Headache service quality evaluation: implementation of quality indicators in primary care in Europe
|
01.12.2021 |
Lenz B.
Katsarava Z.
Gil-Gouveia R.
Karelis G.
Kaynarkaya B.
Meksa L.
Oliveira E.
Palavra F.
Rosendo I.
Sahin M.
Silva B.
Uludüz D.
Ural Y.Z.
Varsberga-Apsite I.
Zengin S.T.
Zvaune L.
Steiner T.J.
|
Journal of Headache and Pain |
10.1186/s10194-021-01236-4 |
0 |
Ссылка
Background: Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods: We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results: The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions: The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.
Читать
тезис
|
Structured Q1 headache services as the solution to the ill-health burden of headache: 1. Rationale and description
|
01.12.2021 |
Steiner T.J.
Jensen R.
Katsarava Z.
Stovner L.J.
Uluduz D.
Adarmouch L.
Al Jumah M.
Al Khathaami A.M.
Ashina M.
Braschinsky M.
Broner S.
Eliasson J.H.
Gil-Gouveia R.
Gómez-Galván J.B.
Gudmundsson L.S.
Herekar A.A.
Kawatu N.
Kissani N.
Kulkarni G.B.
Lebedeva E.R.
Leonardi M.
Linde M.
Luvsannorov O.
Maiga Y.
Milanov I.
Mitsikostas D.D.
Musayev T.
Olesen J.
Osipova V.
Paemeleire K.
Peres M.F.P.
Quispe G.
Rao G.N.
Risal A.
de la Torre E.R.
Saylor D.
Togha M.
Yu S.Y.
Zebenigus M.
Zewde Y.Z.
Zidverc-Trajković J.
Tinelli M.
|
Journal of Headache and Pain |
10.1186/s10194-021-01265-z |
1 |
Ссылка
In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.
Читать
тезис
|
Memory consolidation impairment induced by Interleukin-1β is associated with changes in hippocampal structural plasticity
|
16.09.2019 |
Herrera G.
Calfa G.
Schiöth H.
Lasaga M.
Scimonelli T.
|
Behavioural Brain Research |
10.1016/j.bbr.2019.111969 |
0 |
Ссылка
© 2019 Elsevier B.V. Pro-inflammatory cytokines, particularly Interleukin-1β (IL-1β), can affect cognitive processes such as learning and memory. The aim of this study was to establish whether the effect of IL-1β on contextual fear memory is associated with changes in hippocampal structural plasticity. We also studied the effect of α-melanocyte-stimulating hormone (α-MSH), a potent anti-inflammatory and neuro-protective peptide. Different groups of animals were implanted bilaterally in dorsal hippocampus (DH). After recovery they were conditioned for contextual fear memory and received the different treatments (vehicle, IL-1β, α-MSH or IL-1β + α-MSH). Memory was assessed 24 hs after conditioning and immediately after rats were perfused for dendritic spine analysis. Our results show that local hippocampal administration of IL-1β just after memory encoding induced impairment in contextual memory and a reduction in the total density of CA1 hippocampal dendritic spines, particularly the mature ones. α-MSH administration reversed the IL-1β induced changes. The results suggest that neuro-inflammation induced by IL-1β interferes with experience-dependent structural plasticity in DH whereas α-MSH has a beneficial modulatory role in preventing this effect.
Читать
тезис
|
Dissociation of impulsivity and aggression in mice deficient for the ADHD risk gene Adgrl3: Evidence for dopamine transporter dysregulation
|
15.09.2019 |
Mortimer N.
Ganster T.
O'Leary A.
Popp S.
Freudenberg F.
Reif A.
Soler Artigas M.
Ribasés M.
Ramos-Quiroga J.
Lesch K.
Rivero O.
|
Neuropharmacology |
10.1016/j.neuropharm.2019.02.039 |
4 |
Ссылка
© 2019 Elsevier Ltd Adhesion G protein-coupled receptor L3 (ADGRL3, LPHN3) has putative roles in neuronal migration and synapse function. Various polymorphisms in ADGRL3 have been linked with an increased risk of attention deficit/hyperactivity disorder (ADHD). In this study, we examined the characteristics of Adgrl3-deficient mice in multiple behavioural domains related to ADHD: locomotive activity, impulsivity, gait, visuospatial and recognition memory, sociability, anxiety-like behaviour and aggression. Additionally, we investigated the effect of Adgrl3-depletion at the transcriptomic level by RNA-sequencing three ADHD-relevant brain regions: prefrontal cortex (PFC), hippocampus and striatum. Adgrl3 −/− mice show increased locomotive activity across all tests and subtle gait abnormalities. These mice also show impairments across spatial memory and learning domains, alongside increased levels of impulsivity and sociability with decreased aggression. However, these alterations were absent in Adgrl3 +/− mice. Across all brain regions tested, the numbers of genes found to exhibit differential expression was relatively small, indicating a specific pathway of action, rather than a broad neurobiological perturbation. Gene-set analysis of differential expression in the PFC detected a number of ADHD-relevant pathways including dopaminergic synapses as well as cocaine and amphetamine addiction. The Slc6a3 gene coding for the dopamine transporter was the most dysregulated gene in the PFC. Unexpectedly, several neurohormone/peptides which are typically only expressed in the hypothamalus were found to be dysregulated in the striatum. Our study further validates Adgrl3 constitutive knockout mice as an experimental model of ADHD while providing neuroanatomical targets for future studies involving ADGRL3 modified models. This article is part of the Special Issue entitled ‘Current status of the neurobiology of aggression and impulsivity’.
Читать
тезис
|
Aberrant cardiolipin metabolism is associated with cognitive deficiency and hippocampal alteration in tafazzin knockdown mice
|
01.10.2018 |
Cole L.
Kim J.
Amoscato A.
Tyurina Y.
Bayır H.
Karimi B.
Siddiqui T.
Kagan V.
Hatch G.
Kauppinen T.
|
Biochimica et Biophysica Acta - Molecular Basis of Disease |
|
3 |
Ссылка
© 2018 Elsevier B.V. Cardiolipin (CL) is a key mitochondrial phospholipid essential for mitochondrial energy production. CL is remodeled from monolysocardiolipin (MLCL) by the enzyme tafazzin (TAZ). Loss-of-function mutations in the gene which encodes TAZ results in a rare X-linked disorder called Barth Syndrome (BTHS). The mutated TAZ is unable to maintain the physiological CL:MLCL ratio, thus reducing CL levels and affecting mitochondrial function. BTHS is best known as a cardiac disease, but has been acknowledged as a multi-syndrome disorder, including cognitive deficits. Since reduced CL levels has also been reported in numerous neurodegenerative disorders, we examined how TAZ-deficiency impacts cognitive abilities, brain mitochondrial respiration and the function of hippocampal neurons and glia in TAZ knockdown (TAZ kd) mice. We have identified for the first time the profile of changes that occur in brain phospholipid content and composition of TAZ kd mice. The brain of TAZ kd mice exhibited reduced TAZ protein expression, reduced total CL levels and a 19-fold accumulation of MLCL compared to wild-type littermate controls. TAZ kd brain exhibited a markedly distinct profile of CL and MLCL molecular species. In mitochondria, the activity of complex I was significantly elevated in the monomeric and supercomplex forms with TAZ-deficiency. This corresponded with elevated mitochondrial state I respiration and attenuated spare capacity. Furthermore, the production of reactive oxygen species was significantly elevated in TAZ kd brain mitochondria. While motor function remained normal in TAZ kd mice, they showed significant memory deficiency based on novel object recognition test. These results correlated with reduced synaptophysin protein levels and derangement of the neuronal CA1 layer in hippocampus. Finally, TAZ kd mice had elevated activation of brain immune cells, microglia compared to littermate controls. Collectively, our findings demonstrate that TAZ-mediated remodeling of CL contributes significantly to the expansive distribution of CL molecular species in the brain, plays a key role in mitochondria respiratory activity, maintains normal cognitive function, and identifies the hippocampus as a potential therapeutic target for BTHS.
Читать
тезис
|
Cyclic AMP pathway suppress autoimmune neuroinflammation by inhibiting functions of encephalitogenic CD4 T cells and enhancing M2 macrophage polarization at the site of inflammation
|
25.01.2018 |
Veremeyko T.
Yung A.
Dukhinova M.
Kuznetsova I.
Pomytkin I.
Lyundup A.
Strekalova T.
Barteneva N.
Ponomarev E.
|
Frontiers in Immunology |
|
17 |
Ссылка
© 2018 Veremeyko, Yung, Dukhinova, Kuznetsova, Pomytkin, Lyundup, Strekalova, Barteneva and Ponomarev. Although it has been demonstrated that cAMP pathway affect both adaptive and innate cell functions, the role of this pathway in the regulation of T-cell-mediated central nervous system (CNS) autoimmune inflammation, such as in experimental autoimmune encephalomyelitis (EAE), remains unclear. It is also unclear how cAMP pathway affects the function of CD4 T cells in vivo at the site of inflammation. We found that adenylyl cyclase activator Forskolin besides inhibition of functions autoimmune CD4 T cells also upregulated microRNA (miR)-124 in the CNS during EAE, which is associated with M2 phenotype of microglia/macrophages. Our study further established that in addition to direct influence of cAMP pathway on CD4 T cells, stimulation of this pathway promoted macrophage polarization toward M2 leading to indirect inhibition of function of T cells in the CNS. We demonstrated that Forskolin together with IL-4 or with Forskolin together with IL-4 and IFNγ effectively stimulated M2 phenotype of macrophages indicating high potency of this pathway in reprogramming of macrophage polarization in Th2-and even in Th1/Th2-mixed inflammatory conditions such as EAE. Mechanistically, Forskolin and/or IL-4 activated ERK pathway in macrophages resulting in the upregulation of M2-associated molecules miR-124, arginase (Arg)1, and Mannose receptor C-type 1 (Mrc1), which was reversed by ERK inhibitors. Administration of Forskolin after the onset of EAE substantially upregulated M2 markers Arg1, Mrc1, Fizz1, and Ym1 and inhibited M1 markers nitric oxide synthetase 2 and CD86 in the CNS during EAE resulting in decrease in macrophage/microglia activation, lymphocyte and CD4 T cell infiltration, and the recovery from the disease. Forskolin inhibited proliferation and IFNγ production by CD4 T cells in the CNS but had rather weak direct effect on proliferation of autoimmune T cells in the periphery and in vitro, suggesting prevalence of indirect effect of Forskolin on differentiation and functions of autoimmune CD4 T cells in vivo. Thus, our data indicate that Forskolin has potency to skew balance toward M2 affecting ERK pathway in macrophages and indirectly inhibit pathogenic CD4 T cells in the CNS leading to the suppression of autoimmune inflammation. These data may have also implications for future therapeutic approaches to inhibit autoimmune Th1 cells at the site of tissue inflammation.
Читать
тезис
|
Features of primary hippocampal cultures formation on scaffolds based on hyaluronic acid glycidyl methacrylate
|
01.01.2018 |
Mishchenko T.
Mitroshina E.
Kuznetsova A.
Shirokova O.
Khaydukov E.
Savelyev A.
Popov V.
Zvyagin A.
Vedunova M.
|
Sovremennye Tehnologii v Medicine |
|
0 |
Ссылка
© 2018, Nizhny Novgorod State Medical Academy. All rights reserved. The aim of the study was to investigate the morphological and metabolic features of primary hippocampal cultures formation on hydrogel films and scaffolds based on hyaluronic acid glycidyl methacrylate. Materials and Methods. Hydrogel films and scaffolds with certain architectonics were developed by micromolding technique on the basis of hyaluronic acid glycidyl methacrylate. Primary hippocampal cells obtained from C57BL/6 mouse embryos (E18) were cultured on the created constructs more than 14 days. Testing cell viability, morphometric assessment, and analysis of spontaneous calcium activity of primary hippocampal cultures were performed on day 14 of cultures development in vitro. Results. This study revealed that the material for the development of scaffolds with given architectonics is non-toxic for the nervous system cells. Dissociated hippocampal cells were actively attached to the scaffold surface and were assembled into cell conglomerates, which exhibited spontaneous calcium activity. Conclusion. Scaffolds designed on the basis of hyaluronic acid glycidyl methacrylate have a high biocompatibility with the nervous system cells. Architectonics and adhesive properties of scaffold contribute to the formation of functionally active cell conglomerates.
Читать
тезис
|
Pro-neurogenic, memory-enhancing and anti-stress effects of DF302, a novel fluorine gamma-carboline derivative with multi-target mechanism of action
|
01.01.2018 |
Strekalova T.
Bahzenova N.
Trofimov A.
Schmitt-Böhrer A.
Markova N.
Grigoriev V.
Zamoyski V.
Serkova T.
Redkozubova O.
Vinogradova D.
Umriukhin A.
Fisenko V.
Lillesaar C.
Shevtsova E.
Sokolov V.
Aksinenko A.
Lesch K.
Bachurin S.
|
Molecular Neurobiology |
|
9 |
Ссылка
© Springer Science+Business Media New York 2016. A comparative study performed in mice investigating the action of DF302, a novel fluoride-containing gamma-carboline derivative, in comparison to the structurally similar neuroprotective drug dimebon. Drug effects on learning and memory, emotionality, hippocampal neurogenesis and mitochondrial functions, as well as AMPA-mediated currents and the 5-HT6 receptor are reported. In the step-down avoidance and fear-conditioning paradigms, bolus administration of drugs at doses of 10 or 40 mg/kg showed that only the higher dose of DF302 improved long-term memory while dimebon was ineffective at either dosage. Short-term memory and fear extinction remained unaltered across treatment groups. During the 5-day predation stress paradigm, oral drug treatment over a period of 2 weeks at the higher dosage regimen decreased anxiety-like behaviour. Both compounds supressed inter-male aggression in CD1 mice, the most eminent being the effects of DF302 in its highest dose. DF302 at the higher dose decreased floating behaviour in a 2-day swim test and after 21-day ultrasound stress. The density of Ki67-positive cells, a marker of adult neurogenesis, was reduced in the dentate gyrus of stressed dimebon-treated and non-treated mice, but not in DF302-treated mice. Non-stressed mice that received DF302 had a higher density of Ki67-positive cells than controls unlike dimebon-treated mice. Similar to dimebon, DF302 effectively potentiated AMPA receptor-mediated currents, bound to the 5-HT6 receptor, inhibited mitochondrial permeability transition and displayed cytoprotective properties in cellular models of neurodegeneration. Thus, DF302 exerts multi-target effects on the key mechanisms of neurodegenerative pathologies and can be considered as an optimized novel analogue of the neuroprotective agent dimebon.
Читать
тезис
|
Age-Related Changes in Morphometric Parameters of Hippocampal Neurons in Humans
|
|
S. E. Shemyakov
V. N. Nikolenko
Yu. V. Nesvizhskiy
|
Neuroscience and Behavioral Physiology |
|
|
There was an oversight in the Authorship of a recent Images in Urogynecology article titled: Rectocutaneous fistula with transmigration of the suture: a rare delayed complication of vault fixation with the sacrospinous ligament (DOI 10.1007/ s00192-015-2823-5). We would like to include Adj A/P Han How Chuan’s name in the list of authors. Adj A/P Han is a Senior Consultant and Department Head of Urogynaecology at the KK Hospital for Women and Children, Singapore.
Читать
тезис
PUBMED DOI |
Pro-neurogenic, Memory-Enhancing and Anti-stress Effects of DF302, a Novel Fluorine Gamma-Carboline Derivative with Multi-target Mechanism of Action
|
|
Петер Леш
Стрекалова Т.В.
Умрюхин А.T.
Баженова Н.С.
|
Molecular Neurobiology |
|
|
A comparative study performed in mice investigating the action of DF302, a novel fluoride-containing gamma-carboline derivative, in comparison to the structurally similar neuroprotective drug dimebon. Drug effects on learning and memory, emotionality, hippocampal neurogenesis and mitochondrial functions, as well as AMPA-mediated currents and the 5-HT6 receptor are reported. In the step-down avoidance and fear-conditioning paradigms, bolus administration of drugs at doses of 10 or 40 mg/kg showed that only the higher dose of DF302 improved long-term memory while dimebon was ineffective at either dosage. Short-term memory and fear extinction remained unaltered across treatment groups. During the 5-day predation stress paradigm, oral drug treatment over a period of 2 weeks at the higher dosage regimen decreased anxiety-like behaviour. Both compounds supressed inter-male aggression in CD1 mice, the most eminent being the effects of DF302 in its highest dose. DF302 at the higher dose decreased floating behaviour in a 2-day swim test and after 21-day ultrasound stress. The density of Ki67-positive cells, a marker of adult neurogenesis, was reduced in the dentate gyrus of stressed dimebon-treated and non-treated mice, but not in DF302-treated mice. Non-stressed mice that received DF302 had a higher density of Ki67-positive cells than controls unlike dimebon-treated mice. Similar to dimebon, DF302 effectively potentiated AMPA receptor-mediated currents, bound to the 5-HT6 receptor, inhibited mitochondrial permeability transition and displayed cytoprotective properties in cellular models of neurodegeneration. Thus, DF302 exerts multi-target effects on the key mechanisms of neurodegenerative pathologies and can be considered as an optimized novel analogue of the neuroprotective agent dimebon.
Читать
тезис
|
Age-Related Changes in Morphometric Parameters of Hippocampal Neurons in Humans
|
|
S. E. Shemyakov (professor)
V. N. Nikolenko (director)
Yu. V. Nesvizhskiy (professor)
|
Neuroscience and Behavioral Physiology |
|
|
There was an oversight in the Authorship of a recent Images in Urogynecology article titled: Rectocutaneous fistula with transmigration of the suture: a rare delayed complication of vault fixation with the sacrospinous ligament (DOI 10.1007/ s00192-015-2823-5). We would like to include Adj A/P Han How Chuan’s name in the list of authors. Adj A/P Han is a Senior Consultant and Department Head of Urogynaecology at the KK Hospital for Women and Children, Singapore.
Читать
тезис
PUBMED DOI |
Pro-neurogenic, Memory-Enhancing and Anti-stress Effects of DF302, a Novel Fluorine Gamma-Carboline Derivative with Multi-target Mechanism of Action
|
|
Петер Леш (руководитель лаборатории Психиатрической Нейробиологии)
Стрекалова Т.В. ( зам руководителя лаборатории Психиатрической Нейробиологии)
Умрюхин А.T. (старший научный сотрудник)
Баженова Н.С. (младший научный сотрудник)
|
Molecular Neurobiology |
|
|
A comparative study performed in mice investigating the action of DF302, a novel fluoride-containing gamma-carboline derivative, in comparison to the structurally similar neuroprotective drug dimebon. Drug effects on learning and memory, emotionality, hippocampal neurogenesis and mitochondrial functions, as well as AMPA-mediated currents and the 5-HT6 receptor are reported. In the step-down avoidance and fear-conditioning paradigms, bolus administration of drugs at doses of 10 or 40 mg/kg showed that only the higher dose of DF302 improved long-term memory while dimebon was ineffective at either dosage. Short-term memory and fear extinction remained unaltered across treatment groups. During the 5-day predation stress paradigm, oral drug treatment over a period of 2 weeks at the higher dosage regimen decreased anxiety-like behaviour. Both compounds supressed inter-male aggression in CD1 mice, the most eminent being the effects of DF302 in its highest dose. DF302 at the higher dose decreased floating behaviour in a 2-day swim test and after 21-day ultrasound stress. The density of Ki67-positive cells, a marker of adult neurogenesis, was reduced in the dentate gyrus of stressed dimebon-treated and non-treated mice, but not in DF302-treated mice. Non-stressed mice that received DF302 had a higher density of Ki67-positive cells than controls unlike dimebon-treated mice. Similar to dimebon, DF302 effectively potentiated AMPA receptor-mediated currents, bound to the 5-HT6 receptor, inhibited mitochondrial permeability transition and displayed cytoprotective properties in cellular models of neurodegeneration. Thus, DF302 exerts multi-target effects on the key mechanisms of neurodegenerative pathologies and can be considered as an optimized novel analogue of the neuroprotective agent dimebon.
Читать
тезис
|