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Browsing by Author "Struhal, Walter"

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  • Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants
    Publication . Reis‐Carneiro, Diogo; Skoric, Magdalena Krbot; Habek, Mario; Adamec, Ivan; Calandra‐Buonaura, Giovanna; Cortelli, Pietro; van Dijk, J. Gert; Falup‐Pecurariu, Cristian; Guaraldi, Pietro; Hilz, Max J.; Iodice, Valeria; Jordan, Jens; Rocha, Isabel; Struhal, Walter; Terkelsen, Astrid Juhl; Thijs, Roland; Tijero, Beatriz; Berger, Thomas; Rektorova, Irena; Moro, Elena; Traon, Anne Pavy‐Le; Wenning, Gregor; Panicker, Jalesh N.; Fanciulli, Alessandra
    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.
    2024Journal article Open access Show more
  • Clinical autonomic nervous system laboratories in Europe: a joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies
    Publication . 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.
    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.
    2022Journal article Open access Show more
  • Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection: a systematic review
    Publication . Reis Carneiro, Diogo; Rocha, Isabel; Habek, Mario; Helbok, Raimund; Sellner, Johann; Struhal, Walter; Wenning, Gregor; Fanciulli, Alessandra
    Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. Results: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002). Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.
    2023Journal article Open access Show more
  • EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research
    Publication . Fanciulli, Alessandra; Skorić, Magdalena Krbot; Leys, Fabian; Carneiro, Diogo Reis; Campese, Nicole; 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; Le Traon, Anne Pavy; Rocha, Isabel; Sellner, Johann; Senard, Jean Michel; Terkelsen, Astrid; Wenning, Gregor K.; Moro, Elena; Berger, Thomas; Thijs, Roland D.; Struhal, Walter; Habek, Mario; 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; Sora, Maria Grazia Natali; 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.
    Purpose: To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe. Methods: We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders. Results: Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9 (5; 9) months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN-EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5 (2; 9) months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020-2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year. Conclusions: The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design.
    2023Journal article Open access Show more