Curating a media-linked curriculum.

BACKGROUND: The COVID-19 pandemic motivated considerable educational innovation in technology-enhanced learning (TEL), and educators must now thoughtfully apply identified best practices to both in-person and virtual learning experiences through instructional design and reflective practice. This paper describes the development and evaluation of an innovation utilising TEL to enhance our core curriculum content and students' learning. APPROACH: The curriculum-linked media (CLM) was introduced as a part of a doctoring and clinical skills course for pre-clinical medical students as a structured curriculum that pairs audio and/or video-based content with reflection prompts designed to prime students for active, in-person learning upon arrival to their classrooms. The CLM aimed to help students (1) gain a deeper understanding of the course content, (2) partake in reflective practice and (3) explore diverse perspectives on a particular topic. EVALUATION: All students completed a survey at the end of their academic year to evaluate the activity. Some students found the innovation helpful in that it facilitated perspective taking and prepared them for their in-person class. The reflection questions that paired with the media prompted discussion in class and a deeper connection with the materials. Making the content relevant to the local community and highlighting regional issues made the activity more relatable. IMPLICATIONS: Our experience demonstrated that the CLM model can be a helpful and efficient tool to stretch the educational reach of the classroom. Future applications may consider the implementation and evaluation of the model with clinical students and postgraduate trainees.

The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study.

OBJECTIVES: The objectives of this study were to standardize airway management among critical care fellows and to evaluate whether the completion of a web-based preintubation airway preparation module improves their knowledge and behaviors in the identification and preparation of difficult airways. METHODS: Critical care experts used international guidelines to develop the module, which contained mandatory readings, brief lectures, and a case-based activity. We measured learner satisfaction, improvements in fellows' preintubation preparation knowledge, and safety-oriented behavior. The paired t-test was used to compare knowledge assessment scores and the chi-square test was used to compare the categorical variables in the evaluation of the behavior construct. RESULTS: All trainees (N = 14) completed the module and were satisfied with its contents and structure. Fellows logged 114 intubations during the study period. The mean score on the knowledge test increased (pre 79% vs post 90%, P = .02) postmodule and there was a significant increase in documentation of airway risk stratification in fellows' procedure notes (65.9% vs 72.9%, P = .049). All respondents were confident that they would be able to apply what they learned in the module into clinical practice and that their patients would likely benefit from their new knowledge. CONCLUSION: The implementation of an asynchronous web-based module on airway assessment and intubation preparation was feasible. The module was engaging, enhanced the knowledge of our trainees, and improved procedural documentation.

Rapid Intensive Care Unit Onboarding in Response to a Pandemic.

BACKGROUND: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, hospital resources have been stretched to their limits. We introduced an innovative course to rapidly on-board a group of non-intensive care unit (ICU) nurse practitioners as they begin to practice working in a critical care setting. OBJECTIVE: To assess whether a brief educational course could improve non-ICU practitioners' knowledge and comfort in practicing in an intensive care setting. METHODS: We implemented a multi-strategy blended 12-week curriculum composed of bedside teaching, asynchronous online learning and simulation. The course content was a product of data collected from a targeted needs assessment. The cognitive learning objectives were taught through the online modules. Four simulation sessions were used to teach procedural skills. Bedside teaching simultaneously occurred from critical care faculty during daily rounds. We assessed learning through a pre and post knowledge multiple choice question (MCQ) test. Faculty assessed learners by direct observation and review of clinical documentation. We evaluated learner reaction and comfort in critical practice by comparing pre and post surveys. RESULTS: All 7 NPs were satisfied with the course and found the format to work well with their clinical schedules. The course also improved their self-reported comfort in managing critically ill patients in a medical ICU. There was an increase in the mean group score from the pre-to the post-course MCQ (60% vs 73%). CONCLUSIONS: The COVID-19 Critical Care Course (CCCC) for NPs was implemented in our ICU to better prepare for an anticipated second surge. It focused on delivering practical knowledge and skills as learners cared for critically ill COVID-19 patients. In a short period of time, it engaged participants in active learning and allowed them to feel more confident in applying their education.

Acute Eosinophilic Pneumonia Presenting with an Elevated Procalcitonin Level: A Rare Laboratory Finding.

BACKGROUND We present the case of a 33-year-old female who was transferred to a tertiary care hospital because of acute respiratory failure. CASE REPORT History, imaging, and laboratory testing (including an elevated procalcitonin level) were consistent with a diagnosis of bacterial pneumonia. However, despite broad spectrum intravenous antibiotics, her condition worsened. Shortly after transfer to our hospital, she required intubation and mechanical ventilation. Bronchoscopy with bronchoalveolar lavage (BAL) was performed and a diagnosis of acute eosinophilic pneumonia was made. After discontinuation of antibiotics and initiation of steroids she improved quickly. CONCLUSIONS Our case highlights the importance of considering alternative diagnoses in patients who appear to have bacterial lower respiratory tract infection, even in those with elevated procalcitonin levels.

The impact of smoking on patient outcomes in severe sepsis and septic shock.

BACKGROUND: To assess, in the setting of severe sepsis and septic shock, whether current smokers have worse outcomes compared to non-smokers. METHODS: This is a retrospective analysis of immunocompetent adult patients with severe sepsis and septic shock at a tertiary medical center. The primary outcome was the effect of active smoking on hospital mortality. Chi-square test and logistic regression were used to assess categorical outcomes. Wilcoxon rank-sum was utilized to test the differences in continuous outcomes among the varied smoking histories. Multivariable logistic regression was used to evaluate the association of smoking and mortality, need for vasopressors, mechanical ventilation, and ICU admission. RESULTS: Of the 1437 charts reviewed, 562 patients were included. Current smokers accounted for 19% (107/562) of patients, while 81% (455/562) were non-smokers. The median hospital length of stay in survivors was significantly longer in current smokers versus non-smokers (8 vs 7 days, p = 0.03). There was a trend towards a higher mortality among current smokers, but this failed to meet statistical significance (OR 1.81, 95% CI 0.92-3.54, p = 0.08). On multivariable analysis, current smoking was associated with the need for mechanical ventilation (OR 2.38, 95% CI 1.06-5.34, p = 0.04), but that association was not observed with the need for vasopressors (OR 2.10, 95% CI 1.01-4.36, p = 0.58) nor ICU admission (OR 0.93, 95% CI 0.41-2.13, p = 0.86). CONCLUSIONS: In patients with severe sepsis or septic shock, current smoking was associated with a longer hospital stay, the need for mechanical ventilation, and trended towards a higher mortality. Larger multicenter prospective case-control studies are needed to confirm these findings.

Strategies for prevention of ventilator-associated pneumonia: bundles, devices, and medications for improved patient outcomes.

Ventilator-associated pneumonia is associated with significant patient morbidity, mortality, and increased health care costs. In the current economic climate, it is crucial to implement cost-effective prevention strategies that have proven efficacy. Multiple prevention measures have been proposed by various expert panels. Global strategies have focused on infection control, and reduction of lower airway colonization with bacterial pathogens, intubation, duration of mechanical ventilation, and length of stay in the intensive care unit. Routine use of the Institute for Healthcare Improvement ventilator care bundle is widespread, and has been clearly demonstrated to be an effective method for reducing the incidence of ventilator-associated pneumonia. In this article, we examine specific aspects of the Institute for Healthcare Improvement bundle, better-designed endotracheal tubes, use of antibiotics and probiotics, and treatment of ventilator-associated tracheobronchitis to prevent ventilator-associated pneumonia.