in the context of education., (Copyright © 2011 S. Karger AG, Basel.)
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- 2011
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20. Successful workshop on evidence-based neurology organized by the EAYNT and the Cochrane Neurological Network.
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Sztriha L, Struhal W, Falup-Pecurariu C, and Sellner J
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- Austria, Europe, Evidence-Based Medicine methods, Humans, International Cooperation, Meta-Analysis as Topic, Neurology education, Societies, Medical organization & administration, Evidence-Based Medicine trends, Neurology trends, Societies, Medical trends
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- 2010
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21. The European Asociation of Young Neurologists and Trainees: advocating young neurologists in Europe.
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Struhal W, Falup-Pecurariu C, Sztriha L, and Sellner J
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- Education, Medical, Europe, Humans, International Educational Exchange, Neurology education, Societies, Medical organization & administration
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- 2009
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22. EAYNT: promoting training in neuro-rehabilitation.
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Struhal W, Hess B, Sztriha L, Falup-Pecurariu C, Findling O, and Sellner J
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- Europe, Humans, Neurology methods, Portraits as Topic, Rehabilitation methods, Nervous System Diseases rehabilitation, Neurology education, Rehabilitation education
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- 2009
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23. [From expansion to reality, what to do with trained neurologists?].
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Grisold W and Struhal W
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- Europe, Humans, Workforce, Neurology education, Physicians
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- 2006
24. Rethinking neurological attitudes towards vasovagal syncope: The European Federation of Autonomic Societies (EFAS) recommendations regarding tilt table testing
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van Dijk, J.G., Thijs, R., Brignole, M., Falup‐Pecurariu, C., Fanciulli, A., Freeman, R., Guaraldi, P., Jordan, J., Habek, M., Hilz, M.J., Pavy‐Le Traon, A., Stankovic, I., Struhal, W., Sutton, R., and Wenning, G.K.
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medicine.medical_specialty ,MEDLINE ,Autonomic Nervous System ,Physical medicine and rehabilitation ,Heart Rate ,Tilt-Table Test ,medicine ,Syncope, Vasovagal ,Humans ,European Federation of Autonomic Societies (EFAS) Task Force on Tilt Table Testing ,Vasovagal syncope ,neurological ,Neurology & Neurosurgery ,business.industry ,tilt table testing ,1103 Clinical Sciences ,medicine.disease ,EFAS ,vasovagal syncope ,Tilt (optics) ,Neurology ,Attitude ,Table (database) ,Neurology (clinical) ,1109 Neurosciences ,business - Published
- 2021
25. Clinical autonomic nervous system laboratories in Europe. A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies
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Habek, Mario, Leys, Fabian, Krbot Skorić, Magdalena, Reis Carneiro, Diogo, Calandra‐Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup‐Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Pavy Le Traon, Anne, Rocha, Isabel, Sellner, Johann, Senard, Jean Michel, Terkelsen, Astrid, Wenning, Gregor K., Berger, Thomas, Thijs, Roland D., Struhal, Walter, Fanciulli, Alessandra, Adamec, Ivan, Aerts, Arnaud, Canta, Leo L.R., Delamont, Robert Shane, de Lange, Frederik, Del Sorbo, Francesca, Devigili, Grazia, Di Leo, Rita, Dinh, Trang, Fortrat, Jacques‐Olivier, Gierthmühlen, Janne, Hemels, Martin, Köhn, Julia, Krøigård, Thomas, Lipp, Axel, Maier, Andrea, Marinelli, Lucio, Mazzeo, Anna, Milenkovic, Ivan, Motyl, Maciej, Natali Sora, Maria Grazia, Navarro‐Otano, Judith, Nilsen, Kristian Bernhard, Oliveira, Mario, Omland, Petter Moe, Pelliccioni, Giuseppe, Pereon, Yann, Resch, Roland Josef, Rocchi, Camilla, Roche, Frederic, Rutten, Joost, Tijero Merino, Beatriz, Tutaj, Marcin, van der Heijden‐Montfroy, A.M.H.G., van Hoeve, Bas J.A., van Orshoven, Narender, Wang, Ruihao, Z’Graggen, Werner J., Habek M., Leys F., Krbot Skoric M., Reis Carneiro D., Calandra-Buonaura G., Camaradou J., Chiaro G., Cortelli P., Falup-Pecurariu C., Granata R., Guaraldi P., Helbok R., Hilz M.J., Iodice V., Jordan J., Kaal E.C.A., Kamondi A., Pavy Le Traon A., Rocha I., Sellner J., Senard J.M., Terkelsen A., Wenning G.K., Berger T., Thijs R.D., Struhal W., Fanciulli A., Adamec I., Aerts A., Canta L.L.R., Delamont R.S., de Lange F., Del Sorbo F., Devigili G., Di Leo R., Dinh T., Fortrat J.-O., Gierthmuhlen J., Hemels M., Kohn J., Kroigard T., Lipp A., Maier A., Marinelli L., Mazzeo A., Milenkovic I., Motyl M., Natali Sora M.G., Navarro-Otano J., Nilsen K.B., Oliveira M., Omland P.M., Pelliccioni G., Pereon Y., Resch R.J., Rocchi C., Roche F., Rutten J., Tijero Merino B., Tutaj M., van der Heijden-Montfroy A.M.H.G., van Hoeve B.J.A., van Orshoven N., Wang R., Z'Graggen W.J., Cardiology, ACS - Heart failure & arrhythmias, and Repositório da Universidade de Lisboa
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sweat test ,sweat tests ,neurological disorders ,Autonomic Nervous System ,Autonomic Nervous System Disease ,(disorders of) autonomic nervous system ,cardiovascular autonomic function test ,Composite Autonomic Severity Score ,orthostatic hypotension ,Neurology ,syncope ,Consciousness, disorders ,neurodisparity ,Autonomic nervous system, disorders ,Surveys and Questionnaire ,Neurology (clinical) ,cardiovascular autonomic function tests ,disorders of consciousness (other than epilepsy) ,neurological disorder ,Survey ,Laboratorie ,Human - Abstract
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes., Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.
- Published
- 2022
26. Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS): Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH)
- Author
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Roland D. Thijs, Konstantinos Tsioufis, Isabel Rocha, Sabine Eschlboeck, Satish R. Raj, Lucy Norcliffe Kaufmann, Alessandra Fanciulli, Guido Grassi, Gert Mayer, Max J. Hilz, Giovanna Calandra Buonaura, Giuseppe Mancia, Gregor K. Wenning, Walter Struhal, Jens Jordan, J. Gert van Dijk, David Robertson, William P. Cheshire, Anne Pavy-Le Traon, Pietro Cortelli, Italo Biaggioni, Horacio Kaufmann, Heinz Lahrmann, Fanciulli, Alessandra, Jordan, Jen, Biaggioni, Italo, Calandra–Buonaura, Giovanna, Cheshire, William P., Cortelli, Pietro, Eschlboeck, Sabine, Grassi, Guido, Hilz, Max J., Kaufmann, Horacio, Lahrmann, Heinz, Mancia, Giuseppe, Mayer, Gert, Norcliffe–Kaufmann, Lucy, Pavy–Le Traon, Anne, Raj, Satish R., Robertson, David, Rocha, Isabel, Struhal, Walter, Thijs, Roland, Tsioufis, Konstantinos P., van Dijk, J. Gert, Wenning, Gregor K., Fanciulli, A, Jordan, J, Biaggioni, I, Calandra-Buonaura, G, Cheshire, W, Cortelli, P, Eschlboeck, S, Grassi, G, Hilz, M, Kaufmann, H, Lahrmann, H, Mancia, G, Mayer, G, Norcliffe-Kauffmann, L, Pavy-Le Traon, A, Raj, S, Robertson, D, Rocha, I, Struhal, W, Thijs, R, Tsioufis, K, van Dijk, J, and Wenning, G
- Subjects
medicine.medical_specialty ,Supine position ,Neurology ,Supine hypertension ,Autonomic failure ,Context (language use) ,030204 cardiovascular system & hematology ,Endocrine and Autonomic System ,03 medical and health sciences ,Orthostatic vital signs ,0302 clinical medicine ,Neurogenic orthostatic hypotension ,Epidemiology ,ABPM ,Medicine ,Pure autonomic failure ,Endocrine and Autonomic Systems ,business.industry ,Nocturnal hypertension ,medicine.disease ,3. Good health ,Blood pressure ,Neurogenic supine hypertension ,Physical therapy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Purpose: Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure. Methods: As a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension. Results: In patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management. Conclusions: The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
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- 2018
27. EFNS guidelines on the diagnosis and management of orthostatic hypotension
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Max J. Hilz, Walter Struhal, H. Lahrmann, Pietro Cortelli, M. Tassinari, Christopher J. Mathias, Lahrmann H., Cortelli P., Hilz M., Mathias C.J., Struhal W., and Tassinari M.
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medicine.medical_specialty ,Supine position ,business.industry ,Supine hypertension ,Fludrocortisone ,Midodrine ,Autonomic disorder ,Diagnosis, Differential ,Orthostatic vital signs ,Hypotension, Orthostatic ,Blood pressure ,Neurology ,Anesthesia ,Heart rate ,Practice Guidelines as Topic ,Physical therapy ,Medicine ,Humans ,Neurology (clinical) ,business ,medicine.drug - Abstract
Orthostatic (postural) hypotension (OH) is a common, yet under diagnosed disorder. It may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in primary and secondary autonomic disorders. These range from visual disturbances and dizziness to loss of consciousness (syncope) after postural change. Evidence based guidelines for the diagnostic workup and the therapeutic management (non-pharmacological and pharmacological) are provided based on the EFNS guidance regulations. The final literature research was performed in March 2005. For diagnosis of OH, a structured history taking and measurement of blood pressure (BP) and heart rate in supine and upright position are necessary. OH is defined as fall in systolic BP below 20 mmHg and diastolic BP below 10 mmHg of baseline within 3 min in upright position. Passive head-up tilt testing is recommended if the active standing test is negative, especially if the history is suggestive of OH, or in patients with motor impairment. The management initially consists of education, advice and training on various factors that influence blood pressure. Increased water and salt ingestion effectively improves OH. Physical measures include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise. Fludrocortisone is a valuable starter drug. Second line drugs include sympathomimetics, such as midodrine, ephedrine, or dihydroxyphenylserine. Supine hypertension has to be considered.
- Published
- 2006
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