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Raskurazhev A, Kuznetsova P, Khizhnikova AE, Klochkov A, Bakulin I, Annushkin V, Tanashyan M, Suponeva N, Gnedovskaya E. Neuropoly: An Educational Board Game to Facilitate Neurology Learning. Front Syst Neurosci 2021; 15:688210. [PMID: 34690710 PMCID: PMC8527001 DOI: 10.3389/fnsys.2021.688210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Neurology is arguably one of the most difficult subjects to teach and study in the medical curriculum. Educational games (EG) may be a valid option to enhance motivation in neurology residents. Methods: We developed an educational board game (Neuropoly) to assist in teaching neurology. We present here an overview of the game, as well as the results of a pilot study aimed at determining: (a) the efficacy of the game in teaching certain neurological concepts; and (b) student compliance and satisfaction with the EG. Results: The pre- and post-play questionnaire scores differed significantly (3.2 ± 1.7 vs. 7.8 ± 1.6, p < 0.001). Our group of residents, showing an overwhelmingly positive response, very well received the game. The questions were rated as above average regarding difficulty. Conclusion: The “Neuropoly” educational board game has been shown to be interesting, efficient, and motivational among first- and second-year neurology residents. Novel educational methods for complex medical disciplines should be developed, with board games being a viable and inexpensive approach.
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Affiliation(s)
| | | | | | | | - Ilya Bakulin
- Research Center of Neurology (Russia), Moscow, Russia
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Greer DM, Shemie SD, Lewis A, Torrance S, Varelas P, Goldenberg FD, Bernat JL, Souter M, Topcuoglu MA, Alexandrov AW, Baldisseri M, Bleck T, Citerio G, Dawson R, Hoppe A, Jacobe S, Manara A, Nakagawa TA, Pope TM, Silvester W, Thomson D, Al Rahma H, Badenes R, Baker AJ, Cerny V, Chang C, Chang TR, Gnedovskaya E, Han MK, Honeybul S, Jimenez E, Kuroda Y, Liu G, Mallick UK, Marquevich V, Mejia-Mantilla J, Piradov M, Quayyum S, Shrestha GS, Su YY, Timmons SD, Teitelbaum J, Videtta W, Zirpe K, Sung G. Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA 2020; 324:1078-1097. [PMID: 32761206 DOI: 10.1001/jama.2020.11586] [Citation(s) in RCA: 258] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. OBJECTIVE To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. PROCESS Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery. EVIDENCE SYNTHESIS Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed. RECOMMENDATIONS Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability. CONCLUSIONS AND RELEVANCE This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.
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Affiliation(s)
- David M Greer
- Boston University School of Medicine, Boston, Massachusetts
| | - Sam D Shemie
- McGill University, Montreal Children's Hospital, Montreal, Canada
- Canadian Blood Services, Ottawa, Canada
| | | | | | | | | | - James L Bernat
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | - Anne W Alexandrov
- College of Nursing, University of Tennessee Health Science Center, Memphis
| | - Marie Baldisseri
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas Bleck
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Arnold Hoppe
- Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Stephen Jacobe
- University of Sydney and Children's Hospital of Westmead, Westmead, Australia
| | | | | | | | | | | | | | - Rafael Badenes
- Hospital Clinic Universitari, University of Valencia, Valencia, Spain
| | - Andrew J Baker
- St. Michael's Hospital, Unity Health Toronto and University of Toronto, Toronto, Canada
| | - Vladimir Cerny
- J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic
| | | | - Tiffany R Chang
- The University of Texas Health Science Center at Houston, Houston
| | | | - Moon-Ku Han
- Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | | | | | | | - Gang Liu
- Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | | | | | - Walter Videtta
- National Hospital, Alejandro Posadas, Buenos Aires, Argentina
| | | | - Gene Sung
- University of Southern California, Los Angeles
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Bakulin I, Zabirova A, Lagoda D, Poydasheva A, Cherkasova A, Pavlov N, Kopnin P, Sinitsyn D, Kremneva E, Fedorov M, Gnedovskaya E, Suponeva N, Piradov M. Combining HF rTMS over the Left DLPFC with Concurrent Cognitive Activity for the Offline Modulation of Working Memory in Healthy Volunteers: A Proof-of-Concept Study. Brain Sci 2020; 10:brainsci10020083. [PMID: 32033106 PMCID: PMC7071618 DOI: 10.3390/brainsci10020083] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 01/28/2023] Open
Abstract
It has been proposed that the effectiveness of non-invasive brain stimulation (NIBS) as a cognitive enhancement technique may be enhanced by combining the stimulation with concurrent cognitive activity. However, the benefits of such a combination in comparison to protocols without ongoing cognitive activity have not yet been studied. In the present study, we investigate the effects of fMRI-guided high-frequency repetitive transcranial magnetic stimulation (HF rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on working memory (WM) in healthy volunteers, using an n-back task with spatial and verbal stimuli and a spatial span task. In two combined protocols (TMS + WM + (maintenance) and TMS + WM + (rest)) trains of stimuli were applied in the maintenance and rest periods of the modified Sternberg task, respectively. We compared them to HF rTMS without a cognitive load (TMS + WM −) and control stimulation (TMS − WM + (maintenance)). No serious adverse effects appeared in this study. Among all protocols, significant effects on WM were shown only for the TMS + WM − with oppositely directed influences of this protocol on storage and manipulation in spatial WM. Moreover, there was a significant difference between the effects of TMS + WM − and TMS + WM + (maintenance), suggesting that simultaneous cognitive activity does not necessarily lead to an increase in TMS effects.
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Affiliation(s)
- Ilya Bakulin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
- Correspondence: ; Tel.: +7-495-490-2010
| | - Alfiia Zabirova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Dmitry Lagoda
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Alexandra Poydasheva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Anastasiia Cherkasova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Nikolay Pavlov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Peter Kopnin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Dmitry Sinitsyn
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Elena Kremneva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Maxim Fedorov
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, bld. 1, Territory of Innovation Center «Skolkovo», Moscow 121205, Russia;
| | - Elena Gnedovskaya
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
- Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, bld. 1, Territory of Innovation Center «Skolkovo», Moscow 121205, Russia;
| | - Natalia Suponeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
| | - Michael Piradov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.Z.); (D.L.); (A.P.); (A.C.); (N.P.); (P.K.); (D.S.); (E.K.); (E.G.); (N.S.); (M.P.)
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