Background: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic re...Background: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability. Methods: In a prospective multicentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation. Results: Three hundred and ten patients were included: 173 before and 137 after g uideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33%in the number and costs of routine laboratory inves tigations/patient, and a reduction of 27%in the total number of laboratory tests/patient, despite low guideline adherence. Conclusion: The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay an d the number and costs of investigations for each patient without loss of diag nostic reliability. Continuous evaluation strategies after guideline implementat ion may improve guideline adherence and cost efficiency.展开更多
Background: Little is known about long term prognosis and course after immune treatments in chronic inflammatory demyelinating polyneuropathy (CIDP). Objective: To study long term outcomes and prognostic factors in pa...Background: Little is known about long term prognosis and course after immune treatments in chronic inflammatory demyelinating polyneuropathy (CIDP). Objective: To study long term outcomes and prognostic factors in patients with CIDP. Methods: Clinical and electrophysiological findings, responses to immune modulating treatments, and outcomes five years after the start of treatment were reviewed in 38 CIDP patients. Results: Patients were treated with corticosteroids (89% ), immunoglobulin infusion (45% ), or plasmapheresis (34% ), and 58% received combined therapy. Five years after treatment was begun, 10 (26% ) of the patients had complete remission (lasting >2 years with normal nerve conduction studies), and 23 (61% ) had partial remission (able to walk) with (26% ) or without (34% ) immune treatments. The remaining five patients (13% ) still had severe disability (unable to walk) or treatment dependent relapses. Patients with complete remission more often had subacute onset, symmetrical symptoms, good response to initial corticosteroid treatment, and nerve conduction abnormalities predominant in the distal nerve terminals. In contrast, insidious onset, asymmetrical symptoms, and electrophysiological evidence of demyelination in the intermediate nerve segments were associated with refractoriness to treatment or treatment dependent relapse. Conclusions: The long term prognosis of CIDP patients was generally favourable, but 39% of patients still required immune treatments and 13% had severe disabilities. Mode of onset, distribution of symptoms, and electrophysiological characteristics may be prognostic factors for predicting a favourable outcome.展开更多
文摘Background: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability. Methods: In a prospective multicentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation. Results: Three hundred and ten patients were included: 173 before and 137 after g uideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33%in the number and costs of routine laboratory inves tigations/patient, and a reduction of 27%in the total number of laboratory tests/patient, despite low guideline adherence. Conclusion: The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay an d the number and costs of investigations for each patient without loss of diag nostic reliability. Continuous evaluation strategies after guideline implementat ion may improve guideline adherence and cost efficiency.
文摘Background: Little is known about long term prognosis and course after immune treatments in chronic inflammatory demyelinating polyneuropathy (CIDP). Objective: To study long term outcomes and prognostic factors in patients with CIDP. Methods: Clinical and electrophysiological findings, responses to immune modulating treatments, and outcomes five years after the start of treatment were reviewed in 38 CIDP patients. Results: Patients were treated with corticosteroids (89% ), immunoglobulin infusion (45% ), or plasmapheresis (34% ), and 58% received combined therapy. Five years after treatment was begun, 10 (26% ) of the patients had complete remission (lasting >2 years with normal nerve conduction studies), and 23 (61% ) had partial remission (able to walk) with (26% ) or without (34% ) immune treatments. The remaining five patients (13% ) still had severe disability (unable to walk) or treatment dependent relapses. Patients with complete remission more often had subacute onset, symmetrical symptoms, good response to initial corticosteroid treatment, and nerve conduction abnormalities predominant in the distal nerve terminals. In contrast, insidious onset, asymmetrical symptoms, and electrophysiological evidence of demyelination in the intermediate nerve segments were associated with refractoriness to treatment or treatment dependent relapse. Conclusions: The long term prognosis of CIDP patients was generally favourable, but 39% of patients still required immune treatments and 13% had severe disabilities. Mode of onset, distribution of symptoms, and electrophysiological characteristics may be prognostic factors for predicting a favourable outcome.
