Category: Nevin Manimala

BMJ Open. 2025 Apr 7;15(4):e091656. doi: 10.1136/bmjopen-2024-091656.

ABSTRACT

OBJECTIVE: Observational studies have found that cigarette smoking increased the prevalence and incidence of sarcopenia, whereas alcohol consumption appeared to decrease the risk. These findings, however, may be susceptible to either confounding bias or reverse causation. We conducted a Mendelian randomisation (MR) study to appraise the causal relation of cigarette smoking and alcohol consumption to the risk of sarcopenia.

METHODS: Genetic instruments associated with cigarette smoking (cigarettes per day) and alcohol consumption (drinks per week) were retrieved from the publicly available genome-wide association data. Individual-level, electronic medical record-linked data on sarcopenia, grip strength and appendicular lean mass were obtained from the UK Biobank. We performed two-sample univariable and multivariable MR analyses to examine the relation of genetically determined cigarette smoking and alcohol consumption to the risk of sarcopenia and its indices.

RESULTS: One SD increase of genetically determined cigarette smoking was associated with an increased risk of sarcopenia (OR=2.51, 95% CI: 1.26 to 5.01, p=0.001), decreased grip strength (β=-0.63 kg, 95% CI: -1.13 to -0.13, p=0.01) and less appendicular lean mass (β=-0.22 kg, 95% CI: -0.44 to -0.01, p=0.04). Although one SD increase of genetically determined alcohol consumption was associated with decreased grip strength (β=-1.15 kg, 95% CI: -2.09 to -0.10, p=0.02), no statistically significant causal association was observed between genetically determined alcohol consumption and either sarcopenia (OR=0.96, 95% CI: 0.35 to 2.62, p=0.94) or appendicular lean mass (β=-0.23 kg, 95% CI: -0.91 to 0.45, p=0.51).

CONCLUSIONS: Our findings showed that genetically determined cigarette smoking, but not alcohol consumption, was causally associated with the risk of sarcopenia.

PMID:40194871 | DOI:10.1136/bmjopen-2024-091656

BMJ Open. 2025 Apr 7;15(4):e090746. doi: 10.1136/bmjopen-2024-090746.

ABSTRACT

Between 2020 and 2050, the world’s population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters’ degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 TRIAL REGISTRATION NUMBER: NCT05946109.

PMID:40194869 | DOI:10.1136/bmjopen-2024-090746

BMJ Open Ophthalmol. 2025 Apr 7;10(1):e002144. doi: 10.1136/bmjophth-2025-002144.

ABSTRACT

BACKGROUND/AIMS: To determine the accuracy of an innovative paper-based, low-cost, easily accessed, portable method of evaluating the visual field (VF).

METHODS: Two groups of consecutive patients with glaucoma and controls were enrolled. Both eyes were assessed, and the Humphrey field analyser (HFA) (24-2) was used to identify patients with and without VF defects. The TsiogkaSpaeth grid (TS) grid test was performed in each eye of all participants. The Humphrey VF examination and the TS grid examination were conducted consecutively on the same day by two different examiners, prior to any other eye examinations. Sensitivity, specificity, and positive and negative predictive values of the TS grid scotoma area were assessed, using the results found with the HFA as the reference standard. A mixed-effects logistic regression model with a random intercept per participant was used to account for the correlation between eyes.

RESULTS: This prospective, cross-sectional study recruited 51 participants in a tertiary care hospital-based glaucoma department. Of them, 19 had glaucomatous defects in both eyes, 12 had defects in 1 eye only and 21 had no defects in either eye. The sensitivity and specificity of the TS grid test were 81.63% (95% CI 68% to 91.2%) and 84.91% (95% CI 72.4% to 93.3%), respectively, positive predicted value was 83.33% (95% CI 69.8% to 92.5%) and negative predictive value was 83.33% (95% CI 70.7% to 92.1%). The area under the curve was 0.83 (95% CI 0.76 to 0.91). There was a significant correlation between the TS grid test score and the VF Index of the HFA 24-2 (r=0.87, p<0.0001) and the mean deviation of the HFA 24-2 (r=0.85, p<0.0001).

CONCLUSIONS: The TS grid test offers a reliable, low-cost alternative for VF examination in glaucoma patients. This method could be advantageous in clinical settings with limited access to traditional testing equipment. The TS grid has limitations, including difficulty of fixation loss testing and ensuring the correct fixation distance. The test’s self-administration reliability is uncertain, and some patients were unable to perform it. Other limitations concern the grid’s design and the small sample size of the study.

PMID:40194868 | DOI:10.1136/bmjophth-2025-002144

BMJ Open Ophthalmol. 2025 Apr 7;10(1):e002036. doi: 10.1136/bmjophth-2024-002036.

ABSTRACT

OBJECTIVE: Retinopathy of prematurity (ROP) registers enable population-based studies to monitor ROP screening programmes to improve their effectiveness. The aim of this study was to determine the frequency of ROP and the coverage of screening in a South African cohort using a prospective ROP South African (ROPSA) register.

METHODS AND ANALYSIS: Infants born from 1 May 2022 to 31 January 2023 and screened prospectively for ROP at five neonatal intensive care units in Cape Town were included. The screening criteria were a gestational age (GA) <32 weeks or birth weight (BW) <1250 g. Data were extracted from the ROPSA register and analysed.

RESULTS: 696 of 1154 (60.3%) eligible infants were screened, almost half of whom (45.7%) did not complete screening. ROP was detected in 220 infants (31.6%, 95% CI 28.3% to 35.3%), 7 (1.0%) of whom required treatment. Infants with incomplete screening had a lower mean GA than those who completed screening; 28.7 (SD 1.6, range 25-33) and 29.1 (SD 1.7, range 24-36) weeks, respectively (p=0.004) and a lower mean BW; 1048 (SD 203, range 650-1690) g and 1108.5 (SD 227, range 640-1840) g, respectively (p<0.001).

CONCLUSIONS: Data from the ROPSA register on the frequency of any ROP and treatment-requiring ROP may be biased due to low screening coverage and high incomplete screening. Reasons need to be explored and corrective interventions initiated. The ROPSA register will enable the impact of these interventions to be monitored. The findings of this study will contribute to the ongoing revision of South African national ROP screening guidelines.

PMID:40194866 | DOI:10.1136/bmjophth-2024-002036

J Dent Hyg. 2025 Apr;99(2):9-25.

ABSTRACT

Purpose The World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions introduced a new framework for categorizing periodontal and peri-implant diseases and conditions in 2017. The purpose of this study was to investigate the current implementation practice and factors impacting implementation of the 2017 Classification of Periodontal and Peri-Implant Diseases by clinical dental hygienists.Methods Survey research was conducted in an online format with a non-probability sample of clinical dental hygienists recruited via social media and snowball sampling (n= 255). Components of the survey included personal, environmental, and behavioral factors along with intention to implement the classification of periodontal staging and grading system into patient care. Data analysis included descriptive statistics, correlation, and regression.Results The survey completion rate was 71% (n=181). Environmental factors (β=.352, p<.001) and personal factors (β=.469, p<.001) were positively associated with the intention to implement the 2017 periodontal disease classification system. In contrast, behavioral factors (β=.011, p=.889) and highest degree earned (β=.079, p=.151) were not significant predictors. For the intention to attend continuing education courses on the new classification system, both behavioral factors (β=.388, p<.001) and personal factors (β=.299, p=.003) were significant. However, environmental factors (β=-.048, p=.535), years in practice (β=-.041, p=.506), and familiarity (β=.066, p=.402) were not significant predictors.Conclusion Results demonstrated that both environmental and personal factors significantly influenced the intention to implement the 2017 periodontal disease classification system among clinical dental hygienists. To enhance integration, efforts should be made to focus on improving personal motivation and addressing the environmental/workplace factors.

PMID:40194864

J Dent Hyg. 2025 Apr;99(2):37-47.

ABSTRACT

Purpose Dental hygienists’ knowledge and application of clear communication techniques are critical due to their role as primary providers of education about preventive regimens. The purpose of this study was to obtain information about dental hygiene students’ perceived education regarding recommended communication techniques and their intent to use these techniques in practice.Methods A national online survey was designed by the University of Maryland and structured by the American Dental Association’s Council on Advocacy for Access and Prevention (CAAP). The survey was distributed by the American Dental Hygienists’ Association (ADHA) in 2019 to 9533 student email addresses. The survey included student demographics, the recommended communication techniques they were exposed to, when and where they were assessed, whether they had heard of the term health literacy, and their intent to use the communication techniques once in clinical practice. Statistical analyses included descriptive statistics and analysis of variance. Significance was set at p< 0.05.Results A total of 235 surveys were returned for a 2.5% response rate. The majority were female (95.7%), white (81.7%) and born in the United States (89.8%). Nearly a third (28.1%) were in baccalaureate programs and over half (59.1%) were in associate degree programs. The most frequently reported method used to educate students about provider-patient communication techniques was lectures (88.9%). Respondents were more likely to report having knowledge regarding the use of simple language (98.3%) than asking the patient to repeat back the information or instructions (87.7%). Respondents had greater confidence (82.1%) and intention to use simple language (92.8%) than confidence to ask patients to repeat back information (73.2%) or intention to do so in the future (67.7%) The majority (58.3%) reported being evaluated on communication skills both in the classroom and clinic setting.Conclusions Results of this survey, although non-representative of all dental hygiene students, suggest a need for increased classroom and clinic use of recommended communication techniques in dental hygiene education programs. Dental hygiene graduates must understand the use of recommended communication techniques to reduce misinformation about oral health and increase patients’ knowledge and understanding about preventing oral diseases.

PMID:40194863

J Dent Hyg. 2025 Apr;99(2):26-36.

ABSTRACT

Purpose The popularity of disposable safety syringes has grown because of their established safety record. Previous studies on local anesthetic syringes have mainly concentrated on safety features and the prevention of needlestick injuries, often neglecting the preferences of practitioners. The purpose of this study was to evaluate the preferences of dental hygiene students and faculty for traditional metal syringes compared to disposable safety syringes.Methods An 11-item questionnaire was distributed to a convenience sample of 61 dental hygiene students and 3 faculty members in a pain management course. The questionnaires were administered after the participants’ first exposure to local anesthetic administration on a mannequin and after their final exposure on a live patient to assess any changes in preferences. The post-questionnaire included the same 11 questions, along with an open-ended question inviting participants to share their final thoughts. Data were collected and entered into an Excel spreadsheet for descriptive statistics and inductive content analysisResults The response rate was 93.44% (n=57) for the initial questionnaire and 90.16% (n=55) for the final questionnaire administered to the dental hygiene students. All of the faculty members (n=3) completed both questionnaires. Participants preferred the traditional syringe over the disposable safety syringe for ease of use/comfort and control of the apparatus during set up, aspiration, and injection. However, preferences for disposable safety syringes were indicated in the responses related to syringe break down and clean-up.Conclusion This study assessed the preferences of dental hygiene students and faculty for traditional metal versus disposable safety syringes, revealing a clear preference for the former despite some limitations. Understanding how syringe design affects user comfort and safety could enhance disposable syringe technology and its adoption.

PMID:40194862

Neurology. 2025 Apr 8;104(7_Supplement_1):4269. doi: 10.1212/WNL.0000000000211560. Epub 2025 Apr 7.

ABSTRACT

OBJECTIVE: Objectives of this study are to retrospectively analyze Healthcare Resource Utilization (HCRU) and associated costs in 59 patients diagnosed with SPSD at a large academic center to identify areas for interventions.

BACKGROUND: Stiff Person Syndrome Spectrum Disorder (SPSD) is a rare autoimmune disorder characterized by progressive muscle stiffness and painful spasms.

DESIGN/METHODS: We queried Health Data Compass (HDC), an electronic health data repository for a large academic healthcare system, from 2012 through 2022 for all patients ≥ 18-year-old with ICD-10 codes pertaining to SPSD in a recent epidemiology study to define incidence and prevalence of SPSD (Neurology, in press). In this current study, we then used the HDC database in this well-defined SPSD cohort to capture electronic health records from a large academic health system and claims data from the Colorado All Payers Claim Database to further define HCRU in this population.

RESULTS: 273 patients met the initial inclusion criteria using ICD-10 codes; 59 were confirmed to have SPSD via chart review. Based on our cohort of 59 patients, the mean age of patients was 49.7 years (SD=12.9), 59.3% were female, and 59.3% were antibody-positive. 81.4% self-identified as White, 8.5% Black, 1.2% American Indian or Alaskan Native, and 6.8 % other. 91.5% self-reported as non-Hispanic. 72.9% had ≥ 1 electromyography/nerve conduction study and 81.3% had ≥ 1 brain magnetic resonance image in our system. Additional data collected includes hospitalizations, emergency room and outpatient visits, laboratory and radiology services, and pharmacy related services to evaluate all-cause and SPSD related HCRU and costs.

CONCLUSIONS: Using a well-defined, population-based cohort, we can explore HCRU patterns for patients with SPSD. Understanding the true disease burden of SPSD is fundamental to ensuring optimal patient care, allocating appropriate system resources, and defining standards of care for this rare disease. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Dr. Lowe has nothing to disclose. Mr. Gutierrez has nothing to disclose. Dr. Barlev has received personal compensation for serving as an employee of Kyverna. Dr. Crane has nothing to disclose. Mr. Engebretson has nothing to disclose. Stefan Sillau has nothing to disclose. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Meyers Squibb. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PhRMA Foundation. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MJH Lifesciences. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Anylam . Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Applied Patient Experience. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for ICER. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Phrma Foundation. The institution of Dr. Nair has received research support from Bristol Meyers Squibb. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from NINDS. The institution of Dr. Nair has received research support from Sanofi Genzyme. The institution of Dr. Nair has received research support from Kyverna Therapeutcis. Dr. Nair has a non-compensated relationship as a Board Member with Center for Improving Value in Healthcare that is relevant to AAN interests or activities. Dr. Carlson has received research support from Horizon Therapeutics (Amgen). The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for EMD Serono. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kyverna . Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon/Amgen. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Joe Jones Law Firm. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Novartis. The institution of Dr. Piquet has received research support from Abbvie. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. The institution of Dr. Piquet has received research support from Anokion. The institution of Dr. Piquet has received research support from UCB . The institution of Dr. Piquet has received research support from Foundation for Sarcoidosis. The institution of Dr. Piquet has received research support from Kyverna . Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Autoimmune Encephalitis Alliance (AEA) that is relevant to AAN interests or activities. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Stiff Person Syndrome Research Foundation (SPSRF) that is relevant to AAN interests or activities.

PMID:40194238 | DOI:10.1212/WNL.0000000000211560

Neurology. 2025 Apr 8;104(7_Supplement_1):4274. doi: 10.1212/WNL.0000000000211564. Epub 2025 Apr 7.

ABSTRACT

OBJECTIVE: To investigate the frequency of quality care in moderate-advanced dementia with Lewy bodies (DLB), including in individuals with and without specialty care.

BACKGROUND: DLB is a common degenerative dementia, however the frequency of high-quality care is unknown.

DESIGN/METHODS: Dyads of moderate-advanced DLB patients and their caregivers were recruited from DLB Centers of Excellence, advocacy organizations, or research registries. Caregivers completed questionnaires regarding demographics, healthcare, and ancillary referrals. Descriptive statistics report the frequency of care aligning with dementia and parkinsonism quality measures. Secondary analyses compared specialty and non-specialty care via chi-square and t-tests. P-values were adjusted for multiple testing.

RESULTS: Of 189 dyads, patients were on average 75±8 years-old (77.8% male, 95.2% White, average time since diagnosis 3.2 ± 3.1 years). Forty percent of participants reported care from a movement or dementia specialist, 34% from a DLB specialist, and 51% from general neurology. 132 (69.8%) patients were taking a cholinesterase inhibitor. The average Anticholinergic Burden (ACB) score was 2.0±2.0. Of 84 patients taking antipsychotic medications, 74 (39.2%) were taking preferred antipsychotics and 10 (5.3%) were taking non-preferred antipsychotics. Eighty-eight participants (46.6%) reported rehabilitation (PT/OT/SLP) referrals, 49 (25.9%) social work referrals, 17 (9%) palliative care, and 22 (11.6%) hospice. There were no differences in cholinesterase inhibitor use (p=0.061), mean ACB score (p=0.348), use of preferred (p=0.560) or non-preferred (p=0.230) antipsychotics, rehabilitation referrals (p=0.719), or hospice referrals (p=0.928) between specialty and non-specialty cohorts. Individuals receiving specialty care were less likely to receive social work (13.9% vs. 34%), p=0.001) and palliative care (3.8% vs. 12.7%, p=0.034) referrals.

CONCLUSIONS: Most individuals with moderate-advanced DLB observed received quality care relating to medications and rehabilitation referrals, however frequency of social work and palliative care referrals were low across both specialty and non-specialty cohorts. There is a need to increase availability of these services and connect individuals with DLB to these supports. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Dr. Burke has nothing to disclose. Dr. Li has nothing to disclose. Mrs. Jury has nothing to disclose. Dr. Galvin has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Cognivue. Dr. Galvin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Biogen. Dr. Galvin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eisai. Dr. Galvin has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Galvin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GE Healthcare. Dr. Galvin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Galvin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PassageBio. The institution of Dr. Galvin has received research support from National Institutes of Health. Dr. Galvin has received intellectual property interests from a discovery or technology relating to health care. Dr. Galvin has a non-compensated relationship as a Board of Directors with Alzheimer Association Southeast Florida Chapter that is relevant to AAN interests or activities. Dr. Galvin has a non-compensated relationship as a Board of Directors with Lewy Body Dementia Association that is relevant to AAN interests or activities. Dr. Galvin has a non-compensated relationship as a Board of Directors with Lewy Body Dementia Resource Center that is relevant to AAN interests or activities. The institution of Dr. Fields has received research support from National Institutes of Health. The institution of Dr. Fields has received research support from Patient-Centered Outcomes Research Institute. Mrs. Taylor has received personal compensation for serving as an employee of Lewy Body Dementia Association. The institution of Dr. Armstrong has received research support from National Institute of Aging. The institution of Dr. Armstrong has received research support from Florida Department of Health. The institution of Dr. Armstrong has received research support from Lewy Body Dementia Association. Dr. Armstrong has received research support from Parkinson Foundation. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer’s Clinical Trials Consortium. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer’s Disease Cooperative Study. Dr. Armstrong has a non-compensated relationship as a Member, Scientific Advisory Council with Lewy Body Dementia Association that is relevant to AAN interests or activities.

PMID:40194235 | DOI:10.1212/WNL.0000000000211564

Neurology. 2025 Apr 8;104(7_Supplement_1):4279. doi: 10.1212/WNL.0000000000211566. Epub 2025 Apr 7.

ABSTRACT

OBJECTIVE: We hypothesized that developing standardized training for the neurological coma examination will ensure medical trainees are effectively taught the necessary skills to perform and interpret physical examinations on comatose patients.

BACKGROUND: It has been shown that medical trainees lack confidence in their physical examination skills and understanding the significance of their findings.

DESIGN/METHODS: Twenty-eight third and fourth-year medical students rotating in the Neuro-intensive care unit (NICU) participated in a one-hour coma examination training consisting of a lecture and skills demonstration led by a neurocritical care attending. Students completed an anonymous pre/post-session survey assessing their confidence and comfortability in performing a coma examination. Survey answer options were designed on a Likert scale from 1-5 with 1 being “strongly disagree” and 5 being “strongly agree.” Statistical analysis was performed using the Wilcoxon signed ranks test.

RESULTS: There were statistically significant increases in self-rated comfort level and clinical competency in all areas following the training. Question 9 (“I am able to teach another student how to complete a comprehensive neurological physical examination of a comatose patient”) and question 2 (“I am able to determine a Glasgow coma score for a comatose patient”) showed the greatest improvement from pre- to post-survey responses (p-value: <0.001, Wilcoxon signed ranks test). Half of respondents answered 5 (“strongly agree”) to question 12 (“The coma clinical skills workshop increased my confidence in my ability to perform a comprehensive neurological physical examination on a comatose patient”).

CONCLUSIONS: Our results demonstrate that standardized neurological coma examination training in medical education is an effective teaching method. This approach should be further explored by expanding the training to include more students and learner types such as residents and nurses. Long-term efficacy may need to be determined through a follow-up survey of students at the end of their medical education after working in other ICU settings. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Ms. Streveler has nothing to disclose. Ms. Lauzier has nothing to disclose. Dr. Muzammil has nothing to disclose. Dr. Mohamed has nothing to disclose. Scott Millis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor & Francis. The institution of Scott Millis has received research support from NIH & NIDILRR. Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xenon pharmaceuticals. An immediate family member of Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. The institution of Dr. Zutshi has received research support from UCB Pharmaceuticals.

PMID:40194233 | DOI:10.1212/WNL.0000000000211566