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CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000428382.37640.12
Issue Overview

Issue Overview

Free Access

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

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Learning Objectives

Upon completion of the Continuum: Lifelong Learning in Neurology Neurologic Consultation in the Hospital issue, participants will be able to:

* Demonstrate a systematic approach to a patient with altered mental status, with an understanding of when to initiate a more advanced and potentially more resource-intense diagnostic workup

* Evaluate new neurologic deficits in periprocedural cardiac patients (eg, postcoronary artery bypass grafting) and in those patients initially admitted with active cardiac disease (eg, worsening heart failure)

* Describe the benefits of therapeutic hypothermia when initiated post cardiac arrest, including how this treatment improves the odds of favorable neurologic outcomes

* Identify those inpatients who are at risk for falls and design strategies to mitigate this risk using individualized and systems-based approaches

* Summarize the empiric treatment for suspected bacterial meningitis, including the indications for and timing of administration of adjunctive dexamethasone

* Describe an approach to neurologic consultation for a patient with weakness based on syndromic analysis in various hospital settings

* State key features of different spell types encountered in the hospital in order to create an appropriate differential diagnosis to guide diagnostic evaluation

* Differentiate the fundamental mechanism that contributes to a rise in intracranial pressure and recognize the specific intracranial compartment involved (brain, CSF, blood) in order to lead to early diagnosis and effective treatment

* Describe the potential ethical dilemma posed when a new attending physician assumes the care of a complex and critically ill patient

* Interpret and apply the principles of informed consent when withdrawing or changing an ineffective treatment

* Describe how to recognize and address the ethical dilemma faced by members of the health care team when physicians disagree on a treatment approach

* Recognize the importance of effective mechanisms to improve communication across facilities and at hospital discharge

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Core Competencies

The Continuum Neurologic Consultation in the Hospital issue covers the following core competencies:

▸ Patient Care

▸ Medical Knowledge

▸ Practice-Based Learning and Improvement

▸ Interpersonal and Communication Skills

▸ Professionalism

▸ Systems-Based Practice

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Disclosures

CONTRIBUTORS

S. Andrew Josephson, MD, Guest Editor

Associate Professor, Director, Neurohospitalist Program, University of California, San Francisco, San Francisco, California

*Dr Josephson has received personal compensation for editorial activities from Annals of Neurology and Journal Watch Neurology.

†Dr Josephson reports no disclosure.

Kevin M. Barrett, MD, MSc

Assistant Professor of Neurology, Mayo Clinic Florida, Jacksonville, Florida

*†Dr Barrett reports no disclosure.

Katharina Maria Busl, MD

Fellow in Neurocritical Care, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts

*†Dr Busl reports no disclosure.

Nicole A. Chiota, MD

Resident Physician, Department of Neurology, Mayo Clinic, Jacksonville, Florida

*†Dr Chiota reports no disclosure.

Susannah Brock Cornes, MD

Assistant Professor of Clinical Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, California

*†Dr Cornes reports no disclosure.

Ethan Cumbler, MD, FACP

Associate Professor of Medicine, Director of University of Colorado Hospital Acute Care for the Elderly Service, University of Colorado, Denver, Denver, Colorado

*Dr Cumbler has received honoraria for speaking on systems of care for the elderly from Scan Health.

†Dr Cumbler reports no disclosure.

Karen B. DaSilva, MD

Neuromuscular Fellow, University of California, San Francisco, San Francisco, California

*†Dr DaSilva reports no disclosure.

Liana E. Dawson, MD

Neurologist and Vascular Neurologist, Southern Neurological Acute Care Specialists, LLC, Orange Park, Florida

*†Dr Dawson reports no disclosure.

Vanja C. Douglas, MD

Assistant Clinical Professor, University of California, San Francisco, San Francisco, California

*Dr Douglas has served as editor-in-chief of The Neurohospitalist and has received personal compensation for medical record review and expert witness testimony.

†Dr Douglas discusses the use of antipsychotics for the treatment of agitated delirium.

Joey D. English, MD, PhD

University of California, San Francisco, San Francisco, California

*Dr English has served as assistant editor of Harrison's Practice and has received personal compensation for expert witness testimony and medical record reviews.

†Dr English reports no disclosure.

W. David Freeman, MD

Associate Professor of Neurology, Departments of Neurology and Critical Care; Neurocritical Care Director, Mayo Clinic Florida, Jacksonville, Florida

*†Dr Freeman reports no disclosure.

John E. Greenlee, MD, FAAN

Professor and Vice Chair, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah; Neurologist, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah

*Dr Greenlee has served as a consultant for Perseid Therapeutics and has received personal compensation in an editorial capacity from MedLink.

†Dr Greenlee reports no disclosure.

John David Hixson, MD

Assistant Professor of Clinical Neurology, University of California, San Francisco, San Francisco, California

*Dr Hixson has received personal compensation for medical record review from Lumetra Healthcare Solutions, Inc and for expert testimony.

†Dr Hixson reports no disclosure.

David Likosky, MD, SFHM

Executive Medical Director, Evergreen Neuroscience Institute; Director, Stroke Program, Evergreen Hospital Medical Center, Kirkland, Washington; Clinical Faculty, University of Washington, Seattle, Seattle, Washington

*Dr Likosky has received personal compensation for expert witness case review.

†Dr Likosky reports no disclosure.

Kazuma Nakagawa, MD

Assistant Professor of Medicine, University of Hawaii, Honolulu, Hawaii; Neurointensivist, The Queen's Medical Center, Honolulu, Hawaii

*Dr Nakagawa has received research grants from the American Heart Association and the Hawaii Community Foundation.

†Dr Nakagawa reports no disclosure.

John David Hixson, MD

Assistant Professor of Clinical Neurology, University of California, San Francisco, San Francisco, California

*Dr Hixson has received personal compensation for medical record review from Lumetra Healthcare Solutions, Inc and for expert testimony.

†Dr Hixson reports no disclosure.

Laura B. Powers, MD, FAAN

Dr Powers is retired from private practice.

*Dr Powers serves as ICD-9-CMAdvisor for the Coding Subcommittee of the AAN's Medical Economics and Management Committee.

†Dr Powers reports no disclosure.

Karen L. Roos, MD, FAAN

John and Nancy Nelson Professor of Neurology, Professor of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana

*Dr Roos has served as editor-in-chief of Seminars in Neurology and has received compensation for legal work.

†Dr Roos reports no disclosure.

Allan H. Ropper, MD, FRCP, FACP, FAAN

Professor of Neurology, Harvard Medical School, Boston, Massachusetts; Executive Vice Chair of Neurology, Brigham and Women's Hospital, Boston, Massachusetts

*Dr Ropper has served as associate editor for the New England Journal of Medicine.

†Dr Ropper reports no disclosure.

Tina Shih, MD

Assistant Professor of Clinical Neurology, University of California, San Francisco Epilepsy Center, University of California, San Francisco, San Francisco, California

*†Dr Shih reports no disclosure.

Wade S. Smith, MD, PhD

Professor of Neurology, Director, University of California, San Francisco, Neurovascular Service, University of California, San Francisco, San Francisco, California

*Dr Smith consults for and owns stock in Concentric Medical, Inc., and owns stock in Ornim, Inc. Dr Smith has served as a medical malpractice expert witness on issues related to stroke and neurocritical care.

†Dr Smith reports no disclosure.

MULTIPLE-CHOICE QUESTION WRITERS

Ronnie Bergen, MDAssistant Professor of Clinical Neurology, University of Arizona College of Medicine, Tucson, Arizona

*†Dr Bergen reports no disclosure.

Julie E. Hammack, MD, FAAN

Assistant Professor, Mayo Clinic, Rochester, Minnesota

*†Dr Hammack reports no disclosure.

*Relationship Disclosure

†Unlabeled Use of Products/Investigational Use Disclosure

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Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of the syllabus text, a set of multiple-choice items with preferred responses, case-based sections pertaining to ethical and practice issues related to the issue, and a patient management problem.

The syllabus text emphasizes clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. A CD of patient case vignettes relating to the issue topic accompanies one issue each year.

The practice of neurology presents a series of ethical challenges for the clinician. These rarely have simple or straightforward solutions, but require careful consideration by the neurologist. The Ethical Perspectives section provides a case vignette that raises one or more ethical questions related to the Continuum topic. Discussion follows the case to help the reader understand and resolve the ethical dilemma.

In addition to the lifelong learning of new clinical and scientific knowledge, neurologists must understand the constantly evolving environment in which they practice. Changes occur rapidly in reimbursement and regulatory areas, in the integration of evidence-based medicine, and in the implementation of patient safety measures into clinical practice. The Practice section presents a case-based example of these issues as they relate to the clinical topic as well as a coding table relevant to the issue topic.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If program subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

Multiple-Choice questions accompany each syllabus text. They are not intended as an examination but rather as a means of stimulating thought and helping you assess your general understanding of the course material. Subscribers may complete the questions online. Your responses will be kept completely confidential. Then, review the preferred response and critique for each multiple-choice item. Upon submission of the evaluation at the end of the Multiple-Choice Questions, you may earn up to 10 hours of American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credit™.

Beginning in 2011, each Continuum issue also includes an interactive Patient Management Problem for which participants may earn an additional 2 AMA PRA Category 1 Credits™. The patient management problem should help sharpen critical thinking skills used daily in the clinical practice of neurology.

The opinions of subscribers play a vital role in the future development of the program. Let us know what you think of each issue, using the comment section provided on the answer form. A transcript of credits earned will be available to you on the AAN website within two business days. (Note: Participants have up to 3 years from the date of publication to earn CME credits for each issue, unless otherwise notified by the AAN.)

© 2011 American Academy of Neurology

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