The Neurohospitalist Fellowship Experience
Our first Neurohospitalist Fellow was Vanja Douglas, MD. Asked to describe his fellowship training experience, Dr. Douglas said, "The clinical training I received during my fellowship was invaluable. In addition to seeing a large number of patients with common inpatient conditions, I gained extensive experience in diagnosing and treating rare neurological diseases referred to UCSF from the rest of Northern California. I also gained an understanding of the issues specific to neurological inpatients, especially with regard to patient safety and quality health care delivery. Through the excellent mentorship of Dr. Josephson, I was also able to develop a clinical research program. This specialized training enabled me to take the next step in my career, joining the faculty at UCSF to dedicate my time to teaching students and residents about neurology and caring for inpatients with neurological disease."
One of his goals during the fellowship was to develop a screening tool to predict which patients are at highest risk for the development of delirium in the hospital so that clinicians can find ways to prevent it. The biggest risk factor for the development of delirium is pre-existing cognitive dysfunction, so he asked "How does one identify patients with cognitive dysfunction if they don't already carry a diagnosis of dementia or mild cognitive impairment?" Dr. Douglas and colleagues analyzed the responses to a large battery of questions asked of caregivers of every patient evaluated at the UCSF Memory and Aging Center. From this large group of questions, four turned out to be most relevant in identifying mild cognitive impairment or dementia, and these were combined into a simple screening tool. If a patient's caregiver endorses two or more of these questions, then the chance of the patient having cognitive dysfunction goes up. Dr. Douglas and his colleagues plan to use this tool in a follow-up study of patients admitted to the hospital to see if it can help predict those who develop delirium. In April 2010, Dr. Douglas presented his results in a poster at the 62nd annual meeting of the American Academy of Neurology in Toronto.
Articles from the fellowship:
Josephson SA, Douglas VC, Lawton MT, English JD, Smith WS, Ko NU. Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management. J Neurosurg. 2010 Mar;112(3):626-30.
Abstracts from the fellowship:
VC Douglas, J Liu, SA Josephson, H Kirsch, A Poncelet. Continuous Improvement During Third Year Clerkships: A Novel Feedback Method. Poster presentation at UCSF Education Day, San Francisco, April 2010.
VC Douglas, J Neuhaus, J Johnson, C Racine, BL Miller, SA Josephson. Dementia = (MC)2: A Four-Item Screening Test for Mild Cognitive Impairment and Dementia. Poster presentation at 62nd annual meeting of the American Academy of Neurology, Toronto, April 2010.