Implantation of a vagus nerve stimulator (VNS) to decrease seizure frequency and severity became available for commercial application in Europe in 1994 and in the US since 1997. 1 Randomized clinical trials have reported greater than 50% improvement in seizure control in 20 to 30 percent of patients experiencing therapeutic levels of stimulation. 2-4 Improved seizure control has been correlated with a longer follow-up ABSTRACT: Objective: This prospective, case control study evaluates quality of life (QOL), depressive affect, and memory outcomes of epilepsy patients implanted with a vagus nerve stimulator (VNS). Methods: Three groups of patients with epilepsy underwent assessment on two occasions: 1) patients with a VNS were tested before and 12 months after implantation (n = 16); 2) patients who underwent cerebral resective surgery were tested pre-and post-operatively (n = 10); and 3) patients under medical management (n = 9). Group means were compared on the QOLIE-89, Geriatric Depression Scale, Wechsler Memory Scale -III, and the Memory Observation Questionnaire. Secondary analyses calculated the reliable change index, providing information on change beyond measurement error and chance. Results: Mean ratings of QOL, depression, and memory complaints and objective memory scores remained stable or improved in all the groups. The QOL improved more after cerebral resective surgery than VNS or medication controls, but the VNS and medication control groups did not differ. In the VNS group, QOL was not related to seizure reduction. The percentage of cases showing real change in memory was equivalent across groups, except in one of eight indices (i.e., verbal recognition memory). Conclusions: This first case controlled design found that vagus nerve stimulation as an adjunctive therapy for seizure control did not change QOL, depressive affect, or objective memory scores over one-year more so than medical management alone. We point out the need for larger case control, non-industry funded investigations. RÉSUMÉ: Qualité de vie et mémoire après implantation d'un stimulateur du nerf vague pour traiter l'épilepsie.Objectif : Le but de cette étude prospective cas-témoin était d'évaluer la qualité de vie (QV), l'affect dépressif et la mémoire de patients épileptiques chez qui un stimulateur du nerf vague (SNV) a été implanté. Méthodes : Trois groupes de patients épileptiques ont été évalués à deux reprises : 1) des patients porteurs d'un SNV ont été évalués avant et 12 mois après son implantation (n = 16); des patients qui ont subi une résection cérébrale chirurgicale ont été évalués avant et après la chirurgie (n = 10); 3) des patients sous traitement médical (n = 9). Nous avons comparé les moyennes des groupes pour les tests suivants : QOLIE-89, Geriatric Depression Scale, Wechsler Memory Scale-III et Memory Observation Questionnaire. Nous avons également calculé le reliable change index, ce qui ajoute de l'information sur le changement qui n'est pas dû à l'erreur de mesure ou au hasard. Résultats : La moyenne des évalu...

IMPORTANCE With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care. OBJECTIVE To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments. DESIGN, SETTING, AND PARTICIPANTS A qualitative mixed-methods analysis of survey data collected from February to April 2015, was conducted followed by analysis of narrative data collected in June 2017. The setting was 2 health systems and 4 health professional and graduate schools. Participants were faculty, trainees, staff, and students (3506 survey respondents and 52 narratives) affiliated with the University of Pennsylvania and the University of Pennsylvania Health System. Data analysis was conducted in 2018 and 2019. EXPOSURES Independent variables included the following respondent characteristics: gender identity, sexual orientation, race/ethnicity, position, generational age group, length of employment at institution, disability status, belief system or religion, and primary site of work or study. MAIN OUTCOMES AND MEASURES Survey questions were used to assess participants' perception and experiences of professionalism in the workplace as measured by a 5-point Likert-type scale. RESULTS For the survey, there were 3506 respondents from a pool of 18 550 potential respondents (18.9% response rate). Of 3506 survey respondents, 2082 of 3231 (64.4%) were women, 331 of 3164 (10.5%) identified as gender or sexual minority groups, and 360 of 3178 (11.3%) were non-Hispanic Black individuals. In adjusted analyses, women compared with men (adjusted odds ratio [aOR], 1.8; 95% CI, 1.4-2.3) and Asian individuals (aOR, 2.0; 95% CI, 1.7-2.3) and Hispanic individuals (aOR, 2.0; 95% CI, 1.4-2.7) compared with non-Hispanic White individuals were more likely to value institutional professionalism. In addition, gender identity and sexual minority groups compared with heterosexual respondents (aOR, 1.5; 95% CI, 1.2-1.8) and non-Hispanic Black individuals compared with non-Hispanic White individuals (aOR, 1.3; 95% CI, 1.2-1.4) were statistically significantly more likely to consider changing jobs because of unprofessional behavior at work. The qualitative analysis of narratives revealed that marginalized populations (including but not limited to women, gender and sexual minority groups, racial/ethnic minority groups, those who identify as having a disability, and religious minority groups) reported (1) greater infringements on their professional boundaries, as well as increased scrutiny over their professional actions, and (2) a tension between inclusion vs assimilation.

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By describing an instance of racial violence by a patient against a resident physician, the authors hope to stimulate further discussion by addressing three specific questions about managing racist patients: (1) How should the resident (or any level of trainee) respond to the immediate situation? (2) How should the unit respond to the event as a community? and (3) How should the institution (hospital and/or academic institution) respond to the event? The authors argue that responses to such incidents should acknowledge the history of structural racism in U.S. society and in medicine. The authors recommend an approach that names the racism directly while addressing the safety of the patient and the providers in the moment, supports those affected in the aftermath, and considers appropriate consequences for the perpetrators of violence.

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