A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant.

A 39-year-old woman with no known risk factors presented for a recurrent upper gastrointestinal (GI) bleed. She had a prior history of failed kidney and pancreatic transplants secondary to childhood diabetes mellitus type I. After an extensive workup, she was found to have active hemorrhage into an area of the small bowel from an artery supplying her failed pancreatic transplant. Here, we discuss the importance of a systematic approach to evaluation, a high index of suspicion, and a known but not entirely common method of treatment for this condition.

Assessing Residents' Veteran-Centered Care Skills in the Clinical Setting.

BACKGROUND: Despite their placement in Veterans Health Administration centers nationwide, residents' training and assessment in veteran-centered care is variable and often insufficient. OBJECTIVE: We assessed residents' ability to recognize and address mental health issues that affect US military veterans. METHODS: Two unannounced standardized patient (SP) cases were used to assess internal medicine residents' veteran-centered care skills from September 2014 to March 2016. Residents were assessed on 7 domains: military history taking, communication skills, assessment skills, mental health screening, triage, and professionalism, using a 36-item checklist. After each encounter, residents completed a questionnaire to assess their ability to recognize knowledge deficits. Residents' mean scores were compared across training levels, between the 2 cases, and by SP gender. We conducted analysis of variance (ANOVA) tests to analyze mean performance differences across training levels and descriptive statistics to analyze self-assessment questionnaire results. RESULTS: Ninety-eight residents from 2 internal medicine programs completed the encounter and 53 completed the self-assessment questionnaire. Residents performed best on professionalism (0.92 ± 0.20, percentage of the maximal score) and triage (0.87 ± 0.17), and they scored lowest on posttraumatic stress disorder (0.52 ± 0.30) and military sexual trauma (0.33 ± 0.39). Few residents reported that they sought out training to enhance their knowledge and skills in the provision of services and support to military and veteran groups beyond their core curriculum. CONCLUSIONS: This study suggests that additional education and assessment in veteran-centered care may be needed, particularly in the areas of posttraumatic stress disorder and military sexual trauma.

Ego-depletion and aggressive behavior.

Multiple theoretical frameworks postulate that ego-depletion can influence aggressive behavior. Our experimental study assessed whether ego-depletion is related to aggressive behavioral change and whether provocation moderated this effect. Aggression was measured by asking participants to take raffle tickets from an ostensible partner. First, participants were randomly assigned to either high or low ego-depletion (by having them memorize a short or long number throughout the entire study) prior to engaging in the first ticket exchange. Participants were then either provoked (or not) by having their "partner" take more or fewer tickets than the partner originally requested. The ticket exchange occurred three times to assess behavioral change. Results showed that aggression was highest for ego depleted participants who were provoked. Implications are discussed in terms of the General Aggression Model and the Strength Model of Self-Control. Aggr. Behav. 42:533-541, 2016. © 2016 Wiley Periodicals, Inc.