NEURO

Bullying is nothing new in the healthcare workplace. It has been widely reported among medical residents and nurses and was also the subject of a talk at the most recent annual meeting of ASET- the Neurodiagnostic Society. The COVID-19 pandemic has now introduced a whole new set of stressors to the workplace, and research is showing this may be resulting in a general uptick in bullying. So, as states open and more EEG technologists return to work, does this mean they will also be returning to a potential increase in bullying? If so, what can they do about it? “Bullying is more likely to occur in high-stress settings with high-stakes outcomes, heavy workloads, and low job autonomy,” say the authors of this 2019 study of bullying among nurses, and it can be said of the jobs EEG technologists do as well. Bullying – common within hierarchical work structures like healthcare – is insidious, and its effects go beyond harming the mental health and job satisfaction of the individual targ

For years the call has been slowly building  in EEG labs across the country to replace reusable EEG cup electrodes with the single-use variety. COVID-19 just gave that trend a huge shove. In response to the novel coronavirus pandemic, the American Clinical Neurophysiology Society (ACNS) released updated EEG guidelines stating that disposable electrodes “should be utilized whenever possible.” This was backed up in a paper about performing neurodiagnostic studies on patients with COVID-19, published in May in The Neurodiagnostic Journal. And this same recommendation came up again in a COVID-19 webinar released by ASET – The Neurodiagnostic Society. “By and large we recommend the use of disposable electrodes if and wherever possible,” said Rebecca Khozein, president of ABRET (the nonprofit credentialing board for EEG techs) and clinical program director in neurophysiology at Yale New Haven Hospital. The reasoning behind the recommendation is the same as it was pre-COVID: using si

The practice of neurology has changed dramatically in the wake of the novel coronavirus pandemic. That’s been seen most dramatically in the virtual shift to meeting with patients via Doxy.me , Zoom or even FaceTime. How these changes are playing out in the day-to-day care of patients varies widely between practices and practitioners. Some are adapting better than others. We spoke to Dr. Laurence Kinsella, a neurologist in St. Louis, about his experience practicing neurology right now – both on the ground and in the cloud. NI: What was your initial response, as a physician, to the COVID-19 pandemic? Kinsella: I’m 60 years old, and I fall into a high-risk group, and that weighed on me a bit, I have to say. It’s been quite a process, hasn’t it? There was initial fear and even terror and a real calling up of physicians to ask themselves — certainly I was asking myself — why did I go into this job? Laurence Kinsella This is it; this is the reason, so I am going to step up and see

Used to be there was one thing you could nearly always find in the pocket of a neurodiagnostic technologist: a tape measure, likely the retractable type. This tool, so essential to EEG electrode placement, would always be at the ready. Sometimes, a tech would even keep the retractable reel in her pocket and stretch out the tape to conveniently and quickly take each measurement. The coronavirus pandemic is changing that — but that’s a good thing. A couple of months ago (pre COVID-19) we posted an article about the latest infection control guidelines published by ASET-The Neurodiagnostic Society. In it we mentioned a few surprising new recommendations, and one of them was that technologists stop using retractable measuring tapes. Measuring tapes, along with other items such as blood pressure cuffs, combs, finger pulse oximeters, and china markers fall into a category called “non-critical patient care items.” These are items that come into contact with intact skin but not mucus membr

The novel coronavirus has sparked an unprecedentedly fast and widespread shift to telemedicine. It is remarkable that so many patients can still get care despite the social distancing required by the COVID-19 pandemic. But some view it as a pale comparison to in-person visits. There are some obvious limitations to telemedicine like taking vital signs, giving injections, or testing for spasticity. That, however, is not all there is to the doctor-patient relationship. The Modern Hippocratic Oath reminds us that doctoring is more than just physical interventions: “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” Telemedicine quite literally introduces a sizable distance between provider and patient, and it begs the question: Is it possible via telemedicine to maintain the emotional connection so important to patient care? We talked to three neurology providers who t

As we have seen, the coronavirus pandemic has substantially cut the demand for EEG testing and even resulted in loss of work for some technologists. Now, with growing evidence that the virus can cause neurological complications, the use of EEG testing will likely increase. So say the authors of a new paper offering an enhanced safety protocol for performing EEGs on patients with COVID-19. Due to the many unknowns and highly contagious nature of this virus, researchers in the Neurodiagnostic Department at Medical City Dallas Hospital felt they needed to go beyond standard infection control measures. They applied a new EEG workflow in a case study published in Neurodiagnostic Journal this April. Their patient (a 73-year-old male) was in acute respiratory failure, requiring intubation in the hospital’s COVID-19 ICU unit. The patient experienced a convulsion-like episode with transient left-sided facial droop while being weaned from sedation. The patient was too unstable to undergo

Dr. Tait Shanafelt’s name comes up often when talking about physician burnout. For nearly two decades he has been studying its impact on the healthcare workforce and the ways people and institutions successfully mitigate the problem. Now he has some insight for leadership during the COVID-19 pandemic, a time of unprecedented anxiety among healthcare professionals. “At the same time they cope with the societal shifts and emotional stressors faced by all people, health care professionals face greater risk of exposure, extreme workloads, moral dilemmas, and a rapidly evolving practice environment,” Shanafelt and his co-authors wrote in this Viewpoint , published last month in JAMA. Given the likely duration of this pandemic, these issues need sustainable solutions and they need to come from leadership — people like hospital executives, nursing heads, department chairs, and division chiefs. It is not enough for leaders to offer “generic approaches to stress reduction or resilience,”

Kevin Helm began his job as executive director of ASET – The Neurodiagnostic Society on April 10 th — smack dab at the start of the COVID-19 pandemic. That first day, he went into an empty office, desks abandoned by stay-at-home orders, and began the process of learning the job. “I am going through piles and piles of paper to figure out what is what,” he said in a recent phone interview. Helm is most accustomed to working in a digital environment, not an office, having worked for a virtual organization and co-founding a virtual association network. Prior to joining ASET, Helm was the associate executive director with the Society for Simulation in Healthcare, based in Washington, D.C. While there he helped drive membership and revenue growth and helped boost national and international affiliate programs. Located in the heart of Kansas City, ASET is, by contrast, very much a brick-and-mortar organization. During the hiring process, Helm says he advocated for remote working. Kevin

Patients with Alzheimer’s disease and other forms of dementia are facing their own unique challenges during this pandemic — and so are their caregivers. So says Dr. David Weisman, a neurologist based outside of Philadelphia, Pennsylvania. He referenced a recent New York Times report about an enraged woman who, citing social distancing violations, shoved an 86-year-old woman suffering from dementia, who later died. “I read that and I thought that’s a COVID-19-related death, because she was not allowed to be with her family,” Weisman said during a recent interview. Weisman specializes in treating Alzheimer’s disease and he says that caregivers play an integral role in managing this patient population. He spends a lot of his clinical time talking to them. Dr. David Weisman “It’s sad. They call it the ‘gray veil,’ where you don’t engage the person with Alzheimer’s disease, you only talk to the caregiver.” COVID-19 and the accompanying shutdowns and stay-at-home orders are sources

Hundreds of clinical trials unrelated to COVID-19 are reportedly coming to a halt, and still more are otherwise affected by the virus. Dr. David Weisman, a practicing neurologist and director of the Clinical Trial Center at Abington Neurological Associates in the Philadelphia area, has not had to discontinue any of his trials yet, but he feels strongly that new enrollment should be put on pause. “We, as a site, are not enrolling anybody — full stop,” said Weisman in a recent phone interview. “You take an at-risk population, typically a little bit older, and you have to imagine that they are possibly going to get randomized to placebo. In which case, they have all this increased risk. And it’s not just for the study visits; there are also MRIs, PET scans, and sometimes we do spinal taps.” Dr. David Weisman Weisman’s focus is primarily on Alzheimer’s disease and other forms of cognitive impairment, but he is also currently running trials for new therapies to treat stroke, multi

No healthcare industry is exempt from the effects of the COVID-19 pandemic, and each is affected in its own unique ways. A lot of what is happening to neurodiagnostic technologists is hard, but some changes will ultimately be for the good. That’s how Connie Kubiak, president of ASET-The Neurodiagnostic Society and a traveling EEG tech, sees the situation – and she was recently laid off just a few weeks into a new contract because of the pandemic. Connie Kubiak We spoke to Kubiak by phone at her home in Northern Michigan where she is sheltering in place with her husband. The following are edited excerpts from our conversation with her. NI: What are the biggest issues facing neurodiagnostic technologists right now? Kubiak: They are being furloughed or laid off unless they are in a state or county that’s not majorly affected. Some of them are cutting hours: instead of working 40, maybe they are working 20. Some are just working on call. They have families and they have bills, a

People faint or experience syncope for all kinds of reasons, from the mundane — like standing too long in a stuffy room — to the much more serious, like heart disease or epilepsy. Sometimes even non-physical (psychogenic) stressors can cause this kind of temporary loss of consciousness. Unfortunately, it’s not easy to tell the difference by observation alone. For this reason, clinicians use objective measures such as EEG studies, blood pressure, pulse, and tilt-table testing to help make a differential diagnosis. According to a new protocol published in the Neurodiagnostic Journal , combining these usually independent tests may offer the best chance at quickly determining why a patient keeps fainting, especially when providers suspect it’s psychogenic. More Common Than People Think? Psychogenic pseudosyncope (PPS) is the appearance of a short-term loss of consciousness and motor functions (syncope) that is not an actual or true loss of consciousness. Internal stressors manifes

We want to wish all neurology nurses out there a happy National Nurses Week ! Nurses are facing unique challenges right now, whether they are on the front lines or not. We spoke with neurology nurse practitioner Calli Cook to get some insight into how COVID-19 has impacted her and other nurses in neurology. Like many healthcare providers dealing with the coronavirus, Cook is working from her home (in Georgia), primarily treating patients via telemedicine. “Every healthcare professional is going above and beyond to meet the call during this public health emergency: nurses, nurse practitioners, PAs, physicians, and respiratory therapists,” she says. “I just think that is amazing and I’m very grateful to work with a group of people who are so willing to put others in front of themselves. It’s an incredible time to watch my colleagues’ responses and see how much great work they’re doing.” The following are edited excerpts from our phone conversation. NI: What are the ways that givi

The medical community continues to wrestle with the full implications of the COVID-19 pandemic. Data is surfacing daily based on the experiences of physicians working on the frontlines. Now we must sort out this information to develop a more complete understanding of what it means. We also need to figure out how – or if – it should change the approach to caring for patients infected by the novel coronavirus. This is certainly true for neurologists as case information trickles in about neurologic signs and symptoms. A recent case report in JAMA outlined the clinical course of an elderly patient with COVID-19 who developed encephalopathy. The authors of the paper mentioned other potential neurologic complications of the disease, including acute stroke, impaired consciousness, and skeletal muscle injury. Another case study published in The Lancet on April 1 reports the first known presentation of Guillain-Barré syndrome in a patient with COVID-19. Other reports include trigeminal neu

When Dr. Rachel Salas first encountered the idea of seeing a coach, she was skeptical, to say the least. “How could it really be that meaningful?” thought Salas, associate professor of neurology at the Johns Hopkins University School of Medicine. “This person is not a physician. They don’t know the issues I have.” The coaching was part of a leadership training program she was already attending, so she decided to give it a try. At just 30 minutes, that session turned out to be a game changer – so much so that she would eventually become a certified coach herself. While she does do some occasional physician coaching, the benefits, she says, are most realized in her everyday work as a clinician and clerkship director. Executive and leadership coaching has been around a long time, but it is only recently that physicians have begun to see its value. “Coaching now is where working out at a gym was 30 years ago,” says Keri Bischoff, a certified coach who has worked with the American Aca

The relationship between artificial food coloring and attention deficit hyperactivity disorder (ADHD) has been debated for years, but experts haven’t been able to reach a definitive conclusion about the connection. New research on its effects in EEG in college students with ADHD may help build the case against it for all patients with the disorder. In the European Union, certain additives require a statement on the label that reads “may have an adverse effect on activity and attention in children.” However, the FDA’s official position on artificial food coloring, or AFC, and ADHD is that there is insufficient evidence to establish a connection. The FDA does not require any particular labeling about the potential relationship between the two, only a listing of the additives. This is a source of frustration for some U.S. medical experts who believe the capacity for harm is there. A 2017 meta-analysis of double-blind, placebo-controlled studies evaluating dietary interventions in ch

Every year during Neurodiagnostic Week, a well-deserved light shines on the contributions and quality patient care provided every day be neurodiagnostic technologists. This year, the celebration falls the week of April 19-25 – during one of the worst public health crises in modern times, the COVID-19 pandemic. But that is not stopping ASET- the Neurodiagnostic Society, which sponsors this celebration every year. That’s because they know their members and neurodiagnostic technologists (NDTs) need their support more than ever. To that end, the organization has published a variety of resources to help NDTs navigate their jobs and provide safe and effective patient care. These include a COVID-19 position statement , newsletter , and resource sheet , offering best practices for donning and doffing personal protective equipment (PPE), and performing EEGs on patients with respiratory isolation precautions. According to Executive Director Kevin Helm, starting during Neurodiagnostic week A

Budget cuts and CMS code changes have left hospitals wondering if they should continue to offer EEG monitoring themselves, leading to a rise in remote monitoring for continuous EEG (cEEG) in recent months. And with the COVID-19 pandemic further taxing hospital resources, remote monitoring for cEEG and even for routine tests may become an even more important piece of the neurological care model. But what does that mean for neurodiagnostic technologists (NDTs)? An Accelerated Shift to Remote Monitoring There has already been an increase in remote monitoring for inpatients, particularly for encephalopathies, in the face of the COVID-19 epidemic, according to Petra Davidson, a NDT and remote-monitoring specialist. At the same time, scheduled long-term monitoring procedures, like many other non-essential medical procedures, have been eliminated for the time being. Davidson says facilities are using in-house staff right now to save money. With the cessation of routine and elective proce

When faced with change and unexpected challenges, even the most competent and highly trained professionals can feel out of their depth. When this feeling turns into a paralyzing fear of being found out as a “fraud,” experts call this imposter syndrome . This phenomenon is more common than you might think, even among physicians . The problem is physicians are unlikely to do the one thing that can make it better – talk about it. “Physicians usually just share their successes,” Dr. Rachel Salas , associate professor of neurology at the Johns Hopkins University School of Medicine, tells Neurology Insights. “You’re not going to be telling people ‘I got rejected on this grant and this paper, and I didn’t get that promotion.’ We’ve just never been in that culture where we share our shame, our worries, or our failures.” Salas is among an increasing number of physicians sharing their experiences with imposter syndrome in an effort to destigmatize it. She and her colleague, Dr. Charlene Gam

Earlier this year, the Center for Medicare & Medicaid Services (CMS) made some big changes to the billing and reimbursement system for long-term EEG monitoring. Techs and neurologists in this area went from needing to understand a handful of Current Procedural Terminology (CPT) codes to a mind-boggling 23 of them. The complexity of these codes and the documentation required have increased. The learning curve has been steep, and some fear the change will cause major damage to the industry. We recently had the opportunity to speak with Kathryn Hansen, a neurodiagnostic technologist and coding expert, about these changes. Her view is considerably more optimistic – she sees these changes as an opportunity for technologists to become more empowered and thinks the industry will be better for it. The new codes are outlined in the 2020 CPT Coding book released by the American Medical Association and officially went into effect in January 2020. Much has been written to explain the new