Bio


Dr. Gold is a board-certified neurologist who is fellowship-trained in the diagnosis and treatment of neurological disorders in hospitalized patients. He cares for a broad range of patients, including individuals with seizures, central nervous system infections, autoimmune diseases, headaches, neuromuscular conditions, and neurological complications of cancer. Dr. Gold's primary research interest focuses on enhancing the communication skills of neurology residents, and he serves as the Director of the Stanford Neurology Residency Communication Coaching Program. He is also the Fellowship Director of the Stanford Neurohospitalist Fellowship.

Dr. Gold serves as Vice Chair of Quality, Safety, & Experience for the Department of Neurology & Neurological Sciences. In this role, he coordinates projects aimed at improving care for patients with neurological conditions across the health system.

For more information on the Stanford Neurohospitalist Program & Fellowship, please visit: https://med.stanford.edu/neurology/divisions/neurohospitalist.html

Learn more about the Stanford Neurology Communication Coaching Program by visiting: http://med.stanford.edu/neurology/education/resident-coaching.html

Additional information on Stanford Neurology's efforts in Quality, Safety, & Value can be found here: http://med.stanford.edu/neurology/quality.html

Clinical Focus


  • Neurology
  • Neurohospitalist

Academic Appointments


Administrative Appointments


  • Vice Chair of Quality, Safety, & Experience, Stanford Department of Neurology & Neurological Sciences (2022 - Present)
  • Member, Neurohospitalist Society Board of Directors (2021 - Present)
  • Director, Stanford Neurology Residency Communication Coaching Program (2019 - Present)
  • Chair, Stanford Neurology Quality Council (2017 - Present)
  • Physician Improvement Leader, Improvement Capability Development Program, Stanford Department of Neurology (2017 - Present)
  • Chair, Neurohospitalist Section of the American Academy of Neurology (2017 - 2021)
  • Member, Stanford Quality, Patient Safety, & Effectiveness Comittee (QPSEC) (2016 - Present)
  • Member, Stanford Neurology Professional Practice Evaluation Committee (2016 - Present)
  • Member, Stanford L5 MD-RN Unit Council (2016 - Present)

Honors & Awards


  • Excellence in Quality and Safety Award, Stanford Medical Staff (2021)
  • Relationship-Centered Communication Leader Award, Stanford Health Care (2019)
  • Neurology Medical Student Clerkship Teaching Award, Stanford Department of Neurology (2018)
  • Neurology Medical Student Clerkship Teaching Award, Stanford Department of Neurology (2017)
  • Lysia Forno Award for Excellence in Teaching Neurology Residents, Stanford Department of Neurology (2017)
  • Rathmann Family Foundation Medical Education Fellowship in Patient-Centered Care, Stanford School of Medicine (2017-2018)

Boards, Advisory Committees, Professional Organizations


  • Member, Neurohospitalist Society (2014 - Present)
  • Member, American Academy of Neurology (2009 - Present)

Professional Education


  • Fellowship, University of California, San Francisco, Neurohospitalist Fellowship (2016)
  • Board Certification: American Board of Psychiatry and Neurology, Neurology (2015)
  • Residency, New York-Presbyterian Hospital, Columbia University Medical Center, Neurology (2015)
  • Internship, New York-Presbyterian Hospital, Columbia University Medical Center, Medicine (2012)
  • Medical Education: Rutgers Robert Wood Johnson Medical School (2011) NJ
  • MS, Georgetown University, Physiology (2006)
  • AB, Princeton University, Psychology (2005)

All Publications


  • Outcomes of a Neurohospitalist Program at an Academic Medical Center. The Neurohospitalist Gold, C. A., Scott, B. J., Weng, Y., Bernier, E., Kvam, K. A. 2022; 12 (3): 453-462

    Abstract

    The purpose is to determine the impact of an academic neurohospitalist service on clinical outcomes.We performed a retrospective, quasi-experimental study of patients discharged from the general neurology service before (August 2010-July 2014) and after implementation of a full-time neurohospitalist service (August 2016-July 2018) compared to a control group of stroke patients. Primary outcomes were length of stay and 30-day readmission. Using the difference-in-difference approach, the impact of introducing a neurohospitalist service compared to controls was assessed with adjustment of patients' characteristics. Secondary outcomes included mortality, in-hospital complications, and cost.There were 2706 neurology admissions (1648 general; 1058 stroke) over the study period. The neurohospitalist service was associated with a trend in reduced 30-day readmissions (ratio of ORs: .52 [.27, .98], P = .088), while length of stay was not incrementally changed in the difference-in-difference model (-.3 [-.7, .1], P = .18). However, descriptive results demonstrated a significant reduction in mean adjusted LOS of .7 days (4.5 to 3.8 days, P < .001) and a trend toward reduced readmissions (8.9% to 7.6%, P = .42) in the post-neurohospitalist cohort despite a significant increase in patient complexity, shift to higher acuity diagnoses, more emergent admissions, and near quadrupling of observation status patients. Mortality and in-hospital complications remained low, patient satisfaction was stable, and cost was not incrementally changed in the post-neurohospitalist cohort.Implementation of a neurohospitalist service at an academic medical center is feasible and associated with a significant increase in patient complexity and acuity and a trend toward reduced readmissions.

    View details for DOI 10.1177/19418744221083182

    View details for PubMedID 35755235

    View details for PubMedCentralID PMC9214938

  • Quality Improvement Metrics and Methods for Neurohospitalists. Neurologic clinics Kvam, K. A., Bernier, E., Gold, C. A. 2022; 40 (1): 211-230

    Abstract

    Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, perform systematic analysis, then design and test solutions to drive improved outcomes for patients with neurologic disease.

    View details for DOI 10.1016/j.ncl.2021.08.011

    View details for PubMedID 34798971

  • Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study. BMC medical education Sasnal, M., Miller-Kuhlmann, R., Merrell, S. B., Beres, S., Kipp, L., Lee, S., Threlkeld, Z., Nassar, A. K., Gold, C. A. 2021; 21 (1): 513

    Abstract

    Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual).We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed.Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future.In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.

    View details for DOI 10.1186/s12909-021-02936-w

    View details for PubMedID 34583691

  • Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C. A., Kvam, K. A. 2020; 94 (3): 137–42

    Abstract

    OBJECTIVE: To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.METHODS: We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.RESULTS: Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.CONCLUSIONS: Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.

    View details for DOI 10.1212/WNL.0000000000008752

    View details for PubMedID 31959682

  • A rare neuromyelitis optica mimic: Primary CNS histiocytic sarcoma. Multiple sclerosis (Houndmills, Basingstoke, England) Rogawski, D. S., Nirschl, J. J., McDonald, J., Nie, E., Schwartz, N. U., Vogel, H., Scott, B. J., Gold, C. A., Kipp, L. B. 2022; 28 (10): 1651-1654

    Abstract

    Primary central nervous system (CNS) histiocytic sarcoma is a rare hematolymphoid malignancy with features of mature histiocytes and carries a poor prognosis. We describe a unique case in which a 50-year-old woman presented with recurrent acute brainstem syndrome, area postrema syndrome, and myelitis with corresponding magnetic resonance imaging (MRI) lesions meeting diagnostic criteria for seronegative neuromyelitis optica spectrum disorder (NMOSD). Despite initial improvement with steroids and plasma exchange, she experienced recurrent symptoms over 10months referable to new and persistently enhancing lesions. At autopsy, neuropathology revealed a diffusely infiltrative primary CNS histiocytic sarcoma. This case represents a rare clinicoradiologic mimic of NMOSD, underscoring the importance of evaluation for infiltrative diseases in cases of atypical seronegative NMOSD.

    View details for DOI 10.1177/13524585221097564

    View details for PubMedID 35876468

  • Primary central nervous system histiocytic sarcoma presenting as neuromyelitis optica Nirschl, J., Rogawski, D., McDonald, J., Nie, E., Schwartz, N., Scott, B., Gratzinger, D., Gold, C., Kipp, L., Vogel, H. OXFORD UNIV PRESS INC. 2022: 491
  • Patient and Clinician Perspectives of New and Return Ambulatory Teleneurology Visits. Neurology. Clinical practice Kling, S. M., Falco-Walter, J. J., Saliba-Gustafsson, E. A., Garvert, D. W., Brown-Johnson, C. G., Miller-Kuhlmann, R., Shaw, J. G., Asch, S. M., Yang, L., Gold, C. A., Winget, M. 1800; 11 (6): 472-483

    Abstract

    Background and Objectives: To evaluate the adoption and perceived utility of video visits for new and return patient encounters in ambulatory neurology subspecialties.Methods: Video visits were launched in an academic, multi-subspecialty, ambulatory neurology clinic in March 2020. Adoption of video visits for new and return patient visits was assessed using clinician-level scheduling data from March 22 to May 16, 2020. Perceived utility of video visits was explored via a clinician survey and semistructured interviews with clinicians and patients/caregivers. Findings were compared across 5 subspecialties and 2 visit types (new vs return).Results: Video visits were adopted rapidly; all clinicians (n = 65) integrated video visits into their workflow within the first 6 weeks, and 92% of visits were conducted via video, although this varied by subspecialty. Utility of video visits was higher for return than new patient visits, as indicated by surveyed (n = 48) and interviewed clinicians (n = 30), aligning with adoption patterns. Compared with in-person visits, clinicians believed that it was easier to achieve a similar physical examination, patient-clinician rapport, and perceived quality of care over video for return rather than new patient visits. Of the 25 patients/caregivers interviewed, most were satisfied with the care provided via video, regardless of visit type, with the main limitation being the physical examination.Discussion: Teleneurology was robustly adopted for both new and return ambulatory neurology patients during the COVID-19 pandemic. Return patient visits were preferred over new patient visits, but both were feasible. These results provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care.

    View details for DOI 10.1212/CPJ.0000000000001065

    View details for PubMedID 34992955

  • Neurohospitalist Practice and Well-Being During the COVID-19 Pandemic. The Neurohospitalist Goyal, T., Probasco, J. C., Gold, C. A., Klein, J. P., Weathered, N. R., Thakur, K. T. 2021; 11 (4): 333-341

    Abstract

    Neurohospitalists play an important role in, and have been variably affected by, the ongoing COVID-19 pandemic. In this study, we survey neurohospitalists to characterize practice changes and the impact of the pandemic on their well-being.A 22-item survey was distributed to neurohospitalists through the Neurohospitalist Society and the American Academy of Neurology Neurohospitalist, Stroke & Vascular Neurology, and Critical Care & Emergency Neurology Sections.After 2 weeks of collection, 123 responses were received, with 57% of respondents practicing in academic settings, 23% in private practice, and 7% in community hospitals. A minority of neurohospitalists (8%) were redeployed to care for COVID-19 or non-COVID-19 medicine patients. The most common neurologic diagnoses they reported in COVID-19 patients were delirium (85%), cerebrovascular events (75%), and seizure (35%); however, most neurohospitalists (59%) had evaluated fewer than 10 patients with COVID-19. Respondents observed that fewer patients with unrelated neurological diseases were admitted to the hospital compared to before the pandemic. Neurohospitalists experienced changes in administrative (27%), educational (15%), and research duties (11%), and had overall worse well-being and work-life balance (77%).The most common neurologic diagnoses seen in COVID-19 patients by neurohospitalists in this sample are delirium, cerebrovascular disease, and seizure. Though the majority of survey respondents reported not being primary frontline providers, they report key clinical and operational roles during the pandemic, and report worse well-being as compared to before the pandemic. Our data suggests that there are opportunities to improve neurohospitalists' experience through flexible work practices and providing family care support.

    View details for DOI 10.1177/19418744211016691

    View details for PubMedID 34567394

    View details for PubMedCentralID PMC8442155

  • Detection of Neoplasms by Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid. JAMA neurology Gu, W., Rauschecker, A. M., Hsu, E., Zorn, K. C., Sucu, Y., Federman, S., Gopez, A., Arevalo, S., Sample, H. A., Talevich, E., Nguyen, E. D., Gottschall, M., Nourbakhsh, B., Gold, C. A., Cree, B. A., Douglas, V. C., Richie, M. B., Shah, M. P., Josephson, S. A., Gelfand, J. M., Miller, S., Wang, L., Tihan, T., DeRisi, J. L., Chiu, C. Y., Wilson, M. R. 2021

    Abstract

    Importance: Cerebrospinal fluid (CSF) cytologic testing and flow cytometry are insensitive for diagnosing neoplasms of the central nervous system (CNS). Such clinical phenotypes can mimic infectious and autoimmune causes of meningoencephalitis.Objective: To ascertain whether CSF metagenomic next-generation sequencing (mNGS) can identify aneuploidy, a hallmark of malignant neoplasms, in difficult-to-diagnose cases of CNS malignant neoplasm.Design, Setting, and Participants: Two case-control studies were performed at the University of California, San Francisco (UCSF). The first study used CSF specimens collected at the UCSF Clinical Laboratories between July 1, 2017, and December 31, 2019, and evaluated test performance in specimens from patients with a CNS malignant neoplasm (positive controls) or without (negative controls). The results were compared with those from CSF cytologic testing and/or flow cytometry. The second study evaluated patients who were enrolled in an ongoing prospective study between April 1, 2014, and July 31, 2019, with presentations that were suggestive of neuroinflammatory disease but who were ultimately diagnosed with a CNS malignant neoplasm. Cases of individuals whose tumors could have been detected earlier without additional invasive testing are discussed.Main Outcomes and Measures: The primary outcome measures were the sensitivity and specificity of aneuploidy detection by CSF mNGS. Secondary subset analyses included a comparison of CSF and tumor tissue chromosomal abnormalities and the identification of neuroimaging characteristics that were associated with test performance.Results: Across both studies, 130 participants were included (median [interquartile range] age, 57.5 [43.3-68.0] years; 72 men [55.4%]). The test performance study used 125 residual laboratory CSF specimens from 47 patients with a CNS malignant neoplasm and 56 patients with other neurological diseases. The neuroinflammatory disease study enrolled 12 patients and 17 matched control participants. The sensitivity of the CSF mNGS assay was 75% (95% CI, 63%-85%), and the specificity was 100% (95% CI, 96%-100%). Aneuploidy was detected in 64% (95% CI, 41%-83%) of the patients in the test performance study with nondiagnostic cytologic testing and/or flow cytometry, and in 55% (95% CI, 23%-83%) of patients in the neuroinflammatory disease study who were ultimately diagnosed with a CNS malignant neoplasm. Of the patients in whom aneuploidy was detected, 38 (90.5%) had multiple copy number variations with tumor fractions ranging from 31% to 49%.Conclusions and Relevance: This case-control study showed that CSF mNGS, which has low specimen volume requirements, does not require the preservation of cell integrity, and was orginally developed to diagnose neurologic infections, can also detect genetic evidence of a CNS malignant neoplasm in patients in whom CSF cytologic testing and/or flow cytometry yielded negative results with a low risk of false-positive results.

    View details for DOI 10.1001/jamaneurol.2021.3088

    View details for PubMedID 34515766

  • Impact of a relationship-centered care communication curriculum on pediatric residents' practice, perspectives, and opportunities to evelop expertise. Patient education and counseling Selling, S. K., Kirkey, D., Goyal, T., Singh, A., Gold, C. A., Hilgenberg, S. L., Weimer-Elder, B., Kuo, K. W., Rassbach, C. E. 2021

    Abstract

    OBJECTIVES: To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise.METHODS: Residents (n=77) completed a 4h RCC training and shared resultant RCC goals with Coaches (n=15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise.RESULTS: Pediatric residents reported significant increases (p<0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts.CONCLUSION: Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise.PRACTICE IMPLICATIONS: Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.

    View details for DOI 10.1016/j.pec.2021.08.014

    View details for PubMedID 34538683

  • Evaluation of Patient and Clinician Perspectives for New and Return Ambulatory Teleneurology Visits, with special attention to subspecialty differences Falco-Walter, J., Kling, S., Saliba-Gustafsson, E., Yang, L., Miller-Kuhlmann, R., Garvert, D., Brown-Johnson, C., Shaw, J., Asch, S., Winget, M., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2021
  • Resident-driven strategies to improve the educational experience of teleneurology Ng, J., Chen, J., Liu, M., Yang, L., Miller-Kuhlmann, R., Falco-Walter, J., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2021
  • Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure. The Neurohospitalist Dujari, S., Gummidipundi, S., He, Z., Gold, C. A. 2021; 11 (2): 101-106

    Abstract

    To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set.The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics.Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone.It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.

    View details for DOI 10.1177/1941874420969556

    View details for PubMedID 33791051

    View details for PubMedCentralID PMC7958681

  • Opinion and Special Articles: Competency in serious illness communication for neurology residents. Neurology Goyal, T., Robinson, M. T., Gold, C. A. 2020

    View details for DOI 10.1212/WNL.0000000000011048

    View details for PubMedID 33055275

  • Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience. Neurology Yang, L., Brown-Johnson, C. G., Miller-Kuhlmann, R., Kling, S. M., Saliba-Gustafsson, E. A., Shaw, J. G., Gold, C. A., Winget, M. 2020

    Abstract

    The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians' needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.

    View details for DOI 10.1212/WNL.0000000000010015

    View details for PubMedID 32611634

  • Benchmarking Performance on Administration of Dexamethasone for Bacterial Meningitis Dujari, S., Gummidipundi, S., He, Z., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • A Novel Goals of Care Communication Curriculum for Neurology Residents Improves Confidence and Skills Goyal, T., Merrell, S., Weimer-Elder, B., Kline, M., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward. The Neurohospitalist Murray, N. M., Joshi, A. N., Kronfeld, K., Hobbs, K., Bernier, E., Hirsch, K. G., Gold, C. A. 2020; 10 (2): 100-108

    Abstract

    The transfer of patients with ischemic stroke from the intensive care unit (ICU) to noncritical care inpatient wards involves detailed information sharing between care teams. Our local transfer process was not standardized, leading to potential patient risk. We developed and evaluated an "ICU Transfer Checklist" to standardize communication between the neurocritical care team and the stroke ward team.Retrospective review of consecutive patients with ischemic stroke admitted to the neurocritical care unit who were transferred to the stroke ward was used to characterize transfer documentation. A multidisciplinary team developed and implemented an ICU Transfer Checklist that contained a synthesis of the patient's clinical course, immediate "to-do" action items, and a system-based review of active medical problems. Postintervention checklist utilization was recorded for 8 months, and quality metrics for the postintervention cohort were compared to the preintervention cohort. Providers were surveyed pre- and postintervention to characterize perceived workflow and quality of care.Patients before (n = 52) and after (n = 81) ICU Transfer Checklist implementation had similar demographic and clinical characteristics. In the postchecklist implementation period, the ICU Transfer Checklist was used in over 85% of patients and median hospital length of stay (LOS) decreased (8.6 days vs 5.4 days, P = .003), while ICU readmission rate remained low. The checklist was associated with improved perceptions of safety and decreased time needed to transfer patients.Use of the standardized ICU Transfer Checklist was associated with decreased hospital LOS and with improvements in providers' perceptions of patient safety.

    View details for DOI 10.1177/1941874419873810

    View details for PubMedID 32373272

    View details for PubMedCentralID PMC7191660

  • A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward NEUROHOSPITALIST Murray, N. M., Joshi, A. N., Kronfeld, K., Hobbs, K., Bernier, E., Hirsch, K. G., Gold, C. A. 2020; 10 (2): 100–108
  • Eponyms are here to stay: Usage in the literature and among current neurology trainees. Neurology Zheng, J. n., Gold, C. A. 2020

    Abstract

    To assess the historical trends of medical eponym use in neurology literature and knowledge and attitudes among current trainees related to eponyms.A comprehensive list of medical eponyms compiled from multiple online and print sources was queried against the titles and abstracts of PubMed articles authored by neurologists to assess historical prevalence in the literature from 1988 to 2013. We also surveyed current neurology trainees and trainees who have matched for residency in neurology, but not yet started neurology training, on their familiarity and attitudes toward eponyms.The yearly prevalence of eponyms among neurologist-authored publications ranged from 15% and 25%, with a mean of 21%. The total number of unique eponyms appearing in titles and abstracts increased from 693 in 1988 to 1,076 in 2013, representing 1.8% average annual growth. Our survey showed that residents with at least 1 year of neurology training reported familiarity with significantly more eponyms than those before neurology training (p < 0.001). For familiar eponyms, most residents were either unaware of an alternative descriptor or preferred using the eponym. Despite recognizing both the benefits and drawbacks of eponyms, the vast majority of trainees stated that historical precedent, pervasiveness, and ease of use would drive the continued use of eponyms in neurology.Eponyms will remain a cornerstone in medical education and communication moving forward. Educators in neurology should consider how best to integrate useful eponyms and alternative descriptors into residency training to enhance knowledge acquisition and retention.

    View details for DOI 10.1212/WNL.0000000000008912

    View details for PubMedID 31896619

  • Utilization, yield, and accuracy of the FilmArray Meningitis/Encephalitis panel with diagnostic stewardship and testing algorithm. Journal of clinical microbiology Broadhurst, M. J., Dujari, S. n., Budvytiene, I. n., Pinsky, B. A., Gold, C. A., Banaei, N. n. 2020

    Abstract

    Background: The impact of diagnostic stewardship and testing algorithms on utilization and performance of the FilmArray® Meningitis/Encephalitis (ME) Panel has received limited investigation.Methods: We performed a retrospective single-center cohort study assessing all individuals with suspected ME between February 2017 and April 2019 for whom the ME Panel was ordered. Testing was restricted to patients with cerebrospinal fluid (CSF) pleocytosis. Positive ME Panel results were confirmed before reporting through correlation with direct stain (Gram and Calcofluor white) and CSF Cryptococcal antigen or by repeat ME Panel testing. Outcomes included ME Panel test utilization rate, negative predictive value of non-pleocytic CSF samples, test yield and false-positivity rate, and time to appropriate de-escalation of acyclovir.Results: Restricting testing to pleocytic CSF samples reduced ME Panel utilization by 42.7% (263 vs 459 tests performed) and increased test yield by 61.8% (18.6% vs 11.5% positivity rate; P < 0.01) with application of criteria. The negative predictive value of normal CSF WBC for ME Panel targets was 100% (195/195) for non-viral targets and 98.0% (192/196) overall. All pathogens detected in non-pleocytic CSF samples were herpesviruses. Application of a selective testing algorithm based on repeat testing of non-viral targets avoided 75% (3/4) of false-positive results without generating false-negative results. Introduction of the ME panel reduced the duration of acyclovir treatment from an average of 66 hours (SD, 43) to 46 hours (SD, 36) (P = 0.03).Conclusions: Implementation of the ME Panel with restriction criteria and a selective testing algorithm for non-viral targets optimizes its utilization, yield and accuracy.

    View details for DOI 10.1128/JCM.00311-20

    View details for PubMedID 32493787

  • Rapid implementation of video visits in neurology during COVID-19: a mixed methods evaluation. Journal of medical Internet research Saliba-Gustafsson, E. A., Miller-Kuhlmann, R. n., Kling, S. M., Garvert, D. W., Brown-Johnson, C. G., Lestoquoy, A. S., Verano, M. R., Yang, L. n., Falco-Walter, J. n., Shaw, J. G., Asch, S. M., Gold, C. A., Winget, M. n. 2020

    Abstract

    Telemedicine has been used for decades; yet, despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology's ambulatory subspecialties has been sparse. The SARS-CoV-2 (COVID-19) pandemic however, prompted healthcare systems worldwide to reconsider traditional healthcare delivery. To safeguard healthcare workers and patients many healthcare systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care.To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess the adoption, acceptability, appropriateness, and perceptions of potential sustainability.Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semi-structured interviews with providers (n=30) completed between March and May 2020.Video visits were adopted rapidly; 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted satisfaction. Video visits were reported to be more convenient for patients, families, and/or caregivers than in-person visits; however, access to technology, the patient's technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination.Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

    View details for DOI 10.2196/24328

    View details for PubMedID 33245699

  • National Variability in Prion Disease-Related Safety Policies for Neurologic Procedures. The Neurohospitalist Werbaneth, K., Tummalapalli, P., Gold, C. A. 2019; 9 (4): 222–25

    Abstract

    Prion diseases are fatal neurodegenerative disorders that can be transmitted via contact with infective tissue. Variability in hospital safety policies related to prion disease may place health-care workers at risk. We sought to assess variability of safety policies related to prion disease for neurosurgical procedures and lumbar punctures among neurological institutions in the United States. We e-mailed neurologists associated with 2016 US News and World Report "Top 50" Neurology & Neurosurgery Institutions to request hospital policies regarding safety precautions related to prion disease. For institutional surgical policies, the main outcome was concordance with each of the 8 specific precautions described in World Health Organization (WHO) guidelines published in 1999. No similar guidelines are available for lumbar puncture, so themes were identified and quantified among the lumbar puncture policies we collected. Of the 51 institutions contacted, there were 38 responses. Two institutions did not have relevant policies and 3 institutions declined to share their policies, yielding 33 institutional policies for review. Of these, 85% had a surgical policy and 54% had a lumbar puncture policy. Concordance with all 8 specific precautions described in the WHO guidelines was found in 14% of surgical policies. Lumbar puncture policies demonstrated variability in methods of waste disposal and decontamination procedures. There is significant variability in policies regarding safety precautions in patients with suspected prion disease. We advocate for the formation of national or international committees to examine this issue, set new guidelines, and foster implementation at the level of individual institutions.

    View details for DOI 10.1177/1941874419846338

    View details for PubMedID 31534612

  • Infected Implantable Pulse Generator NEUROHOSPITALIST Dujari, S., Gold, C. A. 2019; 9 (3): 172–73

    View details for DOI 10.1177/1941874418809869

    View details for Web of Science ID 000471642900011

    View details for PubMedID 31244976

    View details for PubMedCentralID PMC6582390

  • Plateau waves of intracranial pressure mimicking seizure in a patient with fungal meningitis Wu, T., Sadat-Hossieny, Z., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Author response: Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies. Neurology Hines, H., Murray, N. M., Ahmad, S., Jaradeh, S., Gold, C. A. 2019; 92 (6): 303

    View details for DOI 10.1212/WNL.0000000000006871

    View details for PubMedID 30718327

  • Coexistence of Neuromyelitis Optica and Amyotrophic Lateral Sclerosis: A Case Report NEUROHOSPITALIST Li, A., McGranahan, T., Su, E., Kipp, L., Gold, C. A. 2019; 9 (1): 37–40
  • Education Research: Understanding barriers to goals of care communication for neurology trainees. Neurology Goyal, T. n., Hasty, B. N., Bereknyei Merrell, S. n., Gold, C. A. 2019; 93 (8): 362–66

    Abstract

    To describe the perspectives of neurology residents regarding barriers to effective goals of care discussions and to identify residents' current and desired educational strategies to improve goals of care communication.All neurology residents at our institution were invited to voluntarily participate in focus groups. Residents were organized into 3 focus groups by year of training. Moderators asked residents open-ended questions about current goals of care communication practice and ideas for improving the frequency and effectiveness of goals of care discussions. All responses were audiorecorded, transcribed, and de-identified. Transcripts of the focus groups were independently read and coded by members of the research team. We performed thematic analysis to identify and systematize relationships across coded data.Twenty out of 29 neurology residents participated in the focus groups. We identified 3 overarching domains impeding goals of care communication: patient factors, resident factors, and systems factors. Residents proposed specific desired strategies to address these 3 domains with the goal of improving the frequency and efficacy of goals of care communication. The desired strategies included receiving feedback from patients and families, developing resident-focused educational opportunities through direct observation and coaching, and systems changes by documenting goals of care discussions.Neurology residents identify multiple barriers to effective goals of care communication and propose specific desired strategies for improvement. This detailed input from residents will be incorporated into future curricular interventions to improve confidence and skill in leading goals of care discussions.

    View details for DOI 10.1212/WNL.0000000000007975

    View details for PubMedID 31427487

  • Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices JAMA NEUROLOGY Culbertson, C. J., Gold, C. A. 2018; 75 (10): 1173–74
  • Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices. JAMA neurology Culbertson, C. J., Gold, C. A. 2018

    View details for PubMedID 29971323

  • Variability of Safety Policies Related to Prion Disease Among Top Neurological Institutions Werbaneth, K., Tummalapalli, P., Kraler, L., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • A Quality Improvement Curriculum for Neurology Residents Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C., Kvam, K. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies. Neurology Hines, H., Murray, N. M., Ahmad, S., Jaradeh, S., Gold, C. A. 2018; 90 (14): 660–61

    View details for PubMedID 29610228

  • Young Man With Paraparesis. Annals of emergency medicine Rider, E. n., Gold, C. A. 2018; 72 (3): e19–e20

    View details for PubMedID 30144875

  • Teaching NeuroImages: Myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis. Neurology Culbertson, C. J., Lummus, S. C., Gold, C. A. 2017; 89 (21): e253

    View details for PubMedID 29158303

  • Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases. The Neurohospitalist Gold, C. A., Odom, N., Srinivasan, S., Schaff, L., Haggiagi, A., Odia, Y. 2016; 6 (4): 161-166

    Abstract

    We describe video electroencephalography (video-EEG) correlates of transient neurological attacks due to plateau waves-paroxysmal elevations in intracranial pressure-in patients with leptomeningeal metastases. We identified 3 patients with leptomeningeal metastases, intracranial hypertension, and transient neurological attacks captured on video-EEG without evidence of seizures or epileptiform activity. We identified all clinical events on video and reviewed the corresponding EEG data for evidence of abnormalities. All 3 patients had mild to moderate slowing and 2 had frontal intermittent rhythmic delta activity during background EEG recording. There were 33 clinical events recorded and stereotyped for each patient. All 33 events were associated with an increase in delta range slowing of ≥30% compared to the background. This abnormality started ≤2 minutes before the onset of clinical symptoms and persisted for minutes after clinical resolution. This study is the first to carefully describe the electrographic correlates of transient neurological attacks due to plateau waves in patients with leptomeningeal metastasis. Clinical attacks were consistently associated with a possible EEG signature of diffuse delta range slowing. Future studies can validate the sensitivity and specificity of these EEG changes as a prognostic and/or response biomarker in patients with leptomeningeal metastases with or without intracranial hypertension.

    View details for DOI 10.1177/1941874416648194

    View details for PubMedID 27695598

    View details for PubMedCentralID PMC5029554

  • Anticipating the Challenges of Zika Virus and the Incidence of Guillain-Barré Syndrome. JAMA neurology Gold, C. A., Josephson, S. A. 2016

    View details for DOI 10.1001/jamaneurol.2016.1268

    View details for PubMedID 27272118

  • Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit NEUROCRITICAL CARE Gold, C. A., Mayer, S. A., Lennihan, L., Claassen, J., Willey, J. Z. 2015; 23 (2): 159-165

    Abstract

    The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU).We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer.A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39% were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17% and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32% of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21%, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50% were transferred within 24 h of admission.Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.

    View details for DOI 10.1007/s12028-015-0123-z

    View details for Web of Science ID 000360700700003

    View details for PubMedID 25680399

  • Opsoclonus-myoclonus syndrome in a patient with an anaplastic oligoastrocytoma JOURNAL OF NEURO-ONCOLOGY Gold, C. A., Lassman, A. B., Odia, Y. 2015; 123 (2): 315-316

    View details for DOI 10.1007/s11060-015-1783-4

    View details for Web of Science ID 000355632800015

    View details for PubMedID 25864100

  • New-onset seizures in two adults with hemophagocytic lymphohistiocytosis JOURNAL OF NEUROLOGY Gold, C. A., Sheth, S. J., Agarwal, S., Claassen, J., Foreman, B. 2015; 262 (4): 1063-1065

    View details for DOI 10.1007/s00415-015-7669-8

    View details for Web of Science ID 000353295400034

    View details for PubMedID 25701009

  • Patient page. Driving after a stroke. Neurology Karceski, S., Gold, C. A. 2011; 76 (8): e35-8

    View details for DOI 10.1212/WNL.0b013e3182104170

    View details for PubMedID 21339494

  • Discrimination and reliance on conceptual fluency cues are inversely related in patients with mild Alzheimer's disease NEUROPSYCHOLOGIA Wolk, D. A., Gold, C. A., Signoff, E. D., Budson, A. E. 2009; 47 (8-9): 1865-1872

    Abstract

    Prior work suggests that patients with mild Alzheimer's disease (AD) often base their recognition memory decisions on familiarity. It has been argued that conceptual fluency may play an important role in the feeling of familiarity. In the present study we measured the effect of conceptual fluency manipulations on recognition judgments of patients with mild AD and older adult controls. "Easy" and "hard" test conditions were created by manipulating encoding depth and list length to yield high and low discrimination, respectively. When the two participant groups performed identical procedures, AD patients displayed lower discrimination and greater reliance on fluency cues than controls. However, when the discrimination of older adult controls was decreased to the level of AD patients by use of a shallow encoding task, we found that controls reliance on fluency did not statistically differ from AD patients. Furthermore, we found that increasing discrimination using shorter study lists resulted in AD patients decreasing their reliance on fluency cues to a similar extent as controls. These findings support the notion that patients with AD are able to attribute conceptual fluency to prior experience. In addition, these findings suggest that discrimination and reliance on fluency cues may be inversely related in both AD patients and older adult controls.

    View details for DOI 10.1016/j.neuropsychologia.2009.02.029

    View details for Web of Science ID 000266701600010

    View details for PubMedID 19428418

  • An evaluation of recollection and familiarity in Alzheimer's disease and mild cognitive impairment using receiver operating characteristics BRAIN AND COGNITION Ally, B. A., Gold, C. A., Budson, A. E. 2009; 69 (3): 504-513

    Abstract

    There is a need to investigate exactly how memory breaks down in the course of Alzheimer's disease (AD). Examining what aspects of memorial processing remain relatively intact early in the disease process will allow us to develop behavioral interventions and possible drug therapies focused on these intact processes. Several recent studies have worked to understand the processes of recollection and familiarity in patients with mild cognitive impairment (MCI) and very mild AD. Although there is general agreement that these patient groups are relatively unable to use recollection to support veridical recognition decisions, there has been some question as to how well these patients can use familiarity. The current study used receiver operating characteristic (ROC) curves and a depth of processing manipulation to understand the effect of MCI and AD on the estimates of recollection and familiarity. Results showed that patients with MCI and AD were impaired in both recollection and familiarity, regardless of the depth of encoding. These results are discussed in relation to disease pathology and in the context of recent conflicting evidence as to whether familiarity remains intact in patients with MCI. The authors highlight differences in stimuli type and task difficulty as possibly modulating the ability of these patients to successfully use familiarity in support of memorial decisions.

    View details for DOI 10.1016/j.bandc.2008.11.003

    View details for Web of Science ID 000264220800008

    View details for PubMedID 19101064

  • The picture superiority effect in patients with Alzheimer's disease and mild cognitive impairment NEUROPSYCHOLOGIA Ally, B., Gold, C. A., Budson, A. E. 2009; 47 (2): 595-598

    Abstract

    The fact that pictures are better remembered than words has been reported in the literature for over 30 years. While this picture superiority effect has been consistently found in healthy young and older adults, no study has directly evaluated the presence of the effect in patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). Clinical observations have indicated that pictures enhance memory in these patients, suggesting that the picture superiority effect may be intact. However, several studies have reported visual processing impairments in AD and MCI patients which might diminish the picture superiority effect. Using a recognition memory paradigm, we tested memory for pictures versus words in these patients. The results showed that the picture superiority effect is intact, and that these patients showed a similar benefit to healthy controls from studying pictures compared to words. The findings are discussed in terms of visual processing and possible clinical importance.

    View details for DOI 10.1016/j.neuropsychologia.2008.10.010

    View details for Web of Science ID 000263815300034

    View details for PubMedID 18992266

  • Memory loss in Alzheimer's disease: implications for development of therapeutics. Expert review of neurotherapeutics Gold, C. A., Budson, A. E. 2008; 8 (12): 1879-1891

    Abstract

    Alzheimer's disease (AD) is a progressive neurodegenerative disease marked by a constellation of cognitive disturbances, the earliest and most prominent being impaired episodic memory. Episodic memory refers to the memory system that allows an individual to consciously retrieve a previously experienced item or episode of life. Many recent studies have focused on characterizing how AD pathology impacts particular aspects of episodic memory and underlying mental and neural processes. This review summarizes the findings of those studies and discusses the effects of current and promising treatments for AD on episodic memory. The goal of this review is to raise awareness of the strides that cognitive neuroscientists have made in understanding intact and dysfunctional memory. Knowledge of the specific memorial processes that are impaired in AD may be of great value to basic scientists developing novel therapies and to clinical researchers assessing the efficacy of those therapies.

    View details for DOI 10.1586/14737175.8.12.1879

    View details for PubMedID 19086882

  • Conceptual fluency at test shifts recognition response bias in Alzheimer's disease: Implications for increased false recognition NEUROPSYCHOLOGIA Gold, C. A., Marchant, N. L., Koutstaal, W., Schacter, D. L., Budson, A. E. 2007; 45 (12): 2791-2801

    Abstract

    The presence or absence of conceptual information in pictorial stimuli may explain the mixed findings of previous studies of false recognition in patients with mild Alzheimer's disease (AD). To test this hypothesis, 48 patients with AD were compared to 48 healthy older adults on a recognition task first described by Koutstaal et al. [Koutstaal, W., Reddy, C., Jackson, E. M., Prince, S., Cendan, D. L., & Schacter D. L. (2003). False recognition of abstract versus common objects in older and younger adults: Testing the semantic categorization account. Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 499-510]. Participants studied and were tested on their memory for categorized ambiguous pictures of common objects. The presence of conceptual information at study and/or test was manipulated by providing or withholding disambiguating semantic labels. Analyses focused on testing two competing theories. The semantic encoding hypothesis, which posits that the inter-item perceptual details are not encoded by AD patients when conceptual information is present in the stimuli, was not supported by the findings. In contrast, the conceptual fluency hypothesis was supported. Enhanced conceptual fluency at test dramatically shifted AD patients to a more liberal response bias, raising their false recognition. These results suggest that patients with AD rely on the fluency of test items in making recognition memory decisions. We speculate that AD patients' over reliance upon fluency may be attributable to (1) dysfunction of the hippocampus, disrupting recollection, and/or (2) dysfunction of prefrontal cortex, disrupting post-retrieval processes.

    View details for DOI 10.1016/j.neuropsychologia.2007.04.021

    View details for Web of Science ID 000249145800015

    View details for PubMedID 17573074