Neurology Health Advocacy Curriculum: Needs Assessment, Curricular Content and Underlying Components.

BACKGROUND: Lack of a health advocacy curriculum and clarity are obstacles for effectively teaching neurology health advocacy (NHA) to neurology residents. Our purpose is to assess the need and develop content for a NHA curriculum and to describe its underlying components. METHODS: This is a cross-sectional study with two steps. In step one, neurologists and neurology residents at University of Calgary were surveyed about their perception of teaching NHA and asked to rank 56 neurological diseases on a Likert scale based on how well they lend themselves to teaching health advocacy. In step two, curricular items were developed for the top five neurological diseases, using a modified Delphi procedure. The reliability of the survey instrument was determined by Cronbach's alpha. Exploratory factor analysis was used to identify the underlying components of NHA. RESULTS: Forty-six neurologists and 14 neurology residents were surveyed, with a response rate of 88.33%. Fifty-six percent of neurologists and 85% of residents believe that NHA curriculum is needed. The top five neurological presentations, that lend themselves easily to teaching NHA were: stroke/transient ischemic attacks, alcoholism, epilepsy, Alzheimer's disease, and multiple sclerosis. The survey instrument reliability was 0.97. Exploratory factor analysis revealed four factors that can explain the variability in the survey instrument: multidisciplinary approach to neurological disorders, prevention of recurrence of neurological disease, collaboration with other medical subspecialties, and communication with professions outside the medical field. CONCLUSION: Neurologists' and residents' responses support that NHA curriculum is needed. Four components of NHA were identified that can be used for teaching NHA as well as health advocacy in general practice.

Blood pressure oscillations in baroreflex failure.

A 67-year-old man presented with labile hypertension and orthostatic hypotension after radical neck dissection and radiotherapy for squamus cell carcinoma. Baroreflex failure is clearly evident on autonomic testing.