Search

Introduction Postural orthostatic tachycardia syndrome (POTS) is an underdiagnosed and undertreated dysautonomia. We hypothesize that there are differences between primary care physicians (PCPs) and patients' perceptions of POTS and that correcting these discrepancies may improve patient care.  Methods Two groups were surveyed: Patients who received care for POTS symptoms from a Cleveland Clinic neurologist or nurse practitioner and patients who received care from Cleveland Clinic family medicine or internal medicine physicians.  Results PCPs (81%) rated lightheadedness as the symptom with the most significant negative impact on patient's quality of life with POTS, while patients rated fatigue (32%) as their worst symptom. PCPs were somewhat comfortable managing POTS but were less confident recommending cardiac rehabilitation and daily behavioral measures.  Conclusion PCPs may need to continue review the negative impact of fatigue on the quality of life of POTS patients as well symptoms of body pain and lightheadedness. Although they are relatively comfortable managing POTS, PCPs may benefit from training on several aspects of POTS treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Cooperrider et al.)

Background: Teleneurology has been well described for acute stroke, but outpatient use has been limited. At home, virtual visits have the potential to improve access to neurological care. Introduction: This study reports on the use of a personal device videoconferencing platform for outpatient neurologic follow-up visits. Materials and Methods: This is a cross-sectional study that identified all virtual neurologic follow-up visits completed by patients ≥18 years at a single institution over 4 years. Virtual visits were conducted by personal smartphone or computer via videoconferencing with a provider. Patients were asked to rate their overall experience with the visit and provider (five-point scale). Travel distance from the institution was calculated using patient's home addresses. Results: Three thousand nine hundred thirteen patients completed 5,581 virtual visits during the study (mean age 49.4 ± 17.0 years, 58.7% female). Number of virtual visits increased from 30 in year 1 to 4,468 in year 4. Virtual visits were completed in all outpatient neurologic subspecialties. A total of 30.1% of patients were local (<50 miles), 25.9% were near regional (50-150 miles), 21.7% were far regional (151-270 miles), and 22.2% were remote (>270 miles). A distance of 1,327,128 miles of travel was prevented across the 5,581 visits. On average, patients rated their overall virtual visit experience 4.7/5 ± 0.89 and rated their provider 4.9/5 ± 0.48. Discussion: Virtual visits prevented a substantial amount of travel and resulted in high patient satisfaction. The sizable proportion of local patients may indicate that teleneurology provides important access for reasons beyond travel distance. Conclusion: This study demonstrates the feasibility of implementing outpatient teleneurology services.

Background and Aims: Individuals with heroin addiction are prone to dysfunctional decision-making. They frequently choose the short-term rewarding option of drug intake despite experiencing long-term negative consequences. Opioid maintenance treatment (OMT) is the most common treatment of heroin addiction., Methods: In this study, 38 individuals in an early stage of abstinence from heroin addiction (ESA-HA individuals) at the end of inpatient detoxification treatment and 41 individuals in long-term OMT were examined. Decision-making was assessed by (I) a modified version of the Iowa Gambling Task (IGT) with drug-related stimuli focusing on decision-making under ambiguity and (II) the Game of Dice Task (GDT) assessing decision-making under objective risk., Results: OMT-individuals showed significantly better performance in the IGT than the ESA-HA-individuals. They also showed significantly less craving under exposure of drug-related pictures. In the GDT, OMT-individuals showed significantly less risky decision-making than ESA-HA-individuals., Conclusion: The results suggest that patients receiving OMT show better functional decision-making and lower craving reactions. It could be assumed that the effectiveness of OMT in preventing relapse is linked to better decision-making and lower craving among these patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The aim of the study was to determine whether onabotulinumtoxinA therapy is effective in the treatment of new daily persistent headache (NDPH)., Background: New daily persistent headache is a difficult to treat headache syndrome resistant to both conventional and unconventional headache therapies. New daily persistent headache was excluded in the registration trials for onabotunlinumtoxinA (onabot) in chronic migraine. Apart from case reports supporting its benefit, little is known about its therapeutic value in NDPH., Design and Methods: We performed a single-center, retrospective chart review of patients with a diagnosis of NDPH who received onabot treatment for a 30-month period at the Cleveland Clinic Headache Center. Measures of interest were headache frequency and headache severity. All patients had received the Food and Drug Administration-approved PREEMPT Protocol., Results: A decrease in headache frequency was noted in 8 (50.0%) of 16 patients at 6 months and 7 (63.6%) of 11 patients at 12 months. Headache severity improved in 5 (50.0%) of 10 patients at 6 months and in 7 (77.8%) of 9 patients at 12 months., Conclusions: Most therapies are unable to break the unremitting course of NDPH. In our investigation, at 1 year (3-4 cycles of onabot treatment), approximately half of the patients treated showed a reduction in headache frequency and approximately 75% demonstrated some improvement in headache severity. Evidence from this small-scale retrospective study suggests that onabot shows strong promise for the treatment of NDPH, which currently is resistant to most therapies, but a randomized controlled study should be the next step in confirmation of this therapy.

To learn whether computerized tomography offered additional useful information over conventional radiographic evaluation of acute distal radial fractures in the younger adult, we scanned 22 consecutive injured wrists. Of the distal radial fractures in 19 wrists, sixteen were defined on plain films as intra-articular. In contrast, computerized tomography demonstrated that all fractures of the distal radius had intra-articular extension. In 3 wrists interpreted as being normal on plain films, despite clinical suspicion of a fracture, fractures were confirmed by computerized tomography. As a result of computerized tomography, injuries were assigned a higher Frykman value in 5 cases, and consideration of alternative patient management became necessary in 5 of the 22 patients.

In order to examine the relationships among social network structure, types of social support, and determinants of support satisfaction, an alternative method was used to score the Social Support Questionnaire (SSQ). Factor analysis procedures suggested that college students' (N=198) social networks consisted of four groups: nuclear family, other family, friends, and others. Satisfaction with support was positively related to the proportion of the network occupied by nuclear family and negatively related to the proportion of friends in the network. Evidence was found for the presence of both support specialists and support generalists in the networks of the college students. These results are discussed from a developmental perspective with attention to the implications for interventions.

The treatment approach presented in this article is an obvious departure from ways physicians are typically trained to handle patients' pain complaints. Traditional medical training focuses primarily on the management of acute pain. Unfortunately, the treatment modalities appropriate for acute pain are not applicable to most chronic pain disorders. Since physicians' practices contain many chronic pain patients, it is important for them to develop a more comprehensive and effective approach to the management of CLBP. Through the use of case vignettes, this article has attempted to elucidate some common problems experienced by patients with CLBP. It is a complex disorder that requires that the physicians be sensitive to the biologic, psychologic, and social aspects of the illness. Simply handing a patient with CLBP a set of back exercises or prescriptions for narcotics and sedatives will not be beneficial. Rather, the patient must be educated about the pain and taught to take an active role in his own treatment. By working with patients and their families, physicians can teach patients with CLBP the self-management skills essential for the resumption of a normal, productive life.