February 2018 Spotlight
Stan Skinner, MD is a board certified neurologist and clinical neurophysiologist who has been involved in intraoperative neurophysiology (IOM) for 25 years. He obtained his medical degree from Washington University School of Medicine. He completed his neurology residency and clinical neurophysiology fellowship at the University of Minnesota. He is currently Director of Clinical Neurophysiology at Abbott Northwestern Hospital Minneapolis, MN. He is a Fellow of the American Clinical Neurophysiology Society (ACNS) and the American Society of Neurophysiological Monitoring (ASNM). Dr. Skinner is also an Associate Editor of the Journal of Clinical Monitoring and Computing. One of his leading societal missions has been advocacy for a patient centered model of IOM supervision. In the last several years, his primary research interests have been: the use of EMG in IOM, the application of Bayesian probability to investigate false reporting in IOM, the investigation of improved methods to monitor lower spine/pelvic surgery including autonomic neurophysiology, and the introduction of new options to explore and clarify the IOM evidence base.
In 2010 he was asked to draft a guideline for supervising IONM professionals (Skinner et al, 2014). As part of that work, he investigated the role of IONM physicians in the care of surgical patients. In 2011, CMS (Centers for Medicare and Medicaid Services) defined physician care in telemedicine, or so-called "remote monitoring". According to CMS, the continuous assessment of patients and the real-time communication of advice on patient care places all supervising IONM physicians, including those remotely connected, squarely in a consulting and co-practice role (Skinner, 2013).
This "co-practitioner" role is also supported by the more than 1200 articles on inter-professional communication in operating rooms. It turns out that poor communication is the key element in 2/3 of medical errors. The extensive scholarship on error avoidance and decision theory specific to ORs implies that IONM physicians should be encouraged to play a much more situationally aware and personal role during discussions of a possible change in case management after an IONM alert. That scholarship also includes clinical outcome studies showing a major reduction in poor outcomes when inter-collegial collaboration standards are improved in ORs. Obviously, the possibility of miscommunication and medical errors is increased if IONM physicians see themselves as something less than co-practitioners with the surgeon and anesthesiologist. The need to get all IONM physician to recognize their role in error reduction and patient safety led to this review.
April 2017 Spotlight
Nicholas S. Abend, MD completed medical school and pediatrics residency at the University of Chicago, child neurology residency and pediatric epilepsy/EEG fellowship at the Children's Hospital of Philadelphia, and a Master's degree in Clinical Epidemiology at the University of Pennsylvania. He is currently an Associate Professor of Neurology and Pediatrics at the University of Pennsylvania and the Children's Hospital of Philadelphia, where is also the Medical Director of the Clinical Neurophysiology Lab. He is a member of the Council of the American Clinical Neurophysiology Society (ACNS), the current chair of the Critical Care EEG Monitoring Research Consortium, an Associate Scholar in the Center for Epidemiology and Biostatistics at the University of Pennsylvania, and a fellow of the ACNS and the American Epilepsy Society. He has received the Cosimo Ajmone-Marson Award from the Journal of Clinical Neurophysiology and the Resident Teaching Award from the Department of Neurology at the University of Pennsylvania.
Dr. Abend's NIH-funded research addresses the neuroprotective potential of EEG monitoring and seizure management in critically ill children and neonates. His studies have demonstrated that electrographic seizures are common in critically ill children with acute encephalopathy, high electrographic seizure exposures are associated with worse neurobehavioral outcomes even after adjustment for brain injury etiology and critical illness severity, and more rapid electrographic seizure management initiation is associated with higher anti-seizure medication efficacy. However, continuous EEG monitoring is resource intense. This led to the question, how much would seizure identification and management have to improve neurobehavioral outcomes to make EEG monitoring a cost effective strategy? A cost effectiveness analysis indicated that even a small improvement in patient outcomes would make EEG monitoring a cost-effective strategy despite the high initial costs. Thus, further study is warranted to determine whether optimized electrographic seizure management improves patient outcomes.