Approach to Tremor Disorders

Lee, Andrea; Sarva, Harini

doi:10.1055/s-0041-1726356

Cited by 2 publications

(1 citation statement)

References 141 publications

(195 reference statements)

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“…Many previously reported wellness initiatives in other residencies seemed to primarily focus on community/team building. 9-12 A dedicated WC should make use of institutional resources but also be innovative in engaging residents and faculty in meaningful reflection and identifying/preventing signs of burnout. Support from faculty at the highest level of departmental leadership is important for the sustained success of a wellness program 13 and this model was recently demonstrated in the Department of Neurology at the Mayo Clinic.…”

Section: Discussionmentioning

confidence: 99%

Six Steps to Achieve Meaning, Wellness, and Avoid Burnout in a Residency Program

Stamm

Lineback

et al. 2020

Journal of Medical Education and Curricular Development

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Burnout has become an increasingly recognized problem in higher medical education and is particularly prevalent within the field of Neurology and its training programs. Many previously reported wellness initiatives in other residencies focused mainly on community/team building. We developed a comprehensive Wellness Curriculum (WC) and established a new role of Resident Wellness Liaison in order to facilitate wellness across the department and training program. Here we present a 6-step outline of our WC which can easily be adapted to the needs of other programs. The steps include creating a Wellness Committee with a Resident Wellness Liaison, identification and optimization of institutional resources, identifying and troubleshooting barriers to wellness, providing education and reflection on wellness, showing appreciation to each other, and assessing the impact of the implemented strategies. In order to measure the impact of our WC and to perform a needs assessment for future directions, we posed questions—grounded in the theory of drivers of burnout and engagement—to our residents (N = 24) at a noon conference in the summer of 2020. Interventions implemented at our institution have been very well received by residents, as evidenced by their comments and feedback. Themes that were highlighted by residents include enjoying flexibility, having a welcoming social support system at work, and being able to find meaning in the day-to-day work. The creation of a comprehensive WC is a feasible and meaningful intervention for addressing resident wellness in a Neurology training program and could be adapted to other programs.

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Section: Discussionmentioning

confidence: 99%

Six Steps to Achieve Meaning, Wellness, and Avoid Burnout in a Residency Program

Stamm

Lineback

et al. 2020

Journal of Medical Education and Curricular Development

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Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Panyakaew,

Phuenpathom,

Bhidayasiri

et al. 2024

Asian Biomedicine

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The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient’s disabilities.

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Approach to Tremor Disorders

Cited by 2 publications

References 141 publications

Six Steps to Achieve Meaning, Wellness, and Avoid Burnout in a Residency Program

Six Steps to Achieve Meaning, Wellness, and Avoid Burnout in a Residency Program

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

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