NEURO

Patient disability following a stroke may depend on the severity, type, or location of the bleed or clot that caused it. But to date, it has been difficult to predict how well any individual might recover from a stroke. This is especially true for anticipating how well a patient may regain common motor functions, like walking or using a spoon. New research shows brain wave patterns may be a biomarker for motor skill recovery potential in stroke patients. That’s according to a study published in October 2020 in the Oxford Academic journal Brain Communications . “While cortical oscillations may be only one of several factors important for motor learning, they may have value as markers of cortical function and plasticity after stroke,” according to the study. Beta oscillations “may offer novel targets for therapeutic interventions aimed at modifying plasticity, such as pharmacological and non-invasive brain stimulation approaches,” the study suggests. Previous studies have shown co...

Many of us are tightening our belts these days, walking a fine line between what we can do ourselves and what absolutely must be outsourced. Digital content marketing is one part of practice management that has a lot of bootstrapping potential. Recently, we shared tips on finding professional images for your website and social media. This week, we take on writing your own medical website content. You can always hire a professional medical writer to explain conditions and treatments and write a weekly blog. These kinds of writers specialize in conveying complex medical information into lay-friendly prose. Many physicians are good at this too, but not everyone is Atul Gawande . Science (medical and otherwise) can be hard for people to read. “Most people assume that its difficulties are born out of necessity, out of the extreme complexity of scientific concepts, data and analysis,” write George D. Gopen and Judith A. Swan in their seminal 1990 paper, The Science of Scientific Writi...

The neurophysiology department at Houston Methodist Hospital in Texas recently developed a unique solution to prevent equipment contamination when performing EEGs on patients with COVID-19: a custom-made plexiglass containment box. “This idea came as a result of our trials and errors in finding ways to protect our NATUS equipment and our patients from spreading airborne and droplet infections,” Amy Reynolds, manager and neurophysiology chair at Houston Methodist, said in a recent interview. While the outside of the computer used during EEG monitoring can be wiped down, the vents, cables, Wi-Fi bridge, and other integrated equipment are difficult to disinfect. The “Bedside Monitor Containment Box” encloses the computer hardware on the bottom of specially designed NATUS mobile carts. The box is made of plexiglass with aluminum and stainless steel reinforcements. Reynolds and lead EEG technologist Robin Chong collaborated on the containment box with the hospital’s maintenance depart...

Remember when we thought that lung cancer was enough to get people to quit smoking? Heart disease and stroke were soon added to the list of risks. More recently, smoking’s link to neurodegenerative diseases , like Alzheimer’s and dementia, is becoming more clear. Not surprisingly, smoking also increases the risk of severe illness associated with COVID-19, according to the U.S. Centers for Disease Control and Prevention ( CDC ) . Still, many continue to smoke – even those who are very sick. Never Too Late to Quit About 32 million American adults smoke cigarettes today, though smoking rates have dropped from 42 percent in 1965 to 13.7 percent in 2019, according to the American Cancer Society . The good news for any of your patients who smoke is that it’s never too late to quit. According to a 2016 American Journal of Preventive Medicine study , quitting smoking at age 60 or even 70 can prolong life. There are resources available to help your patients quit at any age. The America...

Skin safety is a hot-button issue for neurodiagnostic technologists, because EEG placement requires skin abrasion. Even this small amount of disruption to the skin’s protective barrier can increase infection risk. And November, which is American Diabetes Month , is a great time to learn the special measures you need to take to protect diabetic patients who are more prone to skin infection. Diabetes impairs blood flow and sensation in the skin, decreasing pain response. That means once a wound forms, it can remain open for long periods, increasing infection risk. Approximately 34 million people in the U.S. have diabetes and another 88 million adults have been diagnosed as prediabetic. The Standards and Practices Committee of ASET-The Neurodiagnostic Society recently created a Skin Safety Task Force  to address the increased infection risk for diabetics. Resources provided by the task force include: Position Paper on Skin Safety During EEG Procedures Skin Safety During EEG ...

Images create visual interest on your website and social media posts, and they can help you tell a great story. Images also are essential these days if you want your content to be noticed in an increasingly crowded web space. There are plenty of professional web designers and social media experts that will happily take your money and help you with this. But, if you run a small neurology practice and have more of a do-it-yourself budget, there’s a lot you can do to optimize your own images and get that professional look. With a little knowledge and some tricks of the trade you can deliver a high-quality and effective visual presence online . Know About Image Use Liability Running a medical practice comes with a lot of rules around liability and using images for marketing is no exception. Obviously, violating HIPAA laws using unauthorized pictures of patients will get you in trouble. What you may not know, though, is that violating copyright laws can also lead to huge fines – even ...

Certain parts of the brain are considered prime real estate. This is how neurologist Dr. Jeffrey Gertsch describes the eloquent cortex, the part of the brain where vital functions like language and motor function originate. Surgeons working in these areas need to carefully map the brain in real time, and neurodiagnostic technologists play an important role. This was the message of Dr. Gertsch’s talk at the recent annual meeting held by ASET-The Neurodiagnostic Society. Intraoperative brain mapping “is manpower- and equipment-intensive,” he said. Many subspecialties need to be coordinated and that includes the technologist. Brain mapping is typically used during epilepsy and tumor removal surgeries in the eloquent cortex. This includes areas near the temporal and frontal lobes where critical functions like speech, movement, hearing, vision, memory, and touch are centered. Most people generally share these locations in common, but there is slight variation from person to person and...

Todd Barnes knows the business of neurology. With an MBA and more than 20 years of experience he has become an expert in navigating the financial travails increasingly faced by this group of physicians. He knows that sometimes neurologists want to supplement their income, and he knows what opportunities are available. He gave a talk on this subject at the last meeting of the American Academy of Neurology. We were fortunate enough to meet him then and more recently ask him more about this issue. The result was a series of articles we published on medical legal work, consulting for insurance companies , and doing intermittent locum tenens . This post is the last of that series and it focuses on doing side work for the U.S. Department of Veterans Affairs. Todd Barnes The VA has hospitals and medical centers across the country and “the money can be good, especially for the amount of work you are asked to do,” says Barnes. The VA uses a system of “eighths” to determine the amount ...

Somewhere along the way, physicians were replaced by lawyers and business administrators when it comes to running healthcare. Margins grew thinner, healthcare conglomerates emerged, and competition between practices increased. This has drawn lots of criticism, and in recent years physicians have gradually been reinstated in leadership roles. It has taken a global pandemic, however, to propel this issue front and center. COVID-19 has shown us that healthcare isn’t just another business, and right now we need physicians in leadership roles more than ever. ‘Every physician must understand that we all have leadership roles, and we must lead to the best of our abilities,” write the authors of this article on physician leadership during COVID-19 , published in the Journal of Bone & Joint Surgery . “Our patients and communities, our country, and the world are counting on the physician community to step up and act thoughtfully in doing what is best for current and future patients.” Phy...

As we age, our brain changes in predictable ways. MRI studies have, for years now, consistently been used to establish a person’s brain age. When someone’s brain age is older than their chronological age, it can be a sign of neurological illness. A group of researchers out of Boston’s Massachusetts General Hospital recently established that electroencephalography (EEG) can also be used to determine brain age, and now they say it can also spot dementia. The trick is to take the EEG while the patient is sleeping. As people get older, their sleep patterns change: They tend to go to bed and wake up earlier, wake more during the night, and generally sleep fewer hours. According to the Mass General researchers, EEG can also pick up age-related changes while we sleep, including the following: Reduced slow waves during deep sleep Decreased sleep spindle amplitude, density and duration Less phase coupling between slow oscillations and sleep spindles “Using participants with matched c...

The COVID-19 pandemic has put a kink in lots of plans and, unfortunately for neurodiagnostic technologists, the neuroanalyst credential is one of them. It’s still in the works, though, and was generating buzz at the recently held annual meeting of ASET-The Neurodiagnostic Society. Originally estimated to be out mid-2020 , the new ABRET credential should be out in late 2020 or early 2021, said Linda Kelly, ASET’s director of education. “People are really waiting for this credential to come out. So, I know it’s going to be very popular,” she added. “I know they’ve had a great team at ABRET working on it. ASET, in response to that, has been building an LTM analyst course that should also be available this fall, that’ll hopefully get people prepped for that credential.” Kelly made this announcement after Jill Mackey’s talk on what it is like to work as a neuroanalyst. Though the credential isn’t out yet, she like others in neurodiagnostics have effectively taken on this role without t...

October is Health Literacy Month and public health experts agree: The COVID-19 pandemic has highlighted the importance of this issue like nothing before. “In a time like this of the COVID-19 pandemic, full of uncertainties, in which information is constantly changing and a rapid behavior change by the world population is required to reduce the risks of infection and spread of this disease, presenting an adequate level of health literacy has never been more important,” write the authors of a paper published September 2020 in the journal of the Brazilian Medical Association. Health literacy refers to the ability to find and understand health information and then use it to take appropriate action. According to the U.S. Department of Health and Human Services , this applies to both individuals as well as organizations, which have a responsibility to promote health literacy. Health literacy has been important as long as there have been illness and subsequent treatments. The concept, ho...

Time is brain . That phrase has become a well-known rallying cry to waste no time in the treatment of stroke patients. The quicker medical care is given, the more lives are saved and the less disability people suffer. What many do not know is that this phrase also applies to cases of epilepsy where EEG techs become a vital part of the fast-acting team. That was a major message in a talk given by Leisha Osburn at the recent annual meeting of ASET–the Neurodiagnostic Society. “I grew up in EEG hearing many times, ‘It can wait until tomorrow,’” said Osburn, who has been an EEG tech for many years and is now pursuing a Ph.D. studying the use of EEG in the emergency room. “There is never a STAT EEG. We don’t really know that it hurts patients to have seizures or be in status.’” That has changed. Research over the last 10 years has shown that seizures are independently associated with morbidity and mortality, said Osburn who pointed to a study published in 2020 in the journal Pediatric...

Are you considering adding another revenue stream to your practice? You should consider intermittent locum tenens , says Todd Barnes, a clinical business administrator in Oklahoma. With low overhead and a flexible schedule, locum tenens can be very lucrative. It might even help you combat burnout. Locum tenens is gig work for a physician who literally “takes the place of” another physician while they are on vacation, out sick, or away on maternity leave. Some places hire locum tenens doctors simply because of the shortage of neurologists. The length of coverage can vary. If you already have a job, it is important to know that it can be done intermittently. “We’ve been using quite a bit of locum tenens at our place, and some of them work just a weekend here and there. It is extremely lucrative,” says Barnes. “I was shocked to see how much we were paying. Obviously, all that doesn’t go to the physician, some goes to the company.” The “company” he is referring to is a staffing agenc...

Inadequate running water, poor pest control, and improper waste disposal are prerequisites for any number of infectious diseases and parasites. That’s overseas, though – not America, right? Wrong. The novel coronavirus has taught us all that we are not immune to large-scale infectious disease. And many don’t know there is a disease caused by a brain-infecting tapeworm that researchers say has been growing in the U.S. over the last decade: neurocysticercosis. The World Health Organization, the National Institutes of Health, and the Centers for Disease Control and Infection have all identified this disease as a “neglected parasitic infection,” or NPI. This is because the numbers are up, it can be deadly, and the disease is preventable. These groups have put out a call to raise awareness. Neurodiagnostic technologists, in particular, need to know about this disease. Why? It causes epilepsy. There’s even a question about it on the CLTM certification exam . That’s according to Petra ...

Mindfulness has increasingly gained a foothold in the scientific community since the discovery of its effect on the brain’s default mode network, or DMN. The DMN, in turn, continues to be linked to a growing number of neurological and psychiatric illnesses. New research on bipolar disorder (BD) is highlighting the possible importance of treatments, like mindfulness-based activity, that focus on the DMN. The DMN includes brain regions with high degrees of functional connectivity and is active in the brain at rest, “but becomes deactivated when task performance is initiated,” according to this 2016 paper . Dr. Sarah Mulukutla, a neurologist, says this is the part of the brain where mind wandering happens – and it is also where changes are seen in long-time meditators. Dysfunction in the DMN has been found in patients with diseases such as Parkinson’s disease, Alzheimer’s disease, epilepsy, ADHD, and mood disorders such as bipolar. Interestingly, a 2019 study published in the jou...

In 2018, ASET – The Neurodiagnostic Society put state licensure of neurodiagnostic technologists at the top of its three-year strategic plan. Halfway through this plan, they hired a new executive director and the COVID-19 pandemic hit. Despite these shakeups, the group is still on track to get licensure in at least one state in 2021. And it looks like that state might be California, according to an announcement made at ASET’s annual board meeting last month. Jennifer Montgomery, director of operations and government affairs for ASET, announced the awarding of a $20,000 licensure grant to its California chapter. Pursuing state licensure is an expensive undertaking, added Montgomery, a former lobbyist. “There are costs for hiring a lobbyist, which is something you really need to do if you are going to get licensure passed in your state,” she said. There’s a lot of planning and paperwork. One of the biggest pieces of that is drafting a bill. ASET has developed a model bill for this...

Adding clinical trials to your neurology practice can be rewarding, and it can be a nice additional revenue stream. Or it can go horribly, horribly wrong—if you don’t hire the right staff, that is. First on the list of hires, if you want to tip the scales in your favor, is a good study coordinator. That’s according to long-time trialist Dr. David Weisman. Dr. David Weisman A study coordinator, also called a clinical research coordinator, is the person who runs the day-to-day operations of a clinical trial under the direction of the trial’s principal investigator (PI). They perform tasks such as recruiting and screening patients, communicating with trial sponsors, and handling financial matters and personnel. According to the job site Glassdoor.com , a bachelor’s degree in nursing or a health science field is a standard prerequisite for clinical research coordinators. But if you are adding clinical trials to a private practice, you can hire anyone you want. A rookie mistake made...

When physicians think about adding additional revenue streams to their practice, contracting with insurance companies is usually not top of the list. Processing claims and getting prior authorizations is arguably the most headache-inducing part of medicine. Nonetheless, it is a revenue stream worthy of consideration for neurologists, especially during these lean times. It can be an easy work-from-home side gig that ultimately benefits your practice, says Todd Barnes, a neurology practice administrator in Oklahoma. “They need PRN reviewers,” he says. “You can be independent, external. A lot of them have a need for that in their process of determining medical necessity or utilization review. All of this stuff can be done around your normal practice. And you kind of get to understand the other side. It gives some insight into the insurance industry that we all work with.” Barnes also sees a shift happening in the industry where more specialists and subspecialists, like neurologists, ...

Hang around a bunch of EEG techs and sooner or later someone will talk about how they trained back when EEGs involved endless streams of EEG paper printouts. The move to digital EEG was a huge technological jump forward, but these techs adapted. According to Leisha Osburn, who spoke at the ASET annual meeting held last month, techs are once again facing a sea change in their industry. The last decade has brought technological advances like rapid response electroencephalography (rEEG), the subject of Osburn’s talk, that are being pushed even further forward by the coronavirus pandemic. Because COVID-19 is so contagious, minimizing time and contact during EEG testing has become imperative. Also, the neurological sequelae related to the virus are also becoming more apparent, increasing the need for stat EEG testing. “Need begets innovation and a willingness to try new things,” says Osburn. Rapid EEG systems – electrode templates or caps – facilitate getting a rEEG in an acute scena...