News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

Cryoballoon (CB)-guided pulmonary vein isolation (PVI) represents a cornerstone in the treatment of atrial fibrillation (AF). Recently, a novel balloon-guided single shot device (POLARx, Boston Scientific) was designed. Our study aimed to compare the efficacy, safety and characteristics of the novel CB system with the established one (Arctic Front Advance (Pro), AFA, Medtronic). A total number of 596 patients undergoing CB-guided ablation for AF were included. 65 patients (65.0 ± 11.6, 31% female) undergoing PVI with the POLARx were compared to a cohort of 531 consecutive patients (63.0 ± 27.9, 25% female) treated with AFA. Acute PVI was achieved in all patients (n = 596, 100%). Total procedure duration (POLARx 113.3 ± 23.2 min, AFA 100.9 ± 21.3 min; p < 0.001) and fluoroscopy time (POLARx 10.5 ± 5.9 min, AFA 4.8 ± 3.6 min; p < 0.001) were significantly longer in the POLARx group. The POLARx balloon achieved significantly lower nadir temperatures (POLARx −57.7 ± 0.9 °C, AFA −45.1 ± 2.6 °C; p < 0.001) and a significantly higher percentage of pulmonary veins successfully isolated with the first freeze (p = 0.027 *). One major complication occurred in the POLARx (2%) and three (1%) in the AFA group. Both ablation systems are comparably safe and effective. AF ablation utilizing the POLARx system is associated with longer procedure and fluoroscopy times as well as lower nadir temperatures.

The Impact of the Coronavirus Pandemic on Medical Education: A Case Study at a Public University in Romania

The spread of COVID-19 in 2020 forced universities around the world to transfer on-site education to a virtual environment. The main goal of this study was to compare the experiences regarding online learning of students in programs that require clinical experiences with those of students in programs that do not require such experiences. The authors hypothesized that the switch to online instruction has affected medical students more profoundly than other students. Using a convenience sample of students at a Romanian university, the researchers explored differences between the two groups related to technical and personal problems, course quality, and instructional strategies used by faculty. The results indicate that medical students who could not participate in clinical experiences were significantly less satisfied with the transition to online learning than students in other programs. One implication of these results is that faculty teaching in medical schools need to improve in three areas related to online course quality: pedagogy, course content, and course preparation.

Administering Interactive Simulations to Supplement Traditional Clinical Placements

This chapter aims to enhance the ability of healthcare educators to identify learner skill levels, develop and implement an appropriate simulation or scenario-based learning technique, and provide optimal feedback to refine clinical reasoning and decision-making development of the learner. The concept of problem-based learning is outlined and applied to the creation of virtual patient cases to augment clinical experiences for healthcare students amidst the COVID-19 pandemic. Through the use of appropriately targeted learning objectives, case design, and feedback strategies, students will be able to continue their professional and academic development in a post-pandemic landscape.

Four Core Concepts in Psychiatric Diagnosis

In the present article, we aimed at describing the diagnostic process in Psychiatry through a phenomenological perspective. We have identified 4 core concepts which may represent the joints of a phenomenologically oriented diagnosis. The “tightrope walking” attitude refers to the psychiatrist’s ability to swing between 2 different and sometimes contrasting tendencies (e.g., engagement and disengagement). The “holistic experience” includes all those intuitive, nonverbal, and pre-thematic elements that emerge in the early stages of the clinical encounter as an emanation of the atmospheric quality of the intersubjective space. The “co-construction of symptoms” regards the hermeneutic process behind psychiatric symptoms, involving both the patient as a self-interpreting agent and the clinician as a translator of his/her experience. Finally, by the “evolving typification” we mean that the closer the relationship becomes with the patient, the more specific and nuanced becomes the typification behind psychiatric diagnosis. Each of these concepts will be accompanied by an extract from a clinical case deriving from one of the authors’ most recent clinical experiences.

Adolescents on the Autism Spectrum: Music Therapists’ Work with Speech-Language Pathologists

Adolescents on the autism spectrum may experience challenges with multiple domains of communication that impact their quality of life. Both music therapists and speech-language pathologists (SLPs) implement activities to address these challenges. Empirical evidence suggests that incorporating music into treatment can be an effective way to improve communication. The purpose of this article is to provide suggestions for music therapists assisting adolescents on the autism spectrum to improve their communication skills and ways to collaborate with SLPs in doing so. In this paper, we discuss interprofessional collaborative models (e.g., interdisciplinary, transdisciplinary) and competencies (e.g., coordination, adaptability), as well as music-based clinical experiences that appeal to adolescents, and target improvement of communication skills for learners with complex communication needs.

On patients who explode: surviving petrifying psychotherapeutic experiences

Although most of our patients will enter the consulting room quite quietly, often in a depressive state, having contained their sadistic impulses, a tiny fraction of those with whom we work will attack us in a variety of chilling ways. In this article, the author describes in detail two particularly terrifying clinical experiences in which a patient either threatened to kill him or actually sullied his consulting room with bodily fluids. Drawing upon his psychotherapeutic encounters not only with intellectually disabled patients and forensic patients but, also, with those who presented as ordinary “normal-neurotics”, the author considers the phenomenology of these “bomb”-like explosions and explains how he attempted to maintain a classical psychoanalytical focus of understanding, which consisted of a careful scrutiny of the countertransference and a firm commitment to the interpretation of unconscious material, whilst under attack. Furthermore, he examines the essential role of speaking with experienced colleagues who will provide essential supervision or assistance during these challenging chapters of clinical practice. The author also considers the many ways in which “bombs” can be hurled not only by the more obviously dangerous or disturbed individuals but, also, with surprising frequency, by those with no criminal history whatsoever, who, upon first encounter, often present as reasonably healthy.

Fuses igniting in the consulting room

This article on fuses igniting in the consulting room is entirely based on clinical experiences without reference to any theoretical positions. Three clinical vignettes will be described to illustrate situations when the therapist realised there was a sudden unexpected rise in “temperature” of a patient’s mind and/or in her own mind, and why this may have occurred. A fuse was lit but was it a slow or a quick one? A slow match is a very slow-burning fuse presenting only a small glowing tip whereas a quick match is one, which once ignited, burns at top speed. I will relate this ignition to the possibility of premature interpretations, or a failure to realise how anxious the patient was in the presence of the terrifying object–therapist and also, unexpected situations arising during and outside of sessions. I will describe how these situations unfolded during sessions and how, upon reflection, these could have been diffused differently. The emphasis will be on how best to maintain a psychoanalytic stance but also how to clinically judge when a session must be terminated in order to protect patient and therapist from exploding “bombs” inadvertently ignited by patient, therapist, or external events. The importance of supervision and consultation with colleagues will be stressed.