Medicine and Health Sciences Commons^™

Educating Clinician Scientists Once Again—A Societal Need, James Peter Meza

Clinical Research in Practice: The Journal of Team Hippocrates

The Faculty Editor advocates for the training of clinician scientists again, using the body of clinical research as the laboratory.

Proceedings Of 2016 Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 42nd annual Aurora Scientific Day research symposium, held May 25, 2016, in Milwaukee, Wisconsin. Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, students and other allied health professionals affiliated with Aurora Health Care, a not-for-profit health system comprised of integrated hospitals and clinics across eastern Wisconsin and northeastern Illinois.

Benefit Of Report Card Feedback After Point-Of-Care Assessment Of Communication Quality Indicators, Michael H. Farrell, Clair R. Sprenger, Shelbie L. Sullivan, Bree A. Trisler, Jessica J.F. Kram, Erin K. Ruppel

Journal of Patient-Centered Research and Reviews

Background: Communication in health care is crucial for patient experience and biomedical outcomes, but problems with communication are often seen in health care. Training can improve communication, but skills must be reinforced after graduation to remain improved. Since educational methods are too resource intensive for sustained use throughout the Aurora Health Care system, it is necessary to develop affordable, quantitative methods. The first author has developed necessary techniques, including behavior-specific measures called communication quality indicators.

Purpose: To demonstrate secure audio recording in an outpatient visit and to use communication quality indicators with a heterogenous set of patient-clinician conversations.

Methods: Thirty …

Quality Improvement Of Procedural Services In Family Medicine Residency Clinics, Keisha Rogers, Nora Guschwan, Lisa Sullivan Vedder

Journal of Patient-Centered Research and Reviews

Background: Performing common procedures in our family medicine residency clinics is often a difficult and inefficient process. A 2008 Society of Teachers of Family Medicine consensus statement on procedural training found higher job satisfaction and better financial compensation for family practitioners who performed procedures. Patient satisfaction is likely increased when minor procedures are able to be performed by their primary clinician. This would suggest a disconnect between the known benefits of providing procedural services and the ability of our residency clinics to provide those services in an efficient manner.

Purpose: To assess clinician and staff comfort with performance of common …

Wise-Family Medicine: A Statewide Faculty Development Collaborative, Deborah Simpson, Kjersti Knox, Anne Getzin, John R. Brill, Melissa M. Stiles, Jeffrey A. Morzinski

Journal of Patient-Centered Research and Reviews

Background: In many states, family medicine residencies and medical schools compete clinically for patients, educationally for trainees and, more recently, for community preceptors (CPs). As Wisconsin’s medical schools and health care systems have expanded their geographic footprints, our CPs now teach trainees from competing institutions. Yet residency and medical student accrediting bodies require faculty and preceptor development.

Purpose: To evaluate the impact of a statewide collaborative of family medicine educators on meeting faculty development needs of our CPs and collaborative members.

Methods: Faculty development leaders representing the three largest family medicine residency training sponsors in the state created the Wisconsin …

Effect Of Code Status Handout On Resident Physician Comfort During The Admission Process, Krystina Pischke, Jessica Schmid, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Discussing code status can be a difficult part of the admission process, especially for residents. There have been various research studies looking at interventions to improve end-of-life discussions. However, these studies have focused on well-acquainted physicians and patients. With increasing use of hospitalists for inpatient care, there is increased need for improving code status discussions at admission.

Purpose: To determine if an easy-to-use handout would improve resident comfort with the code status discussion.

Methods: Following a literature search on how to discuss advance directives and end-of-life care, a code status handout was developed. The handout, written at fifth-grade reading …

Bias In The Eyes Of Resident Physicians, Abel H. Irena, Kern A. Reid, Richard Battiola, Anthony Cáceres

Journal of Patient-Centered Research and Reviews

Background: The utilization of patient characteristics can allow health care providers to arrive at diagnosis or decide on treatment options; however, the subjective nature of patient characterization can negatively affect patient care. A 2003 Institute of Medicine report, called Unequal Treatment, recognized that bias or stereotyping may affect provider-patient communication or the care offered.

Purpose: To investigate residents’ recognition of bias in an inpatient care setting.

Methods: In order to explore the topic of bias among providers, we elected to indirectly assess its recognition among providers by asking their opinion in an anonymous manner about their fellow residents. This, we …

Are There Advantages To Hiring In-House Training Program Graduates?, Jessica J.F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Several studies have compared international graduates on measures of performance, quality and satisfaction. No studies have compared internally versus externally hired graduates in relation to these measures.

Purpose: To identify if there is a difference in hiring patterns and care management (CM)/patient satisfaction (PS) scores between internal and external graduate hires.

Methods: We conducted a quality improvement study on graduates hired by Aurora Health Care from Jan. 1, 2006, to Dec. 14, 2015. CM scores were determined based on hire date. PS scores were calculated based on the calendar year, regardless of exact hire date. PS scales for scoring …

Patient And Health Professions Student Team Perceptions Of Patient-Centeredness In An Inter-Professional Education Home-Visit Program: An Exploratory Study, Kayla Bastian, Christian Banez, Miranda Ketcherside, Mackenzie Maher, Elijah Puett, Darson L. Rhodes, Carol Cox

Patient Experience Journal

The purpose of this study was to compare patient and health professions student team perceptions of patient-centeredness in an inter-professional clinical education home-visit program. Following an inter-professional clinical education home-visit program, patient and health professions student team perceptions of patient-centeredness were compared using a modified version of the Patient Perception of Patient Centeredness Questionnaire. The results showed both patient and student team participants perceived that student teams focused on how much they cared about the patient as a person and the opportunity to discuss any questions. Patients, however, reported significantly higher levels of patient-centered clinical method used during the visits …

Rural Surgery Training Programs In The United States: A Review Of The Literature, Daniel M. Avery Jr, Joseph C. Wallace

Online Journal of Rural Research & Policy

RURAL SURGERY TRAINING PROGRAMS IN THE UNITED STATES:

A REVIEW OF THE LITERATURE

Abstract: Rural surgery training programs have been developed to train general surgeons for community and rural service. There are 10 rural surgery training programs in the United States. Rural surgery training began in 1974 in LaCrosse, Wisconsin to prepare general surgery residents for rural service. There is a national shortage of general surgeons which translates into a deficit of surgeons in rural areas. The terms “general surgeon” and “rural surgeon” are not synonymous as rural surgery is more extensive, more broad-based and more subspecialty with more trauma, …

Developing Healthcare Practitioners’ Professional Expertise Through Effective Continuing Education: Commentary, Caroline Faucher

Internet Journal of Allied Health Sciences and Practice

Development of professional expertise is the transition from novice to expert within a profession through deliberate practice with feedback. While this development is actively stimulated during undergraduate studies, encouraging practicing healthcare professionals to pursue their development towards expertise doesn’t seem as obvious. This commentary briefly describes the development of professional expertise and the possible decline in performance that can occur with time. It then gives insight into the roles of continuing professional education in healthcare practitioners’ acquisition and maintenance of professional expertise.

Why Medical Students Choose Rural Clinical Campuses For Training: A Report From Two Campuses At Opposite Ends Of The Commonwealth, William Crump, Anthony D. Weaver, R. Steve Fricker, Alllison M. Crump

Marshall Journal of Medicine

Introduction

Although US medical schools have increased their enrollment by about 30%, most of the increase has occurred in urban areas. The affinity model proposes that rural training of a rural student will more likely result in a rural physician, but the exact role of these rural campuses is unclear. Do they solidify and reinforce a pre-existing career plan, do they create social and marital ties that make the transition to rural medicine easier, or could they be replaced with a briefer and more efficient rural rotation? We administered a questionnaire to students attending two different two year rural clinical …

Medicine Outside The Clinic: The Growing Need For Physicians In Sexual Education Policy, Zachary Sanford

Marshall Journal of Medicine

Sex and sexuality are both topics of immense social and personal importance, owing their openness or constraint in large part to the society in which they are discussed. In homogenous groups it may be possible to reach firm consensus on what is, or is not, appropriate to consider a sexual norm and use an overarching set of religious or spiritual morals to reaffirm this decision. However, in western society and specifically in the United States, a theme of integration and amalgamation of wildly different cultures has presented an interesting case study in searching for common ground on basic social issues. …

Spinal Cord Injury And Autonomic Dysreflexia- A Case Report, Apurva Bhatt, Brit Moore, Talal Asif, Kristy E. Steigerwalt, Rebecca R. Pauly

Marshall Journal of Medicine

Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent debilitating episodic diaphoresis, hypertension, low body temperature, and bradycardia. Previous hospitalizations presumed sepsis from UTI to be the etiology, however on further evaluation his symptoms were consistent with undiagnosed AD. This article describes a unique case presentation and reviews AD in depth, including the etiology, pathophysiology and management.

Contribution Of Medical Education To Rural Health, Roger Y. Wong

Marshall Journal of Medicine

Rural health is an important priority in many jurisdictions as an example of social accountability. The choice to practice in a rural community can be influenced by personal factors, educational factors, and systemic factors. Medical education makes significant contribution to rural health by proactively and positively modifying the educational factors. The experience of the Faculty of Medicine at the University of British Columbia, Canada is used to illustrate how this can be accomplished. A multi-component approach that is tailored to address the personal and systemic determinants of rural practice must also be developed to maximize the positive impact of medical …

Academic Medicine Responds To The Opioid Crisis, John Prescott

Marshall Journal of Medicine

Opioid dependence has devastated communities across the nation particularly in rural states and academic medicine has responded in a variety of ways. Through its tripartite mission of education, research, and clinical care, creative solutions are being implanted. Medical schools and teaching hospitals are partnering with public health and law enforcement agencies, as well as local healthcare providers to address the clinical, social, and rehabilitative challenges. Academic medicine continues to adapt to the needs of the nation and teach, train, and prepare the next generation of physicians to be at their best when things are at their worst.

Earth Suit, Bowhee Gwak, Young Park

Clinical Research in Practice: The Journal of Team Hippocrates

The authors reflect on an experience learning at the feet of a spirited patient.

Qualitative Research In Pbl In Health Sciences Education: A Review, Jun Jin, Susan Bridges

Interdisciplinary Journal of Problem-Based Learning

CONTEXT Qualitative methodologies are relatively new in health sciences education research, especially in the area of problem-based learning (PBL). A key advantage of qualitative approaches is the ability to gain in-depth, textured insights into educational phenomena. Key methodological issues arise, however, in terms of the strategies of inquiry, data collection methods, and analytical approaches. This review aims to identify and appraise the current applications of qualitative studies in PBL and indicate possible new methodological directions.

METHODS Two computerized databases, Educational Resources Information Center (ERIC) and PubMed, were screened for solely qualitative studies of PBL in health sciences education between 2000 …

Another Piece Of The “Silence In Pbl” Puzzle: Students’ Explanations Of Dominance And Quietness As Complementary Group Roles, Vicki J. Skinner, Annette Braunack-Mayer, Tracey A. Winning

Interdisciplinary Journal of Problem-Based Learning

A problem-based learning (PBL) assumption is that silence is incompatible with collaborative learning. Although sociocultural studies have reinterpreted silence as collaborative, we must understand how silence occurs in PBL groups. This essay presents students’ explanations of dominance, leadership, and silence as PBL group roles. An ethnographic investigation of PBL groups, informed by social constructionism, was conducted at two dental schools (in Australia and Ireland). The methods used were observation, interviews, and focus groups. The participants were volunteer first-year undergraduates. Students attributed dominance, silence, and members’ group roles to personal attributes. Consequently, they assumed that groups divided naturally into dominant leaders …

Letter To The Editor: Restarting Warfarin After A Gastrointestinal Bleed, Lauren Smith

Clinical Research in Practice: The Journal of Team Hippocrates

This letter addresses the dilemma of restarting anticoagulation after recent gastrointestinal bleeding.

There Is A Trend Favoring Vancomycin Vs. Metronidazole In Treating Severe C. Difficile Infection, Dean D. Fouchia

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Johnson S, Louie TJ, Gerding DN, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59(3):345-354. doi: 10.1093/cid/ciu313

Critical Appraisal Is A Skill That Takes Practice: Our Patients Are Counting On Us, Dorothy Bourdet

Clinical Research in Practice: The Journal of Team Hippocrates

A fumbling attempt at critical analysis in support of a clinical decision crystallizes the author's understanding that skillful analysis of research is crucial to good practice.

Early Haart Should Be Used For Treatment-Naive Hiv Patients With Pneumocystis Pneumonia, Maxwell L. Winkler

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Manzardo C, Esteve A, Ortega N, et al. Optimal timing for initiation of highly active antiretroviral therapy in treatment-naïve human immunodeficiency virus-1-infected individuals presenting with AIDS-defining diseases: the experience of the PISCIS Cohort. Clin. Microbiol. Infect. 2013 July;19(7):646-653. doi: 10.1111/j.1469-0691.2012.03991.x

Pharmacologic Diuresis Is Safer Than Ultrafiltration For Cardiorenal Syndrome, Grace Choong

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Bart BA, Goldsmith SR, Lee KL et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367:2296-2304. doi: 10.1056/NEJMoa1210357

Spinal Compression Fractures: No Additional Pain Relief With Use Of Back Braces, Kayla A. Berigan, Brandon Baker, Zakaria Ahmad, Aaron Simpson

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Li M, Law SW, Cheng J, Kee HM, Wong MS. A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture. J. Prosthet. Orthot. Int. 2015;39(4):270-276. doi: 10.1177/0309364614528204

Anticoagulation Following Gastrointestinal Bleeding: Assessing Harms And Benefits, Jacob Jeffers

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Sengupta N, Feuerstein JD, Patwardhan VR, et al. The risks of thromboembolism vs. recurrent gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized in patients with gastrointestinal bleeding: a prospective study. Am. J. Gastroenterol. 2014;110:328-335. doi: 10.1038/ajg.2014.398

Abstracts From The 22nd Annual Health Care Systems Research Network Conference, April 13–16, 2016, Atlanta, Georgia

Journal of Patient-Centered Research and Reviews

This proceedings supplement includes selected abstracts presented at the 22nd annual conference of the Health Care Systems Research Network (HCSRN), held April 13–16, 2016, in Atlanta, Georgia. The HCSRN connects the resources and capabilities of research departments from its member health care systems. Collectively, the organization represents more than 1,900 scientists and research staff from an array of disciplines such as epidemiology, economics, disparities, outcomes and quality assessment, trials and genomics.

Incidence Of Hypomagnesemia On Proton Pump Inhibitors At The Huntington Veterans Affairs Medical Center – Ihop, Ebrahim Sabbagh, Do, Chelsey R. Houchins, James Allman, Ii, Pharmd, Samson Teka, Md

Marshall Journal of Medicine

Abstract

Title: Incidence of hypomagnesemia on proton pump inhibitors at the Huntington Veterans Affairs Medical Center – IHOP

Purpose:

Proton pump inhibitors (PPIs), both prescription and over-the-counter, are widely used for the treatment of acid-related disease states such as dyspepsia, gastroesophageal reflex disease, esophagitis, and peptic ulcers. These medications are generally considered safe in most patient populations; however, there are several adverse effects that may occur with long-term use. Hypomagnesemia is a newer complication arising in the literature following multiple case reports over the past several years, although the true incidence of hypomagnesemia associated with PPI use remains unclear at …

Endovascular Therapy Of Tasc-D Lesion In Critical Limb Ischemia, Ahmed Amro, Md, Alaa Gabi, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

CLI (Rutherford class IV-VI) is a terminal stage of peripheral artery disease (PAD); it is defined by the presence of resting pain and/or tissue loss for at least two weeks that may require urgent revascularization to promote healing and prevent limb loss.For patients with infrarenal aortoiliac occlusive disease, the revascularization options are surgery like aortofemoral bypass and axillofemoral bypass or percutaneous intervention. Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies.These operations may imply a significant morbidity and mortality on CLI patients who usually have …

Linezolid Induced Delirium In The Absence Of Serotonin Syndrome: A Psychiatric Consultation/Liaison Case Report, Hani Nazha, Md, Nathan T. Harrington, Md

Marshall Journal of Medicine

Delirium is one of the most common mental illnesses that can affect elderly patients and patients with advanced medical problems. Because these patients are frequently on multiple medications and/or are more sensitive to medications secondary to their age, interactions with current medications, or existing medical problems; medication toxicity is frequently the etiology behind their delirium. This is a case report of a patient admitted for cellulitis that developed delirium from Linezolid however did not develop any other signs or symptoms of Serotonin Syndrome; a known side effect of Linezolid. This distinctive case highlights the importance of a careful analysis of …