In recent years, clinical trial research on stroke intervention measures has been developing rapidly. In order to provide reliable conclusions, the outcome assessment of clinical trials is crucial. Tools for functional status evaluation have been widely adopted as outcome assessment, and have become mandatory for qualified clinical trials of stroke treatment. In this paper, the classification of functional assessment scales in stroke is reviewed, and the applications of functional assessment scales in clinical trials of stroke treatment are presented. National Institute of Health Stroke Scale, Barthel Index, and modified Rankin Scale are the top three frequently applied assessment scales in stroke trials. Also, their validity, reliability, responsiveness, and feasibility are described. Furthermore, analytical methods used to assess those functional assessments are highly heterogenous, while dichotomy of scale score is the most widely used. Although there is no consensus on designation of the functional assessment time, three-month is the most popular, reliable, and feasible choice in stroke trails.
Evidence grading and recommendation strength assessment are key steps in the development of evidence-based guidelines, and have made significant progress in recent years. This article systematically reviews the development and evolution of evidence grading and recommendation strength in the past 30 years, and introduces the main representative standards. At the same time, a brief introduction is given to the guidelines and consensus evaluation results published in the field of neurological diseases in China, and future improvements are proposed. This article aims to help readers understand the development patterns of evidence grading and recommendation strength, in order to better understand the guidelines, and to develop more standardized guidelines.
ObjectiveTo explore the correlation between urinary disorders and imaging changes of cerebral small vessel diseases (CSVDs) in community-dwelling populations.MethodsA cross-sectional analysis was conducted on participants enrolled in the Shunyi study from June 2013 to April 2016. Eligible participants were community-dwelling populations aged ≥35 years with interpretable magnetic resonance imaging scans and no history of stroke or urinary system diseases. Data on demographic characteristics, vascular risk factors, cognitive functions, and urinary disorders (including any form of urinary disorders, incontinence, daytime urination frequency, and nocturnal urination frequency) were collected. Imaging changes including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVSs), and brain volume were measured using 3 T magnetic resonance imaging. Logistic regression model analysis was performed to identify the potential correlations between urinary disorders and imaging markers of CSVD.ResultsA total of 916 participants (with a mean age of 57.4 years; 36.2% were males) were finally enrolled in this study based on the enrollment criteria. CSVD imaging changes of WMHs, lacunes, CMBs, PVSs or brain volume were not associated with any form of urinary disorders in multivariable models (P>0.05). CSVD imaging changes were not associated with presence of urinary incontinence (P>0.05). In terms of urinary frequency, the CSVD imaging changes were not related to nocturnal urinary frequency (P>0.05). However, lower brain volume was correlated with daytime urination frequency [3-5 vs. <3 times per day: odds ratio (OR)=2.520, 95% confidence interval (CI) (1.278, 4.972), P=0.008; >5 vs. <3 times per day: OR=3.115, 95%CI (1.317, 7.372), P=0.010].ConclusionBrain atrophy may affect daytime urination frequency in community-dwelling populations.
Objective To explore and implement a systematic, case guided online interactive training course for neurologists to improve their diagnosis and treatment of rare genetic diseases. Methods Doctors who participated in the course investigation of the neurogenetic project of the Department of Neurology of Peking Union Medical College Hospital between January and September 2021 were selected. Based on andragogy theory, a genetics training course for neurologists was developed by applying Kern’s six steps of curriculum development. According to the time of participating in the doctor’s courses, they were divided into three groups: completed all courses (10.7 h group), completed more than 1/2 courses (5.3～10.7 h group) and completed less than 1/2 courses (<5.3 h). According to the length of service, they were divided into groups of less than 10 years, 10-20 years and more than 20 years. Analyze the benefit difference of different doctors’ training time, and collect their feedback scales on the curriculum for the improvement of follow-up courses. Results A total of 54 doctors were included. Among them, 17 (31.5%) completed all courses, 29 (53.7%) completed more than 1/2 courses, and 8 (14.8%) completed less than 1/2 courses. There was a statistically significant difference among the three groups in the self-assessment improvement score (H=12.341, P=0.002). The results of pairwise comparison between groups of self-assessment improvement score showed that the <5.3 h group was lower than that of the 10.7 h group (P=0.007), and the the <5.3 h group was also lower than that of the 5.3～10.7 h group (P=0.002). 33 (61.1%) in the less than 10 years group, 16 (29.6%) in the 10-20 years group, and 5 (9.3%) in the more than 20 years group. There was no correlation between participating in work and course time (rs=0.113, P=0.418). 54 (100.0%) believed that they had more than moderate help (≥3 points). Most doctors (>90%) had a good evaluation of the curriculum. Conclusion The periodic neurogenetic re-education project is helpful for clinical diagnosis and treatment of rare neurogenetic diseases.