Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Neurology
Total Results:
23001
Nationwide Clinical Practice Patterns of Anesthesiology Critical Care Physicians-A Survey to Members of the Society of Critical Care Anesthesiologists
BACKGROUND:Despite the growing contributions of critical care anesthesiologists to clinical practice, research, and administrative leadership of intensive care units (ICUs), relatively little is known about the subspecialty-specific clinical practice environment. An understanding of contemporary clinical practice is essential to recognize the opportunities and challenges facing critical care anesthesia, optimize staffing patterns, assess sustainability and satisfaction, and strategically plan for future activity, scope, and training. This study surveyed intensivists who are members of the Society of Critical Care Anesthesiologists (SOCCA) to evaluate practice patterns of critical care anesthesiologists, including compensation, types of ICUs covered, models of overnight ICU coverage, and relationships between these factors. We hypothesized that variability in compensation and practice patterns would be observed between individuals. METHODS:Board-certified critical care anesthesiologists practicing in the United States were identified using the SOCCA membership distribution list and invited to take a voluntary online survey between May and June 2021. Multiple-choice questions with both single- and multiple-select options were used for answers with categorical data, and adaptive questioning was used to clarify stem-based responses. Respondents were asked to describe practice patterns at their respective institutions and provide information about their demographics, salaries, effort in ICUs, as well as other activities. RESULTS:A total of 490 participants were invited to take this survey, and 157 (response rate 32%) surveys were completed and analyzed. The majority of respondents were White (73%), male (69%), and younger than 50 years of age (82%). The cardiothoracic/cardiovascular ICU was the most common practice setting, with 69.5% of respondents reporting time working in this unit. Significant variability was observed in ICU practice patterns. Respondents reported spending an equal proportion of their time in clinical practice in the operating rooms and ICUs (median, 40%; interquartile range [IQR], 20%-50%), whereas a smaller proportion-primarily those who completed their training before 2009-reported administrative or research activities. Female respondents reported salaries that were $36,739 less than male respondents; however, this difference was not statistically different, and after adjusting for age and practice type, these differences were less pronounced (-$27,479.79; 95% confidence interval [CI], -$57,232.61 to $2273.03; P = .07). CONCLUSIONS:These survey data provide a current snapshot of anesthesiology critical care clinical practice patterns in the United States. Our findings may inform decision-making around the initiation and expansion of critical care services and optimal staffing patterns, as well as provide a basis for further work that focuses on intensivist satisfaction and burnout.
PMID: 35950751
ISSN: 1526-7598
CID: 5287072
Advanced ovarian clear cell carcinoma with RAD50 mutation treated by PARP inhibitor pamiparib combined with anti-angiogenesis therapy: a case report [Case Report]
Ovarian clear cell carcinoma (OCCC) is a relatively uncommon epithelial ovarian malignancy with unique clinical, histopathologic and genetic characteristics. Patients with advanced OCCC have poor outcomes and are resistant to standard chemotherapy. Targeted therapy offers a novel approach for treating OCCC. We report the case of a 45-year-old female patient with advanced OCCC who experienced relapse after standard treatment. Further, a frameshift mutation in the homologous recombination repair-related gene RAD50 (RAD50-p.I371Ffs*8) was identified by genetic testing. Next, the patient had received targeted combination therapy with poly (ADP-ribose) polymerase (PARP) inhibitor pamiparib and bevacizumab, achieving partial remission. Patient's symptoms improved significantly compared to before. To date, the patient has been followed up for more than half a year with favorable survival and high quality of life. The case report suggested that parmiparib-targeted therapy is a viable treatment option for advanced OCCC patients with RAD50 mutation.
PMCID:9815817
PMID: 36729997
ISSN: 1473-5741
CID: 5442312
Machine Learning to Classify Relative Seizure Frequency From Chronic Electrocorticography
PURPOSE/OBJECTIVE:Brain responsive neurostimulation (NeuroPace) treats patients with refractory focal epilepsy and provides chronic electrocorticography (ECoG). We explored how machine learning algorithms applied to interictal ECoG could assess clinical response to changes in neurostimulation parameters. METHODS:We identified five responsive neurostimulation patients each with ≥200 continuous days of stable medication and detection settings (median, 358 days per patient). For each patient, interictal ECoG segments for each month were labeled as "high" or "low" to represent relatively high or low long-episode (i.e., seizure) count compared with the median monthly long-episode count. Power from six conventional frequency bands from four responsive neurostimulation channels were extracted as features. For each patient, five machine learning algorithms were trained on 80% of ECoG, then tested on the remaining 20%. Classifiers were scored by the area-under-the-receiver-operating-characteristic curve. We explored how individual circadian cycles of seizure activity could inform classifier building. RESULTS:Support vector machine or gradient boosting models achieved the best performance, ranging from 0.705 (fair) to 0.892 (excellent) across patients. High gamma power was the most important feature, tending to decrease during low-seizure-frequency epochs. For two subjects, training on ECoG recorded during the circadian ictal peak resulted in comparable model performance, despite less data used. CONCLUSIONS:Machine learning analysis on retrospective background ECoG can classify relative seizure frequency for an individual patient. High gamma power was the most informative, whereas individual circadian patterns of seizure activity can guide model building. Machine learning classifiers built on interictal ECoG may guide stimulation programming.
PMCID:8617083
PMID: 34049367
ISSN: 1537-1603
CID: 5418582
Response to Machado re: Revisions to the Uniform Determination of Death Act and Other Controversial Aspects of the Determination of Death by Neurologic Criteria [Letter]
PMID: 36526944
ISSN: 1556-0961
CID: 5382592
Functional and clinical studies reveal pathophysiological complexity of CLCN4-related neurodevelopmental condition
Missense and truncating variants in the X-chromosome-linked CLCN4 gene, resulting in reduced or complete loss-of-function (LOF) of the encoded chloride/proton exchanger ClC-4, were recently demonstrated to cause a neurocognitive phenotype in both males and females. Through international clinical matchmaking and interrogation of public variant databases we assembled a database of 90 rare CLCN4 missense variants in 90 families: 41 unique and 18 recurrent variants in 49 families. For 43 families, including 22 males and 33 females, we collated detailed clinical and segregation data. To confirm causality of variants and to obtain insight into disease mechanisms, we investigated the effect on electrophysiological properties of 59 of the variants in Xenopus oocytes using extended voltage and pH ranges. Detailed analyses revealed new pathophysiological mechanisms: 25% (15/59) of variants demonstrated LOF, characterized by a "shift" of the voltage-dependent activation to more positive voltages, and nine variants resulted in a toxic gain-of-function, associated with a disrupted gate allowing inward transport at negative voltages. Functional results were not always in line with in silico pathogenicity scores, highlighting the complexity of pathogenicity assessment for accurate genetic counselling. The complex neurocognitive and psychiatric manifestations of this condition, and hitherto under-recognized impacts on growth, gastrointestinal function, and motor control are discussed. Including published cases, we summarize features in 122 individuals from 67 families with CLCN4-related neurodevelopmental condition and suggest future research directions with the aim of improving the integrated care for individuals with this diagnosis.
PMCID:9908558
PMID: 36385166
ISSN: 1476-5578
CID: 5673852
Life after acute pandysautonomia: a 40-year journey [Letter]
PMID: 36574076
ISSN: 1619-1560
CID: 5409562
Author Correction: Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity (Nature Food, (2022), 3, 9, (694-702), 10.1038/s43016-022-00594-9)
EMBASE:2021228968
ISSN: 2662-1355
CID: 5513812
Focal epilepsies: update on diagnosis and classification
Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults. In children, focal epilepsies are typically subdivided in three groups: self-limited focal epilepsy syndromes (e.g., self-limited epilepsy with centrotemporal spikes), focal epilepsy of unknown cause but which do not meet criteria for a self-limited focal epilepsy syndrome, and focal epilepsy of known cause (e.g., structural lesions - developmental or acquired). In adults, focal epilepsies are often acquired and may be caused by a structural lesion such as stroke, infection and traumatic brain injury, or brain tumors, vascular malformations, metabolic disorders, autoimmune, and/or genetic causes. In addition to seizure semiology, neuroimaging, neurophysiology, and neuropathology constitute the cornerstones of a diagnostic evaluation. Patients with focal epilepsy who become drug-resistant should promptly undergo assessment in an epilepsy center. After excluding pseudo-resistance, these patients should be considered for presurgical evaluation as a means to identify the location and extent of the epileptogenic zone and assess their candidacy for a surgical procedure. The goal of this seminar in epileptology is to summarize clinically relevant information concerning focal epilepsies. This contributes to the ILAE's mission to ensure that worldwide healthcare professionals, patients, and caregivers continue to have access to high-quality educational resources concerning epilepsy.
PMID: 36938903
ISSN: 1950-6945
CID: 5462702
The Clinical Autonomic Research journal 2022 and onward [Editorial]
PMID: 36580219
ISSN: 1619-1560
CID: 5409682
Post-Vaccine Evaluation to Assist with Subsequent COVID-19 Vaccine Administration [Meeting Abstract]
Rationale: During roll-out of Pfizer-BioNTech, Moderna, and Johnson & Johnson (J&J) COVID-19 vaccines, adverse reactions led patients to seek Allergy evaluation following vaccination.
Method(s): We conducted retrospective chart review of patients >= 18 years seeking vaccine counseling between December 1, 2020 - May 1, 2021 after experiencing COVID-19 vaccine reactions. Demographics, atopic history, anaphylaxis history and vaccine administration/reactions were recorded. Follow up phone calls were used to complete data collection.
Result(s): We identified 24 patients (N= 21 Female, 3 Male) reporting reactions to COVID-19 vaccination; 19 after 1st dose, 2 after 2nd dose, and 3 after both. The 27 total reactions were classified as immediate (12), or delayed (15) and subdivided further based on features. Two patients had symptoms consistent with anaphylaxis and were evaluated in the ER, one received epinephrine and subsequently tolerated J+J. The other did not pursue additional vaccination. Among the additional 10 immediate reactions, 6 were cutaneous/mucocutaneous-only and 4 involved subjective systemic symptoms. Six patients were evaluated in the emergency room (3 delayed, 3 immediate). Overall, 22 of 24 patients completed vaccination series (defined as one dose of J&J or 2 doses of an mRNA vaccine).
Conclusion(s): Many patients reported reactions to COVID-19 vaccine, most following first vaccine dose with isolated cutaneous or mucocutaneous symptoms. No patients with delayed cutaneous reactions went on to have more severe reactions and only 1 patient had return cutaneous symptoms with 2nd dose. Patients with adverse reactions may be reluctant to pursue additional vaccination; 2 of our patient cohort remain incompletely vaccinated to COVID-19.
Copyright
Method(s): We conducted retrospective chart review of patients >= 18 years seeking vaccine counseling between December 1, 2020 - May 1, 2021 after experiencing COVID-19 vaccine reactions. Demographics, atopic history, anaphylaxis history and vaccine administration/reactions were recorded. Follow up phone calls were used to complete data collection.
Result(s): We identified 24 patients (N= 21 Female, 3 Male) reporting reactions to COVID-19 vaccination; 19 after 1st dose, 2 after 2nd dose, and 3 after both. The 27 total reactions were classified as immediate (12), or delayed (15) and subdivided further based on features. Two patients had symptoms consistent with anaphylaxis and were evaluated in the ER, one received epinephrine and subsequently tolerated J+J. The other did not pursue additional vaccination. Among the additional 10 immediate reactions, 6 were cutaneous/mucocutaneous-only and 4 involved subjective systemic symptoms. Six patients were evaluated in the emergency room (3 delayed, 3 immediate). Overall, 22 of 24 patients completed vaccination series (defined as one dose of J&J or 2 doses of an mRNA vaccine).
Conclusion(s): Many patients reported reactions to COVID-19 vaccine, most following first vaccine dose with isolated cutaneous or mucocutaneous symptoms. No patients with delayed cutaneous reactions went on to have more severe reactions and only 1 patient had return cutaneous symptoms with 2nd dose. Patients with adverse reactions may be reluctant to pursue additional vaccination; 2 of our patient cohort remain incompletely vaccinated to COVID-19.
Copyright
EMBASE:2022491136
ISSN: 1097-6825
CID: 5509722
