Tools to Increase Resident Aesthetic Clinic Volume.

INTRODUCTION: Resident Aesthetic Clinics (RACs) are an important element for training in plastic surgery residency programs. RACs provide increased exposure to aesthetic surgery as well as greater autonomy in clinical decision making. In an effort to increase RAC volume and thereby enhance resident education, we made two important changes to our operations. First, we reduced the resident surgeons' fees by 75%, and second, we began utilizing social media to promote our residency program and their involvement in aesthetic surgery. METHODS: Total RAC cases were queried using a RAC specific billing code and individual chief resident case logs for quality control. To generate an accurate timeframe, cases and procedures were compared from 18 months before and after the implemented changes. RESULTS: We found that the number of cases and procedures increased by 135% and 255%, respectively. The five most commonly performed procedures were liposuction, augmentation mammoplasty, abdominoplasty, mastopexy, and rhytidectomy. CONCLUSION: By both reducing the resident surgeons' fee and promoting the RAC on social media, we have demonstrated a pronounced increase in both cases and procedures performed by residents. As other institutions seek to increase resident exposure to aesthetic surgery, they may consider similar changes to these. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors: www.springer.com/00266 ."

Would earlier microbe identification alter antibiotic therapy in bacteremic emergency department patients?

BACKGROUND: Although debate exists about the treatment of sepsis, few disagree about the benefits of early, appropriately targeted antibiotic administration. STUDY OBJECTIVES: To determine the appropriateness of empiric antimicrobial therapy and the extent to which therapy would be altered if the causative organism for sepsis was known at the time of administration. METHODS: This was a retrospective cohort study, conducted in an academic Emergency Department (ED), on consecutive positive blood cultures between November 1, 2008 and February 1, 2009. Blood cultures and the appropriateness of administered antimicrobial therapy were evaluated. Therapy choices were categorized based on whether or not a physician, complying with antimicrobial guidelines, would have made changes to empiric antibiotic therapy had the causative organism initially been known. RESULTS: There were 90 positive blood cultures obtained from 84 patients. Of these, 21.1% (n=19) were considered contaminants. The final categorization of empiric antibiotics given in the ED for the remaining blood culture results were: 1) therapy would be changed to narrower-spectrum antibiotics (n=34, 55.7%); 2) therapy would be changed because the organism was not covered (n=13, 21.3%); and 3) therapy would remain the same (n=14, 23.0%). There was 90.2% inter-rater agreement for these classifications (p<0.0001), with a kappa of 0.84. Polymerase chain reaction analysis had a statistically significant advantage (p<0.0001) over Infectious Disease Society of America protocols in facilitating accurate antimicrobial therapies. CONCLUSION: This study confirms the need for more rapid and accurate laboratory methods for bloodstream pathogen identification.

Non-invasive detection of severe neutropenia in chemotherapy patients by optical imaging of nailfold microcirculation.

White-blood-cell (WBC) assessment is employed for innumerable clinical procedures as one indicator of immune status. Currently, WBC determinations are obtained by clinical laboratory analysis of whole blood samples. Both the extraction of blood and its analysis limit the accessibility and frequency of the measurement. In this study, we demonstrate the feasibility of a non-invasive device to perform point-of-care WBC analysis without the need for blood draws, focusing on a chemotherapy setting where patients' neutrophils-the most common type of WBC-become very low. In particular, we built a portable optical prototype, and used it to collect 22 microcirculatory-video datasets from 11 chemotherapy patients. Based on these videos, we identified moving optical absorption gaps in the flow of red cells, using them as proxies to WBC movement through nailfold capillaries. We then showed that counting these gaps allows discriminating cases of severe neutropenia (<500 neutrophils per µL), associated with increased risks of life-threatening infections, from non-neutropenic cases (>1,500 neutrophils per µL). This result suggests that the integration of optical imaging, consumer electronics, and data analysis can make non-invasive screening for severe neutropenia accessible to patients. More generally, this work provides a first step towards a long-term objective of non-invasive WBC counting.