74 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
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3. Visual vignette. F-wave hyperexcitability in Isaac syndrome.
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Kass JS, Button JH, and Chiou-Tan FY
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- 2008
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4. A Guide for Aspiring Neurology Educators.
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Feldman AM, Safdieh JE, Kass JS, and Nascimento FA
- Abstract
Deans of medical schools have diverse roles and responsibilities. In this article, we use the career development trajectories of neurologists who have become education deans in student affairs and curriculum to offer advice to aspiring clinician educators of all levels and backgrounds. Although their roles differ, the advice they share is universal and essential for the career development of future clinician educators. ANN NEUROL 2024., (© 2024 American Neurological Association.)
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- 2024
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5. False Claims Act and Anti-Kickback Statute: Avoiding Legal Landmines.
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Rose RV and Kass JS
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- United States, Humans, Fraud prevention & control, Medicaid, Medicare
- Abstract
Health care entities doing business with the federal government may run afoul of the False Claims Act and Anti-Kickback Statute not only when they directly submit fraudulent claims for government reimbursement but also when they create schemes that manipulate others into submitting (whether knowingly or unknowingly) illegal claims. In recent years, the Department of Justice is deploying these statutes to ensure that electronic health records are built and maintained with appropriate cybersecurity protections., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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6. Protecting Privacy: Health Insurance Portability and Accountability Act of 1996, Twenty-First Century Cures Act, and Social Media.
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Rose RV, Kumar A, and Kass JS
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- United States, Humans, Privacy, Confidentiality, Health Insurance Portability and Accountability Act, Social Media
- Abstract
Advances in electronic health record technology, the ever-expanding use of social media, and cybersecurity sabotage threaten patient privacy and render physicians and health care organizations liable for violating federal and state laws. Violating a patient's privacy is both an ethical and legal breach with potentially serious legal and reputational consequences. Even an unintentional Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation can result in financial penalties and reputational harm. Staying complaint with HIPAA requires vigilance on the part of both individuals with legitimate access to protected health information (PHI) and the organizations handling that PHI., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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7. Medicolegal and Ethical Issues in Neurology.
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Kass JS and Rubin MA
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- Humans, Neurology ethics, Neurology legislation & jurisprudence
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- 2023
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8. Neurolymphomatosis of the brachial plexus from atypical primary central nervous system lymphoma lesions: A case report and review of the literature.
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Kizek DJ, Goethe EA, Karas PJ, Treiber JM, Jalali A, Gopinath SP, and Kass JS
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Background: Primary central nervous system lymphoma (PCNSL) is an aggressive and extranodal non-Hodgkin lymphoma limited to the neuroaxis. In immunocompetent individuals, PCNSL is more common in older adults and lacks the association with the Epstein-Barr virus found in individuals with AIDS-associated PCNSL. Because the clinical presentation and radiographic findings of PCNSL are highly variable, stereotactic brain biopsy is typically required for definitive diagnosis. High-dose methotrexate, in combination with other chemotherapeutic agents with or without whole brain radiation, is the mainstay of treatment., Case Description: A 70-year-old HIV-negative woman presented with confusion, acute flaccid left arm weakness, and left hand numbness. Head computed tomography without contrast demonstrated a 1 cm hyperdense round lesion in the suprasellar cistern that prompted further evaluation. Gadolinium-enhanced brain magnetic resonance imaging demonstrated enhancing lesions with heterogeneous signal intensity in the suprasellar, pineal, and right periatrial regions that did not explain the limb weakness and numbness. Serum and cerebrospinal fluid (CSF) studies were unrevealing, and a diagnosis of PCNSL was made following stereotactic biopsy. The patient's liver cirrhosis precluded chemotherapy, but treatment with whole-brain radiation was pursued., Conclusion: The myriad clinical presentations and insidious course of PCNSL contribute to diagnostic difficulties, delays in treatment, and poor outcomes. Stereotactic brain biopsy is the primary method of PCNSL diagnosis since malignant cells are typically not detected in CSF. PCNSL should be considered in the differential diagnosis when immunocompetent elderly patients present with multiple intracranial lesions, even in the presence of lower motor neuron findings., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Surgical Neurology International.)
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- 2022
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9. The Medicolegal and Ethical Dimensions of Physician Prescription Reluctance.
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Rose RV and Kass JS
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- 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.)
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- 2022
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10. Legal and Ethical Challenges in the Care of the Pregnant Patient After Brain Death.
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Kass JS and Rose RV
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- 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.)
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- 2022
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11. Connecting Cohorts to Diminish Alzheimer's Disease (CONCORD-AD): A Report of an International Research Collaboration Network.
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Pavlik VN, Burnham SC, Kass JS, Helmer C, Palmqvist S, Vassilaki M, Dartigues JF, Hansson O, Masters CL, Pérès K, Petersen RC, Stomrud E, Butler L, Coloma PM, Teitsma XM, Doody R, and Sano M
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- Aged, Biomarkers, Cognition, Cohort Studies, Humans, Observational Studies as Topic, Alzheimer Disease, Computer Communication Networks, International Cooperation
- Abstract
Longitudinal observational cohort studies are being conducted worldwide to understand cognition, biomarkers, and the health of the aging population better. Cross-cohort comparisons and networks of registries in Alzheimer's disease (AD) foster scientific exchange, generate insights, and contribute to the evolving clinical science in AD. A scientific working group was convened with invited investigators from established cohort studies in AD, in order to form a research collaboration network as a resource to address important research questions. The Connecting Cohorts to Diminish Alzheimer's Disease (CONCORD-AD) collaboration network was created to bring together global resources and expertise, to generate insights and improve understanding of the natural history of AD, to inform design of clinical trials in all disease stages, and to plan for optimal patient access to disease-modifying therapies once they become available. The network brings together expertise and data insights from 7 cohorts across Australia, Europe, and North America. Notably, the network includes populations recruited through memory clinics as well as population-based cohorts, representing observations from individuals across the AD spectrum. This report aims to introduce the CONCORD-AD network, providing an overview of the cohorts involved, reporting the common assessments used, and describing the key characteristics of the cohort populations. Cohort study designs and baseline population characteristics are compared, and available cognitive, functional, and neuropsychiatric symptom data, as well as the frequency of biomarker assessments, are summarized. Finally, the challenges and opportunities of cross-cohort studies in AD are discussed.
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- 2022
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12. Interprofessional Internet Consultations: The Potential Benefits and Perils of eConsults.
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Kass JS and Rose RV
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- 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
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13. Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.
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Grotta JC, Yamal JM, Parker SA, Rajan SS, Gonzales NR, Jones WJ, Alexandrov AW, Navi BB, Nour M, Spokoyny I, Mackey J, Persse D, Jacob AP, Wang M, Singh N, Alexandrov AV, Fink ME, Saver JL, English J, Barazangi N, Bratina PL, Gonzalez M, Schimpf BD, Ackerson K, Sherman C, Lerario M, Mir S, Im J, Willey JZ, Chiu D, Eisshofer M, Miller J, Ornelas D, Rhudy JP, Brown KM, Villareal BM, Gausche-Hill M, Bosson N, Gilbert G, Collins SQ, Silnes K, Volpi J, Misra V, McCarthy J, Flanagan T, Rao CPV, Kass JS, Griffin L, Rangel-Gutierrez N, Lechuga E, Stephenson J, Phan K, Sanders Y, Noser EA, and Bowry R
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- Aged, Disability Evaluation, Female, Humans, Ischemic Stroke complications, Ischemic Stroke diagnostic imaging, Male, Middle Aged, Odds Ratio, Severity of Illness Index, Tomography, X-Ray Computed, Ambulances, Emergency Medical Services, Ischemic Stroke drug therapy, Mobile Health Units, Time-to-Treatment, Tissue Plasminogen Activator therapeutic use
- Abstract
Background: Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether and how much MSUs alter outcomes has not been extensively studied., Methods: In an observational, prospective, multicenter, alternating-week trial, we assessed outcomes from MSU or EMS management within 4.5 hours after onset of acute stroke symptoms. The primary outcome was the score on the utility-weighted modified Rankin scale (range, 0 to 1, with higher scores indicating better outcomes according to a patient value system, derived from scores on the modified Rankin scale of 0 to 6, with higher scores indicating more disability). The main analysis involved dichotomized scores on the utility-weighted modified Rankin scale (≥0.91 or <0.91, approximating scores on the modified Rankin scale of ≤1 or >1) at 90 days in patients eligible for t-PA. Analyses were also performed in all enrolled patients., Results: We enrolled 1515 patients, of whom 1047 were eligible to receive t-PA; 617 received care by MSU and 430 by EMS. The median time from onset of stroke to administration of t-PA was 72 minutes in the MSU group and 108 minutes in the EMS group. Of patients eligible for t-PA, 97.1% in the MSU group received t-PA, as compared with 79.5% in the EMS group. The mean score on the utility-weighted modified Rankin scale at 90 days in patients eligible for t-PA was 0.72 in the MSU group and 0.66 in the EMS group (adjusted odds ratio for a score of ≥0.91, 2.43; 95% confidence interval [CI], 1.75 to 3.36; P<0.001). Among the patients eligible for t-PA, 55.0% in the MSU group and 44.4% in the EMS group had a score of 0 or 1 on the modified Rankin scale at 90 days. Among all enrolled patients, the mean score on the utility-weighted modified Rankin scale at discharge was 0.57 in the MSU group and 0.51 in the EMS group (adjusted odds ratio for a score of ≥0.91, 1.82; 95% CI, 1.39 to 2.37; P<0.001). Secondary clinical outcomes generally favored MSUs. Mortality at 90 days was 8.9% in the MSU group and 11.9% in the EMS group., Conclusions: In patients with acute stroke who were eligible for t-PA, utility-weighted disability outcomes at 90 days were better with MSUs than with EMS. (Funded by the Patient-Centered Outcomes Research Institute; BEST-MSU ClinicalTrials.gov number, NCT02190500.)., (Copyright © 2021 Massachusetts Medical Society.)
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- 2021
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14. False Claims Act Overview and Implications for Neurologists.
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Rose RV and Kass JS
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- 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
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15. Criminal Culpability for Acts Committed During a Possible Episode of REM Sleep Behavior Disorder.
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Kass JS and Rose RV
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- 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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16. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper.
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Bhaskar S, Sinha A, Banach M, Mittoo S, Weissert R, Kass JS, Rajagopal S, Pai AR, and Kutty S
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- Adrenal Cortex Hormones therapeutic use, Angiotensin-Converting Enzyme 2, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, CD4-CD8 Ratio, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, COVID-19, Clinical Decision-Making methods, Coronavirus Infections blood, Coronavirus Infections mortality, Critical Illness, Endothelial Cells metabolism, Female, Humans, Immunocompromised Host, Interleukin-6 antagonists & inhibitors, Janus Kinase Inhibitors therapeutic use, Male, Pandemics, Peptidyl-Dipeptidase A metabolism, Pneumonia, Viral blood, Pneumonia, Viral mortality, SARS-CoV-2, Sex Factors, Thrombosis, Betacoronavirus immunology, Coronavirus Infections drug therapy, Coronavirus Infections immunology, Critical Care methods, Cytokines blood, Pneumonia, Viral drug therapy, Pneumonia, Viral immunology
- Abstract
Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint., (Copyright © 2020 Bhaskar, Sinha, Banach, Mittoo, Weissert, Kass, Rajagopal, Pai and Kutty.)
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- 2020
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17. Legal Liability Associated With rtPA Administration and Surrogate Decision Makers.
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Kass JS and Rose RV
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- 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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18. 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.)
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- 2019
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19. Liability and Failure to Warn a Patient.
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Kass JS and Rose RV
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- 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.
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- 2019
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20. Driving and Epilepsy: Ethical, Legal, and Health Care Policy Challenges.
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Kass JS and Rose RV
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- 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
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21. Prescribing Antipsychotic Medications to Patients With Dementia: Boxed Warnings and Mitigation of Legal Liability.
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Rose RV and Kass JS
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- 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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22. Ethical Considerations in End-of-life Care in the Face of Clinical Futility.
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Kass JS, Lewis A, and Rubin MA
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- Humans, Male, Middle Aged, Brain Neoplasms therapy, Glioblastoma therapy, Terminal Care ethics, Terminal Care methods
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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.
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- 2018
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23. Legal and Ethical Considerations of Disclosing Human Immunodeficiency Virus Seropositivity to a Surrogate Decision Maker.
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Rose RV and Kass JS
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- 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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24. Reorienting Orientation: Introducing the Social Determinants of Health to First-Year Medical Students.
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Song AY, Poythress EL, Bocchini CE, and Kass JS
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- Adult, Curriculum, Education, Medical, Undergraduate trends, Female, Humans, Male, Sexual Behavior, Surveys and Questionnaires, Education, Medical, Undergraduate methods, Social Determinants of Health, Students, Medical psychology
- Abstract
Introduction: Medical students rarely learn about the intersection of socioeconomic and environmental effects on access to health care and maintenance of health. Case-based discussion can cohesively highlight the social determinants of health to complement preclinical education. Our modules can foster future interest in working with vulnerable populations, help students recognize barriers to care, and identify strategies to help these patients., Methods: The Social Determinants of Health Orientation Program (SDHOP) introduced students to the nonbiomedical factors that contribute to patients' health. Key topics were presented in small discussion groups led by faculty facilitators. The subjects addressed included access to care; immigration/language barriers; lesbian, gay, bisexual, and transgender health; human trafficking; race/ethnicity; and women's health., Results: The SDHOP initiative was integrated into the formal curriculum and successfully implemented in its first year at our institution. Pre- and postsurveys were administered to assess student satisfaction with the course, as well as changes in knowledge and attitude regarding the topics covered. Of the 186 SDHOP participants, 111 medical students responded to both surveys and reported improvements in both knowledge of and comfort level with these topics and specific related terms. Ninety-one percent rated the overall quality of SDHOP and its individual modules as good or excellent., Discussion: SDHOP contributes to medical education by providing an all-inclusive model for teaching students about the social determinants of health. Our results suggest that presenting these topics in a small-group discussion model improves medical student cultural competency and comfort level with patients of diverse backgrounds., Competing Interests: None to report.
- Published
- 2018
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25. 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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26. Assessment of Medical Decision-making Capacity in Patients With Dementia.
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Rodgers JJ and Kass JS
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- 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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27. Liability for Referrals to Other Physicians.
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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
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28. An Infant Born to a Mother With Anti-N-Methyl-d-Aspartate Receptor Encephalitis.
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Chourasia N, Watkins MW, Lankford JE, Kass JS, and Kamdar A
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- Adult, Anti-N-Methyl-D-Aspartate Receptor Encephalitis immunology, Anti-N-Methyl-D-Aspartate Receptor Encephalitis therapy, Autoantibodies blood, Brain diagnostic imaging, Brain growth & development, Brain immunology, Fatal Outcome, Female, Humans, Infant, Newborn, Ovarian Neoplasms immunology, Ovarian Neoplasms therapy, Pregnancy, Receptors, N-Methyl-D-Aspartate immunology, Teratoma immunology, Teratoma therapy, Anti-N-Methyl-D-Aspartate Receptor Encephalitis complications, Ovarian Neoplasms complications, Pregnancy Complications, Infectious immunology, Pregnancy Complications, Infectious therapy, Pregnancy Complications, Neoplastic therapy, Teratoma complications
- Abstract
Background: Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is an autoimmune disorder that often affects women of childbearing age, and maternal-fetal transfer of anti-NMDAR antibodies during pregnancy has been documented in both symptomatic and asymptomatic women. The effects of these antibodies on the fetus, however, are incompletely understood., Patient Description: This term infant exhibited depressed respiratory effort, poor feeding, and abnormal movements after birth. Magnetic resonance imaging revealed diffuse cerebral edema with ischemic and hemorrhagic injury. Her mother had experienced anti-NMDAR encephalitis secondary to an ovarian teratoma 18 months earlier. The baby's serum NMDAR antibody titer was elevated at 1:320. Intravenous immunoglobulin did not result in clinical improvement, and care was withdrawn on day of life 20. Her mother had an elevated serum NMDAR antibodies (1:80), positive CSF antibody titers, and a new ovarian teratoma., Conclusion: Routine testing of NMDAR antibodies in pregnant women with a previous history of anti-NMDAR encephalitis may be warranted. Infants born to these mothers should be closely monitored throughout pregnancy and after birth., (Published by Elsevier Inc.)
- Published
- 2018
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29. Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy.
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Prakash PA, Jin J, Matharu K, Garg T, Tsai WC, Patel P, Weatherhead JE, and Kass JS
- Subjects
- Anti-N-Methyl-D-Aspartate Receptor Encephalitis diagnosis, Female, Humans, Middle Aged, Uterine Cervical Neoplasms diagnosis, Anti-N-Methyl-D-Aspartate Receptor Encephalitis virology, Herpesvirus 3, Human isolation & purification, Uterine Cervical Neoplasms virology
- Published
- 2018
- Full Text
- View/download PDF
30. Pearls & Oy-sters: CNS lymphoma in a patient with relapsing-remitting multiple sclerosis treated with interferon.
- Author
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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
- Full Text
- View/download PDF
31. Author response: 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
- Burnout, Psychological, Depersonalization, Humans, Job Satisfaction, Burnout, Professional, Neurologists
- Published
- 2017
- Full Text
- View/download PDF
32. Mentored peer review of standardized manuscripts as a teaching tool for residents: a pilot randomized controlled multi-center study.
- Author
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Wong VSS, Strowd RE 3rd, Aragón-García R, Moon YP, Ford B, Haut SR, Kass JS, London ZN, Mays M, Milligan TA, Price RS, Reynolds PS, Selwa LM, Spencer DC, and Elkind MSV
- Abstract
Background: There is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality., Methods: A partially blinded, randomized, controlled multi-center study was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts., Results: Sixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (-8.5%) and non-mentored (-13.9%) residents ( p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50)., Conclusions: We used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice.
- Published
- 2017
- Full Text
- View/download PDF
33. 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
- View/download PDF
34. 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
35. Neurological and Neuropsychiatric Adverse Effects of Dermatologic Medications.
- Author
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Liu M, Huang YY, Hsu S, and Kass JS
- Subjects
- Animals, Humans, Dermatologic Agents adverse effects, Drug-Related Side Effects and Adverse Reactions etiology, Nervous System Diseases chemically induced
- Abstract
Severe, recalcitrant dermatologic conditions often require systemic treatment. Although efficacious, these medications have been associated with wide-ranging adverse reactions. Some are reversible, predictable, and either dose-dependent or treatment length-dependent, while others are unpredictable, irreversible, and potentially fatal. This review examines the neuropsychiatric adverse effects associated with US FDA-approved medications for treatment of the following dermatologic pathologies that typically require systemic therapy: autoimmune dermatoses, acne, psoriasis, and melanoma. A search of the literature was performed, with adverse effects ranging from mild headaches and neuropathy to severe encephalopathies. The medications associated with the most serious reactions were those used to treat psoriasis, especially the older non-biologic medications such as cyclosporine A and methotrexate. Given the importance of these systemic dermatologic therapies in treating severe, recalcitrant conditions, and the wide variety of potentially serious neuropsychiatric adverse effects of these medications, neurologists, psychiatrists, dermatologists, oncologists, and primary care providers must be aware of the potential for these neuropsychiatric adverse reactions to allow for appropriate counseling, management, and medication withdrawal.
- Published
- 2016
- Full Text
- View/download PDF
36. 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
37. Palliative Care in Multiple Sclerosis.
- Author
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Vanopdenbosch LJ, Oliver DJ, and Kass JS
- Subjects
- 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
- View/download PDF
38. 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
- View/download PDF
39. Medical Malpractice Reform--Historical Approaches, Alternative Models, and Communication and Resolution Programs.
- Author
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Kass JS and Rose RV
- Subjects
- History, Ancient, History, Medieval, Humans, Liability, Legal, Malpractice history, Malpractice legislation & jurisprudence, Malpractice trends, Negotiating methods, Truth Disclosure ethics
- Published
- 2016
- Full Text
- View/download PDF
40. Ethical Challenges for the Medical Expert Witness.
- Author
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Kass JS and Rose RV
- Subjects
- Beneficence, Brain Injuries complications, Civil Rights ethics, Civil Rights legislation & jurisprudence, Compensation and Redress ethics, Ethical Analysis, Guidelines as Topic, Humans, Severity of Illness Index, Unconsciousness etiology, Virtues, Compensation and Redress legislation & jurisprudence, Expert Testimony ethics, Liability, Legal, Malpractice legislation & jurisprudence, Morals
- Published
- 2016
- Full Text
- View/download PDF
41. Cutaneous Adverse Effects of Neurologic Medications.
- Author
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Bahrani E, Nunneley CE, Hsu S, and Kass JS
- Subjects
- Central Nervous System Agents therapeutic use, Humans, Nervous System Diseases drug therapy, United States, United States Food and Drug Administration, Central Nervous System Agents adverse effects, Drug Eruptions etiology, Drug-Related Side Effects and Adverse Reactions etiology
- Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
- Published
- 2016
- Full Text
- View/download PDF
42. 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
43. 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
- View/download PDF
44. Recent US Case of Variant Creutzfeldt-Jakob Disease-Global Implications.
- Author
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Maheshwari A, Fischer M, Gambetti P, Parker A, Ram A, Soto C, Concha-Marambio L, Cohen Y, Belay ED, Maddox RA, Mead S, Goodman C, Kass JS, Schonberger LB, and Hussein HM
- Subjects
- Adult, Animals, Biopsy, Brain metabolism, Brain pathology, Cattle, Creutzfeldt-Jakob Syndrome transmission, Electrocardiography, Female, Global Health, Humans, Immunohistochemistry, Magnetic Resonance Imaging, Male, Population Surveillance, Tomography, X-Ray Computed, United States epidemiology, Creutzfeldt-Jakob Syndrome diagnosis, Creutzfeldt-Jakob Syndrome epidemiology
- Abstract
Variant Creutzfeldt-Jakob disease (vCJD) is a rare, fatal prion disease resulting from transmission to humans of the infectious agent of bovine spongiform encephalopathy. We describe the clinical presentation of a recent case of vCJD in the United States and provide an update on diagnostic testing. The location of this patient's exposure is less clear than those in the 3 previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the United States more than a decade before illness onset. This case exemplifies the persistent risk for vCJD acquired in unsuspected geographic locations and highlights the need for continued global surveillance and awareness to prevent further dissemination of vCJD.
- Published
- 2015
- Full Text
- View/download PDF
45. Challenges in providing critical care for patients with anti-N-methyl-D-aspartate receptor encephalitis.
- Author
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Howard CM, Kass JS, Bandi VDP, and Guntupalli KK
- Subjects
- Anti-N-Methyl-D-Aspartate Receptor Encephalitis diagnosis, Cerebrospinal Fluid chemistry, Cognitive Behavioral Therapy methods, Critical Care standards, Dose-Response Relationship, Drug, Female, Humans, Immunologic Factors administration & dosage, Injections, Intravenous, Receptors, N-Methyl-D-Aspartate immunology, Receptors, N-Methyl-D-Aspartate metabolism, Young Adult, Anti-N-Methyl-D-Aspartate Receptor Encephalitis therapy, Critical Care trends, Glucocorticoids administration & dosage, Immunoglobulins, Intravenous administration & dosage, Plasma Exchange methods, Respiration, Artificial methods
- Abstract
Anti-N-methyl-d-aspartate receptor encephalitis (NMDARE) is characterized by a constellation of psychiatric, neurologic, autonomic, and cardiopulmonary manifestations. Although patients typically recover with appropriate treatment, they commonly require weeks to months of inpatient care, including prolonged stays in critical care units. This case series not only advocates for consideration of the disease in the appropriate context but also specifically highlights the distinct challenges intensivists encounter caring for patients with NMDARE. With a greater knowledge of the nuances and sequelae of NMDARE, critical care specialists will be better equipped to anticipate and manage the potentially life-threatening complications of the disease.
- Published
- 2014
- Full Text
- View/download PDF
46. Improving secondary stroke self-care among underserved ethnic minority individuals: a randomized clinical trial of a pilot intervention.
- Author
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Evans-Hudnall GL, Stanley MA, Clark AN, Bush AL, Resnicow K, Liu Y, Kass JS, and Sander AM
- Subjects
- Anxiety complications, Anxiety therapy, Cognitive Behavioral Therapy, Depression complications, Depression therapy, Diet, Female, Health Behavior, Humans, Male, Medication Adherence, Middle Aged, Pilot Projects, Stroke nursing, Stroke prevention & control, Stroke psychology, Ethnicity psychology, Minority Groups psychology, Secondary Prevention methods, Self Care psychology, Stroke therapy, Vulnerable Populations psychology
- Abstract
The overall purpose of this study was to pilot a multibehavioral, brief, stroke self-care treatment adapted for implementation with underserved racial/ethnic minority groups and to test the moderating effects of anxiety and depression on engagement in secondary stroke-prevention behaviors. Fifty-two participants were randomized to the secondary stroke prevention (STOP) (N = 27) or usual care (N = 25) group. The STOP program consisted of 3 culturally tailored information sessions and goal-setting activities that were delivered in person by a research assistant. Participants were assessed at baseline and 4-week follow-up for stroke knowledge, exercise, fruit and vegetable consumption, tobacco and alcohol use, and medication adherence (primary outcomes) and anxiety and depression (moderator variables). Between-groups analysis of covariance and logistic multiple regressions revealed significant between-group differences for stroke knowledge, tobacco use and moderating effects between tobacco and anxiety, and improved alcohol use. The STOP program decreased secondary stroke risk factors among underserved racial/ethnic minorities and should be tested in large-scale trials.
- Published
- 2014
- Full Text
- View/download PDF
47. Neurological and psychiatric adverse effects of antiretroviral drugs.
- Author
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Abers MS, Shandera WX, and Kass JS
- Subjects
- Anti-Retroviral Agents administration & dosage, Anti-Retroviral Agents pharmacology, Anti-Retroviral Agents therapeutic use, Clinical Trials as Topic, DNA-Directed DNA Polymerase metabolism, Humans, Mental Disorders enzymology, Mental Disorders epidemiology, Mental Disorders psychology, Neurotoxicity Syndromes diagnosis, Neurotoxicity Syndromes enzymology, Neurotoxicity Syndromes epidemiology, Peripheral Nervous System Diseases diagnosis, Peripheral Nervous System Diseases enzymology, Peripheral Nervous System Diseases epidemiology, Treatment Outcome, Anti-Retroviral Agents adverse effects, Mental Disorders chemically induced, Neurotoxicity Syndromes etiology, Peripheral Nervous System Diseases chemically induced
- Abstract
Antiretroviral drugs are associated with a variety of adverse effects on the central and peripheral nervous systems. The frequency and severity of neuropsychiatric adverse events is highly variable, with differences between the antiretroviral classes and amongst the individual drugs in each class. In the developing world, where the nucleoside reverse transcriptase inhibitor (NRTI) stavudine remains a commonly prescribed antiretroviral, peripheral neuropathy is an important complication of treatment. Importantly, this clinical entity is often difficult to distinguish from human immunodeficiency virus (HIV)-induced peripheral neuropathy. Several clinical trials have addressed the efficacy of various agents in the treatment of NRTI-induced neurotoxicity. NRTI-induced neurotoxicity is caused by inhibition of mitochondrial DNA polymerase. This mechanism is also responsible for the mitochondrial myopathy and lactic acidosis that occur with zidovudine. NRTIs, particularly zidovudine and abacavir, may also cause central nervous system (CNS) manifestations, including mania and psychosis. The non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz is perhaps the antiretroviral most commonly associated with CNS toxicity, causing insomnia, irritability and vivid dreams. Recent studies have suggested that the risk of developing these adverse effects is increased in patients with various cytochrome P450 2B6 alleles. Protease inhibitors cause perioral paraesthesias and may indirectly increase the relative risk of stroke by promoting atherogenesis. HIV integrase inhibitors, C-C chemokine receptor type 5 (CCR5) inhibitors and fusion inhibitors rarely cause neuropsychiatric manifestations.
- Published
- 2014
- Full Text
- View/download PDF
48. 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.
- Published
- 2014
- Full Text
- View/download PDF
49. Churg-Strauss syndrome: an uncommon cause of intracerebral hemorrhage.
- Author
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Murthy SB, Khalaf N, Shah S, Ma B, Goldsmith CE, and Kass JS
- Subjects
- Cerebral Hemorrhage diagnosis, Churg-Strauss Syndrome diagnosis, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Occipital Lobe diagnostic imaging, Occipital Lobe pathology, Tomography, X-Ray Computed, Cerebral Hemorrhage etiology, Churg-Strauss Syndrome complications
- Published
- 2013
- Full Text
- View/download PDF
50. 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
- View/download PDF
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