2024
SOFA score performs worse than age for predicting mortality in patients with COVID-19
Sherak R, Sajjadi H, Khimani N, Tolchin B, Jubanyik K, Taylor R, Schulz W, Mortazavi B, Haimovich A. SOFA score performs worse than age for predicting mortality in patients with COVID-19. PLOS ONE 2024, 19: e0301013. PMID: 38758942, PMCID: PMC11101117, DOI: 10.1371/journal.pone.0301013.Peer-Reviewed Original ResearchConceptsCrisis standards of careIn-hospital mortalityIntensive care unitAcademic health systemSequential Organ Failure Assessment scoreCohort of intensive care unitSequential Organ Failure AssessmentStandard of careLogistic regression modelsMortality predictionPredicting in-hospital mortalityHealth systemUnivariate logistic regression modelCrisis standardsDisease morbidityCOVID-19
2022
A Hub and Spoke Model for Improving Access and Standardizing Ethics Consultations Across a Large Healthcare System
Tolchin B, Bruce L, Mercurio M, Latham SR. A Hub and Spoke Model for Improving Access and Standardizing Ethics Consultations Across a Large Healthcare System. The American Journal Of Bioethics 2022, 22: 42-45. PMID: 35420520, DOI: 10.1080/15265161.2022.2044551.Peer-Reviewed Original ResearchVisually sensitive seizures: An updated review by the Epilepsy Foundation
Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022, 63: 739-768. PMID: 35132632, DOI: 10.1111/epi.17175.Peer-Reviewed Original ResearchConceptsPhotosensitive seizuresAntiseizure drugsPhotoparoxysmal responseEpilepsy FoundationPrevention of seizuresLight-induced seizuresWhite matter tractsSignificant public health hazardSpontaneous seizuresNonsystematic literature reviewGeneralized epilepsyPublic health hazardPhotosensitivity modelAbnormal connectivityOccipital cortexProvocative stimuliSeizuresVisual fieldVisual stimulationBrain imagingColor flashesUpdated reviewEpilepsySelection biasDrugs
2021
Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary
Gloss D, Pargeon K, Pack A, Varma J, French JA, Tolchin B, Dlugos DJ, Mikati MA, Harden C. Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary. Neurology 2021, 97: 1072-1081. PMID: 34873018, DOI: 10.1212/wnl.0000000000012944.Peer-Reviewed Original ResearchConceptsAntiseizure medicationsSeizure recurrenceSeizure freedomASM withdrawalPediatric patientsInsufficient evidenceAntiseizure medication withdrawalSeizure-free adultsSeizure-free patientsNeurology practice parameterSignificant differencesLong-term riskQuality of lifeMedication withdrawalStatus epilepticusEpilepsy surgeryPractice parametersRecurrencePatientsAmerican AcademyEpileptiform EEGMonthsWithdrawalAdultsRiskReflections on New Evidence on Crisis Standards of Care in the COVID-19 Pandemic.
Tolchin B, Latham SR, Bruce L, Ferrante LE, Kraschel K, Jubanyik K, Hull SC, Herbst JL, Kapo J, Moritz ED, Hughes J, Siegel MD, Mercurio MR. Reflections on New Evidence on Crisis Standards of Care in the COVID-19 Pandemic. The Journal Of Clinical Ethics 2021, 32: 358-360. PMID: 34928864, DOI: 10.1086/jce2021324358.Commentaries, Editorials and LettersConceptsSOFA scoreBlack patientsCrisis standardsSequential Organ Failure Assessment scoreOrgan Failure Assessment scoreAccurate prognostic scoresNext public health emergencyCOVID-19 patientsLife-saving medical resourcesMedical resourcesCOVID-19 pandemicSame scoring systemPublic health emergencyPrognostic scoreBody of evidenceRare casePatientsScoring systemTriage purposesAssessment scoresHealth emergencyCareHealthcare systemCOVID-19ScoresHow to do things with words Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures
Wardrope A, Dworetzky BA, Barkley GL, Baslet G, Buchhalter J, Doss J, Goldstein LH, Hallett M, Kozlowska K, LaFrance WC, McGonigal A, Mildon B, Oto M, Perez DL, Riker E, Roberts NA, Stone J, Tolchin B, Reuber M. How to do things with words Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures. Seizure 2021, 93: 102-110. PMID: 34740139, PMCID: PMC9308960, DOI: 10.1016/j.seizure.2021.10.016.Peer-Reviewed Original ResearchConceptsPsychogenic non-epileptic seizuresNon-epileptic attack disorderFunctional seizuresDissociative seizuresNon-epileptic seizuresAmerican Epilepsy SocietyHealth care systemNew diagnostic labelSynchronous electrical activityPatient responseDifferential diagnosisEpilepsy SocietyAttack disorderConversion disorderEpileptic seizuresSeizuresCare systemElectrical activityDiagnostic labelsDiagnosisDisordersEpilepsyPseudoseizuresBrainParoxysmsRacial disparities in the SOFA score among patients hospitalized with COVID-19
Tolchin B, Oladele C, Galusha D, Kashyap N, Showstark M, Bonito J, Salazar MC, Herbst JL, Martino S, Kim N, Nash KA, Tiako M, Roy S, Greeno R, Jubanyik K. Racial disparities in the SOFA score among patients hospitalized with COVID-19. PLOS ONE 2021, 16: e0257608. PMID: 34535009, PMCID: PMC8448580, DOI: 10.1371/journal.pone.0257608.Peer-Reviewed Original ResearchConceptsNon-Hispanic white patientsNon-Hispanic black patientsNon-Hispanic blacksSOFA scoreHours of admissionNon-Hispanic whitesWhite patientsHispanic patientsBlack patientsCOVID-19Yale New Haven Health SystemSequential Organ Failure Assessment scoreOrgan Failure Assessment scoreElevated SOFA scoreRetrospective cohort studyCrisis standardsMedical resourcesFull multivariate modelHospital mortalityCohort studyConsecutive patientsMedian agePrimary outcomeFirst admissionInclusion criteriaThe potential impact of triage protocols on racial disparities in clinical outcomes among COVID-positive patients in a large academic healthcare system
Roy S, Showstark M, Tolchin B, Kashyap N, Bonito J, Salazar MC, Herbst JL, Nash KA, Tiako M, Jubanyik K, Kim N, Galusha D, Wang KH, Oladele C. The potential impact of triage protocols on racial disparities in clinical outcomes among COVID-positive patients in a large academic healthcare system. PLOS ONE 2021, 16: e0256763. PMID: 34529684, PMCID: PMC8445412, DOI: 10.1371/journal.pone.0256763.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overBlack or African AmericanConnecticutCOVID-19Delivery of Health CareFemaleHealthcare DisparitiesHispanic or LatinoHospital MortalityHospitals, UniversityHumansMaleMiddle AgedOrgan Dysfunction ScoresPandemicsRetrospective StudiesSARS-CoV-2TriageWhite PeopleYoung AdultConceptsCOVID-positive patientsHigher SOFA scoreSOFA scoreClinical outcomesBlack patientsHospital mortalityICU admissionTriage protocolYale New Haven Health SystemSequential Organ Failure Assessment scoreHealthcare systemLarge academic healthcare systemOrgan Failure Assessment scoreRacial disparitiesSimilar clinical outcomesWorse clinical outcomesAcademic healthcare systemChi-square testRace/ethnicityPredictors of interestRetrospective cohortWhite patientsInsurance statusCOVID patientsTriage toolHow Should Clinicians Minimize Harms and Maximize Benefits When Diagnosing and Treating Disorders Without Biomarkers?
Tolchin B, Tolchin DW, Stein MA. How Should Clinicians Minimize Harms and Maximize Benefits When Diagnosing and Treating Disorders Without Biomarkers? The AMA Journal Of Ethic 2021, 23: e530-536. PMID: 34351262, DOI: 10.1001/amajethics.2021.530.Peer-Reviewed Original ResearchFunctional Seizures
Marcolini E, Tolchin B. Functional Seizures. Emergency Medicine Clinics Of North America 2021, 39: 123-132. PMID: 33218653, DOI: 10.1016/j.emc.2020.09.007.Peer-Reviewed Original ResearchConceptsFunctional seizuresEpileptic seizuresFunctional neurologic disordersElectroencephalography findingsPsychogenic seizuresTherapeutic challengeClinical historyEpileptic dischargesNeurologic disordersConversion disorderSeizuresMental illnessBiopsychosocial modelDisordersSocial factorsSymptomsIllness
2020
Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency.
Tolchin B, Latham SR, Bruce L, Ferrante LE, Kraschel K, Jubanyik K, Hull SC, Herbst JL, Kapo J, Moritz ED, Hughes J, Siegel MD, Mercurio MR. Developing a Triage Protocol for the COVID-19 Pandemic: Allocating Scarce Medical Resources in a Public Health Emergency. The Journal Of Clinical Ethics 2020, 31: 303-317. PMID: 32991327, DOI: 10.1086/jce2020314303.Peer-Reviewed Original ResearchConceptsPublic health emergencyTriage protocolScarce medical resourcesYale New Haven Health SystemMedical resourcesEthical challengesHealth emergencyCOVID-19 pandemicAllocating Scarce Medical ResourcesFuture wavesMajor ethical challengesChronic comorbiditiesPregnant patientsSimilar public health emergenciesHealthcare workersTriage assessmentClinical judgmentCoronavirus diseaseHealth systemSocioeconomic disparitiesRole of ageCOVID-19Less needPublic discussionSecondary goalNeuropsychiatric Aspects of Epilepsy
Tolchin B, Hirsch LJ, LaFrance WC. Neuropsychiatric Aspects of Epilepsy. Psychiatric Clinics Of North America 2020, 43: 275-290. PMID: 32439022, DOI: 10.1016/j.psc.2020.02.002.Peer-Reviewed Original ResearchConceptsNeuropsychiatric disordersNeuropsychiatric aspectsCertain neuropsychiatric disordersAntiseizure medicationsClinical outcomesTherapeutic optionsEpidemiologic studiesEpilepsyMultidisciplinary teamNeuropsychiatric impactDisordersBidirectional relationshipTreatmentClose collaborationComorbiditiesMedicationsPathophysiologySocial factorsDiagnosisAAN position statement: Ethical issues in clinical research in neurology
Tolchin B, Conwit R, Epstein LG, Russell JA, Law A. AAN position statement: Ethical issues in clinical research in neurology. Neurology 2020, 94: 661-669. PMID: 32179700, PMCID: PMC7251519, DOI: 10.1212/wnl.0000000000009241.Peer-Reviewed Original ResearchConceptsEthical issuesInstitutional review board oversightWorld Medical Association DeclarationImportant ethical issuesPrinciple-based frameworkCommon rulesModern bioethicsEthical frameworkNuremberg CodeBelmont ReportEthical conductFoundational documentsResearch participantsClinical researchReplication crisisBoard oversightParticipant inclusionHuman participantsDeclarationNeurologic researchPosition statementBioethicsIssuesConductGenetic testing
2019
Motivational Interviewing Techniques to Improve Psychotherapy Adherence and Outcomes for Patients With Psychogenic Nonepileptic Seizures
Tolchin B, Baslet G, Martino S, Suzuki J, Blumenfeld H, Hirsch LJ, Altalib H, Dworetzky BA. Motivational Interviewing Techniques to Improve Psychotherapy Adherence and Outcomes for Patients With Psychogenic Nonepileptic Seizures. Journal Of Neuropsychiatry 2019, 32: 125-131. PMID: 31466516, DOI: 10.1176/appi.neuropsych.19020045.Peer-Reviewed Original ResearchConceptsPsychogenic nonepileptic seizuresClinician-patient communicationNonepileptic seizuresTreatment of PNESPoor clinician-patient communicationPatient-based barriersMajority of patientsFunctional neurological disorderEmergency medicine physiciansHealth care providersMotivational interviewing techniquesPsychiatric comorbidityTreatment nonadherenceTreatment existsCare providersMedicine physiciansPatient engagementPatientsNeurological disordersSomatic symptomsPatient ambivalenceTime-limited goalsPsychological therapiesHealth careTreatment planningTreatment of Patients With Psychogenic Nonepileptic Attacks
Tolchin B, Martino S, Hirsch LJ. Treatment of Patients With Psychogenic Nonepileptic Attacks. JAMA 2019, 321: 1967-1968. PMID: 31026015, DOI: 10.1001/jama.2019.3520.Peer-Reviewed Original ResearchClinical Reasoning: A 71-year-old man receiving treatment for cryptococcal meningitis, developing new-onset lethargy
Peng TJ, Kimbrough T, Tolchin BD. Clinical Reasoning: A 71-year-old man receiving treatment for cryptococcal meningitis, developing new-onset lethargy. Neurology 2019, 92: 815-820. PMID: 31010911, DOI: 10.1212/wnl.0000000000007379.Peer-Reviewed Original ResearchRandomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures
Tolchin B, Baslet G, Suzuki J, Martino S, Blumenfeld H, Hirsch LJ, Altalib H, Dworetzky BA. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia 2019, 60: 986-995. PMID: 30980679, DOI: 10.1111/epi.14728.Peer-Reviewed Original ResearchConceptsPsychogenic nonepileptic seizuresQuality of lifeMI participantsPNES frequencyMotivational interviewingControl participantsNonepileptic seizuresQuaternary care medical centerEmergency department visitsEmergency department utilizationSingle neurologistDepartment visitsTreatment adherenceControl armMedical CenterMI armsSeizuresVisitsTrialsAdherenceParticipantsPsychotherapyAdherentArmReferralAdherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures.
Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures. Neurology 2019, 92: e675-e679. PMID: 30610097, PMCID: PMC6382361, DOI: 10.1212/wnl.0000000000006848.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAdult Survivors of Child AbuseAgedAged, 80 and overCohort StudiesConversion DisorderEmergency Service, HospitalEthnicityFemaleFollow-Up StudiesHumansMaleMiddle AgedMinority GroupsOdds RatioProspective StudiesPsychotherapyQuality of LifeSeizuresTreatment Adherence and ComplianceTreatment OutcomeYoung AdultConceptsPsychogenic nonepileptic seizuresQuality of lifePNES frequencyNonepileptic seizuresProspective cohort studyEmergency department utilizationTime of referralBaseline characteristicsCohort studyED visitsSeizure frequencyED utilizationPotential confoundersWomen's HospitalTreatment outcomesMedium effect sizeLocal therapistsMultivariate modelAdherenceChildhood abuseSeizuresHospitalSignificant reductionOutcomesEffect size
2018
Naming things: Its importance in youth with epilepsy.
Hermann BP, Tolchin B. Naming things: Its importance in youth with epilepsy. Neurology 2018, 92: 13-14. PMID: 30518555, DOI: 10.1212/wnl.0000000000006680.Peer-Reviewed Original ResearchMedical Ethics Education for Neurology Residents: Where Do We Go from Here?
Traner CB, Tolchin DW, Tolchin B. Medical Ethics Education for Neurology Residents: Where Do We Go from Here? Seminars In Neurology 2018, 38: 497-504. PMID: 30321887, DOI: 10.1055/s-0038-1667381.Peer-Reviewed Original Research