By Panayiotis (Panos) N. Varelas, MD, PhD, FAAN, FNCS
A Focus on Spring
As we are moving towards the Ides of March, there is a glimpse of hope that this gloomy day of yore, immortalized as a deadly warning in William Shakespeare’s play Julius Caesar, may not be as bad this year. Even though the pandemic is still here and still affects patients we treat daily in our ICUs, the most recent data seemingly show we are heading towards weathering the storm. Is it going to go away and disappear like a bad dream or linger at a low endemic level, waiting to find the right moment to emerge again as a new alphabetical strain one day?
And us, how can we go back to normalcy, focus again on treating sick non-COVID patients and return to in-person meetings with full facial disclosure of emotions? NCS is an international society, with members located around the world. Over the last two years, our international members were the ones most affected, despite joining NCS activities from their laptops. Will we be crossing borders to visit other countries without fear again? It is not the same as in the past, but will it soon be?
Although adjusted to pandemic times, NCS activities have not stopped and continue unscathed:
- Sarah Livesay and the Annual Meeting Committee are actively planning the upcoming 20th Annual Meeting in San Antonio, Texas, and we had a record number of session submissions.
- We are actively exploring locations for the 2024 and 2025 Annual Meetings. There are choices as remote as Hawai’i (again!) or Canada, as well as past cities we know well and some newcomers.
- New NCS Practice Guidelines are expected to be released soon.
- World Coma Day is on March 22, and we are confident it will be just as successful as before.
- The Neurocritical Care Foundation has just launched and has its own website, where donors can make informed decisions and donate directly.
ENLS®, our flagship educational product, is launching its 5.0 version this month. There are substantial changes:
- The online course will be updated with simulation scenarios featuring six fully interactive case studies.
- New or updated diagnostic and management algorithms based on new guidelines for TBI, acute ischemic stroke, targeted temperature management post cardiac arrest, traumatic spinal cord injury and meningitis/encephalitis.
- Expanded sections for prehospital providers, nursing, and pediatrics.
- Detailed communication tables with sample scenarios to use when transitioning care from prehospital to ED to NICU.
Thanks to Wade’s vision, I hope one day ENLS® will become a requirement, not a choice, for every colleague in neurology, neurosurgery, ED, or critical care, like ACLS and ATLS.
I would like to hear from you. Please click here and complete a one-question survey stating what you think is important or crucial for the society to sail the winds of the future and to the safe port where land should be.
This past October, many of us sat for the first ABMS NCC exam to get ready for applying for ACGME Fellowship Program accreditation in our institutions. However, the way the ACGME rules were recently written poses two major hurdles for applying: The first, which is less problematic, is that the program should have both a Neurology and a Neurosurgery residency. The vast majority of Neuro-ICUs meet this criterion. The second is the requirement for having both an ABMS certified neurologist (or Internal Medicine, ED) and an ABMS certified neurosurgeon with qualifications in neurocritical care to serve as core faculty. This is challenging because ACGME does not recognize the traditional path for neurosurgeons via UCNS or CAST, and only two of those colleagues sat for the ABMS/ABNS exams. Therefore, there is an almost total roadblock for ACGME Program applications. NCS has communicated with ACGME and its neurology and neurosurgery review committees to try to solve this impasse and we are currently collecting data on how many of the existing UCNS-accredited Neuro-ICU Programs could apply. I am expressing my appreciation to Alex Rabinstein, Angela Shapshak, Atul Kalanuria and Paul Vespa for their contribution to these dialogues. Hopefully, we will have an acceptable resolution soon.
My favorite ancient Greek philosopher is Heraclitus. He lived between 544 and 484 BC in the city of Ephesus in Asia Minor. Although his oeuvre “About Nature” is lost, there are fragments of it that have been saved through the eons. I don’t know anyone else who has condensed universal truths in so few words. Sometimes he is so difficult to understand that he is rightfully called the “obscure” or “dark” philosopher. Two of his most emblematic statements are “Τα πάντα ρει, μηδέποτε κατά τ’αυτό μένειν”(everything moves, nothing stays the same) and “Ποταμώ ουκ έστιν εμβήναι δις τω αυτώ” (you cannot step twice on the same river). How 2,500 years ago, he was able to imagine the eternal move and change in the natural forms and project it to a cosmic foundation, is beyond me. If you think about it, in its core it is a sad truth: Nothing we love, we admire, we cherish, stays the same. It is our brains that lie to us every moment about this deep, natural truth and, at the same time, allow us to reason about it and move on…
Panayiotis (Panos) N. Varelas, MD, PhD, FAAN, FNCS
President, NCS Board of Directors
Professor of Neurology and Chairman, Department of Neurology
Albany Medical College