34 results on '"Kass JS"'
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2. Physical medicine and rehabilitation conditions in the Astrodome Clinic after Hurricane Katrina.
- Author
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Chiou-Tan FY, Bloodworth DM, Kass JS, Li X, Gavagan TF, Mattox K, and Rintala DH
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- 2007
- Full Text
- View/download PDF
3. Visual vignette. F-wave hyperexcitability in Isaac syndrome.
- Author
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Kass JS, Button JH, and Chiou-Tan FY
- Published
- 2008
- Full Text
- View/download PDF
4. The Medicolegal and Ethical Dimensions of Physician Prescription Reluctance.
- Author
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Rose RV and Kass JS
- Subjects
- Aged, Humans, Neurologists, Prescriptions, United States, United States Food and Drug Administration, Alzheimer Disease diagnosis, Alzheimer Disease drug therapy, Medicare
- Abstract
Abstract: This article addresses the potential legal ramifications for neurologists caring for patients with Alzheimer disease (AD) who elect neither to prescribe aducanumab nor to refer patients with AD for treatment with aducanumab. To prevail against a neurologist for failing to prescribe aducanumab or refer for aducanumab treatment, the plaintiff would have to establish that the neurologist's failure to prescribe the medication or refer for treatment was a breach of the standard of care. The standard of care is conceptualized as the generally accepted approach to diagnosing or treating a condition. However, the controversy surrounding the US Food and Drug Administration's (FDA's) approval process for aducanumab (which was based on the drug's efficacy at reducing brain amyloidosis rather than on clinically meaningful efficacy) as well as the American Academy of Neurology (AAN) position statement on aducanumab and the recent decision by the Centers for Medicare & Medicaid Services (CMS) to limit Medicare coverage of the drug and its associated costs to patients enrolled in qualifying clinical trials indicate that aducanumab cannot yet be considered the standard of care for the treatment of AD. Although deciding not to prescribe aducanumab does not violate the standard of care, neurologists treating patients with AD and not recommending this treatment should explain to their patients and their patients' surrogate decision makers why they are not recommending the treatment., (Copyright © 2022 American Academy of Neurology.)
- Published
- 2022
- Full Text
- View/download PDF
5. Legal and Ethical Challenges in the Care of the Pregnant Patient After Brain Death.
- Author
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Kass JS and Rose RV
- Subjects
- Ethics, Medical, Female, Fetus, Humans, Pregnancy, Brain Death diagnosis, Brain Death legislation & jurisprudence, Pregnant Women
- Abstract
Abstract: Using two scenarios based on real-life cases reported in the media, this article examines the ethical and legal controversies that arise when a pregnant woman dies based on neurologic criteria while her fetus remains alive. In the first scenario, all parties agreed to maintain physiologic support until a safe delivery could be achieved, whereas in the second scenario the woman's family sought a legal remedy to stop the hospital from continuing to provide physiologic support for the patient and her neurologically devastated fetus., (Copyright © 2022 American Academy of Neurology.)
- Published
- 2022
- Full Text
- View/download PDF
6. Interprofessional Internet Consultations: The Potential Benefits and Perils of eConsults.
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Kass JS and Rose RV
- Subjects
- Humans, Internet, Liability, Legal, Physician-Patient Relations, Malpractice, Referral and Consultation
- Abstract
Abstract: This article addresses the question of whether neurologists performing interprofessional internet consultations, known as eConsults, face the same malpractice liability as for face-to-face patient care. Because the physician-patient relationship is usually unambiguous, determining the scope of legal liability arising from these relatively new approaches to patient care requires understanding the types of interactions courts have found to establish a patient-physician relationship., (Copyright © 2021 American Academy of Neurology.)
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- 2021
- Full Text
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7. False Claims Act Overview and Implications for Neurologists.
- Author
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Rose RV and Kass JS
- Subjects
- Fraud, Humans, Physician Self-Referral, United States, Medicare, Neurologists
- Abstract
Abstract: The US Department of Health and Human Services Office of the Inspector General identifies the five most important federal fraud and abuse laws that are most applicable to physicians: the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law (Stark Law), the Exclusion Authorities, and the Civil Monetary Penalties LawThe False Claims Act is the US government's primary tool for combating fraud perpetrated through the filing of false claims for federal government reimbursement. Neurologists and companies serving the needs of neurologic patients have not been immune from False Claims Act-related legal action. This article provides an overview of the False Claims Act, uses real-life neurologic cases to illustrate the range of False Claims Act violations and recoveries, and offers some practical compliance suggestions., (Copyright © 2021 American Academy of Neurology.)
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- 2021
- Full Text
- View/download PDF
8. Criminal Culpability for Acts Committed During a Possible Episode of REM Sleep Behavior Disorder.
- Author
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Kass JS and Rose RV
- Subjects
- Humans, Male, Middle Aged, Spouses, Criminal Law, Homicide, REM Sleep Behavior Disorder complications
- Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed partner while acting out a dream. This article examines the complexities associated with RBD as a criminal defense strategy as well as the legal implications for physicians and their duty to patients and their families to mitigate risks associated with possible injuries related to RBD.
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- 2020
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9. Legal Liability Associated With rtPA Administration and Surrogate Decision Makers.
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Kass JS and Rose RV
- Subjects
- Aphasia etiology, Humans, Male, Middle Aged, Neurologists legislation & jurisprudence, Stroke complications, Time Factors, Fibrinolytic Agents administration & dosage, Liability, Legal, Neurologists standards, Standard of Care legislation & jurisprudence, Stroke drug therapy, Third-Party Consent legislation & jurisprudence, Thrombolytic Therapy standards, Tissue Plasminogen Activator administration & dosage
- Abstract
Stroke is one of the most common conditions neurologists treat in emergency situations. This article examines the issues of surrogate decision makers and the physician's potential legal liability in the context of the administration or nonadministration of recombinant tissue plasminogen activator (rtPA) in a common emergency department scenario.
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- 2020
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10. End of life: Expert care and support, not physician-hastened death.
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Masdeu JC, Aksamit AJ, Carver AC, Foley KM, Kass JS, Martin RA, McCusker EA, McQuillen MP, Mehanna R, Payne R, Victor SJ, and Warach S
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- Humans, Netherlands, Neurology ethics, Neurology methods, Societies, Medical, United States, Palliative Care ethics, Palliative Care methods, Terminal Care ethics, Terminal Care methods
- Abstract
In legal physician-hastened death, a physician prescribes medication with the primary intent of causing the death of a willing terminally ill patient. This practice differs radically from palliative sedation, intended to relieve a patient's suffering rather than cause a patient's death. In this position paper, we argue that the practice of physician-hastened death is contrary to the interests of patients, their families, and the sound ethical practice of medicine. Therefore, the American Academy of Neurology should advise its members against this practice, as it had done until 2018., (Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
- Published
- 2019
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11. Liability and Failure to Warn a Patient.
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Kass JS and Rose RV
- Subjects
- Dopamine D2 Receptor Antagonists adverse effects, Drug-Related Side Effects and Adverse Reactions prevention & control, Humans, Metoclopramide adverse effects, Tardive Dyskinesia chemically induced, Tardive Dyskinesia prevention & control, Liability, Legal, Malpractice, Patient Education as Topic standards, Physicians standards
- Abstract
This medicolegal article examines a physician's liability when he or she has knowledge of adverse effects associated with a prescription medication and suggests ways to mitigate that liability risk. The article also discusses the circumstances under which pharmaceutical companies face liability for side effects such as tardive dyskinesia.
- Published
- 2019
- Full Text
- View/download PDF
12. Driving and Epilepsy: Ethical, Legal, and Health Care Policy Challenges.
- Author
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Kass JS and Rose RV
- Subjects
- Counseling, Humans, Neurologists ethics, Automobile Driving legislation & jurisprudence, Automobile Driving psychology, Bioethical Issues, Epilepsy psychology, Health Policy, Neurologists legislation & jurisprudence, Patient Safety legislation & jurisprudence
- Abstract
Although the principle of autonomy allows patients to refuse interventions their physicians recommend, patients are not free to ignore legally mandated restrictions on driving, and physicians are ethically justified in constraining their patients' driving rights in compliance with state law. Furthermore, the standard of care for treatment of patients with epilepsy includes counseling about lifestyle modifications that promote patient safety and compliance with the law. Neurologists should not only counsel their patients with epilepsy about legally mandated driving restrictions but also document this counseling in the medical record. Failure to counsel and to document may result in legal liability if patients experience seizures while driving and injure either themselves or third parties. The neurologist's duty of care may be limited to the patient in some jurisdictions but may be extended to injured third parties in others. Furthermore, a patient's own contributory negligence may limit or completely foreclose recovery against the physician to varying degrees, depending on the state in which the injury occurred.
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- 2019
- Full Text
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13. Prescribing Antipsychotic Medications to Patients With Dementia: Boxed Warnings and Mitigation of Legal Liability.
- Author
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Rose RV and Kass JS
- Subjects
- Aged, Dementia diagnosis, Drug-Related Side Effects and Adverse Reactions prevention & control, Female, Humans, Liability, Legal, United States, Antipsychotic Agents therapeutic use, Dementia drug therapy, Drug Labeling legislation & jurisprudence, United States Food and Drug Administration legislation & jurisprudence
- Abstract
Clinicians caring for patients with dementia are often at a loss when trying to manage dementia-related behavioral disturbances pharmacologically because no drugs have been proven effective for this indication. Antipsychotics are commonly prescribed for these patients despite a US Food and Drug Administration (FDA)-mandated boxed warning about the heightened risk of death in patients with dementia treated with antipsychotic drugs. This boxed warning does not prevent clinicians from prescribing antipsychotics to patients with dementia. However, it serves as a heightened warning to prescribers to include the specific risks mentioned in the boxed warning in their discussion of risks and benefits of the proposed therapy with their patients or their patients' health care proxy and to document this informed consent conversation in the medical record. By documenting that the risks of the treatment, including those the FDA has deemed serious enough to include in a boxed warning, were discussed and accepted by the medical decision maker, the prescriber also reduces the risk of liability should an adverse event ensue.
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- 2019
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14. Ethical Considerations in End-of-life Care in the Face of Clinical Futility.
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Kass JS, Lewis A, and Rubin MA
- Subjects
- Humans, Male, Middle Aged, Brain Neoplasms therapy, Glioblastoma therapy, Terminal Care ethics, Terminal Care methods
- Abstract
Management of patients with terminal brain disorders can be medically, socially, and ethically complex. Although a growing number of feasible treatment options may exist, there are times when further treatment can no longer meaningfully improve either quality or length of life. Clinicians and patients should discuss goals of care while patients are capable of making their own decisions. However, because such discussions can be challenging, they are often postponed. These discussions are then conducted with patients' health care proxies after patients lose the capacity to make their own decisions. Disagreements may arise when a patient's surrogate desires continued aggressive interventions that are either biologically futile (incapable of producing the intended physiologic result) or potentially inappropriate (potentially capable of producing the patient's intended effect but in conflict with the medical team's ethical principles). This article explores best practices in addressing these types of conflicts in the critical care unit, but these concepts also broadly apply to other sites of care.
- Published
- 2018
- Full Text
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15. Legal and Ethical Considerations of Disclosing Human Immunodeficiency Virus Seropositivity to a Surrogate Decision Maker.
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Rose RV and Kass JS
- Subjects
- Adult, Cognition Disorders etiology, Cognition Disorders virology, Humans, Male, Biomarkers metabolism, Decision Making, Disclosure ethics, Disclosure legislation & jurisprudence, HIV Infections complications, HIV Infections diagnostic imaging, HIV Infections psychology, HIV Infections therapy
- Abstract
Ethical and legal issues arise when a patient who is human immunodeficiency virus (HIV) positive lacks decision-making capacity and the HIV status must be disclosed to a surrogate decision maker to allow for informed medical decision making. This article discusses the special exceptions to confidentiality built into the Health Insurance Portability and Accountability Act privacy protections, the limitations on claims of common-law marriage, and public health laws that often require informing individuals who are either sex partners or needle-sharing partners of newly diagnosed HIV-infected individuals that they have been exposed to HIV infection.
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- 2018
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16. Common Legal Considerations When Moving to a New Medical Practice.
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Kass JS and Rose RV
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- Humans, Group Practice legislation & jurisprudence, Liability, Legal, Neurology legislation & jurisprudence, Physicians legislation & jurisprudence
- Abstract
This article presents a hypothetical case of the legal issues a physician must consider when moving to a new medical practice, such as the enforceability of a noncompete clause, malpractice insurance, communicating this change in practice to existing patients, and custody of medical records.
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- 2018
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17. Assessment of Medical Decision-making Capacity in Patients With Dementia.
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Rodgers JJ and Kass JS
- Subjects
- Aged, Dementia diagnosis, Ethics, Medical, Female, Humans, Personal Autonomy, Clinical Decision-Making, Decision Making physiology, Dementia psychology, Informed Consent psychology
- Abstract
Medical decision-making capacity, the patient's ability to exercise autonomy reasonably, is an essential component of both informed consent and informed refusal. The assessment of medical decision-making capacity is thus fundamental to the ethical practice of medicine. Medical decision-making capacity is not all or nothing but rather exists on a continuum and should be assessed on a decision-by-decision basis. Alzheimer disease and other neurocognitive disorders can affect a patient's medical decision-making capacity and may pose special challenges to capacity assessment. To illustrate some of these challenges, this article presents a case of a patient with Alzheimer disease who refused a recommended operation and discusses the components of capacity, a useful mnemonic and tools, the variability of state laws, and the roles neurologists and psychiatrists play in the assessment of capacity.
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- 2018
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18. Liability for Referrals to Other Physicians.
- Author
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Kass JS
- Subjects
- Adult, Communication, Female, Humans, Male, Middle Aged, Physicians, Decision Making, Neurologists, Physician's Role, Referral and Consultation
- Abstract
This article presents four hypothetical cases that demonstrate ways in which neurologists may be vulnerable to liability for how they manage patients they refer to other physicians for consultations. This article also discusses the importance of protecting neurologists from claims of negligence through documentation, which includes the rationale for ordering a consultation, deferring a consultation, or disagreeing with a consultant's recommendations. Lastly, the article discusses the importance of including patients in the decision-making process and detailing these conversations in the medical record.
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- 2018
- Full Text
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19. Pearls & Oy-sters: CNS lymphoma in a patient with relapsing-remitting multiple sclerosis treated with interferon.
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Chiang S, Kesari NK, Bradshaw A, Chen W, Samudralwar R, Alobaidy AM, and Kass JS
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Brain Neoplasms complications, Brain Neoplasms diagnostic imaging, Brain Neoplasms drug therapy, Diagnosis, Differential, Female, Humans, Interferon beta-1a therapeutic use, Lymphoma complications, Lymphoma diagnostic imaging, Lymphoma drug therapy, Middle Aged, Multiple Sclerosis, Relapsing-Remitting diagnostic imaging, Multiple Sclerosis, Relapsing-Remitting drug therapy, Brain Neoplasms diagnosis, Interferon beta-1a adverse effects, Lymphoma diagnosis, Multiple Sclerosis, Relapsing-Remitting diagnosis
- Published
- 2017
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20. Author response: Burnout, career satisfaction, and well-being among US neurologists in 2016.
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Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB, Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, and Cascino TL
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- Burnout, Psychological, Depersonalization, Humans, Job Satisfaction, Burnout, Professional, Neurologists
- Published
- 2017
- Full Text
- View/download PDF
21. Mitigating Cybersecurity Risks.
- Author
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Rose RV and Kass JS
- Subjects
- Adult, Humans, United States, Computer Security, Confidentiality, Legislation as Topic, United States Dept. of Health and Human Services
- Abstract
Cybersecurity issues and their impact on compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act are becoming more of an enforcement focus for a variety of government agencies, including the US Department of Health and Human Services, the Federal Trade Commission, and the Department of Justice. In the case presented in this article, a nurse in a neurology practice opted to speak with a patient about human immunodeficiency virus testing procedures in a manner audible to others in the waiting room. Computer screens with patient information were visible to anyone approaching a desk, the staff had not been trained on cybersecurity issues, and malware infected the computers used in the practice. In light of these circumstances and the launch of Phase 2 of the HIPAA Audit Program by the US Department of Health and Human Services Office for Civil Rights, the neurology practice must consider the following questions. First, could the gaps in the technical, administrative, and physical requirements of HIPAA and the HITECH Act result in an adverse audit and penalties? Second, what course of action does the law mandate in response to a ransomware attack?
- Published
- 2017
- Full Text
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22. Burnout, career satisfaction, and well-being among US neurologists in 2016.
- Author
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Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB, Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, and Cascino TL
- Subjects
- Academic Medical Centers, Adult, Age Factors, Aged, Attitude of Health Personnel, Burnout, Professional etiology, Burnout, Professional psychology, Depersonalization epidemiology, Fatigue epidemiology, Fatigue psychology, Female, Humans, Male, Middle Aged, Multivariate Analysis, Personal Autonomy, Prevalence, Quality of Life, United States epidemiology, Burnout, Professional epidemiology, Job Satisfaction, Neurologists psychology, Neurologists statistics & numerical data
- Abstract
Objective: To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists., Methods: A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016., Results: Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction., Conclusions: Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists., (© 2017 American Academy of Neurology.)
- Published
- 2017
- Full Text
- View/download PDF
23. Legal Implications of Physician Investment and Ownership in Health Care Enterprises.
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Rose RV and Kass JS
- Subjects
- Ambulatory Care Facilities economics, Fraud economics, Fraud legislation & jurisprudence, Healthcare Financing, Humans, Investments economics, Neurologists economics, Ownership economics, Private Sector economics, Ambulatory Care Facilities legislation & jurisprudence, Investments legislation & jurisprudence, Neurologists legislation & jurisprudence, Ownership legislation & jurisprudence, Private Sector legislation & jurisprudence
- Abstract
This article presents a case in which a neurology group practice is considering investing in an imaging center that is owned by nonphysician investors with the aim of referring patients to this imaging center. The article reviews some important legal pitfalls in federal law that physicians must be aware of when considering such an investment and focuses on the general outlines of and exceptions to the Stark Law and the Federal Anti-Kickback Statute.
- Published
- 2016
- Full Text
- View/download PDF
24. Palliative Care in Multiple Sclerosis.
- Author
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Vanopdenbosch LJ, Oliver DJ, and Kass JS
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- Adult, Antidepressive Agents therapeutic use, Baclofen administration & dosage, Caregivers psychology, Female, Humans, Injections, Spinal, Multiple Sclerosis psychology, Muscle Relaxants, Central administration & dosage, Palliative Care psychology, Multiple Sclerosis diagnostic imaging, Multiple Sclerosis therapy, Palliative Care methods, Patient Care Team
- Abstract
Collaboration between the neurologist and palliative care team in the care of patients with severe demyelinating disease can result in improved patient care, and discussion of the complex ethical issues that arise when a patient expresses a wish to die may be rewarding for both patients and caregivers.
- Published
- 2016
- Full Text
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25. Ethical Considerations for the Use of Next-Generation Alzheimer Drugs in Symptomatic and At-Risk Patients.
- Author
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Gauthier S, Rosa-Neto P, and Kass JS
- Subjects
- Aged, Alzheimer Disease complications, Cognition Disorders etiology, Cognition Disorders prevention & control, Female, Humans, Alzheimer Disease drug therapy, Antipsychotic Agents therapeutic use, Ethics, Medical
- Abstract
This article presents a case in which a patient with mild Alzheimer disease requests a prescription for a newly developed Alzheimer disease drug, after which the patient's daughter inquires about its potential usefulness as a prevention strategy for herself. The article discusses the physician's responsibility to balance the ethical principles of beneficence, nonmaleficence, and respect for patient autonomy when evaluating requests for medications from patients with neurocognitive disease as well as from asymptomatic but at-risk patients.
- Published
- 2016
- Full Text
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26. Patient management problem.
- Author
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Kass JS
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Neuropsychological Tests, Cognition Disorders complications, Cognition Disorders diagnosis, Cognition Disorders therapy, Depression complications, Depression diagnosis, Depression therapy, Disease Management
- Published
- 2015
- Full Text
- View/download PDF
27. Managing outpatients with suicidal or homicidal ideation.
- Author
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Poa E and Kass JS
- Subjects
- Female, Humans, Male, Middle Aged, Outpatients, Disease Management, Suicidal Ideation, Suicide psychology
- Abstract
Regardless of their specialty, physicians encounter various potential clinical emergencies in their outpatients that may require referring patients for the appropriate level and urgency of care. One such situation is the outpatient who presents with suicidal or homicidal ideation. In this circumstance, the physician is faced with performing a rapid evaluation of the symptoms, determining the acuity of the situation, and safely referring the patient to an appropriate level of care. Using case vignettes, this article reviews some of the immediate critical factors to consider in evaluating and managing the outpatient who expresses thoughts of suicide or homicide.
- Published
- 2015
- Full Text
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28. Epilepsy and pregnancy: a practical approach to mitigating legal risk.
- Author
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Kass JS
- Subjects
- Adult, Epilepsy drug therapy, Female, Humans, Pregnancy, Anticonvulsants adverse effects, Cognition Disorders etiology, Epilepsy complications, Obstetric Labor Complications etiology, Prenatal Exposure Delayed Effects chemically induced
- Abstract
Women with epilepsy are at increased risk of obstetric complications and poorer cognitive outcomes for their offspring. This article aims to provide neurologists with a practical framework for understanding, identifying, and managing legal risk when treating pregnant women with epilepsy.
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- 2014
- Full Text
- View/download PDF
29. A case of severe chronic progressive axonal polyradiculoneuropathy temporally associated with anti-CV2/CRMP5 antibodies.
- Author
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Hannawi Y, Goldsmith CE, Kass JS, Olar A, Ubogu EE, and Kalkonde YV
- Subjects
- Autoantigens immunology, Fatal Outcome, Humans, Hydrolases, Male, Microtubule-Associated Proteins, Middle Aged, Autoantibodies immunology, Nerve Tissue Proteins immunology, Polyradiculoneuropathy immunology, Polyradiculoneuropathy pathology
- Abstract
Objectives: The involvement of the peripheral nervous system by anti-CV2/CRMP5 paraneoplastic antibodies is typically encountered as a mixed sensorimotor polyneuropathy. We report a fatal case of severe chronic progressive axonal polyradiculoneuropathy in association with this antibody., Methods: Review of the patient's chart, nerve conduction/electromyographic studies, and nerve biopsy., Results: A 51-year-old man presented with a progressive quadriparesis over a 4-month period. Extensive evaluation for potential etiologies was significant only for positive anti-CV2/CRMP5 antibodies without detection of an underlying neoplasm. Despite multiple immunomodulatory therapies, the patient progressed and demonstrated electrodiagnostic evidence for a chronic axonal polyradiculoneuropathy with ongoing denervation. The patient eventually died of respiratory failure., Conclusions: This case adds to the clinical spectrum of the peripheral nervous system involvement in patients with paraneoplastic anti-CV2/CRMP5 antibodies.
- Published
- 2013
- Full Text
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30. Toxoplasmosis myelopathy and myopathy in an AIDS patient: a case of immune reconstitution inflammatory syndrome?
- Author
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Kung DH, Hubenthal EA, Kwan JY, Shelburne SA, Goodman JC, and Kass JS
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections pathology, Acquired Immunodeficiency Syndrome drug therapy, Adult, Antiretroviral Therapy, Highly Active, Humans, Immune Reconstitution Inflammatory Syndrome pathology, Male, Toxoplasmosis drug therapy, Toxoplasmosis pathology, Treatment Outcome, AIDS-Related Opportunistic Infections physiopathology, Acquired Immunodeficiency Syndrome complications, Immune Reconstitution Inflammatory Syndrome etiology, Immune Reconstitution Inflammatory Syndrome physiopathology, Toxoplasmosis complications, Toxoplasmosis physiopathology
- Abstract
Introduction: concurrent toxoplasmosis infection of the brain, spinal cord, and muscle has never been reported together in a patient antemortem. Toxoplasma gondii is the most common focal central nervous system opportunistic infection in the acquired immune deficiency syndrome (AIDS) population. Despite this fact, isolated toxoplasmosis infection in the spinal cord is rarely reported. In addition, toxoplasmic myositis is also rarely diagnosed and Toxoplasma cysts are seldom found on biopsy. We present a patient with AIDS and toxoplasmosis resistant to standard anti-Toxoplasma therapy., Case Report: a 34-year-old man with a history of untreated AIDS presented with symptoms of myelopathy. Pathologically proven toxoplasmosis of the spinal cord was diagnosed and no brain lesions were found. However, despite appropriate treatment and initiation of highly active antiretroviral therapy, the patient developed worsening symptoms, including myopathy and autonomic instability. Muscle biopsy revealed Toxoplasma cysts, and there was laboratory evidence of a restored immune system., Conclusion: we report the first case of toxoplasmosis presenting initially with myelitis in the absence of encephalitis that subsequently progressed to myositis despite antiparasitic treatment. We also discuss the possibility of immune reconstitution inflammatory syndrome as a cause of his deterioration.
- Published
- 2011
- Full Text
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31. Sectional neuroanatomy of the pelvic floor.
- Author
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Kass JS, Chiou-Tan FY, Harrell JS, Zhang H, and Taber KH
- Subjects
- Female, Humans, Male, Muscle, Skeletal anatomy & histology, Pelvic Floor anatomy & histology, Magnetic Resonance Imaging, Pelvic Floor innervation
- Abstract
This is the sixth in a series of articles on the spine. The first 5 reviewed the sectional anatomy of the cervical, thoracic, and lumbosacral spines. This paper will review both the male and female pelves. Procedures performed in the pelvis include electromyography of the anal sphincter, pudendal and sacral nerve stimulator implants, and botulinum toxin type A injections into the prostate, the bladder, the urethra, and the anus. Complications from these procedures are rare. Electromyography in this region is particularly uncomfortable. Botulinum toxin type A denervation may result in local effects such as incontinence or urinary retention or rarely remote effects such as limb weakness. Neurostimulators may get infected or may fail. This article provides anatomically accurate schematics of innervations of the pelvis that can be used to interpret magnetic resonance images of muscles and nerves in the pelvic floor region. Cross-sectional schematics of the male and female pelves were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and the skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of both the male and female pelves allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomic map could also assist the electromyographer in correlating the clinical and electrophysiologic findings on magnetic resonance images.
- Published
- 2010
- Full Text
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32. Procedure-oriented sectional anatomy of the shoulder.
- Author
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Harrell JS, Chiou-Tan FY, Zhang H, Kass JS, and Taber KH
- Subjects
- Adrenal Cortex Hormones administration & dosage, Adrenal Cortex Hormones adverse effects, Arthritis, Infectious etiology, Arthritis, Infectious prevention & control, Bacterial Infections etiology, Bacterial Infections prevention & control, Humans, Injections adverse effects, Injections, Intra-Articular adverse effects, Injections, Intra-Articular methods, Shoulder Joint anatomy & histology, Injections methods, Shoulder anatomy & histology
- Abstract
This is the first in a series of papers on procedure-oriented joint anatomy. This paper will review anatomy of the shoulder joint and focus on non-imaging-guided procedures. Needle procedures of the shoulder include glenohumeral, subacromial, and acromioclavicular joint injections; electromyography; trigger point and other intramuscular injections; bicipital tendon sheath injection; suprascapular nerve blocks; and botulinum toxin injections. The accuracy of these non-imaging-guided procedures is reviewed. Complications of these procedures include infection, damage to tendon, and local or systemic response to medication. This paper provides anatomically accurate schematics of the shoulder anatomy relevant to needle procedures. Cross-sectional schematics of the shoulder were drawn as they appear on axial and sagittal projections. Superficial and deep landmarks are highlighted and sources of potential complications. The schematics allow for safer and more accurate non-image-guided needle procedures in the shoulder region.
- Published
- 2009
- Full Text
- View/download PDF
33. F-wave hyperexcitability in Isaac syndrome.
- Author
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Kass JS, Button JH, and Chiou-Tan FY
- Subjects
- Adolescent, Electrophysiology, Female, Humans, Isaacs Syndrome physiopathology, Electromyography, Isaacs Syndrome diagnosis
- Published
- 2008
- Full Text
- View/download PDF
34. Sectional neuroanatomy of the lumbosacral spine (L1-S5).
- Author
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Chiou-Tan FY, Miller JS, Zhang H, Kass JS, and Taber KH
- Subjects
- Humans, Anatomy, Cross-Sectional, Lumbosacral Region anatomy & histology, Magnetic Resonance Imaging methods
- Abstract
This paper will review the lumbosacral spine (L1-S5). Procedures performed in the lumbosacral spine include electromyography, spinal stimulator implants, spinal infusion implants for spasticity or pain medications, sacroiliac spine injections, facet blocks, and steroid injections. Complications from these procedures include iatrogenic paraplegia or paraplegia due to transverse myelitis, intravascular penetration, dural puncture, increased pain at the injection site, increased radicular pain, increased spine pain, lightheadedness, nausea, nonspecific headache, and vomiting. Long-term complications include implant infection, implant or catheter dislodgment/kinking, and device failure. This paper provides anatomically accurate schematics of innervations of the lumbosacral spine (L1-S5) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the lumbosacral spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the lumbosacral spine allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomical map could also assist the electromyographer in correlating the clinical and electrophysiological findings on magnetic resonance images.
- Published
- 2007
- Full Text
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