Skip to main content
  1. Courses
  2. NCS Podcast Series
  3. Episode 99: PERSPECTIVES - ...

Episode 99: PERSPECTIVES - Dr Clio Rubinos

Loading audio, please wait...

Description

In this week's episode, Dr Lauren Koffman is joined by Dr Clio Rubinos to discuss her recent article in Currents - The Tower of Babel: Translating the ICU-EEG Nomenclature in Spanish.

Contributors

  • Clio Rubinos, MD

  • Lauren Koffman DO, MS

    Assistant Professor, Clinical Neurology, Lewis Katz School of Medicine at Temple University

  1. 00:00:20
    Hi, everyone. This is Lauren Kaufman.
  2. 00:00:21
    Welcome you back to the NCS podcast.
  3. 00:00:24
    Today, we have an episode from our
  4. 00:00:25
    perspective series where we'll explore
  5. 00:00:27
    the diverse perspectives and
  6. 00:00:28
    neurocritical care. I would like to
  7. 00:00:30
    welcome Dr. Cleo Rubino from UNC Chapel
  8. 00:00:33
    Hill to discuss her current article,
  9. 00:00:35
    The Tower of Babel, translating the
  10. 00:00:36
    ICUEG
  11. 00:00:38
    nomenclature in Spanish. So welcome,
  12. 00:00:40
    Cleo. Thanks for joining us today.
  13. 00:00:43
    Thank you so much for inviting me and
  14. 00:00:44
    giving me the opportunity to be the
  15. 00:00:45
    podcast So before we get talking about
  16. 00:00:48
    your project, why don't you just give
  17. 00:00:50
    us a little bit of background about who
  18. 00:00:52
    you are and why this is an interest?
  19. 00:00:54
    Yes, absolutely. So I was born and
  20. 00:00:57
    raised in Peru, where I completed my
  21. 00:00:59
    medical education and later on I came to
  22. 00:01:02
    the United States to undertake my
  23. 00:01:03
    residency. And the residency is when I
  24. 00:01:06
    realized that I fell in love with
  25. 00:01:07
    critical care and neurophysiology,
  26. 00:01:09
    reason why I did both fellowships and
  27. 00:01:12
    fellowship in both of the fields And
  28. 00:01:14
    early on my career, even since I came
  29. 00:01:16
    to America, I always knew that I wanted
  30. 00:01:18
    to work with the medical landscape in
  31. 00:01:21
    Latin America, for what I established
  32. 00:01:23
    contact with Latin America bring injury
  33. 00:01:25
    consortium in 2018 when I was the
  34. 00:01:28
    critical guard fellow. And after I
  35. 00:01:30
    contact them, I had the opportunity to
  36. 00:01:32
    give a couple of talks, a couple of
  37. 00:01:34
    presentations in a conference in Peru,
  38. 00:01:36
    and later on to collaborate with labic
  39. 00:01:38
    presidents in some educational
  40. 00:01:41
    initiatives, particularly in the realm
  41. 00:01:43
    of ICU, EEG, and also the state of
  42. 00:01:46
    state elliptical management talks. In
  43. 00:01:50
    2021, working also with labic, I
  44. 00:01:52
    directed an ICU, EEG workshop in
  45. 00:01:55
    Colombia, Cali, Colombia, a workshop
  46. 00:01:58
    that was indoors and is indoors by the
  47. 00:01:59
    American clinical of neurophysiology
  48. 00:02:01
    society. And during that workshop, we
  49. 00:02:04
    realized that what we do in the talks,
  50. 00:02:07
    it was very evident that some EEG terms
  51. 00:02:10
    like in a precise, disadvantaged
  52. 00:02:11
    equivalent. And this realization is for
  53. 00:02:14
    us, of the speakers, it was five of us,
  54. 00:02:18
    to initiate the translation of ICU
  55. 00:02:20
    digital neurology and mean to bridge the
  56. 00:02:22
    linguistic gap. I mean, yeah, I know
  57. 00:02:25
    even in English, the terminology is
  58. 00:02:26
    frequently changing and it can be hard
  59. 00:02:28
    to keep up with. So I can't imagine
  60. 00:02:30
    what it's like to try and convey these
  61. 00:02:32
    terms in another language. So you
  62. 00:02:35
    mentioned you have this interest, you
  63. 00:02:37
    were giving all these talks. And so
  64. 00:02:39
    when did this consortium form that is
  65. 00:02:42
    ultimately the group leading the project
  66. 00:02:44
    and who's a part of it? Yes, no, the
  67. 00:02:46
    consortium was formed So we started the
  68. 00:02:48
    early process of consortium in 2021
  69. 00:02:52
    right after the workshop. And it was
  70. 00:02:54
    very well established last year. And
  71. 00:02:56
    then we presented this year the critical
  72. 00:02:58
    care of EDG consortium. And it started
  73. 00:03:02
    with five of us. And we recruit more
  74. 00:03:04
    people who are a total of 14 individuals
  75. 00:03:07
    now. And these 14 individuals are from
  76. 00:03:09
    various countries, including Mexico,
  77. 00:03:12
    Uruguay, Peru, Ecuador, Dominican
  78. 00:03:14
    Republic, Colombia, Spain, Argentina.
  79. 00:03:18
    Nicaragua, and also we have someone
  80. 00:03:19
    from Puerto Rico, which is from the
  81. 00:03:21
    United States, but they speak Spanish
  82. 00:03:22
    as well. And there are practitioners
  83. 00:03:25
    that are both, we have the
  84. 00:03:28
    narratricians and we also have adults,
  85. 00:03:30
    epileptologists and neurophysiologists,
  86. 00:03:32
    and two of us are also in
  87. 00:03:35
    their intensities. And we have a
  88. 00:03:36
    combination of both, of Spanish
  89. 00:03:38
    speaking, all of them are bilingual.
  90. 00:03:41
    So we have some of them that live in the
  91. 00:03:43
    United States, and some of them that
  92. 00:03:45
    are working in the respective home
  93. 00:03:47
    countries. Wow, that's awesome. And
  94. 00:03:50
    when you guys came together, what's
  95. 00:03:52
    like the ultimate goal of your group?
  96. 00:03:55
    Yeah, the primary objective of the
  97. 00:03:56
    group is to translate, and that first
  98. 00:03:58
    objective, it will translate the ICU
  99. 00:04:00
    easier maker group from English to
  100. 00:04:01
    Spanish. So we're not trying to
  101. 00:04:03
    establish a new one, which is one to
  102. 00:04:05
    use the one that has already been
  103. 00:04:06
    established, and it's not for many
  104. 00:04:07
    years from the ACNS to Trothele in
  105. 00:04:09
    Spanish, because this translation would
  106. 00:04:11
    have facilitate research and
  107. 00:04:13
    collaboration within Spanish speaking
  108. 00:04:15
    countries, but also enhancing.
  109. 00:04:17
    academic diversity within the field.
  110. 00:04:20
    Cool, and in your current article you
  111. 00:04:23
    mentioned, there is a specific
  112. 00:04:25
    methodology you're using to develop
  113. 00:04:27
    these translation. How, like, can you
  114. 00:04:29
    just tell us about that process? Yes,
  115. 00:04:31
    we have been working also with a PhD in
  116. 00:04:33
    education, which is, you know, Andres
  117. 00:04:36
    of Fagmatis his collaborators to give us
  118. 00:04:36
    good advice and mentoring in the
  119. 00:04:36
    instructor one also and,
  120. 00:04:38
    translation of the ICU eG terminology
  121. 00:04:46
    'Cause one can think just, you know,
  122. 00:04:49
    put a Spanish equivalent, but it might
  123. 00:04:53
    not be accepted because Latin America
  124. 00:04:54
    and Spain, so Spanish-speaking
  125. 00:04:54
    countries is very diverse. So the
  126. 00:04:58
    methodologies involve like mainly three
  127. 00:05:00
    bigger steps. The first step
  128. 00:05:12
    is to form the core group, which is a
  129. 00:05:13
    14 of us, and this core group was
  130. 00:05:13
    divided into three subgroup. And each
  131. 00:05:13
    subgroup had a task to iteratively
  132. 00:05:13
    translate a specific section for the
  133. 00:05:15
    momenta group. you know, they will get
  134. 00:05:17
    together in a regular basis and then
  135. 00:05:18
    translate their specific section that
  136. 00:05:21
    was given to them. And then the second
  137. 00:05:23
    step is that whenever these groups get
  138. 00:05:25
    into a disagreement for recognition of a
  139. 00:05:28
    Spanish equivalent, we'll call into a
  140. 00:05:30
    discussion with an entire group level in
  141. 00:05:33
    which we like, during these meetings,
  142. 00:05:35
    the entire group will agree or disagree
  143. 00:05:38
    or argue about the multiple options that
  144. 00:05:40
    we have for the translation of a certain
  145. 00:05:43
    EEG term And all the discussion was
  146. 00:05:47
    recorded in notes. And then with the
  147. 00:05:50
    discussion, we all agree into which are
  148. 00:05:52
    the multiple choices that we can
  149. 00:05:54
    probably translate this English word.
  150. 00:05:57
    And then now having all these options is
  151. 00:06:00
    what is going to lead us to the next
  152. 00:06:01
    step, which is a third one, which is
  153. 00:06:06
    the creation of a focus group which
  154. 00:06:08
    expert leaders within the field that
  155. 00:06:10
    reside in Spanish-speaking countries to
  156. 00:06:10
    obtain a
  157. 00:06:13
    consensus of individuals who will use
  158. 00:06:15
    the nomenclature. in their local
  159. 00:06:17
    settings, but also would pitch to the
  160. 00:06:18
    common generations. Wow, that sounds
  161. 00:06:21
    pretty extensive. How far into this
  162. 00:06:22
    process are you at this point? Yeah,
  163. 00:06:25
    when I did this point, we are, of
  164. 00:06:26
    course, like the IRB is under the
  165. 00:06:28
    process, but we also have been
  166. 00:06:30
    recognizing the leaders into the leaders
  167. 00:06:33
    within the countries, and that has been
  168. 00:06:35
    taking a lot of time, because as you
  169. 00:06:38
    can imagine, very diverse and have its
  170. 00:06:39
    own challenges too. And I think you did
  171. 00:06:43
    include a survey link in your current
  172. 00:06:45
    article, which will attach on the show
  173. 00:06:47
    link so that if anyone's interested in
  174. 00:06:48
    participating, they can go ahead and
  175. 00:06:50
    fill that out, right? Yes, that would
  176. 00:06:52
    be fantastic. We're like, you know,
  177. 00:06:54
    we would like everybody that is
  178. 00:06:55
    interested to just come and reach out to
  179. 00:06:57
    us, and the current article actually
  180. 00:06:59
    helps us recognize and some people from
  181. 00:07:01
    certain countries that we have not had,
  182. 00:07:03
    recognize someone. So if you are
  183. 00:07:05
    interested, if you're not someone,
  184. 00:07:07
    please let us know, and there's a link
  185. 00:07:09
    that you can fill your information. So
  186. 00:07:11
    now it sounds like you're very much in
  187. 00:07:13
    the early stages but have you already
  188. 00:07:14
    had any like challenges or do you
  189. 00:07:16
    anticipate some that will kind of come
  190. 00:07:18
    up along the way and how are you
  191. 00:07:19
    preparing for that? Yeah no they
  192. 00:07:22
    definitely challenges we're trying to
  193. 00:07:23
    you know create and Spanish
  194. 00:07:27
    translation because of that many many
  195. 00:07:30
    like background and cultural diversity
  196. 00:07:30
    that we have in Latin America speaking
  197. 00:07:30
    countries and also it's not only the
  198. 00:07:30
    cultural but it's also diverse
  199. 00:07:34
    geographical regions and one of the
  200. 00:07:38
    things
  201. 00:07:41
    that have been very challenging and
  202. 00:07:44
    having very time consuming is recruiting
  203. 00:07:46
    suitable professionals because we need
  204. 00:07:48
    to have a good representation from
  205. 00:07:50
    neurology epilepsy and neurophysiology
  206. 00:07:52
    societies amongst multiple countries.
  207. 00:07:54
    Within America we're used to have
  208. 00:07:57
    neurology as a big umbrella and in that
  209. 00:08:00
    big umbrella neurophysiology and it
  210. 00:08:01
    leaves me full of pain but this is not
  211. 00:08:04
    true in other countries they have
  212. 00:08:06
    different societies and now working on
  213. 00:08:08
    polarity with these different societies.
  214. 00:08:11
    and unifying a translation post a bit,
  215. 00:08:13
    some more challenges. Yeah, and so
  216. 00:08:17
    this is like, obviously a relevant
  217. 00:08:19
    knowledge project. How do you foresee
  218. 00:08:21
    finalizing this? Do you think it'll be
  219. 00:08:22
    like a statement paper or a presentation,
  220. 00:08:25
    both? Yeah, we have been working with
  221. 00:08:28
    ACNS and the plan is to publish in the
  222. 00:08:31
    journal of clinical neurophysiology.
  223. 00:08:33
    And hopefully we can complete this by
  224. 00:08:35
    early next year. Awesome And how do you
  225. 00:08:39
    think that eventually having this
  226. 00:08:41
    published will change practice or future
  227. 00:08:44
    research projects? Yeah, it's not only
  228. 00:08:47
    the research but it also can help in the
  229. 00:08:48
    patient curve. I think the translation
  230. 00:08:50
    therefore will facilitate communication
  231. 00:08:52
    and research collaboration, but also
  232. 00:08:55
    patient curve across Spanish speaking
  233. 00:08:57
    countries. In terms of the research
  234. 00:08:59
    collaboration, I think it's going to
  235. 00:09:01
    foster a community akin like the English
  236. 00:09:03
    speaking figure at very EEG monitoring
  237. 00:09:05
    research consortium that can help
  238. 00:09:07
    accelerate a happy data bank. So we can
  239. 00:09:09
    create our own data.
  240. 00:09:11
    And with our local tools, you can use
  241. 00:09:15
    this data for the management of our
  242. 00:09:16
    critical patients or hospitalised
  243. 00:09:18
    patients. And for the patient curve,
  244. 00:09:21
    enhancing the terminology will aid
  245. 00:09:23
    epilepsy surgery patients who seek care
  246. 00:09:26
    across borders. It's underizing the ED
  247. 00:09:29
    terminology will also help better
  248. 00:09:30
    understanding the EDG reports that
  249. 00:09:33
    sometimes we receive from different
  250. 00:09:34
    countries and it will help the medical
  251. 00:09:36
    professionals understand whether we're
  252. 00:09:38
    looking into those recordings And as you
  253. 00:09:41
    know, surgical care is not available
  254. 00:09:43
    everywhere. Sometimes they have, you
  255. 00:09:45
    know, within Latin America, you have
  256. 00:09:46
    to apply either to Chile, Colombia, or
  257. 00:09:49
    Brazil, or sometimes they seek for a
  258. 00:09:50
    second opinion, but also within
  259. 00:09:52
    Spanish-speaking countries, or come
  260. 00:09:54
    here to America, as I should receive
  261. 00:09:56
    sometimes, technologists from New York
  262. 00:09:58
    or Florida asking me what the visitor
  263. 00:10:00
    means or not. But it's not only for
  264. 00:10:03
    epilepsy care, but also it's gonna be
  265. 00:10:05
    beneficial for any other patient that
  266. 00:10:07
    requires any EDG care, whether it's
  267. 00:10:09
    ice-cream related. or not, while
  268. 00:10:11
    they're traveling to Spanish-speaking
  269. 00:10:12
    countries. So whenever they want to go
  270. 00:10:14
    back to the countries and establish care
  271. 00:10:17
    of good continuity of care by bringing
  272. 00:10:17
    in the medical records, it's underizing
  273. 00:10:18
    these easy reports. We understand that
  274. 00:10:18
    home country decisions, know what has
  275. 00:10:18
    happened to these patients where they
  276. 00:10:18
    were traveling abroad. Wow, I hadn't
  277. 00:10:18
    even really thought of
  278. 00:10:31
    all those implications and applications
  279. 00:10:33
    for developing such a statement. So
  280. 00:10:37
    that's great With your interesting and
  281. 00:10:39
    unique background, I'm just curious to
  282. 00:10:41
    know if there's any other areas or
  283. 00:10:43
    projects you envisioning working on the
  284. 00:10:45
    future that can help bridge these gaps
  285. 00:10:47
    that do exist between English and
  286. 00:10:49
    non-English speaking practices and
  287. 00:10:51
    countries. Yes, right now we're
  288. 00:10:54
    assessing the ICU-EIGI
  289. 00:10:57
    resources and practices in a
  290. 00:10:58
    Spanish-speaking country, which is a
  291. 00:11:00
    survey that is ongoing right now. And
  292. 00:11:03
    it's also gonna help us right now to
  293. 00:11:04
    understand the state of the arts, of
  294. 00:11:06
    the e-gric course, how the ICU e-gid
  295. 00:11:09
    technology. a momenta tour is being
  296. 00:11:11
    used but is not used at all. And the
  297. 00:11:14
    other project that we have is involved
  298. 00:11:18
    in establishing regular group meetings
  299. 00:11:20
    for ongoing educations. We want to
  300. 00:11:23
    mirror what has been successful already
  301. 00:11:26
    in epilepsy surgical, in epilepsy
  302. 00:11:28
    surgery, education initiative that has
  303. 00:11:30
    been led out of Borneo, out of Mayor.
  304. 00:11:33
    But Borneo is from Peru and he lives in
  305. 00:11:34
    Canada, not on Mayor, he lives in
  306. 00:11:36
    Colombia. And what they do is they have
  307. 00:11:38
    these monthly meetings in which has
  308. 00:11:40
    discussed surgical cases. So we want to
  309. 00:11:43
    mirror these successful educational
  310. 00:11:44
    across Latin American or Spanish
  311. 00:11:46
    speaking countries because obviously
  312. 00:11:48
    Spain is also involved in which we're
  313. 00:11:50
    going to try to provide a platform for
  314. 00:11:53
    clinical discussions centering around
  315. 00:11:55
    complex cases of ICUD cases. So we can
  316. 00:11:58
    promote continued learning and education.
  317. 00:12:01
    It's a lot to look forward to, You
  318. 00:12:03
    sound very busy.
  319. 00:12:05
    Before we sign off, is there anything
  320. 00:12:07
    else you want to tell people about this
  321. 00:12:08
    project or any other pleas to get people
  322. 00:12:11
    involved? Yeah, well, I think like
  323. 00:12:14
    the biggest, it's said that we want to
  324. 00:12:16
    fulfill right now that there is depth in
  325. 00:12:18
    order to have enough diversity and
  326. 00:12:20
    representation for central countries.
  327. 00:12:22
    Specifically, Central America has a
  328. 00:12:25
    little bit more of challenging and to
  329. 00:12:26
    recognize leaders in the fields. So if
  330. 00:12:29
    anybody knows someone, please let us
  331. 00:12:30
    know, they'll be fantastic And if
  332. 00:12:33
    anybody also has any suggestions or
  333. 00:12:35
    comments or ideas that we can use with
  334. 00:12:37
    the current group that we have as a
  335. 00:12:38
    theater project, we're really open for
  336. 00:12:41
    collaborations and for ideas that we can
  337. 00:12:43
    work together. Awesome, thank you
  338. 00:12:46
    again so much for joining and sharing
  339. 00:12:48
    your project with us. Thanks to
  340. 00:12:49
    everyone for listening. You can find
  341. 00:12:51
    the NCS podcast on whichever platform
  342. 00:12:53
    you prefer. Don't forget to add us to
  343. 00:12:55
    your favorites. You never miss an
  344. 00:12:56
    episode. And for more information on
  345. 00:12:58
    current articles, please head to
  346. 00:12:59
    currentsneurocriticalcareorg.