Neurological Community Research Articles

Extraction and reduction of parameters from hand-drawn Archimedes spirals for clinical tremor assessment

BackgroundPatients’ hand-drawn Archimedes spirals are widely used in the neurological community to grade tremors. These spirals are either drawn on paper and Xeroxed/scanned into digital images or digitizing tablets are used for the drawings. This process introduces artifacts such as variable widths of the drawn lines with varying pixel grey scale values. Xeroxing introduces additional artifacts resulting from paper misalignments. These artifacts and the presence of the reference spiral in the image complicate an automatic extraction of a mathematical spiral signal from the image. New methodsWe introduce a mathematical mapping that transforms the image pixels of the patient's hand-drawn spiral into a one-dimensional discrete signal that can be used for mathematical analysis. ResultsA cohort of 18 hand-drawn spirals with various artifacts is used to validate our method.We extract the parameters of the discrete signals and show that the signals can be represented by truncating to as few as 150 parameters with a truncation RMS error of 6.26 % across the cohort. Using only 150 features makes machine learning a viable option for future applications. Furthermore, our method can be used to evaluate the frequency and the amplitude of the tremor. Comparison with existing methodsIn existing methods, the patient draws the spiral on a digitizing tablet, and features are extracted from this data for machine learning. We recognize that a vast majority of hospitals are still using the pencil-and-paper approach, and there is an abundance of ready-to-be-mined tremor-related data already stored as paper or digitized drawings. Our procedure is equally applicable to Xeroxed documents as well as files generated from digital tablets. ConclusionsWe have validated a new procedure requiring minimal user intervention to automatically extract a patient's hand-drawn spiral as a discrete mathematical one-dimensional signal from a scanned image or a file from a digital tablet.

Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis.

Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies. We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO. In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2-22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9-21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1-2.0]; p = 0.016). Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.

Surgical Treatment Options for Degenerative Lumbosacral Spinal Stenosis

Degenerative spinal stenosis is the most common type of degenerative and dystrophic spine disease. The clinical picture of stenosis, which may include axial pain syndrome, leg pain, intermittent claudication syndrome, weakness and loss of sensitivity in the legs, and impaired pelvic functions, can significantly worsen patients’ quality of life and reduce their ability to work and lead an active lifestyle.&#x0D; Degenerative spinal stenosis mostly affects the elderly. Therapeutic and neurological communities have stereotypes about spine surgery being too traumatic and invasive, and, therefore, they believe that their use should be contraindicated to and limited in elderly patients. However, surgeons are increasingly giving preference to minimally invasive interventions with high efficacy and safety together with a low risk of complications.&#x0D; We aimed at reviewing current treatment methods for degenerative lumbosacral spinal stenosis with an emphasis on surgical treatment methods.

Neurological Practice in the Time of War: Perspectives and Experiences from Ukraine.

The full-scale Russian invasion of Ukraine has significantly impacted the country's healthcare system. Insufficient infrastructure, destruction of medical facilities, and barriers to prevention and treatment efforts hinder the provision of timely, high-quality care to our patients. We aim to describe the impact of the war on neurological care across Ukraine. In this article, leading national experts in stroke, epilepsy, multiple sclerosis, and movement disorders describe their personal experience and efforts in organizing and providing care since the war started in February 2022. A neurologist who cared for patients in Mariupol recounts the first weeks of the war when the city was under constant attacks. An international stroke expert describes the role of Task Force for Ukraine, a European Stroke Organization initiative to support the Ukrainian stroke community. We discuss a series of critical challenges facing Ukraine's neurologists, patients, and healthcare delivery system, including shortages of personnel and medical supplies, disrupted logistics, and lack of funding. In addition, we highlight various interventions and strategies aimed at counteracting these challenges, including international support, collaborations within Ukraine, and initiatives enhancing the resilience of the Ukrainian neurology community. As the war is ongoing, this article emphasizes the pressing need for continuous support and investment in the Ukrainian healthcare system to preserve guaranteed access to high-quality healthcare for the Ukrainian people during the war and in its aftermath. Insights from the essays can inform the development and implementation of effective strategies and interventions tailored to such extraordinary circumstances.

Neurological patients confronting climate change: A potential role for the glymphatic system and sleep

Interest in the health consequences of climate change (global warming, heatwaves) has increased in the neurological community. This review addresses the impact of elevated ambient temperatures and heatwaves on patients with neurological and mental health disorders, including multiple sclerosis, synucleinopathies, dementia, epilepsies, mental health, and stroke. Patients with such conditions are highly vulnerable during heatwaves because of functional disorders affecting sleep, thermoregulation, autonomic system reactivity, mood, and cognitive ability. Several medications may also increase the risk of heatstroke. Special attention is devoted to the involvement of common underlying mechanisms, such as sleep and the glymphatic system. Disease prevention and patient care during heatwaves are major issues for caregivers. Beyond the usual recommendations for individuals, we favor artificially induced acclimation to heat, which provides preventive benefits with proven efficacy for healthy adults.

Improving the quality of life through vitamin D supplementation in people with multiple sclerosis: Pathobiological, immunologically based, A narrative review of the literature

An inadequate vitamin D nutritional status is associated with autoimmune diseases, heart disease, deadly types of cancer, neurological disorders and undesirable consequences in pregnancy, amongother things. In a nationally representative sample of adults in Australia on vitamin D (VitD) congestion in the general population, 20% of participants were verified to be Vit D deficient and 43% to have insufficient VitD levels [1]. It is therefore to be welcomed that in 2020 a guideline on VitD supplementation for medical use was created, taking into consideration the opinions of various global institutions [2]. For more than 15 years there have been reports that vitamin D (VitD) has an immunomodulatory function in multiple sclerosis (MS) [3] and that there is an association between low circulating serum levels of 25-hydroxyvitamin D [s25(OH)D] and an increase in inflammatory activity and impact on quality of life in persons with multiple sclerosis (PwMS) [4] [5]. Nevertheless, up to the present the "neurological community" has not been able to agree to start a daily add-on therapy using an easy to carry out, inexpensive and low-side effect vitamin D supplementation (VitD suppl. from the beginning of the diagnosed MS disease or the chronically isolated syndrome (CIS). In the last decade, there has been an accumulation of evidence of immunological and pathophysiological mechanisms that VitD positively influences the course of the disease and should become an eminent factor in therapy ([6]. For 13 years, neurologists in Sweden have been informing PwMS about the benefits of VitD-suppl. and given a recommendation for add-on therapy [7].

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey

BackgroundAcute peripheral facial paralysis may be diagnosed and treated by different specialists. ObjectiveThe aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. MethodsAn anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). Results1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). ConclusionThere is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

Climate change: Attitudes and concerns of, and learnings from, people with neurological conditions, carers, and health care professionals.

Concern about climate change among the general public is acknowledged by surveys. The health care sector must play its part in reducing greenhouse gas emissions and adapting to a changing climate, which will require the support of its stakeholders including those with epilepsy, who may be especially vulnerable. It is important to understand this community's attitudes and concerns about climate change and societal responses. A survey was made available to more than 100 000 people among a section of the neurological community (patients, carers, and clinicians), focused on epilepsy. We applied quantitative analysis of Likert scale responses supported by qualitative analyses of free-text questions with crossover analyses to identify consonance and dissonance between the two approaches. A small proportion of potential respondents completed the survey; of 126 respondents, 52 had epilepsy and 56 explicitly declared no illness. The survey indicated concern about the impact of climate change on health within this neurological community focused on epilepsy. More than half of respondents considered climate change to have been bad for their health, rising to 68% in a subgroup with a neurological condition; over 80% expected climate change to harm their health in future. Most (>75%) believed that action to reduce greenhouse gas emissions will lead to improved health and well-being. The crossover analysis identified cost and accessibility as significant barriers. The high level of concern about climate change impacts and positive attitudes toward policies to reduce greenhouse gas emissions provide support for climate action from the epilepsy community. However, if policies are implemented without considering the needs of patients, they risk being exclusionary, worsening inequalities, and further threatening neurological health and well-being.

Henry Head (1861-1940) and his importance for neurology

Nowadays, Henry Head is best known for his Head zones. The concept was understood very differently by Head in comparison to what current medical books falsely describe them to be. In reality, there is no direct relationship between one particular skin zone and one single organ. It is certain that the drawings considered depictions of the Head zones in today's medical textbooks were actually not created by Head. From aneurological point of view, Head is important for two reasons: his self-experiment in 1909 to damage one of his own peripheral nerves followed by regeneration was heroic. It has helped generations of neurologists to have a better understanding of the pathophysiology of peripheral nerve damage and thus make a better assessment of the prognosis of such injuries. Head's second contribution pertains to the radicular organization at the level of the spinal cord. The pathophysiology of herpes zoster radiculitis enabled him to develop the concept of the dermatomes on the basis of preliminary work around 1900. Henry Head's contribution was the systematic compilation of the existing publications of the time and amendment of his own cases. As he was the most important neurologist at that time, at least in the English speaking world, and was well connected with people in the German neurology community, it was probably easy for him to make his dermatome maps well known. In retrospect, Head was less successful in neuropsychology with holistic concepts for higher cognitive functions which were in vogue during his lifetime. His late work on aphasia is now considered refuted. Head's criticism of the strict localization was well in syncronization with the zeitgeist of the early twentieth century. Establishing the fact that Broca's aphasia and Wernicke's aphasia are not easily diagnostically distinguishable from each other was more an achievement of subsequent generations of neurologists and neuropsychologists as well as technical advances.

Skersinis mielitas po COVID-19: klinikinis atvejis

Currently, a significant number of post-COVID-19 disease neurological disorders still occur, and precise analysis of them could expand the knowledge of the neurological community for future pandemics. It is important to evaluate and recognize potential neurological manifestations and complications of COVID-19, as some of them can progress rapidly and require urgent treatment.We present a clinical case of transverse myelitis after a COVID-19 in a 35-year-old man who was treated at the Neurology Department of the Hospital of Lithuanian University of Health Sciences Kaunas Clinics.

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey

BackgroundAcute peripheral facial paralysis may be diagnosed and treated by different specialists. ObjectiveThe aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. MethodsAn anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). Results1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). ConclusionThere is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

An introduction to ICD code development for pediatric neurology

AbstractObjectiveQuerying large data sets in the United States is challenging due to limitations of International Classification of Diseases 10th edition Clinical Modification (ICD‐10‐CM) codes. ICD codes were developed for tracking mortality and for billing purposes but are also the most widely used data structure to represent clinically significant and distinct disorders. We report an approach for developing new ICD codes based on our work creating new codes for leukodystrophies.MethodsImportant steps in ICD‐10‐CM code development include working with the ICD‐10‐CM Coordination and Maintenance Committee, a subset of the National Center of Health Statistics (NCHS); working to ensure the code has the best placement and is appropriate for submission; presenting the code and accompanying proposal (rationale) at a Coordination and Maintenance Committee Meeting; and requesting letters of support and addressing concerns raised by various groups.ResultsWe describe the historical development of ICD codes as well as their current hierarchical structure. Important features for successful code development included consulting future ICD‐11‐CM code structure; determining which codes are most important to the community; having a multidisciplinary approach; and obtaining organizational and institutional support.ConclusionFocusing on the clinical importance of leukodystrophy codes was important for their approval. Although challenging, there is a route for new code development, and we were ultimately successful in obtaining approval for 10 new leukodystrophy ICD‐10‐CM codes. Understanding ICD codes and their structure, considering their usage for clinical and research work, and appreciating how new codes can be developed is important for the pediatric neurology community.

60. A Comparison of Outcomes in Trigger Site Deactivation Surgery: A Systematic Review and Meta-analysis of the Migraine Headache Index versus Monthly Migraine Days

PURPOSE: To foster common communication between plastic surgeons and neurologists alike by assessing the effect of trigger site deactivation surgery on monthly migraine days (MMD), the preferred outcome measure of neurologists, compared to outcomes traditionally reported in the plastic surgery literature. METHODS: An updated literature search was performed according to the PRISMA guidelines. The National Library of Medicine (PubMed), Scopus, and EMBASE were systematically searched for relevant articles. Data was extracted and analyzed from studies which met the inclusion criteria. RESULTS: A total of 19 studies were included in this review. There was a significant overall reduction in monthly migraine days (mean difference [MD] 14.11, 95% CI 10.95 to 17.27; I2 = 92%), migraine headache index (MD 76.59, 95% CI 60.85 to 92.32; I2 = 98%), migraine intensity (MD 3.84, 95% CI 3.35 to 4.33; I2 = 98%), and migraine duration (MD 11.80, 95% CI 6.44 to 17.16; I2 = 99%) at follow-up (range 6-38 months). CONCLUSION: This study demonstrates the efficacy of trigger site deactivation surgery on outcomes reported by both the plastic surgery and neurology communities. We hope this will open a common conversation and lead to optimized management for treatment-refractory migraine patients.

The Power of a Post-It: The Reach and Impact of the Twitter Teaching Initiative “#NeuroPostItPearls” (P7-2.001)

<h3>Objective:</h3> To assess the feasibility of using social media for neurologic education using the Twitter hashtag “#NeuroPostItPearls.” <h3>Background:</h3> Social media platforms like Twitter offer a powerful way to reach a global audience and the #neurotwitter community has grown exponentially since the COVID19 pandemic. To be searchable, educational posts are often hashtagged with a unique moniker. Creation of the #PostItPearls microteaching movement is credited to Michelle Lin, an emergency medicine physician, who in 2017 started highlighting teaching “pearls” by writing them on Post-its that were then shared on Twitter. Although widely shared, these were largely not applicable to the neurology community. <h3>Design/Methods:</h3> The hashtag #NeuroPostItPearls was launched on July 1^st, 2022 with the aim of sharing bite-sized teaching with incoming neurology residents. For this study, data was collected about the number of participants and the Twitter analytics of top posts. We used an AI-driven Twitter analytic platform (“Tweepsmap”) to create a descriptive analysis of the data and to visualize the global reach and summative impact of the hashtag through September 2022. <h3>Results:</h3> Six authors shared original Post-it “Pearls” (“Pearls” per author ranged from 1–31). The most widely liked and retweeted content focused on neurologic differentials (Retweets 133/Likes 447), hypertonic bicarb for ICP crisis (96/449), strategies for tPA reversal (71/387), anti-seizure drug interactions (76/351) and the Guillain-Barré 20/30/40 Rule (78/281). The impression of high impact tweets was between 30k and 60k views. In total, posts with the hashtag generated nearly 1 million views (972K). The 48 original “pearls” were retweeted a cumulative of 969 times by 663 individuals across 58 countries. 67.4% of the Twitter users that retweeted them were healthcare workers. <h3>Conclusions:</h3> Twitter is a viable platform for sharing microteaching with the global neurology community. Further study is needed about the long-term educational impact and best practices for teaching through social media. <b>Disclosure:</b> Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy. Dr. Charidimou has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Imperative Care. Dr. Charidimou has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, Journal of Neurological Sciences. Dr. Jones has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Jones has received publishing royalties from a publication relating to health care. Dr. Jones has a non-compensated relationship as a member of the Board of Directors with 44690 that is relevant to AAN interests or activities.

Measuring The Impact of a Twitter-Based Educational Initiative: The #EmoryNCCTweetorials Project (P7-2.005)

<h3>Objective:</h3> Analyze a Twitter-Based Educational Initiative for a Neurocritical Fellowship <h3>Background:</h3> “Tweetorials” are online tutorials published on Twitter. This style of microteaching is an innovative way to provide free, globally accessible online medication education. For trainees, authoring a Tweetorial is a novel way to distill specialized knowledge and reach a large academic audience while also receiving immediate feedback. Authoring a Tweetorial may be a way for trainees to network and engage in longitudinal conversations within the medical community. We present analytic data about the impact of our fellowship program’s Twitter teaching initiative. <h3>Design/Methods:</h3> The Twitter education project #EmoryNCCTweetorials was announced in the Summer of 2021 as optional participation for the neurocritical care fellows. Data was collected regarding the number of participating fellows and number of Tweetorials. An AI-driven platform for Twitter analytics, “Tweepsmap ®,” was utilized to analyze the number of tweets, impact, and various types of engagement from July 1, 2021 to September 28, 2022. Participants were surveyed about their opinions of writing Tweetorials and what they learned. <h3>Results:</h3> In a fifteen-month period, five of seven fellows participated in the initiative. Twenty-two Tweetorials were created by fellows, which in total garnered over 2.5 million impressions (cumulative number of views). Together the Tweetorials were retweeted (shared) over a thousand times and received nearly five thousand likes. The Tweetorials were viewed in 62 countries and most engagement was from healthcare-associated accounts (73.1%) with the remainder being characterized as students, education, science and technology and others. The fellows rated the experience positively. <h3>Conclusions:</h3> Social media-based educational initiatives are innovative strategies for teaching neurocritical care topics and may promote trainee engagement in the neurology community and have far-reaching networking effects. Further analyses are needed to investigate longitudinal participation, information retention and value-added aspects of social media education for trainees. <b>Disclosure:</b> Dr. Sigman has nothing to disclose. Dr. Pimentel has nothing to disclose. Dr. Kandiah has nothing to disclose. Dr. Lawson has nothing to disclose. Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy.

Dejerine and Klumpke: An Homage to Relationship and Partnership in Neurology (P4-3.009)

<h3>Objective:</h3> Provide historical homage to Drs. Jule Dejerine and Augusta Klumpke by outlining their neurologic contributions, and revealing how their unique partnership fostered neurologic discovery, community, and inclusivity. <h3>Background:</h3> Augusta Dejerine Klumpke (1859–1927) and Jules Joseph Dejerine (1849–1917) represent a powerful partnership, brought together by neuroscience, solidified in marriage, and cemented in their legacy of neurologic contributions. This paper summarizes the history of Dejerine and Klumpke’s serendipitous relationship developed at work and how their partnership catalyzed advances to the field of neurology. We then raise the larger question of whether workplace relationships should remain taboo or even become more encouraged in medicine. We bring to light other successful neurologic partnerships for comparison. <h3>Design/Methods:</h3> Not applicable. <h3>Results:</h3> Drs. Jules Dejerine and Augusta Klumpke were a married couple who both significantly contributed to the history of medicine and neurology beyond the commonly used eponyms related to their discoveries. Dejerine rose to the highest prominence in the field of neurology during his time and contributed to establishing the foundation of our current understanding of clinical neurology with the likes of Charcot, and Klumpke was the first female intern in a Paris hospital. Dr. Klumpke and Dejerine used to host neurologists and research collaborators at their home regularly. Their partnership and the way in which it promoted discovery and community enabled synergistic and exponential impact. <h3>Conclusions:</h3> Drs. Dejerine and Klumpke relationship and collaborations have no doubt made a positive impact on the future of neurology, and through historical review may serve as a healthy model for scientific collaboration within relationships. <b>Disclosure:</b> Dr. Crissinger has nothing to disclose. Dr. Dobson has nothing to disclose.

International Consensus on Smoldering Disease in Multiple Sclerosis using the Delphi Method (P11-3.013)

International Consensus on Smoldering Disease in Multiple Sclerosis using the Delphi Method (P11-3.013)

Free Neurology Community Health Clinic: Insights on Patient Population and Resident Experience (S29.005)

<h3>Objective:</h3> To describe the patient population at FNCHC and its impact on neurology resident education and training. <h3>Background:</h3> Uninsured patients with neurologic diseases suffer worse healthcare outcomes than insured patients. Limited access to care is exacerbated by lack of subspeciality neurology care in free community health clinics. Our neurology residency partnered with the local free clinic, establishing Free Neurology Community Health Clinic (FNCHC) to provide neurology evaluations for uninsured patients. <h3>Design/Methods:</h3> FCHC operates one half day per month with 4–6 patient slots, staffed by 1–2 neurology residents and one attending. Diagnostics and medications prescribed are free for patients. Patient variables are collected from clinic EHR. Six neurology residents who volunteered 2+ clinics were given feedback surveys pertaining to educational value, clinical decision making, personal fulfillment, and career practice graded on a 5-point Likert Scale from “strongly disagree” to “strongly agree”. <h3>Results:</h3> Over the fifteen months since inception, 73 new or return clinic appointments were scheduled, 66 were seen (91.6% show rate). Most common spoken language was Spanish (66.7%), then Polish (18%). The most frequent chief complaint was headache (50%), then parasthesias (9.1%), double vision (6.1%) and stroke (4.5%). Subspecialities fields represented included vascular, headache, neuromuscular, epilepsy, movement disorders, sleep, and cognitive neurology. Most therapeutics initiated were targeted at headache management, followed by antiseizure medications, and myasthenic medications. 6/6 residents completed feedback surveys. All residents strongly agreed that their FNCHC experiences was fulfilling and educational for CDM in low resource settings. Furthermore, all residents agreed their experiences encouraged continued commitment to underprivileged populations during residency and future careers. <h3>Conclusions:</h3> Diversity of patient population and neurologic disorders are well represented in FNCHC. Resident feedback demonstrated overwhelmingly positive impact on fulfillment and clinical education, as well as future career involvement in underserved populations. Future directions for FNCHC include expanding diagnostics, therapeutics, and formal integration into residency education. <b>Disclosure:</b> Dr. Jia has nothing to disclose. Dr. Deliz Gonzalez has nothing to disclose. Dr. Attarian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clearview. Dr. Attarian has received publishing royalties from a publication relating to health care. Dr. Curran has nothing to disclose. Dr. Cherayil has nothing to disclose. Dr. Carroll has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.

The Veterans Affairs Healthcare System (VA) National Neurology Community Care Dashboard: Development and Evaluation (P4-7.003)

<h3>Objective:</h3> Evaluate a national neurology community care dashboard and describe its build and functionality. Demonstrate its public health application and neurological care coordination. <h3>Background:</h3> Neurological care coordination at a population level requires an accurate and reliable database that is user-friendly and produces timely and relevant reports. Furthermore, the ability to forecast public health needs requires standardized clinical and financial data collection over time. A neurology dashboard was set up to monitor and predict cost estimates of the medical services provided through community care referrals. The system was also responsible for assessing the number of patients remaining in the network. <h3>Design/Methods:</h3> A quality improvement (QI) study is currently in progress. A mixed methods design is being used, drawing from the Unified Theory of Acceptance and Use of Technology (UTAUT) model. A 15-item survey of the value and usability of the dashboard and in-depth key informant interviews of neurology dashboard users are being conducted. <h3>Results:</h3> After several cycles of building and editing the dashboard, a beta version of the dashboard has been deployed. The current iteration displays utilization of community care among veterans with various neurology related conditions. Volume and cost of care by facility, patient demographic, ICD co-morbidities, and procedure codes can be extracted and visualized. Preliminary results of stakeholder interviews indicate that the dashboard was perceived as a useful tool among its users and was beneficial in improving cost analysis and monitoring patient flow in the network. <h3>Conclusions:</h3> The dashboard has the potential to be a highly valuable tool to monitor the coordination of neurological care. Although the tool was developed for a specific healthcare network, modules, and components of the dashboard may help inform the development of population-level neurology dashboards for other healthcare systems. <b>Disclosure:</b> Dr. Baig has nothing to disclose. Dr. Gopaul has nothing to disclose. Dr. Martini has nothing to disclose. The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from Eisai. The institution of Dr. Altalib has received research support from Sunovian. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS.

@NMatch2023: A Student-Led Social Media-Based Initiative to Guide Adult and Child Neurology Residency Applicants and Programs in a Digital Era (P10-2.002)

<h3>Objective:</h3> To describe the expansion of the @NeurologyMatch2023 project in supporting medical students applying to Adult and Child Neurology Residency programs in the United States. To offer recommendations for the online presence of Neurology Programs to encourage engagement with applicants. <h3>Background:</h3> The COVID-19 pandemic has left a lasting impact on the residency application process. Virtual interviews offer a viable alternative to traditional in-person interviews, and residency programs rely on a strong online presence for applicant engagement. @NeurologyMatch is a student-operated, social media initiative to promote networking, education, and information-sharing within the online neurology community. @NMatch2023 has continued to expand and improve this resource for both neurology applicants and residency programs. <h3>Design/Methods:</h3> <h3>Timeline:</h3> <b>May:</b> @NMatch2023 leaders transitioned, Feedback Survey released <b>June:</b> Match Motivation Mondays launched <b>July:</b> Mentorship program launched <b>August:</b> Program calendar and features launched <b>September:</b> NMatch Panel with the PDs <b>October:</b> Data collection <h3>Results:</h3> <h3>Frequent ERAS Questions (n=189):</h3> The most commonly asked questions were about USMLE scores (36.3%), preliminary vs. advanced positions (18.1%) and personal statements (13.7%). <h3>Twitter Analytics:</h3> Since the transition of leadership in May 2022, we had an average of 114 tweets; 140,000 impressions; 49,200 profile visits; 440 mentions; and 295 followers per month. <h3>Instagram Analytics:</h3> Compared to May 2022, our analytics demonstrate a 174% increase in accounts, with 4,443 accounts in the last 90 day period. There was an increase in account engagement by 155%, with a total number of 730. <h3>Conclusions:</h3> Since May 2022, @NMatch2023 experienced a substantial increase in follower activity on Instagram and consistent Twitter engagement. From the applicant perspective, NMatch is a resource to see program highlights and compare programs. From the perspective of Neurology residency programs, NMatch serves as a tool to determine what is important for applicants in choosing a program as well as suggest information their program makes available for student review prior to applying. <b>Disclosure:</b> Miss Goel has nothing to disclose. Miss Pertsovskaya has nothing to disclose. Ms. Mendez Colmenares has nothing to disclose. Melanie Orr has nothing to disclose. Ms. Naveed has nothing to disclose. Mr. Yarlagadda has nothing to disclose. Mr. Emmanuel has nothing to disclose.