Patient Characteristics Associated with Seizure Freedom after Vagus Nerve Stimulation in Pediatric Intractable Epilepsy: An Analysis of “Super-Responders”

Clinical responses to vagus nerve stimulation (VNS) therapy for intractable epilepsy can be unpredictable, and factors that predict response to therapy are elusive. Minority of children undergoing VNS achieve seizure freedom. The current study aimed to characterize this exceptional patient population, defined as “super-responders” (SRs). Retrospective data were collected from 150 children who underwent VNS at a single pediatric institution. The patients' mean age at VNS device implantation was 12.0 years (range, 3.09–17.9 years). Ten SRs (6.7%) were identified who achieved and maintained seizure freedom for longer than 1 year following implantation. The interval between epilepsy onset and VNS device implantation was significantly shorter in SRs than in the other children (mean epilepsy duration 5.72 vs. 8.44 years, respectively; p = 0.032). SRs also had a significantly shorter proportion of life with epilepsy compared with the other children (mean ratio of epilepsy duration to age at implantation 0.52 vs. 0.71, respectively; p = 0.023). SRs reported their seizure freedom relatively early (six patients within 6 months and all patients within 12 months after implantation) at relatively low device settings (mean output current 0.81 mA at their last follow-up). Compared with conventional models, responsive VNS models with autostimulation features did not increase the ratio of SRs. No other clinical or imaging characteristic difference between SRs and the other children was found in this cohort. The current study showed a significant association between shorter epilepsy duration and shorter proportion of life with epilepsy and seizure freedom after VNS.

Curiosity and Caring Levels in Undergraduate Nursing Education: A Relational Investigation Toward Understanding Empathetic Curiosity

Emotional caring and curiosity are associated with exceptional patient care. Combined, the characteristics form empathetic curiosity. Little is known about nursing students' curiosity. Our quantitative research study provides insight into connections between caring and curiosity of nursing students both early and late in their programs of study. Students early their program perceived more caring from others toward them than the students late in the program. The students did not differ in their curiosity or caring levels for others. Our findings indicate a positive relationship between caring and curiosity. Nursing student curiosity may be reflective of their preparation as professionals.

Postgraduate Specialization Fellowship Training for Audiologists: Survey Results From Educators, Supervisors, and Students

Purpose From the Audiology Education Summit held in 2017, several working groups were formed to explore ideas about improving the quality and consistency in graduate education in audiology and externship training. The results are described here from one of the working groups formed to examine postgraduate specialization fellowships. Method Over the course of a year, the committee designed and implemented two surveys: one directed toward faculty and one toward students. The rationale for the survey and the results are presented. Comparisons between faculty and student responses are made for similar questions. Results Overall, the results demonstrate that the majority of both students and faculty believe that postgraduation specialization fellowships are needed for either 1 year or a flexible length. There was a consensus of opinion that the fellowship should be paid, as these would be designed for licensed audiologists. Most believed that the fellowships should be “governed by a professional organization (e.g., American Speech-Language-Hearing Association, American Academy of Audiology, American Doctors of Audiology, etc.),” or less so, a “separate body for this specific purpose.” Potential topics for specialization identified were the following: tinnitus, vestibular, cochlear implants, pediatrics, and intraoperative monitoring. The highest priority attributes for a specialization site were “abundant access to patient populations,” “staff of clinical experts,” and “active research.” The weight put toward these attributes differed between faculty and students with faculty prioritizing “university/academic centers,” and “access to academic coursework in the fellowship area.” The faculty rated “caseload diversity,” “minimum hours,” “research,” and “academic affiliation” as requirements for a fellowship site, with less weight for “coursework” and “other.” Finally, the students valued “improved personal ability to provide exceptional patient care,” “the potential for increased job opportunities,” and the “potential for a higher salary” as benefits most important to them, with lower ratings for “recognition as a subject matter expert” or “potential pathway to Ph.D. program.” Conclusions As a result of the survey, further exploration of a postgraduate specialization fellowship is warranted, especially to determine funding opportunities to offset cost for the sites and to ensure that fellows are paid adequately.

The COVID-19 Crisis: A Mental Health Perspective and Response Using Telemedicine

With the outbreak of COVID-19, patients and providers were forced to isolate and become innovative in ways to continue exceptional patient care. The Cleveland Clinic went from mostly in-person medical appointments to all virtual/telemedicine care in about 2 weeks’ time. In this piece, we show specifically the thought process and our conversion of the Mellen Center for Multiple Sclerosis Behavioral Medicine to ensure that our patients still receive exceptional care and patient experience. Additionally, we discuss the importance of innovating the training and supervision of postdoctoral trainees using telepsychology and virtual options.

An exceptional patient journey

Dr Safa Al-Naher is clinical lead at The Care Dental Group. Here, she outlines the team's preventive ethos

The resident physician as leader within the healthcare team

Purpose The purpose of this study was to explore inter-professional clinicians’ perspectives on resident leadership in the context of inter-professional teams and to identify a definition for leadership in the clinical context. In 2015, CanMEDS changed the title of one of the core competencies from manager to leader. The shift in language was perceived by some as returning to traditional hierarchical and physician-dominant structures. The resulting uncertainty has resulted in a call to action to not only determine what physician leadership is but to also determine how to teach and assess it. Design/methodology/approach Focus groups and follow-up individual interviews were conducted with 23 inter-professional clinicians from three pediatric clinical service teams at a large, Canadian tertiary-level rehabilitation hospital. Qualitative thematic analysis was used to inductively analyze the data. Findings Data analysis resulted in one overarching theme: leadership is collaborative – and three related subthemes: leadership is shared; leadership is summative; and conceptualizations of leadership are shifting. Research limitations/implications Not all members of the three inter-professional teams were able to attend the focus group sessions because of scheduling conflicts. Participation of additional clinicians could have, therefore, affected the results of this study. The study was conducted locally at a single rehabilitation hospital, among Canadian pediatric clinicians, which highlights the need to explore conceptualization of leadership across different contexts. Practical implications There is an evident need to prepare physicians to be leaders in both their daily clinical and academic practices. Therefore, more concerted efforts are required to develop leadership skills among residents. The authors postulate that continued integration of various inter-professional disciplines during the early phases of training is essential to foster collaborative leadership and trust. Originality/value The results of this study suggest that inter-professional clinicians view clinical leadership as collaborative and fluid and determined by the fit between tasks and team member expertise. Mentorship is important for increasing the ability of resident physicians to develop collaborative leadership roles within teams. The authors propose a collaborative definition of clinical leadership based on the results of this study: a shared responsibility that involves facilitation of dialog; the integration of perspectives and expertise; and collaborative planning for the purpose of exceptional patient care.