Association of a Gamified Journal Club on Internal Medicine Residents' Engagement and Critical Appraisal Skills.

Background: Prior literature demonstrates internal medicine residents have suboptimal competence in critical appraisal. Journal clubs are a common intervention to address this skill, but engagement and critical appraisal skill improvement are variable. Objective: We evaluated journal club engagement and critical appraisal skills after implementation of a gamified format. Methods: This was a single-arm study, conducted from July 1, 2020 to June 30, 2021, involving internal medicine residents at 2 US programs. Residents participated in a 12-month gamified journal club that sorted residents into 2 teams. Residents attended an orientation followed by 6 to 10 monthly, hour-long competitions. In each competition, a subset of the resident teams competed to answer a clinical prompt by critically appraising an original article of their choice. A chief medical resident or faculty member moderated each session and chose the winning team, which received a nominal prize of candy. The primary outcome was engagement, measured by a 7-question survey developed de novo by the authors with Likert scale responses at baseline and 12 months. The secondary outcome was critical appraisal skills assessed by the Berlin Questionnaire. Results: Sixty-one of 72 eligible residents (84.7%) completed both engagement surveys. Residents reported statistically significant improvements in most dimensions of engagement, including a higher likelihood of reading articles before sessions (posttest minus pretest score -1.08; 95% CI -1.34 to -0.82; P<.001) and valuing time spent (posttest minus pretest score -0.33; 95% CI -0.55 to -0.11; P=.004). Critical appraisal skills marginally improved at 12 months (posttest minus pretest score -0.84; 95% CI -1.54 to -0.14; P=.02). Conclusions: Our study demonstrates a gamified journal club was associated with improvements in engagement and minimal change in critical appraisal skills.

Cryptosporidium infection in a case of appendicitis.

A 39-year-old Caucasian woman presented to the emergency department with worsening abdominal pain, localised to the right lower quadrant, and diarrhoea for a week. Stool tested negative for Clostridium difficile, Giardialamblia and Cryptosporidium Following an abdominal CT, she was diagnosed with appendicitis. The histological preparation, along with the acute inflammatory changes of the vermiform appendix, was notable for clusters of small, basophilic spherical bodies most consistent with Cryptosporidium parvum infection. Ultimately, the patient was diagnosed with appendicitis secondary to C. parvum infection. This is exceedingly rare and only one other case has been previously reported.

Changes in vascular reactivity and endothelial Ca2+ dynamics with chronic low flow.

Disruption of blood flow promotes endothelial dysfunction and predisposes vessels to remodeling and atherosclerosis. Recent findings suggest that spatial and temporal tuning of local Ca2+ signals along the endothelium is vital to vascular function. In this study, we examined whether chronic flow disruption causes alteration of dynamic endothelial Ca2+ signal patterning associated with changes in vascular structure and function. For these studies, we performed surgical PL of the left carotid arteries of mice to establish chronic low flow for 2 weeks; right carotid arteries remained open and served as controls (C). Histological sections showed substantial remodeling of PL compared to C arteries, including formation of neointima. Isometric force measurements revealed increased PE-induced contractions and decreased KCl-induced contractions in PL vs C arteries. Endothelium-dependent vasorelaxation in response to ACh; 10-8 to 10-5  mol/L) was significantly impaired in PL vs C vessels. Evaluation of endothelial Ca2+ using confocal imaging and custom analysis exposed distinct impairment of Ca2+ dynamics in PL arteries, characterized by reduction in active sites and truncation of events, corresponding to attenuated vasorelaxation. Our findings suggest that endothelial dysfunction in developing vascular disease may be characterized by distinct shifts in the spatial and temporal patterns of localized Ca2+ signals.