neurologists

hidden

The Pursuit of Gender Equality: A WISE Idea

Siddharth Sehgal, MD

Each year, the second Sunday of May is observed as Mother’s Day. This day provides an opportunity to celebrate and honor the mothers in our lives. Mothers make many sacrifices to ensure that their kids lead healthy and successful lives. They continually strive to balance their family and professional responsibilities. Women often put their careers on hold in order to raise their families. Even though there has been some improvement in recognition of gender bias issues inside workplaces, women are more likely to face family related interruptions in their careers1. This social construct along with the culture of bias and discrimination in the workplace has led to women being grossly underrepresented in positions of leadership and influence, healthcare being no exception to this phenomenon. Lower salaries, a work culture that favors men, and sexual harassment are some grave challenges that women encounter in their professional lives. There has been a growing awareness of this problem in the last few years, thanks to efforts lead by organizations such as TIME’S UP.

Within the field of academic Neurology, there has been a growing call to recognize these issues related to gender disparity2. Women are underrepresented both as recruited subjects in neurological clinical trials and also as project leaders for those clinical trials. A recent observational study found that only about 31% of all academic Neurology positions are held by women; this disparity widens as the academic rank increases with only 13.8% of Neurology professors being women3. Men also appear to have a higher rate of academic publications than women, with larger gaps seen at junior faculty positions. Similar gender inequities have been noted in other specialties including neurosurgery, orthopedic surgery and radiology4. However, this disparity cannot be explained by a lack of female representation in medical schools. American Association of Medical Colleges data from 2017 revealed that female students accounted for 50.7% of all enrollees in medical schools, which is a 9.6% increase since 20155.

Similar to the business world, social media has played an important role in increasing recognition and reporting of gender disparities within the field of Neurology. Women Neurologists Group (WNG) was formed in 2015 as a closed Facebook group, which now has more than 2,000 members and also has more than 1,000 followers on Twitter (@WNGtweets). This group of “Women neurologists networking and supporting each other” provides a platform for women neurologists to discuss, among other topics, issues related to maintaining the family-work balance. According to Dr. Kathrin Lafaver (@LaFaverMD, Assistant Professor of Neurology at University of Louisville) who is one of the founding members of the group, this forum has provided a safe space for women to share their experiences and opinions about a variety of subjects including the problem of gender disparity and it’s potential solutions6. The American Academy of Neurology set up a task force to study the underlying causes of gender disparity in the field and put forth recommendations to tackle this problem. As part of this initiative, the academy established a “Women leading in Neurology” program in 2017 which aims to help women neurologists gain the appropriate leadership skills to advance their careers and attain top tier positions within their field.

Gender disparity in healthcare is obviously not an issue unique to the United States and is becoming recognized around the world. Last year, the European Stroke Organization (ESO) established WISE (Women Initiative for Stroke in Europe), with its main goal of improving stroke care for women across Europe. The group aims to increase awareness about stroke risk factors and symptoms  in women and to ensure gender equity when it comes to stroke care in the continent. One of the objectives of the group is to support women clinicians and researchers in the field of stroke medicine and to help them attain leadership positions. The group organized their second annual WISE stroke leadership workshop earlier this week in conjunction with the ESO conference in Milan, Italy. During this workshop, Dr. Natalia Rost (@nsanar Professor of Neurology, Harvard University) represented the STROKE journal and provided a call for action to increase female leadership in the field of academic stroke neurology. She advocated for increased transparency within academic departments, recognizing achievements and contributions of women scientists and promoting diversity within scientific committees and editorial boards7. These are important steps toward establishing a culture of equality and fairness within the field of medicine.

While there is a clear commitment within neuroscience and the medical community at large to promote diversity inside academic and clinical arenas; a lot still needs to be done to help women maximize their potential as clinicians, educators and researchers. At this time of the year when we celebrate Mother’s day, let’s all pledge to support the women in our lives so that they can attain all the personal and professional success that they deserve.

 

References:

  1. https://www.pewresearch.org/fact-tank/2015/03/10/women-still-bear-heavier-load-than-men-balancing-work-family/
  2. Silver JK, Bank AM, Slocum CS, Blauwet CA, Bhatnagar S, Poorman JA, et al. Women physicians underrepresented in American Academy of Neurology recognition awards. Neurology. 2018;91:e603–e614
  3. McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV, et al. Sex differences in academic rank and publication rate at top- ranked US neurology programs. JAMA Neurol. 2018;75:956–961
  4. Jagsi, Reshma et al. Sex, Role Models, and Specialty Choices Among Graduates of US Medical Schools in 2006–2008. Journal of the American College of Surgeons , Volume 218 , Issue 3 , 345 – 352
  5. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/5c/26/5c262575-52f9-4608-96d6-a78cdaa4b203/2017_applicant_and_matriculant_data_tables.pdf
  6. https://journals.lww.com/neurotodayonline/FullText/2018/07190/Neurologists_on_Social_Media__The_Women.13.aspx
  7. Charlotte Cordonnier, Shelagh B. Coutts, Karen C. Johnston, Natalia S. Rost. Crucial Role of Women’s Leadership in Academic Stroke Medicine You Can’t Be What You Can’t See. https://doi.org/10.1161/STROKEAHA.118.024788
hidden

Parsing The Updated 2018 Acute Ischemic Stroke Guidelines: Smoking Cessation

Neal Parikh, MD

The 2018 International Stroke Conference was headlined by the practice-changing results of DEFUSE 3 and related acute stroke care guideline updates. Having returned to our institutions, neurologists are parsing the updated 2018 acute ischemic stroke guidelines1 and wondering how best to operationalize the latest data.
 
Overshadowed by updated guidelines regarding the extended window and buried among changes regarding the utility of indiscriminate use of routine diagnostic testing, was a change regarding smoking cessation.
 
While the guidelines committee did not find any randomized trials of pharmacological smoking cessation aides specifically for stroke patients, they cite a randomized trial in acute coronary patients:2 patients randomized to receive a pharmacological cessation aide had a significant improvement in abstinence. In terms of observational data, a recent study found that patients with stroke who quit smoking had a reduced rate of cardiovascular disease and mortality over 5 years.3 Based partially on such evidence, the updated guidelines provide a IIb recommendation that “for smokers with an acute ischemic stroke, in-hospital initiation of varenicline might be considered”.1
 
A class I recommendation to “strongly advise every patient with acute ischemic stroke who has smoked in the past year to quit” remains in place and is buttressed with a IIb option to consider “interventions that incorporate both pharmacotherapy and behavioral support”.1
 
While Get With the Guidelines-Stroke has seen a substantial improvement in “appropriate” smoking cessation interventions at the time of hospital discharge,4 a distinction between counselling and pharmacotherapy was not made. Therefore, whether effective smoking cessation interventions are being initiated is unknown.
 
Whereas the extended window guidelines influence care for a small group of acute stroke patients, the smoking cessation guidelines apply to every single acute stroke and TIA patient who is an active smoker. Neurologists, particularly stroke neurologists and hospitalists, should familiarize themselves with the updated guidelines, the relevant data, and pharmacological interventions. 
 
References:

  1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke 2018. DOI: 10.1161/STR.0000000000000158.
  2. Eisenberg MJ, Windle SB, Roy N, Old W, Grondin FR, Bata I, et al. Varenicline for Smoking Cessation in Hospitalized Patients with Acute Coronary Syndrome. Circulation. 2016:133;21-30.
  3. Epstein KA, Viscoli CM, Spence JD, Young LH, Inzucchi SE, Gorman M, et al. Smoking cessation and outcome after ischemic stroke or TIA. Neurology. 2017:89;1723-1729. 
  4. Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke and Vascular Neurology 2017;2:doi:10.1136/svn-2017-000092

Neal Parikh Headshot

Neal S. Parikh, MD, earned his MD from Weill Cornell Medical College and completed residency training in neurology at the same institution. He is now an NIH T32 neuro-epidemiology and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center. He tweets @NealSParikhMD and contributes to Blogging Stroke as a blogger.
hidden

New Hypertension Guidelines: Why Neurologists Should Pay Attention

Neal Parikh, MD

Scientific Sessions generated a great deal of buzz in the traditional and social media spheres, particularly with regards to the new ACC/AHA High Blood Pressure Guidelines. The lay media was quick to note that nearly half of the US population will now be considered hypertensive, and some doctors expressed concern that some patients may incur undue harm from over-zealous anti-hypertensive therapy.
 
It is important first to note that the guidelines do not require or recommend that individuals with blood pressure values falling in the “Elevated Blood Pressure” or “Stage I Hypertension” categories be reflexively treated with anti-hypertensive medication. There is room for consideration of overall-risk and prior cardiovascular events. There is an explicit role for non-pharmacological therapy. Some have noted that that while the number of individuals now considered “hypertensive” will increase, the number requiring pharmacological treatment will not increase as dramatically.
 
That said, why should neurologists pay attention? First, the previously-used term “pre-hypertensive” is decidedly not alarming. The updated guidelines’ use of “elevated blood pressure” is clear and unambiguous; patients and their physicians will be prompted to action earlier. Given that hypertension is a leading risk factor for stroke, we will hopefully see stroke rates decrease with time. Second, neurologists should pay attention because some patients may see us more frequently than their primary care physicians. We should be aware of these guidelines so that we are prepared to appropriately counsel and/or refer patients with elevated blood pressure. A check-in for a migraine or epilepsy medication refill may yield an opportunity to reduce long-term cardiovascular risk!
 
I look forward to seeing the public health gains materialize from dissemination and implementation of these guidelines.

Neal Parikh Headshot

Neal S. Parikh, MD, earned his MD from Weill Cornell Medical College and completed residency training in neurology at the same institution. He is now an NIH T32 neuro-epidemiology and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center. He tweets @ NealSParikhMD and contributes to Blogging Stroke as a blogger.