Dr. Gold is a board-certified general 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 has a particular clinical interest in the inpatient diagnosis of uncommon or rare neurological disorders. He directs quality improvement for the department of Neurology and is actively involved in projects to improve the experience of hospitalized patients with neurological conditions at Stanford. His 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.
For more information on the Stanford Neurohospitalist Program & Fellowship, please visit: https://med.stanford.edu/neurology/divisions/neurohospitalist.html
Additional information on Stanford Neurology's efforts in Quality, Safety, & Value can be found here: http://med.stanford.edu/neurology/quality.html
Director, Neurology Residency Communication Coaching Program (2019 - Present)
Chair, Neurology Quality Council (2017 - Present)
Physician Improvement Leader for Improvement Capability Project, Department of Neurology (2017 - Present)
Chair, Neurohospitalist Section of the American Academy of Neurology (2017 - 2021)
Member, H1/L5 MD-RN Unit Council (2016 - Present)
Member, Neurology Professional Practice Evaluation Committee (2016 - Present)
Member, Stanford Quality, Patient Safety, & Effectiveness Comittee (QPSEC) (2016 - Present)
Honors & Awards
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 (2017-2018)
Boards, Advisory Committees, Professional Organizations
Member, American Academy of Neurology (2009 - Present)
Member, Neurohospitalist Society (2014 - Present)
Fellowship, University of California, San Francisco, Neurohospitalist Fellowship (2016)
Board Certification: Neurology, American Board of Psychiatry and 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)
Education Research: A novel resident-driven neurology quality improvement curriculum.
2020; 94 (3): 137–42
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
Eponyms are here to stay: Usage in the literature and among current neurology trainees.
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
National Variability in Prion Disease-Related Safety Policies for Neurologic Procedures.
2019; 9 (4): 222–25
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 2019; 9 (3): 172–73
Plateau waves of intracranial pressure mimicking seizure in a patient with fungal meningitis
LIPPINCOTT WILLIAMS & WILKINS. 2019
View details for Web of Science ID 000475965901049
- Author response: Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies. Neurology 2019; 92 (6): 303
- Coexistence of Neuromyelitis Optica and Amyotrophic Lateral Sclerosis: A Case Report NEUROHOSPITALIST 2019; 9 (1): 37–40
Education Research: Understanding barriers to goals of care communication for neurology trainees.
2019; 93 (8): 362–66
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 2018; 75 (10): 1173–74
Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices.
View details for PubMedID 29971323
Variability of Safety Policies Related to Prion Disease Among Top Neurological Institutions
LIPPINCOTT WILLIAMS & WILKINS. 2018
View details for Web of Science ID 000453090805308
A Quality Improvement Curriculum for Neurology Residents
LIPPINCOTT WILLIAMS & WILKINS. 2018
View details for Web of Science ID 000453090805218
Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies.
2018; 90 (14): 660–61
View details for PubMedID 29610228
- Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies NEUROLOGY 2018; 90 (14): 660–61
Young Man With Paraparesis.
Annals of emergency medicine
2018; 72 (3): e19–e20
View details for PubMedID 30144875
Teaching NeuroImages: Myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis.
2017; 89 (21): e253
View details for PubMedID 29158303
- Anticipating the Challenges of Zika Virus and the Incidence of Guillain-Barré Syndrome. JAMA neurology 2016
Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases.
2016; 6 (4): 161–66
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
Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit
2015; 23 (2): 159-165
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 2015; 123 (2): 315-316
- New-onset seizures in two adults with hemophagocytic lymphohistiocytosis JOURNAL OF NEUROLOGY 2015; 262 (4): 1063-1065
- Patient page. Driving after a stroke. Neurology 2011; 76 (8): e35-8
Discrimination and reliance on conceptual fluency cues are inversely related in patients with mild Alzheimer's disease
2009; 47 (8-9): 1865-1872
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
2009; 69 (3): 504-513
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
2009; 47 (2): 595-598
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
2008; 8 (12): 1879-1891
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 10.1586/14737184.108.40.2069
View details for PubMedID 19086882
Conceptual fluency at test shifts recognition response bias in Alzheimer's disease: Implications for increased false recognition
2007; 45 (12): 2791-2801
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