RESUMO
OBJECTIVE: To develop and validate tools for measuring inpatient gastroenterology (GI) consultation quality on oncologic patients. METHODS: A total of 145 inpatient GI consults were analyzed using electronic health records in this cross-sectional study. Essential Consult Elements on oncologic-hospitalized patients (EE-COH) and Hospitalized Oncologic Patients Enhanced Quality of Consult Assessment Tool (HOPE-QCAT) were used for grading. Interrater reliability was assessed. RESULTS: Both EE-COH and HOPE-QCAT showed near-perfect interrater reliability across most measures in the validation cohort. On application of these measures for quality assessment, basic evaluation by the requesting hospitalist was partially complete in 24.8%, the request for GI consultation was inappropriate in 18.6%, while the rationale for recommended studies from the GI consultant was provided in 55.7% of cases suggesting key areas for quality improvement. CONCLUSION: We developed highly reliable quality measures for inpatient GI consults on oncology patients. The EE-COH and HOPE-QCAT tools can be utilized in future studies of inpatient GI consult quality and to form the basis for interventions to improve communication between consultants and hospitalists. Such tools could be adapted for inpatient quality assessment across other specialties and settings.
RESUMO
Many experts have foretold of a digital transformation in medical education. Yet, until recently, day-to-day practices for frontline clinician-educators, who cherish close physical and intellectual contact between the patient, learner, and teacher, have remained largely unchanged. The COVID-19 pandemic disrupted that model and is forcing teachers to pursue new ways to reach learners. We provide a roadmap for educators to start their transformation from an analog to a digital approach by harnessing existing tools including podcasts, social media, and videoconferencing. Teachers will need to enhance the same pedagogical and interpersonal practices that underpin effective in-person education while they learn new skills as they become curators, creators, and moderators in the digital space. This adaptation is essential, as many of the changes in medical education spurred by COVID-19 will likely far outlast the pandemic.
Assuntos
COVID-19 , Educação Médica , Humanos , Aprendizagem , Pandemias , SARS-CoV-2Assuntos
Ácidos Bóricos/intoxicação , Praguicidas/intoxicação , Intoxicação/diagnóstico , Choque Séptico/diagnóstico , Idoso , Ácidos Bóricos/sangue , Diagnóstico Diferencial , Humanos , Hipotensão/etiologia , Masculino , Transtornos Mentais/etiologia , Intoxicação/complicações , Transtornos Urinários/etiologiaRESUMO
BACKGROUND: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. METHODS: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). RESULTS: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. CONCLUSIONS: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
Assuntos
Competência Clínica/normas , Técnicas de Diagnóstico Cardiovascular , Educação de Pós-Graduação em Medicina , Medicina Interna/educação , Exame Físico , Testes Imediatos , Adulto , Currículo , Técnicas de Diagnóstico Cardiovascular/normas , Avaliação Educacional , Humanos , Exame Físico/normasAssuntos
Bacteriemia/microbiologia , Infecções por Clostridium/sangue , Clostridium perfringens/isolamento & purificação , Hemólise , Icterícia/etiologia , Jejunostomia/efeitos adversos , Idoso , Fosfatase Alcalina/sangue , Bacteriemia/diagnóstico , Colangite/diagnóstico , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/etiologia , Ducto Colédoco/lesões , Ducto Colédoco/cirurgia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Hiperbilirrubinemia , Icterícia/sangue , Masculino , Fatores de RiscoAssuntos
Febre de Causa Desconhecida/etiologia , Linfoma Difuso de Grandes Células B/diagnóstico , Pele/patologia , Neoplasias Vasculares/diagnóstico , Biópsia , Diagnóstico Tardio , Humanos , Linfoma Difuso de Grandes Células B/complicações , Masculino , Pessoa de Meia-Idade , Pancitopenia/etiologia , Esplenomegalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/complicaçõesAssuntos
Diarreia/etiologia , Gastrinoma/diagnóstico , Neoplasias Hepáticas/secundário , Fígado/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico , Síndrome de Zollinger-Ellison/diagnóstico , Abdome/diagnóstico por imagem , Dor Abdominal/etiologia , Idoso , Análise Química do Sangue , Doença Crônica , Diagnóstico Diferencial , Gastrinoma/complicações , Gastrinoma/diagnóstico por imagem , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Primárias Desconhecidas/complicações , Policitemia/complicações , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Síndrome de Zollinger-Ellison/complicaçõesAssuntos
Leptospira interrogans/isolamento & purificação , Leptospirose/diagnóstico , Pneumopatias/diagnóstico por imagem , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Diarreia/etiologia , Humanos , Icterícia Obstrutiva/etiologia , Leptospirose/complicações , Leptospirose/tratamento farmacológico , Lipase/sangue , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/microbiologia , Masculino , Mialgia/etiologia , Radiografia , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Tecido Adiposo/transplante , Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Adulto , Autoenxertos , Feminino , Humanos , Infecções por Mycobacterium não Tuberculosas/etiologia , Mycobacterium abscessus/isolamento & purificaçãoAssuntos
Competência Clínica/normas , Infecções por Vírus Epstein-Barr/diagnóstico , Leucemia/diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Resolução de Problemas , Idoso , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/terapia , Humanos , Células Matadoras Naturais/metabolismo , Leucemia/complicações , Leucemia/terapia , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/terapia , MasculinoRESUMO
The purpose of this study was to evaluate the microbial characteristics of coastal waters which are impacted by anthropogenic pollution as well as estimate the health risks associated with exposure to enteric and non-enteric microorganisms during swimming. Fecal indicator bacteria were highly detected in samples. Moreover, pathogenic and opportunistic microorganisms were found, with the highest frequency for Pseudomonas aeruginosa followed by Adenovirus 40/41, Acanthamoeba spp., Salmonella enterica, and Cryptosporidium parvum. The median risk of gastrointestinal illness through ingestion of water was estimated to be above the benchmark value of 0.05 per event recommended by WHO. Cryptosporidium followed by Adenovirus, showed higher illness risks than Salmonella. The potential risks of Acanthamoeba and P. aeruginosa were estimated to be low for both dermal and ocular exposure routes. However, there are uncertainties about the infectious fraction of pathogens existing in coastal waters and the delivered dose of microorganisms from dermal/ocular exposure during recreational activities.