Clinical Features of Lewis-Sumner Syndrome: Can Trauma Precipitate Symptoms?

INTRODUCTION: Lewis-Sumner syndrome (LSS) is a demyelinating peripheral neuropathy described in 1982. METHODS: We reviewed the charts of nine LSS patients in neurological care for their symptoms, response to different treatment regimens, and pattern of nerve involvement. RESULTS: One patient had an Adie's pupil. Every patient studied had median nerve involvement. Seven of nine patients required intravenous immunoglobulin (IVIg) therapy and all showed improvement with IVIg. Four of nine patients received oral steroid therapy and had some improvement. Two of nine patients received azathioprine to little effect. Two of nine patients experienced significant trauma while receiving neurological follow-up and their symptoms worsened to a clinically significant degree afterward. DISCUSSION: We noticed a possible association between trauma and symptom severity in cases of LSS with preexisting neurological follow-up. We hypothesize that physical trauma exacerbates LSS. To our knowledge, this is an unreported phenomenon.

Making medical student course evaluations meaningful: implementation of an intensive course review protocol.

BACKGROUND: Ongoing course evaluation is a key component of quality improvement in higher education. The complexities associated with delivering high quality medical education programs involving multiple lecturers can make course and instructor evaluation challenging. We describe the implementation and evaluation of an "intensive course review protocol" in an undergraduate medical program METHODS: We examined pre-clerkship courses from 2006 to 2011 - prior to and following protocol implementation. Our non-parametric analysis included Mann-Whitney U tests to compare the 2006/07 and 2010/11 academic years. RESULTS: We included 30 courses in our analysis. In the 2006/07 academic year, 13/30 courses (43.3 %) did not meet the minimum benchmark and were put under intensive review. By 2010/11, only 3/30 courses (10.0 %) were still below the minimum benchmark. Compared to 2006/07, courses ratings in the 2010/11 year were significantly higher (p = 0.004). However, during the study period mean response rates fell from 76.5 % in 2006/07 to 49.7 % in 2010/11. CONCLUSION: These results suggest an intensive course review protocol can have a significant impact on pre-clerkship course ratings in an undergraduate medical program. Reductions in survey response rates represent an ongoing challenge in the interpretation of student feedback.

Food addiction: its prevalence and significant association with obesity in the general population.

BACKGROUND: 'Food addiction' shares a similar neurobiological and behavioral framework with substance addiction. However whether, and to what degree, 'food addiction' contributes to obesity in the general population is unknown. OBJECTIVES: to assess 1) the prevalence of 'food addiction' in the Newfoundland population; 2) if clinical symptom counts of 'food addiction' were significantly correlated with the body composition measurements; 3) if food addicts were significantly more obese than controls, and 4) if macronutrient intakes are associated with 'food addiction'. DESIGN: A total of 652 adults (415 women, 237 men) recruited from the general population participated in this study. Obesity was evaluated by Body Mass Index (BMI) and Body Fat percentage measured by dual-energy X-ray absorptiometry. 'Food addiction' was assessed using the Yale Food Addiction Scale and macronutrient intake was determined from the Willet Food Frequency Questionnaire. RESULTS: The prevalence of 'food addiction' was 5.4% (6.7% in females and 3.0% in males) and increased with obesity status. The clinical symptom counts of 'food addiction' were positively correlated with all body composition measurements across the entire sample (p<0.001). Obesity measurements were significantly higher in food addicts than controls; Food addicts were 11.7 (kg) heavier, 4.6 BMI units higher, and had 8.2% more body fat and 8.5% more trunk fat. Furthermore, food addicts consumed more calories from fat and protein compared with controls. CONCLUSION: Our results demonstrated that 'food addiction' contributes to severity of obesity and body composition measurements from normal weight to obese individuals in the general population with higher rate in women as compared to men.

Improving patient access at a movement disorder clinic by participating in a Process Improvement Program.

Our multi-disciplinary neurology team were dissatisfied with long access times for consultation for new referrals. We participated in a rapid process improvement workshop and a structured improvement process. Over a six-month period we were able to reduce our access time for initial appointment for patients with suspected movement disorders from 133 to 20 days. We implemented a 'carousel' multi-disciplinary appointment and a standardised clinic form that improved the flow of patients and that we estimate will save 150 hours of physician time and 320 hours of administrative time per year.