ABSTRACT
INTRODUCTION: In 2013, the American College of Cardiology and American Heart Association updated the cholesterol guideline. Despite strong evidence supporting the recommendations, a discernible gap exists in the number of residents who practice them. Our study aimed to identify barriers hindering residents from guideline implementation. METHODS: Twenty eight residents were administered a preintervention and postintervention questionnaire to identify barriers in guideline application. The questionnaire was categorized into three barriers: knowledge, attitude, and behavior. A multifaceted educational intervention consisting of directed teaching sessions and supervised patient encounters was conducted. RESULTS: Our analysis showed that our residents lacked awareness, familiarity, and self-efficacy in using the cholesterol guideline. The intervention led to significant improvements in awareness (79% vs. 43%, p = .0129), familiarity (61% vs. 29%, p = .0306), and self-efficacy (65% vs. 16%, p = .0018) and achieved a 31% increase in knowledge (p = .0001), 38% in attitude (p = .0001), and 20% in behavior (p = .019). The overall improvement in scores averaged 30% (p = .0001). CONCLUSION: Our quality improvement initiative successfully improved our resident's comprehension and applicability of the 2013 ACC/AHA cholesterol guideline. We recommend a multifaceted educational approach tailored toward addressing specific barriers to improve the practice of evidence-based medicine.
Subject(s)
Cardiology/education , Cardiology/standards , Cholesterol/standards , Evidence-Based Medicine/education , Guideline Adherence/statistics & numerical data , Internship and Residency/organization & administration , Quality Improvement/standards , Adult , Aged , Aged, 80 and over , American Heart Association , Evidence-Based Medicine/standards , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , United States , Young AdultABSTRACT
True aneurysm of the splenic artery is the third most common intraabdominal aneurysm and constitutes 60% of all visceral aneurysms. The incidence of splenic artery aneurysms ranges from 0.01% to as high as 10.4% in the elderly. In approximately 30% of cases, the aneurysm may rupture into a viscus. Aneurysmal rupture into the colon is a potentially fatal but extremely uncommon complication. We report a case of splenic artery aneurysm communicating with the descending colon, presenting as massive lower gastrointestinal tract bleeding. The patient was treated and survived the episode. In English literature, fewer than 15 cases have been described with only two patients surviving.
