Mullan, Aidan F.

ObjectiveTo explore the clinical progression of the brain‐/body‐first categories within Lewy body disease (LBD): Parkinson's disease (PD), dementia with Lewy bodies (DLB), and PD dementia.MethodsWe used of the Rochester Epidemiology Project to establish a population‐based cohort of clinically diagnosed LBD. We used two definitions for differentiating between brain‐ and body‐first LBD: a previously hypothesized body‐first presentation in patients with rapid eye movement sleep behavior onset before motor symptoms onset; and an expanded definition of body‐first LBD when a patient had at least 2 premotor symptoms between constipation, erectile dysfunction, rapid eye movement sleep behavior, anosmia, or neurogenic bladder.ResultsBrain‐first patients were more likely to be diagnosed with PD (RR = 1.43, p = 0.003), whereas body‐first patients were more likely to be diagnosed with DLB (RR = 3.15, p < 0.001). Under the expanded definition, there was no difference in LBD diagnosis between brain‐first and body‐first patients (PD: RR = 1.03, p = 0.10; DLB: RR = 0.88, p = 0.58) There were no patterns between brain‐ or body‐first presentation, PD dementia under either definition (original: p = 0.09, expanded: p = 0.97), and no significant difference in motor symptoms between brain‐first and body‐first.InterpretationOur findings do not support the dichotomous classification of body‐first and brain‐first LBD with the currently proposed definition. Biological exposures resulting in PD and DLB are unlikely to converge on a binary classification of top‐down or bottom‐up synuclein pathology. ANN NEUROL 2024;96:551–559

AbstractObjectivesThis needs assessment aimed to improve understanding of flexible endoscopic intubation training and practice in emergency medicine (EM), providing insights to educators and practice leaders seeking to improve education and practices.MethodsWe conducted a multicenter, mixed‐methods needs assessment of emergency physicians (EPs) incorporating focus groups and a survey. Focus groups comprised community EPs, academic EPs, and resident EPs. We analyzed focus group transcripts using grounded theory, qualitatively describing EM endoscopic intubation. The qualitative analysis shaped our survey instrument, which we deployed in cross‐sectional fashion. We report survey data with descriptive statistics.ResultsFocus groups with 13 EPs identified three themes: indications for use of endoscopic intubation, factors impacting a physician's decision to endoscopically intubate, and attaining and maintaining endoscopic intubation competency. Of 257 surveyed EPs (33% response rate), 79% had received endoscopic intubation training during residency, though 82% had performed this procedure 10 or fewer times in their career. Despite 97% acknowledging the necessity of competency, only 23% felt highly confident in their ability to perform endoscopic intubation. Participants (93%) reported scarce opportunities to perform the procedure and identified factors believed to facilitate competency acquisition and maintenance, including opportunities to perform endoscopic intubation in practice (98%), local champions (93%), and performing nasopharyngoscopy (87%).ConclusionsWhile most EPs acknowledged the importance of competency in endoscopic intubation, they reported scarce procedural opportunities and commonly expressed low confidence. Further research is needed on this topic, and we propose avenues to enhance education and practices related to endoscopic intubation. These include development of robust procedural curricula, support of local champions, and incorporating nasopharyngoscopy into EM practice.

This cross-sectional study assesses list prices, cash prices, and negotiated rates for emergency department services.