A simulated patient experience to improve pharmacy student empathy for patients on hemodialysis.

INTRODUCTION: The aim of this study was to increase student empathy towards hemodialysis patients through an educational intervention that simulates a hemodialysis patient experience. METHODS: Second-year pharmacy students (n = 83) in a required therapeutic module were asked to follow key lifestyle modifications of a hemodialysis patient for two weeks. Students' self-perceived empathy level was assessed using the Kiersma-Chen Empathy Scale (KCES) pre- and post-intervention and post-reflection questions captured students' perceptions of the experience. Data were analyzed using frequencies and Wilcoxon signed ranks tests to assess pre-post changes. Reflection questions were assessed using a grounded analysis to identify themes. RESULTS: Significant differences were found on 13 of 15 KCES items and KCES composite scores. Of the 13 significant KCES items, nine were related to the cognitive domain and four were related to the affective domain. When asked how the experience impacted the student personally, 38 responded that it provided them with a better understanding of the challenges associated with managing hemodialysis treatments. In response to how this experience would change their professional interactions with a hemodialysis patient, students explained that they felt more equipped to empathize with patients (n = 22). CONCLUSIONS: This intervention improved students' cognitive and affective empathy towards hemodialysis patients, which may prepare them to be more compassionate healthcare professionals. Experiencing first-hand some of the quality-of-life challenges hemodialysis patients face significantly influenced student empathy levels towards this population.

Integration of the Saline Process on Holistic Patient Care to Improve Student Understanding of Interprofessional Team Roles, Values, and Ethics.

DESCRIPTION OF THE PROBLEM: Healthcare practitioner students currently report feeling underprepared to provide holistic and spiritual care to their patients upon transitioning into practice, and there is currently little data on the efficacy of holistic care-focused interventions on interprofessional outcomes. The goal of this research was to assess the impact of an interprofessional training session on holistic care on student perceptions of interprofessional 1) roles/responsibilities and 2) values/ethics. THE INNOVATION: A live, interactive interprofessional training session to address holistic patient care was implemented in fall of 2017. Students' pre- and post-training perceptions of their confidence in study outcomes were assessed using a survey instrument. CRITICAL ANALYSIS: Significant positive changes were seen in students' perceived ability to participate in team discussions and clarify misconceptions regarding their role in healthcare following the training. Students had high confidence in interacting ethically at pre-test and sustained that confidence. NEXT STEPS: Live, interactive educational interventions with skills practice and group discussions can help to increase students' awareness of team roles and responsibilities, as well as expand their understanding of the values and ethics within healthcare professions.

New-onset refractory status epilepticus in an adult with an atypical presentation of cat-scratch disease: successful treatment with high-dose corticosteroids.

New-onset refractory status epilepticus (NORSE) is defined as a sudden onset of refractory status epilepticus in patients who do not have a history of epilepsy. It is a neurologic emergency, and determining the underlying etiology is an important factor for effectively managing and predicting the prognosis of NORSE. We describe the case of a 28-year-old woman who was hospitalized with NORSE secondary to an unknown etiology. She did not respond to traditional anticonvulsant therapy, including benzodiazepines, fosphenytoin, propofol, and levetiracetam. The patient was placed on continuous electroencephalography (EEG) monitoring and was treated further with multiple antiepileptics, which were titrated aggressively based on EEG readings and therapeutic drug levels; despite this treatment, EEG monitoring revealed continued seizures. Thus, high-dose corticosteroids were started for seizure control. Her workup included computed tomography and magnetic resonance imaging of the head, a lumbar puncture, toxicology screening, and extensive testing for multiple infectious and inflammatory etiologies. The patient's history revealed recent exposure to a new cat. Serologic results were positive for Bartonella henselae, and she was diagnosed with cat-scratch disease (CSD). She did not have the typical presentation of symptoms of lymphadenopathy, however, which is common in CSD. Doxycycline 100 mg and rifampin 300 mg twice daily were added to the patient's anticonvulsant and corticosteroid therapy. She was hospitalized for a total of 26 days and discharged with only minor neurologic impairment (short-term memory deficits and minor cognitive problems). The patient was discharged receiving antiepileptics, antibiotics, and a corticosteroid taper. To our knowledge, this is the first clinically known case of NORSE secondary to CSD without typical CSD symptoms in the adult population. The patient failed to respond to traditional anticonvulsant therapy alone. With the addition of high-dose corticosteroids to aggressive anticonvulsant therapy, seizure control was achieved. Further studies are needed to determine the effectiveness of high-dose corticosteroid and anticonvulsant therapy followed by antibiotics in patients with NORSE secondary to CSD.