New Editors’ Perspective on Innovations in Care Delivery section

Healthcare innovations are frequently in the news and factors influencing care delivery are evolving at a fast pace. Most of what you hear though is not specific to neurology. The Innovations in Care Delivery section aims to fill this void. The initiation of this section by Bob Gross and Ray Dorsey demonstrates the commitment of the journal Neurology to publishing rigorous health services research aiming to describe, develop, test, implement, or evaluate the impact of the many organizational, behavioral, social, financial, and technological factors that influence neurologic care delivery, health, and well-being. Your submissions on these topics will be of strong interest here. This section also curates relevant articles, and utilizes blogs, podcasts, and interviews, to extend information and discussions on these important topics. The Innovations in Care Delivery section will also be a resource for collaboration and training. Soon, this site will maintain a list of data sources and persons experienced in using these. Available large databases create substantial opportunities for hypothesis generating research, and new discoveries about trends and the impact of healthcare delivery changes. Finally, we will work closely with the policy and practice sections of the American Academy of Neurology to keep you up-to-date on the most important issues regarding neurologic care delivery.

Zoonotic bacterial meningitis in adult humans

Check out this interesting review article on zoonotic meningitides by van Samkar and colleagues from the Netherlands. They point out that zoonoses of this nature are relatively uncommon—but in reality in resource limited tropical settings, we don’t generally have the capacity to definitively diagnose zoonotic infections clinically and there are virtually no epidemiologic insights on this at all from low income settings. Key risk factors identified in the review include residence in sub-tropical regions, close exposure to animals, consumption of poorly prepared or unpasteurized animal products and an immunocompromised state. These are all very common exposures in sub-Saharan Africa given the ongoing HIV epidemic and rural living conditions that place humans in very close proximity to their domestic animals and livestock. Animals in sub-Saharan Africa often have sub-optimal health as well further increasing the risk of illness transmission to humans. Collaborations between clinical researchers and veterinary medicine specialists are needed to explore this further1

  1. van Samkar A, Brouwer MC, van der Ende A, van de Beek D. Zoonotic bacterial meningitis in human adults. Neurology Epub 2016 Aug 17.

A Get ‘Er Done Team in Brazil Waits for No One

The online Urban Dictionary defines “get ‘er done” as a redneck phrase meaning to go ahead and complete a task and Yahoo answers says it is a phrase used in the military meaning don’t waste time, no matter how difficult the task, just do it and get it done. After reading the Global Perspectives section of this week’s Neurology, I think there can be no better adjective to describe the RIO GBS-ZIKV Research Network than to call them a get ‘er done team. This multidisciplinary group of self-funded clinicians and researchers in Rio using low cost technologies, like WhatsApp for group communications, have organized themselves into a lean, mean Zika fighting machine. While authoritative global health organizations are still trying to agree upon basic definitions (what IS microcephaly?), team RIO has developed standardized data collection instruments, protocolized treatment strategies and streamlined referral and triage procedures all while also collecting foundational data on the neurologic manifestations of Zika Virus in Brazil. Don’t miss what promises to be the first of many interesting reports from this inspiring group.

Summer Olympics 2016?

Although the World Health Organization (WHO) announced there would be additional meetings to review the public health risks associated with the 2016 Olympics scheduled to commence on August 5th in Rio, no new updates have been released to date (30 June). WHO’s recommendations in May indicated that holding the Olympics in Brazil would not appreciably alter the risk of spread of Zika. Pregnant women were advised not to travel to any Zika-affected regions and other Olympic attendees should avoid mosquito exposure, unprotected sex and travel to poor regions of Brazil more affected by Zika. The Rio Olympic Committee leadership have openly stated they will follow any WHO recommendations including, presumably, canceling the event. WHO maintains that it isn’t within their mandate to make decisions regarding the Olympics. If you are mind-numbingly frustrated with WHO’s handling of this looming issue, you might find a kindred spirit in Richard Horton’s June offline commentary—WHO’s Phoney War..1

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In The Global Know

As the program promised, the AAN Annual Meeting in Vancouver was teeming with internationally oriented activities and programs. In addition to the Global Heath Session (which admittedly, you needed a compass and breadcrumbs to find), there were presentations on work outside of the US interspersed at many of the other Sessions, HeadTalks addressing issues in Global Neurology, an INS on Practical Approaches to Narrowing the Epilepsy Treatment Gap and an excellent presentation by Rufus O. Akinyemi, MD of Ibadan, Nigeria with his acceptance of the Bruce S. Schoenberg International Award in Neuroepidemiology. Drs. Omar Siddiqi (from Harvard’s BIDMC and the University of Zambia) and Kiran Thakur (Columbia University) took up the leadership gauntlet within the AAN’s Global Health Section. Check out Synapse for more details on the program they are envisioning and planning for the coming 2 years.

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Why neurology needs to embrace telemedicine

When Lawrence D. first started having sporadic episodes of déjà vu followed by hours of mild confusion, he became concerned and informed his family physician. He was told that if it did not occur in his office, he could not offer any insight. Several months later, Lawrence had a generalized tonic clonic seizure and was admitted to the hospital where he was seen by a neurologist and diagnosed with epilepsy.

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A plethora of “Global” possibilities in Vancouver

The 68th Annual Meeting for the American Academy of Neurology in Vancouver will start next week. This year features a significant change in the structure of the meeting—access to MOST of the sessions is now entirely included in the basic registration fee. For the neurologist practicing in a resource limited setting who may be working without ready access to a large cadre of sub-specialized neurology colleagues, this means having the option of picking and choosing within the sub-specialty programs for those specific sessions most relevant to one’s own setting and situation. This year’s program also features three sessions on Teleneurology, which is a growing opportunity for expanding the reach of neurologic expertise while also providing ongoing support to colleagues working in situations with few other neurologists.Topical coverage of Neuroinfectious Diseases is also especially robust this year. Saturday, Global Health is going strong with, “Navigating your career: International Resident and Fellow Roundtable” , Global Health Session and excellent international coverage in Poster Session 1 (Global NCDs, Global capacity building, neuro-ID and neuro-HIV topics). Tuesday is the Global Health section meeting—an important opportunity to get involved in the sections leadership or simply offer your perspectives on growth priorities for the section. Wednesday from 3:30-5:30pm is “Neurocysticercosis and Globalization” and Thursday 1:00pm-5:30pm “Practical Approaches to Narrowing the Epilepsy Treatment Gap”. A new feature this year will be Experiential Learning with HEADTalks—15 minute presentations modelled from the now famous TED talk forum with select speakers presenting well-developed perspectives on timely topics. Neurology:Without Borders is clear evidence of Neurology’s (a.k.a. the green journal’s) growing interest in international research and engagement. On Monday at 5pm you have the opportunity to ask Robert Gross, Editor-in-Chief of Neurology anything global or otherwise. Hope to see you in Vancouver!

Teleneurology Sessions

Applications of Teleneurology: General 
Applications of Teleneurology: Telestroke 
Navigating Your Career: Teleneurology Panel

Availability, Affordability, and Accessibility: Unpacking Three Scary Words in Global Health

“What do you mean, you can’t get a head CT tonight? This man is having a stroke!”

My frustration must have seemed utterly naïve to the rural emergency physician on the other end of the line. It was 0100 on a Saturday, and I was taking a telephone consultation at a hospital in northern England, about a patient who appeared to have developed classic symptoms of a lateral medullary stroke. In the heat of the moment, I had forgotten that I was no longer in my familiar comfort zones of the John Radcliffe Hospital (Oxford) or the Foothills Medical Centre (Calgary, Canada), where I could always count on an emergent CT scan for an acute stroke. Fortunately for the patient in question, we could quickly arrange for the patient to be transferred to my centre for urgent neuroimaging and stroke-unit admission.

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Intra-African Ethnicity May for Be Important for Drug Choices in Epilepsy Care

Epilepsy care in African countries continues to rely largely upon older antiepileptic agents, so new findings in Acta Tropica by Motshoge and colleagues are of interest to physicians working in the region1. They evaluated the prevalence of CYP2C8*2, a slow drug metabolism allele, in San and Bantu populations in Botswana and found 17.5% amongst the San compared to 8.5% in the Bantu. The authors credit the differing evolutionary pressures on hunter-gatherers (the San). CYP2C8*2 is particularly important in the metabolism of carbamazepine and is virtually absent outside of African populations.2 Prior studies have indicated the San are also more likely to be slow acetylators3 and have lower CYP2D6 activity as well.4

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