Correction to: Chimeric Antigen Receptor T Cell-Related Neurotoxicity: Mechanisms, Clinical Presentation, and Approach to Treatment.

The correct spelling of the co-author should be listed as Sarah Nagle, MD.

Chimeric Antigen Receptor T Cell-Related Neurotoxicity: Mechanisms, Clinical Presentation, and Approach to Treatment.

PURPOSE OF REVIEW: Chimeric antigen receptor T cell (CAR-T) adoptive cell therapy is an effective treatment for patients with refractory B cell malignancies. As its use has grown, there has been an increase in the incidence of a serious, potentially fatal neurotoxicity known as immune effector cell-associated neurotoxicity syndrome (ICANS). This review discusses the clinical manifestations of this neurotoxicity syndrome, current grading systems, management strategies, and proposed biologic mechanisms leading to neurotoxicity. RECENT FINDINGS: Current research suggests that patients with a higher disease burden and higher CAR-T cell doses are positively associated with the development of ICANS, as are elevated serum levels of proinflammatory cytokines and the presence of cytokine release syndrome (CRS). While patterns observed on neuroimaging and electroencephalogram (EEG) are non-specific for the diagnosis of ICANS, each modality may provide helpful clinical information such as the detection of cerebral edema, the most serious of associated symptoms. Anti-epileptic medications and corticosteroids may ameliorate the symptoms of ICANS. The mechanism for ICANS is currently unknown; however, systemic inflammation and cytokine production triggering a cascade of endothelial activation and BBB disruption likely contribute. With limited treatment options available, further clinical research into the precise mechanism and treatment is urgently needed as the use of CAR-T and other adoptive cell therapies continues to grow.

American Academy of Neurology members' preparedness to treat sexual and gender minorities.

OBJECTIVE: To measure the attitudes and knowledge of American Academy of Neurology (AAN) member neurologists in caring for sexual and gender minority (SGM) patients (e.g., those who identify in the lesbian, gay, bisexual, transgender, queer, or questioning [LGBTQ+] spectrum) to inform future educational offerings. METHODS: A questionnaire was created in an iterative process by the LGBTQ+ Survey Task Force, consisting of 21 questions examining self-reported knowledge, attitudes, and clinical preparedness in caring for SGM patients. Participants responded to each statement with a 5-point Likert scale ("strongly disagree" to "strongly agree"). The survey was distributed via electronic and conventional mail to a random, representative sample of 1,000 AAN members. RESULTS: The response rate was 13.5% (n = 135). Most respondents (60%-66%) were aware of local and national barriers that inhibit SGM individuals from using health care services; the majority (73%-91%) felt comfortable assessing SGM patients. Over half believed sexual orientation (SO) and gender identity (GI) to be social determinants of health (61% and 57%, respectively). Yet a third would not tailor neurologic care based on a patient's SGM identity, and 43% believed that SO/GI has no bearing on the management of neurologic illness. CONCLUSIONS: Most neurologists surveyed were aware of overarching barriers to care experienced by SGM individuals; however, a minority of respondents recognized the intersection of SGM identity with neurologic health. Our results highlight awareness gaps that could be addressed via targeted educational opportunities, ensuring that neurologists provide high-quality neurologic care to patients of all sexual orientations and gender identities.

Medical Education Manager: A Title Worthy of the Description.

At a national meeting, an informal conversation took place between a group of medical education coordinators/administrators who reviewed and identified requisite skills needed for their vocation. Upon conclusion, it became evident that the profession was undervalued. It was also determined that retention and sustainability in this position is becoming transitory and that the need to raise awareness and construct a professional identity is crucial. A nation-wide review of 30 institutions, literature searches, and national surveys revealed the need to construct a professional identity and tools for career growth. A focus group of medical education coordinators/administrators were tasked with the goal of creating a publication to encourage recognition and validity of this profession. The growth potential within the position needs to be elevated to a higher level with greater advantage for medical education coordinators/administrators. There are certifications available for both undergraduate medical education (UME) and graduate medical education (GME); however, results in achieving these qualifications are shown to be more of a personal satisfaction rather than enhancing career growth. Due to this insufficiency, medical education coordinators/administrators will look for other employment opportunities to advance their careers. In order to retain talented coordinators/administrators, there needs to be an element of growth opportunity in place for them to advance. Other careers provide growth opportunities to retain their valuable assets. Thus, it would appear logical that the same opportunities are made available to medical education coordinators/administrators. The job responsibilities of program coordinators/administrators are determined to be diverse in nature. Therefore, it is apparent that the role is important to the success of any medical education program and identifies as a true "profession". Research shows the identity of the medical education coordinators/administrators is moving from "administrator-coordinator" towards academic managers, which more accurately depicts their role. The administrative role of managing medical education programs has evolved tremendously with the need for a multilateral approach to develop a new job title and description. It is essential that institutions recognize administrators for the integral management positions they hold within a training program to help make it successful.