Bio

Clinical Focus


  • Neurology

Academic Appointments


Professional Education


  • Fellowship: Stanford University Vascular Neurology Fellowship (2019) CA
  • Board Certification: American Board of Psychiatry and Neurology, Neurology (2018)
  • Residency: Stanford University Neurology Residency (2018) CA
  • Internship: Santa Clara Valley Medical Center Internal Medicine Residency (2015) CA
  • Medical Education: University of Southern California Keck School of Medicine Registrar (2014) CA

Publications

All Publications


  • Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C. A., Kvam, K. A. 2020; 94 (3): 137–42

    Abstract

    OBJECTIVE: To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.METHODS: We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.RESULTS: Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.CONCLUSIONS: Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.

    View details for DOI 10.1212/WNL.0000000000008752

    View details for PubMedID 31959682

  • Clinicoradiographic Course of Focal Intracranial Arteriopathy in Young Adults MacLellan, A., Kraler, L., Schwartz, N., Lee, S. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • A Unique Case of Malignant Edema due to Cerebellar Diaschisis Necessitating Decompressive Craniectomy Hurtubise, B., Kraler, L. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Blood Pressure Elevation and Risk of Moyamoya Syndrome in Patients With Trisomy 21 PEDIATRICS Santoro, J. D., Lee, S., Mlynash, M., Thuy Nguyen, Lazzareschi, D. V., Kraler, L. D., Mayne, E. W., Steinberg, G. K. 2018; 142 (4)
  • Blood Pressure Elevation and Risk of Moyamoya Syndrome in Patients With Trisomy 21. Pediatrics Santoro, J. D., Lee, S., Mlynash, M., Nguyen, T., Lazzareschi, D. V., Kraler, L. D., Mayne, E. W., Steinberg, G. K. 2018

    Abstract

    OBJECTIVES: Individuals with Down syndrome (DS) are at risk for the development of moyamoya syndrome (MMS); MMS is often recognized only after a resulting stroke has occurred. Our goal with this study was to determine if elevations in blood pressure (BP) precede acute presentation of MMS in individuals with DS.METHODS: A single-center, retrospective case-control study was performed. Thirty patients with MMS and DS and 116 patients with DS only were identified retrospectively. Three BP recordings were evaluated at set intervals (18-24 months, 12-18 months, and 6-12 months before diagnosis of MMS). These were then compared against control averages from patients with DS only. To assess changes over the time, we used general linear model repeated measures analysis of variance. To identify independent predictors of MMS and DS, we used a multivariable analysis using generalized estimating equations accounting for repeated measures of BP.RESULTS: BP in patients with MMS and DS rose significantly over the 24-month period preceding presentation (34th, 42nd, and 70th percentiles at the 18-24-month, 12-18-month, and 6-12-month periods, respectively). BPs in the patients with both MMS and DS were significantly higher than in the DS-only controls in the 6 to 12 (P < .001) and 12 to 18 months before presentation (P = .016). Higher Suzuki scores, bilateral disease, and posterior circulation involvement were also predictive of BP elevation before presentation.CONCLUSIONS: Elevations in BP may foreshadow presentation of MMS in individuals with DS. This simple, low-cost screening measure may lead to early identification of at-risk patients in the medical home and prevent irreversible neurologic injury.

    View details for PubMedID 30190347

  • Variability of Safety Policies Related to Prion Disease Among Top Neurological Institutions Werbaneth, K., Tummalapalli, P., Kraler, L., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • A Quality Improvement Curriculum for Neurology Residents Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C., Kvam, K. LIPPINCOTT WILLIAMS & WILKINS. 2018

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