BACKGROUND AND PURPOSE: Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants. METHODS: A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders. RESULTS: In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum. CONCLUSIONS: Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.

• MeSH
• autonomní nervový systém patofyziologie   fyziologie   MeSH
• dospělí MeSH
• klinické kompetence * MeSH
• konzultanti MeSH
• kurikulum * MeSH
• kurzy a stáže v nemocnici * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci autonomního nervového systému terapie   MeSH
• neurologie * výchova   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. OBJECTIVE: Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND. METHODS: We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS). RESULTS: Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations. CONCLUSIONS: FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.

• MeSH
• dostupnost zdravotnických služeb MeSH
• lidé MeSH
• nemoci nervového systému terapie   MeSH
• neurologie výchova   MeSH
• neurologové MeSH
• roztroušená skleróza terapie   MeSH
• zdravotní politika * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

AIM OF STUDY: We aimed to compare knowledge, opinions, and clinical experiences among Czech, Slovak, and Italian neurologists to identify potential educational gaps and unify understanding. CLINICAL RATIONALE FOR STUDY: Functional neurological disorder (FND) is a disabling condition characterised by motor, sensory, or cognitive symptoms which are incompatible with other neurological disorders. Novel diagnostic and treatment approaches have improved FND management. However, the extent of their adoption, and any differences or similarities across European communities, remain to be established. MATERIAL AND METHODS: Members of the Czech and Slovak Neurological Societies were invited via e-mail to participate in a 14- -item web-based survey investigating their approach to FND. This data was compared to results from a previous study involving 492 Italian neurologists. RESULTS: 232 questionnaires were completed by Czech and Slovak neurologists (CZ-SK). Similarities were found between CZ- -SK and Italian neurologists in their preference for the term 'FND' over other psychological-related terms and in explaining symptoms as due to abnormal functioning of the nervous system rather than attributing them to mental illness. However, only fewer than 5% in both groups thought that simulation was highly unlikely. Both groups reported relying on positive signs (e.g. inconsistency, distractibility) according to the current diagnostic criteria, but also a tendency to perform additional tests to exclude other causes. However, some differences were observed: Italian neurologists placed a greater emphasis on psychological factors including litigation. CZ-SK neurologists were more likely to suggest physiotherapy as a treatment option and to provide educational intervention for patients and their relatives. CONCLUSIONS: Overall, our findings suggest that although Czech, Slovak, and Italian neurologists have adopted some new developments in the field of FND, significant gaps still exist in their understanding and common practices regarding conceptualisation, diagnosis, and treatment. CLINICAL IMPLICATIONS: Our results suggest that promoting knowledge through postgraduate curricula and teaching courses for neurologists is necessary to optimise patient management in various European countries.

• MeSH
• lidé MeSH
• nemoci nervového systému * terapie   MeSH
• neurologie výchova   MeSH
• neurologové * psychologie   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Itálie MeSH
• Slovenská republika MeSH

• Klíčová slova
• neurooftalmologie,
• MeSH
• kongresy jako téma MeSH
• mezioborová komunikace MeSH
• neurologie * organizace a řízení   výchova   MeSH
• oftalmologie * organizace a řízení   výchova   MeSH

William Richard Gowers se narodil 20. 3. 1845 v rodině obuvníka v Londýně. Ve věku 11 let přišel o otce a tři sourozence, zřejmě v důsledku tyfu, a jeho matka se rozhodla vrátit do rodného Doncasteru, Gowers však nastoupil do Christ Church Cathedral School v Oxfordu. Po absolutoriu koleje zkoušel krátkou dobu farmařit, ale potom byl díky rodinným konexím přijat na místo "practitioner´s apprentice" tedy něco jako místo "lékařského učně" u praktika v Coggeshallu. Po třech letech úspěšně složil zkoušky a byl přijat ke studiu medicíny na University College of London, promoval zde v roce 1870. Po promoci nastoupil na místo sekundáře v The National Hospital for Paralysed and Epileptic na Queen Square v Londýně (dnešní The National Hospital for Neurology and Neurosurgery), v této nemocnici strávil veškerý svůj profesionální život až do roku 1910, kdy odešel do penze. Ve 30 letech se Gowers oženil s Mary Baines, která pocházela z vlivné kongregacionalistické rodiny, se kterou měl čtyři děti. Talent mezi Gowersovými potomky byl různorodý: kromě vrcholné politiky a klasické hudby je jeden z Gowersových pravnuků význačným světovým matematikem a profesorem v tomto oboru na univerzitě v Cambridge. Gowers po celý svůj profesionální život neúnavně konzultoval, léčil, vyučoval a psal. Kromě nemocniční konzultační činnosti konzultoval denně i privátně ve své ordinaci na Queen Anne Street, a několikrát týdně na Queen Square přednášel či organizoval klinické demonstrace, za obrovského zájmu studentů i graduovaných lékařů. Kromě toho psal a nemálo. Za celou svou profesionální kariéru, tj. od roku 1870 do roku 1915, napsal a vydal celkem 43 učebnic a monografií a neuvěřitelných 268 přehledných nebo původních časopiseckých prací. Jeho životním dílem však byla (a stále je) dvoudílná učebnice neurologie, nazvaná "A Manual of Diseases of the Nervous System", která vyšla v letech 1886 (1. svazek, věnovaný nemocem periferních nervů a míchy) a 1888 (2. svazek, věnovaný nemocem mozku, mozkových nervů a ostatním poruchám nervových funkcí) v londýnském nakladatelství J & A Churchill; její americká mutace byla vydána ve Philadelphii nakladatelstvím P Blakiston, Son & Co v letech 1888 a 1889. Gowers toto monumentální dílo nepovažoval za dokončené patrně nikdy. Poměrně rychle připravil druhé, doplněné vydání, jehož oba svazky vyšly opět u Churchilla v Londýně v letech 1892 a 1893. Třetí vydání již připravoval za pomoci svého asistenta Jamese Taylora a jeho první svazek vyšel v roce 1899. Druhý svazek však již nebyl vydán a Gowers nikdy nezveřejnil, proč k tomu došlo. Prokazatelně totiž třetí vydání druhého svazku připravoval, v roce 1949 MacDonald Critchley v Gowersově životopise uvedl, že na vlastní oči viděl ve třicátých letech minulého století stránky druhého vydání, opatřené Gowersovými opravami, připomínkami a novými obrázky. Potom byl zřejmě veškerý materiál k chystanému třetímu vydání druhého svazku pečlivě "uschován" a dokonce Ian McDonald v roce 1986, když pronášel slavnostní "Gowers Memorial Lecture", veřejně uvedl, že "jsou patrně bohužel ztraceny". V roce 2008 Gowersova pravnučka, historička medicíny Ann Scott, sbírala materiál pro biografii svého dědečka, Gowersova syna Ernesta, který býval po válce předsedou správní rady nemocnice na Queen Square. V téže době zároveň knihovna nemocnice na Queen Square převzala nově zodpovědnost za obsah léta neotevřených skříní plných nemocničních dokumentů, které byly umístěny v jedné z nesčetných a málo navštěvovaných chodeb staré nemocnice. Ann Scott společně s knihovnicí nalezla v jedné z těchto skříní album Gowersových kreseb z dovolených na venkově (!) a pod ním svazek dokumentů, který se ukázal být podkladovým materiálem pro třetí vydání druhého svazku Manuálu. Ani tímto nálezem však nebyla zodpovězena otázka, proč Gowers ještě v době aktivní kariéry (odcházel do výslužby v roce 1910, ve věku 65 let) zanechal přípravných prací a třetí vydání Manuálu omezil na první svazek. Podobně není dosud zodpovězena taktéž téměř detektivní otázka, zda Gowers a jeho medicínské aforismy sloužily Siru Arthuru Conanu Doylovi jako předloha při tvorbě postavy Sherlocka Holmese.

William Richard Gowers was born into a shoemaker family in London on 20 March 1845. When he was eleven years old, his father and three of his siblings have died, probably due to typhoid fever, and his mother decided to return to live in Doncaster, but he started to attend Christ Church Cathedral School in Oxford. When he left the college, he tried farming for a short time, but then, thanks to his family connections, he became a medical apprentice with a local doctor in Coggeshall, Essex. Three years later, he passed the exams and was accepted to study medicine at the University College of London, graduating in 1870. After graduation, he was appointed medical registrar to the National Hospital for the Paralysed and Epileptic in Queen Square, London (nowadays known as the National Hospital for Neurology and Neurosurgery), and spent the rest of his career in this hospital, retiring in 1910. At the age of 30, Gowers married Mary Baines who came from a prominent congregationalist family and had with her four children. Gowers' offspring had diverse talents, ranging from classical music to top-level politics, with one of Gowers' great-grandsons being a world-renowned mathematician and professor in this field at Cambridge University. Gowers devoted all his working life to consulting, treating, teaching, and writing. In addition to providing in-hospital consulting services, he saw his patients daily in his own private consulting rooms in Queen Anne Street and, several times a week, gave lectures or organized clinical demonstrations at Queen Square, widely attended by both students and graduate physicians. He also was a prolific writer. Throughout his professional career, that is from 1870 to 1915, he wrote and published a total of 43 textbooks and monographs as well as an incredible 268 review or original journal articles. However, his life's work was (and still is) the two-volume neurology textbook titled "A Manual of Diseases of the Nervous System" published by J & A Churchill in London in the years 1886 (Volume 1, dealing with diseases of the peripheral nerves and spinal cord) and 1888 (Volume 2, dealing with diseases of the brain, cranial nerves, and general and functional diseases of the nervous system); its American mutation was published in Philadelphia by P. Blakiston's Son & Co in the years 1888 and 1889. Gowers apparently never considered this monumental work finished. He prepared a second, supplemented edition relatively quickly: both volumes were again published by Churchill in London in the years 1892 and 1893. The third edition was prepared with the help of his assistant James Taylor, and Volume 1 was published in 1899. However, no Volume 2 was ever published, and Gowers never revealed why it was so. Arguably, the third edition of Volume 2 was being prepared because, in 1949, MacDonald Critchley said in his biography of Gowers that, in the 1930s, he had seen with his own eyes pages of the second edition provided with Gowers' corrections, comments, and new images. However, all the material for the planned third edition of Volume 2 appears to have been carefully "hidden" afterwards, and, when delivering his Gowers Memorial Lecture in 1986, even Ian McDonald said publicly that "unfortunately, it is apparently lost". In 2008, Ann Scott, Gowers' great-granddaughter and historian of medicine, was researching for the biography of her grandfather, Gowers' son Ernest, who was Chairman of the Board of Governors at Queen Square after the war. At that time, the Queen Square Library had just assumed responsibility for the contents of cabinets unopened in years full of hospital documents which were placed in one of the numerous and infrequently visited corridors of the old hospital. It was in one of these cabinets that Ann Scott and a librarian found an album of Gowers' drawings made during holidays in the countryside (!), and underneath it was a collection of documents which was shown to be a background material for the third edition of Volume 2 of the Manual. But even this finding failed to answer the question why Gowers, while still professionally active (he retired in 1910 at the age of 65 years), stopped preparatory work and restricted the third edition of the Manual to Volume 1. Likewise, the almost detective question whether Gowers and his medical aphorisms were used by Sir Arthur Conan Doyle as a model when creating the character of Sherlock Holmes still remains to be answered.

• MeSH
• dějiny 19. století * MeSH
• neurologie * dějiny   výchova   MeSH
• Check Tag
• dějiny 19. století * MeSH
• Publikační typ
• historické články MeSH

• O autorovi
• Gowers, William Richard, 1845-1915 Autorita

BACKGROUND: Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. OBJECTIVE: To survey the accessible MD clinical training in these regions. METHODS: We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. RESULTS: The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. CONCLUSION: Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.

• MeSH
• akreditace statistika a číselné údaje   MeSH
• kurikulum statistika a číselné údaje   MeSH
• lidé MeSH
• neurologie výchova   statistika a číselné údaje   MeSH
• pohybové poruchy * MeSH
• průzkumy zdravotní péče statistika a číselné údaje   MeSH
• studium lékařství specializační postgraduální statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Egypt MeSH
• Evropa MeSH
• Tunisko MeSH

BACKGROUND: Paediatric Neurology (PN) is a discipline focused on diagnosis, comprehensive management and research into diseases of the central and peripheral nervous system from fetal life to transition into adulthood. The European Paediatric Neurology Society first designed and published the European PN training programme in the European Paediatric Neurology Syllabus in 2002. This was important in gaining recognition for the sub-specialty from the European Academy of Paediatrics and the European Academy of Neurology and in 2003 PN was recognized as a sub-specialty of paediatrics and neurology by the Board of the European Union of Medical Specialties. In 2004, the EPNS founded the Committee of National Advisors (CNA) that comprised representatives from national Paediatric Neurology societies, in order to further enhance Europe wide standards in training and practice., The EPNS Training Advisory Board (TAB) offers nation specific advice/support to PN societies on developing training and care systems. In 2019, the 2nd revision of the Paediatric Neurology Syllabus was approved by the EPNS Board and CNA. We aim to give an overview of the training of Paediatric Neurology (PN) specialists (i.e. Paediatric Neurologists), the relevant professional bodies and the current practice of Paediatric Neurology in Europe, as defined geographically by the World Health Organization. METHODS: A structured online data collection form was completed by CNA representatives from European countries. The data included training routes and structure of training, epidemiological data, nature of professional societies, organization of Paediatric Neurology care, research, academic life and recognition of the specialty. RESULTS: Data was collected from 43 European countries of which 38 have a national PN Society. In 10 (6 European Union (EU) and 4 non-EU countries) PN is recognized as a core specialty. In 26 countries PN is recognized as a sub-specialty of Paediatrics, Neurology or both (15 EU-11 non-EU). PN is not recognized as a core or sub-specialty in 7 countries (4 EU and 3 non-EU). In 35 countries paediatric neurologists begin their training from Paediatrics, but in 19 countries PN training from Neurology is also possible or the preferred route. Training in PN differs, but in over 50% of countries the three main training modules named in the 2019 2nd revision of the European PN Syllabus (PN, Paediatrics and adult Neurology) are included. Many countries have already adapted their curriculum to the suggestions in the European PN syllabus. CONCLUSIONS: There is diversity among European countries in terms of professional organization and PN training. The European PN syllabus has had impact on the development of PN training throughout Europe, independent of duration of training or route from paediatrics or neurology. The syllabus provides a basis for the future development of PN training, the recognition of PN as a (sub) specialty in individual countries and for improving the care of children with neurological disorders in Europe.

• MeSH
• dítě MeSH
• dospělí MeSH
• kurikulum normy   MeSH
• lidé MeSH
• neurologie výchova   organizace a řízení   normy   MeSH
• pediatrie výchova   organizace a řízení   normy   MeSH
• společnosti lékařské MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• úvodníky MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• kurikulum MeSH
• neurologie výchova   zákonodárství a právo   MeSH
• studium lékařství specializační postgraduální organizace a řízení   zákonodárství a právo   MeSH
• Publikační typ
• směrnice MeSH

• MeSH
• cerebrovaskulární poruchy diagnóza   etiologie   terapie   MeSH
• deprese terapie   MeSH
• epilepsie terapie   MeSH
• kongresy jako téma * MeSH
• lidé MeSH
• nemoci bazálních ganglií diagnóza   etiologie   terapie   MeSH
• nemoci nervového systému diagnóza   etiologie   terapie   MeSH
• nemoci páteře chirurgie   MeSH
• neurochirurgické výkony metody   využití   MeSH
• neurodegenerativní nemoci diagnóza   etiologie   terapie   MeSH
• neurologie * metody   trendy   výchova   MeSH
• neuromuskulární příznaky a symptomy MeSH
• roztroušená skleróza diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• dítě MeSH
• klinické kompetence MeSH
• kurikulum MeSH
• lidé MeSH
• mladiství MeSH
• neurologie výchova   MeSH
• specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby normy   MeSH
• studium lékařství specializační postgraduální * organizace a řízení   zákonodárství a právo   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• směrnice MeSH