How to deliver quality care to patients with epilepsy:

That is a quest that we can all share.

For the first time ever, ASET – The Neurodiagnostic Society will be hosting a one-day course at the 2013 American Epilepsy Society meeting in Washington D.C.  The date of the course is Sunday, December 8^th.  The course title is:  "Making an LTM/ICU Monitoring Program Work:  Technical Aspects"

This course is designed to be of interest to anyone who is involved in the planning and operation of a comprehensive epilepsy program, long term monitoring program, or an ICU continuous EEG program.  Physicians, fellows, residents, nurses and technologists are invited to attend.  When designing this course, I felt that there are some skills that we have built upon over the years, that have become our niche within the epilepsy care team, and we now have the opportunity to share this information with other caregivers.   Subjects we will be covering include:

·        How to configure a LTME unit, including equipment, networking for remote access and other design details to optimize the function of the unit, and ensure that files can be accessed by staff 24 hours a day, to allow for rapid interpretation and intervention when needed.

·        How to build quality improvement and daily communication into your patient care model to ensure patient safety and a customized LTME admission for each patient.  This will enhance your chances of capturing essential data as quickly as possible, to reduce prolonged admissions, which are difficult for the patient to endure and costly.  We will also discuss how to address the patient’s comfort, support and cultural needs throughout the admission.

·        Addressing concerns about skin breakdown during prolonged recording, selecting the optimal electrodes and application methods, determining how to edit files for review and archiving.

·        How to conduct a seizure assessment that will reveal essential information and assess loss of specific functions during an event, taking into consideration unique factors for each patient: cognitive ability, disabilities, language and cultural issues.

·        How to build a continuous EEG monitoring program for an ICU – equipment, staffing, enabling a variety of caregivers to assess the ongoing recording to determine the need for urgent intervention using innovative staffing models, trending software, and remote access to data.

We are able to offer this course for a flat rate registration fee of $120.  You do not have to register for the entire AES conference to attend this course.  We will accept registrations throughout the next month and even on-site.  You may read about this course complete the registration process via the  ASET website, at this link: ASET AES Course registration

There is no hotel room block associated with this course.  I suggest that you visit travel websites to seek the best price on a room, and keep in mind that this course is being held at the Washington D.C. Convention Center, with easy access to the Metro transit system, so you may be able to find reasonably priced accommodations a bit further away from the convention center.

I am really excited about this course.  I hope to see you there!

Building Neurodiagnostic Education to address the shortage of qualified technologists

We have been aware of a nation-wide shortage of highly skilled technologists for a very long time.  In my role,  I get calls all the time from employers who just can’t find the techs they need to fill open positions and from people who would like to pursue a career in neurodiagnostics but who do not have access to a Neurodiagnostic Program in their area.  The on-line programs alleviate this problem somewhat, but there are very large areas of the country, covering many states, that do not have one single neurodiagnostic technology training program!  The on-line schools also have some difficulty recruiting out-of-state students who do not qualify for in-state student loans.

At this time ASET lists 30 schools in the USA, and 23 of these schools are currently CAAHEP accredited.
2011 is the last year that CAAHEP has statistics available regarding graduates of these programs, and that year 180 NDT technologists graduated.

The Washington Post currently has 778 Neurodiagnostic Technologist positions listed in their on-line job search website.  So, we are far from able to fill all job openings with our new graduates.

So, what to do?  How can we build more new programs?  The ASET Formal Education Task Force has created a “Dean’s Packet”.  This packet includes a cover letter addressed to a Dean, and a seven page document that provides an overview of pertinent statistics that a Dean would require to justify the opening of a new program.  The statistics include locations of current schools, salary statistics, ABRET exam statistics and other key facts that help to illustrate the state of our profession.  If you are aware of a community college in your area that might be willing to consider opening a new course of study, or has a grant or mission to address needs of the local community, and you would like to reach out to a Dean with this information, please contact me directly and I will send you a copy of the packet items via e-mail.

We are hoping to build a database of contacts at colleges that do not yet have a program in Neurodiagnostics, so any suggestions you have will be greatly appreciated.

My e-mail address is: faye@aset.org and I welcome your comments, queries and suggestions.

Electroencephalography Veterinarian Style: EEG Recordings on Dogs and Cats

One of the abstract presentations at the ASET 2013 Annual Conference in Reno last month was particularly of interest to me as a dog lover and owner of two Labrador retrievers.  The title of the presentation was  “Electroencephalographic and Clinical Findings in 37 dogs and 4 cats.”  The author of the abstract was Dr. William Bush, V.MD, DACVIM, and his presentation was fascinating!

He showed videos of some of his canine and feline patients having clinical spells that could very well be seizures.  The confirmation of seizure activity has been a challenge in veterinary medicine, and for the most part, is done by clinical observation and pathology affecting the brain may be detected with MRI, and lab studies of the cerebral spinal fluid.  Dr. Bush explained that when these tests are positive, there is a greater chance that the EEG recording will be abnormal as well.  But in cases where there is no structural or infectious process to cause seizures, an EEG recording can be done and is very helpful.  His study included three patients who were diagnosed with non-convulsive status epilepticus based upon their EEG findings.

It is also interesting to contemplate exactly how an EEG can be done on cats and dogs.  Dr. Bush discussed the use of sedation and a small number of needle electrodes.

I actually have some experience with recording an ambulatory EEG on a dog.  In the past, when I was working at Children’s Hospital in Boston, I was contacted by a veterinary behavioral specialist from Florida, who was a consultant for a show dog: a standard poodle, living in New Hampshire, who had frequent spells which may represent seizures.  Since the animal was a show dog, the owner did not want to start prescription anticonvulsants unless the seizures could be documented.  She was seeking a neurodiagnostic technologist who would be willing to work with the dog to record an ambulatory EEG at the nearby state-of-the-art facility, “Angell Memorial Animal Center”.  That person would be me!

We coordinated a dedicated exam room at the veterinary hospital, a flight to Boston for the specialist, and the use of the ambulatory EEG equipment donated for the session by Digitrace.  We knew that the dog would need to wear a backpack with the ambulatory recorder so for a few weeks prior to the recording session, the owner placed a harness and backpack on the dog for several hours per day, to acclimate the dog to the device he would be wearing.

A team of helpers met the dog, Flair, the owner and the behavioral specialist on the appointed day.  Our team included a clinical applications specialist from Digitrace, a veterinary neurologist from Angell and myself and another tech from Children’s.  We were prepared to administer a sedative for lead placement.  I had brought disk electrodes, collodion, and an air compressor with me.  We decided to try applying electrodes without sedation first.  The owner held the dog’s muzzle still, made eye contact with the dog, and calmed him verbally, while I placed leads.  No problem!  Frankly, the dog was easier to work with than most 2 year olds!

The dog wore the equipment for 48 hours and stayed with the owner in a pet-friendly hotel nearby.  Once a day, she brought the dog to a Digitrace office to have the leads checked and regelled.  It took a while but eventually typical clinical events were recorded which correlated to EEG activity that could be electrographic seizures.

We videotaped the patient set-up and the owner videotaped the clinical events.  I presented this case study as an abstract at the ASET annual conference in New Orleans in 2002.

A picture of me with my poodle patient:

It is interesting to speculate that in the future, there will be more utilization of clinical EEG in veterinary practice.  My thanks to Dr. Bush for sharing this fascinating topic with us.  Many of the techs in the audience agreed with me and would like to hear more from him in the future.

The Future of Neurodiagnostics: ASET 2013 Keynote Address

So, our 2013 ASET Annual Conference in Reno kicked off with our Lewis Kull Memorial Keynote Address, given by Fred Lenhoff, who is with the AMA and on the Board of Directors for the Health Professions Network.  The title of his talk was  “The Future of the Health Care Workforce in America: Is it Supercalifragilistic Neurodiagnostic?”

He is a very animated and energetic speaker, and he used a new presentation software called “Prezi” that had a lot more motion than PowerPoint.  I plan on learning to use Prezi myself since it really livens up the visuals during a presentation!  He provided a broad overview of the status of health care in America and how allied health care fits in, and how it will likely fare in the future.  Here is a link to his Prezi to view some of the facts from his talk.  Just use the forward arrow to move through the presentation.http://prezi.com/6ovfdoue7bcc/?utm_campaign=share&utm_medium=copy

He actually composed two songs for this presentation.  One was a rap song and the other was sung to the tune from Mary Poppins, “Supercalifragilisticexpealidosious”.   Just for fun, I have included the lyrics here.  I will be back with more substantial content soon.  I have lots of information to share with you since the annual conference, but I am tallying conference attendee evaluations right now, I am a bit busy right now!

Rap Song:

Electro neuro diagnostic

Just saying this phrase gets me all exhausted.

Neurodiagnostics is somewhat an improvement,

but I need more than than that if I'm gonna be grooving

with this brain field, I'm a dude not a brainiac,

Do y'all electrocute peeps in the cranium? That's wack!

I ain't no maniac, don't wanna do no lobotomy,

just starting out on my work-life odyssey.

And y'all, it's odd to see a field so fertile

with a name like something from Yertle the Turtle.

Dr. Seuss could've used some of these here semantics,

but in real life it comes across a wee bit pedantic.

Don't get frantic, this field's got potential,

it may be evoked (that's a joke), see, I get mental

when I get challenged, and the brain is the real deal,

lemme close to let you know y'all got job appeal.

(My note:  He was illustrating the difficulty with terms for our profession)

And Supercalifragilistic Neurodiagnostic:

Supercalifragilistic neurodiagnostic

when you're in this field you're used to verbal acrobotics.

EEG and LTM and CPT my goodness

37 dogs and then 4 cats you've got a mess, miss! (My note: he is referring to an abstract from our program).

Anesthesia aneuyrsm epilectic seizures,

nerve conduction neurologic metabolic features

Neuro ICU and polygraphic channel overlays,

magneto encephalo graphy i'd never ix-nay

Supercalifragilistic neurodiagnostic

when you're in this field you're used to verbal acrobotics.

I'm not Mary Poppins or a vonTrapp family member,

but I got a few words that I sure hope you will remember.

We got more modalities than you could shake a stick at.

We evoke potential, we could educate a dead rat.

We're an “asset” to our doctors, they would choose no other,

our patient care is tops we treat each one just like our mothers.

Supercalifragilistic neurodiagnostic

when you're in this field you're used to verbal acrobotics.

This tune is done, I'll shut up now, but first let me assure y'all,

I'm glad we've had this time together, now it's sayanora!

Changes in Health Care and Neurodiagnostics

I am heading to the 2013 ASET Annual Conference in Reno this weekend!  It is time to put a new blog post up prior to heading to traveling.  I can’t let my readers get bored while they wait for something new to appear!  I have been thrilled with the increase in my blog readership since I started doing this a couple of years ago.  I now have over 500 readers per month, when I used to have less than 200!  The demographic statistics on my blog dashboard show that I have readers in Europe and Africa as well as in the USA.  We truly have become a global society, and hopefully a global neurodiagnostic society!

I would guess that most of my readers are not coming to Reno, so I thought I would write up an overview of a theme that has emerged in the conference program,  which may be on the minds of a lot of neurodiagnostic technologists and other allied health workers as well.

For this year’s ASET Annual Conference, our daily plenary sessions each address an aspect of health care reform and the far-reaching implications for those of us who work in the medical field.  There is always the fear of change and the unknown, fueling a sense of apprehension.  But in one form or another, we will survive as a profession.  With baby-boomers (like myself) aging, there will be more patients with neurological complications in the future.  Plus, we boomers will eventually retire from the work force, creating a shortage of skilled technologists.  So, we have to “grow” a lot of young, vital techs to take over where we leave off.  We also expect to see a trend toward more continuous monitoring of EEG in the critically ill patient population, so we will be required to cover more neuro-intensive care cases.

We have four different sessions at the conference that will help us get a handle on the future workplace for us.  The Keynote Speaker is Fred Lenhoff, who is on staff for the AMA, and is on the Board of Directors for the Health Professions Network.  He is an expert on allied health professions and trends in health care.  He will help us understand the “big picture”of health care reform.  He  will provide a comparison with our profession and other allied health specialties and how we will all fare in the future.

Our Ellen Grass Lecturer is Dr. Marc Nuwer, who has been involved on a government level as an advisor, serving on committees that set the rules for reimbursement.  He is a great advocate to have in our corner, as his specialty is IONM and ICU monitoring.  He will discuss how new legislation will affect our profession.

Our Kathleen Mears Lecturer is Sabrina Galloway, a technologist who has always had a keen interest in continuous EEG in the ICU, way before it became a recognized trend.  She also has managed services for a busy IONM company.  She will speak about how to position yourself, with credentials and education, to be a valuable member of the workforce.

And lastly:  Our Symposium:  “Doing More with Less and Reducing the Stress: Preventing Job Burn-Out” will include three panelists: a lab manager and a staff technologist will each explain their perspective and daily experience in this time of change.  The third panelist is a professional life coach, Beverly Marshall, will give us some tips on how to survive stress in the work place. 

I hope that this year’s conference program helps us develop strength in our profession as we position ourselves for the future.

See you on the other side of Reno!