Pearls and pitfalls in letters of recommendation for neurology residency applications.

Letters of recommendation are a cornerstone of residency applications. Variability and bias in letters exists across specialties, neurology being no exception. Studies done in other specialty fields assessing nuanced language uncovered key attention points for improvement and mitigation of bias, lessons from which should be applied in the field of neurology. We review common pearls and pitfalls in the letter solicitation, writing and reading process, with suggested best-practices for residency applicants, letter writers, and program faculty reviewers. We advocate for the thoughtful selection of writers, emphasis on highlighting professional skills, and attention to implicit bias. This discussion focuses on recommendations for US advanced or categorical neurology programs, but elements of this guidance may apply more broadly to fellowship and faculty promotion letters as well.

Efficacy of immunotherapy for melanoma brain metastases in patients with concurrent corticosteroid exposure.

Aim: Immune checkpoint inhibitor (ICI) efficacy is undefined for melanoma brain metastases (MBM) with concurrent corticosteroid exposure. Materials & methods: We retrospectively evaluated patients with untreated MBM who received corticosteroids (≥1.5 mg dexamethasone equivalent) within 30 days of ICI. mRECIST criteria and Kaplan-Meier methods defined intracranial progression-free survival (iPFS). The lesion size-response association was evaluated with repeated measures modeling. Results: A total of 109 MBM were evaluated. The patient level intracranial response rate was 41%. Median iPFS was 2.3 months and overall survival was 13.4 months. Larger lesions were more likely to progress, with diameter >2.05 cm most predictive of progression (OR: 18.9; 95% CI: 2.6-139.5; p = 0.004). There was no difference in iPFS with steroid exposure pre- versus post-ICI initiation. Conclusion: In the largest reported ICI+corticosteroid cohort, we identify size dependent MBM response.

Checkpoint inhibitor immunotherapy stimulates the body to attack melanoma and other cancers, but the immune system can be counteracted by steroid medication. On the other hand, steroids are sometimes needed to reduce swelling caused by brain tumors. To understand whether steroid use at the same time as immunotherapy impacts the response in melanoma brain metastases, the authors examined how 17 such patients fared. Brain tumors in these patients responded fairly well, though this was especially the case in the smaller tumors. This may help guide how patients with melanoma brain metastases are treated in the future.

Neurosurgery in COVID-19 Ground Zero: The Weill Cornell Medicine Experience.

The mobilization of subspecialty departments in reaction to the unique demands of the onset of the coronavirus disease 2019 (COVID-19) pandemic in New York City was swift and left little time for reflection and commemoration. The early days of the pandemic brought unprecedented stressors on the medical system that necessitated a restructuring of hospitals, reallocation of health care workers, and a shift in care and education paradigms to meet patient care demands and public health needs. As the number of cases, intensive care unit patients, and deaths skyrocketed in New York City, many struggled with a somewhat paradoxical difficulty in perceiving the human value of what these numbers mean. Easily lost in the statistics are the stories and experiences of the physicians and trainees who were counted on to halt their own clinical practices and adapt their skillsets to tackle the pandemic. In this article, we present 10 brief narratives from the student members of the Neurosurgery Publication Group at Weill Cornell Medical College and members of the Weill Cornell Medicine Neurological Surgery Residency Program and Department of Neurological Surgery faculty. Reflecting on these individual experiences gives us an opportunity to simultaneously contribute to a history of New York City's reaction to COVID-19 and commemorate the individuals who were impacted by or succumbed to this disease.