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Background: Prevention of post-intensive care syndrome (PICS) in critically ill patients requires interprofessional collaboration among physicians, physical therapists, occupational therapists, speech-language pathologists, and nutritionists. Interprofessional education promotes interprofessional collaborative practice, yet formalized interprofessional education during residency is uncommon. Objective: We sought to improve internal medicine residents' knowledge of interprofessional roles in the intensive care unit (ICU) and confidence in managing PICS by designing a virtual multimodal training module. Methods: We created a 3-hour virtual module with physical therapy, occupational therapy, speech-language pathology, and nutrition experts. First, learners reviewed PICS and multidisciplinary interventions to optimize patient recovery. Second, attendees watched videos created by physical therapy and occupational therapy colleagues demonstrating mobility strategies to manage ICU-acquired weakness and delirium. Third, participants learned how speech-language pathology experts evaluate and manage swallowing disorders. Finally, attendees identified common nutritional therapy challenges with a trivia session. Participants completed pre- and postcourse assessments. Results: Thirty-four residents completed both pre- and postcourse assessments (52% response rate). The mean objective assessment score improved from 51% to 79% (P < 0.001). All respondents reported that their knowledge of PICS increased, and almost all (97%) believed that their knowledge of interprofessional roles increased. Respondents' confidence in facilitating discussions about critical illness recovery significantly improved, from 77% rating as either not very confident or not at all confident before the course to 94% rating as somewhat confident or very confident after the course (P < 0.001). Conclusion: This single-site pilot study suggests that integrating interprofessional training in PICS education using virtual platforms may improve residents' knowledge of interprofessional roles in the ICU and confidence in managing PICS.
RESUMO
BACKGROUND: Serum 25-hydroxyvitamin D [25(OH)D] concentration is an indicator of vitamin D exposure, but it is also influenced by clinical characteristics that affect 25(OH)D production and clearance. Vitamin D is the precursor to 25(OH)D but is analytically challenging to measure in biological specimens. OBJECTIVES: We aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for quantification of vitamins D3 and D2 in serum and to explore the potential of circulating vitamin D as a biomarker of exposure in supplementation trials. METHODS: The method was validated using guideline C62-A from the Clinical and Laboratory Standards Institute and was applied in 2 pilot clinical trials of oral vitamin D3 supplementation. Pilot study 1 included 22 adults randomly assigned to placebo or 2000 IU/d. Blood was collected at baseline, 1, 3, 6, and 12 mo. Pilot study 2 included 15 adults randomly assigned to 2000 or 4000 IU/d. Blood and subcutaneous (SUBQ) adipose tissue were collected at baseline and 3 mo. RESULTS: In study 1, mean change (baseline to 3 mo) in serum vitamin D3 was -0.1 ng/mL in the placebo group and 6.8 ng/mL in the 2000 IU/d group (absolute difference: 6.9; 95% CI: 4.5, 9.3 ng/mL). In study 2, mean change (baseline to 3 mo) in serum vitamin D3 was 10.4 ng/mL in the 2000 IU/d group and 22.2 ng/mL in the 4000 IU/d group (fold difference: 2.15; 95% CI: 1.40, 3.37). Serum and adipose tissue vitamin D3 concentrations were correlated, and the dose-response of vitamin D3 in adipose mirrored that in serum. CONCLUSIONS: We validated a sensitive, robust, and high-throughput LC-MS/MS method to quantify vitamins D3 and D2 in serum. Serum and SUBQ adipose tissue vitamin D3 concentrations increased proportionally to dose with 3 mo of daily supplementation.These trials were registered at clinicaltrials.gov as NCT00552409 (pilot study 1) and NCT01477034 (pilot study 2).