Lemierre syndrome: a diagnostic dilemma of critical care in the post-COVID era.

Lemierre syndrome (LS) is referred to as the 'forgotten Disease' owing to its rarity in the postantibiotic era with an estimated yearly incidence of 1/million population. The classic triad of LS includes internal jugular vein thrombosis, oropharyngeal infection and metastatic septic emboli. We present a case of typical LS with Fusobacterium and Prevotella infection, presenting with peritonsillar abscess and jugular vein thrombosis complicated by sepsis, acute hypoxic respiratory failure due to multiple pulmonary emboli and severe thrombocytopaenia in the absence of disseminated intravascular coagulation.

New ACGME Clinician Educator Milestones as a Roadmap for Faculty Development: a Position Paper from the Society of General Internal Medicine Education Committee.

Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development.

Designing a Checklist for Directly Observing Use of One-Minute Preceptor Steps on Inpatient Rounds: A Pilot Study.

BACKGROUND: "One-minute preceptor" (OMP) is a well-established educational technique; however, primary literature on OMP lacks a tool to assess behavioral change after delivery of curricula.Primary aim of this pilot study was to design a checklist for direct observation of teachers using OMP on general medicine rounds and obtain inter-rater reliability evidence for the checklist. METHODS: This study pilots an internally designed 6-item checklist to assess change in directly observed behavior. We describe the process of developing the checklist and training the observers. We calculated a percent agreement and Cohen's kappa to assess inter-rater reliability. RESULTS: Raters had a high percent agreement ranging from 0.8 to 0.9 for each step of OMP. Cohen's kappa ranged from 0.49 to 0.77 for the five OMP steps. The highest kappa obtained was for getting a commitment (κ = 0.77) step, whereas the lowest agreement was for correcting mistakes (κ = 0.49). CONCLUSION: We showed a percent agreement ≥0.8 and moderate agreement based on Cohen's kappa with most steps of OMP on our checklist. A reliable OMP checklist is an important step in further improving the assessment and feedback of resident teaching skills on general medicine wards.

Pharmacogenomics update in pancreatic cancer.

Pancreatic cancer is the fourth leading cause of cancer-related deaths in United States. Despite advances in understanding cancer biology and therapeutics, this malignancy carries a grave prognosis with a poor overall survival rate. This is especially true for patients with locally advanced and metastatic disease that are not amenable to surgical resection. Given advances in human genome sequencing and pharmacogenomics, we now better understand the complex genetic makeup of these tumors and numerous gene mutations have been identified that could be potential targets for drug development. In this review, we discuss two abstract (Abstracts #208 and #192) presented at the 2014 ASCO Gastrointestinal Cancers Symposium about pancreatic cancer genome sequencing and their implications for the future of this disease. We discuss what is known about the genome of pancreatic tumors, including common mutations like KRAS, TP53 and SMAD4, as well as discovery of additional mutations. In particular, KRAS2 mutations in a subset of patients with pancreatic cancer are discussed. While limited in size and clinical correlativity, these abstracts provide at least seven novel/targetable mutations and elucidate biologic differences in tumors with wild type and mutant KRAS. These are important steps in understanding tumor biology and genetic basis of pancreatic cancer to help develop targeted drug therapies in the fast approaching era of personalized medicine.

International academic service learning: lessons learned from students' travel experiences of diverse cultural and health care practices in morocco.

Academic service learning (ASL) is an active teaching-learning approach to engage students in meaningful hands-on activities to serve community-based needs. Nine health professions students from a private college and a private university in the northeastern United States volunteered to participate in an ASL trip to Morocco. The participants were interviewed to reflect on their experiences. This article discusses the lessons learned from students' ASL experiences regarding integrating ASL into educational programs. The authors recommend a paradigm shift in nursing and dental hygiene curricula to appreciate diversity and promote cultural competency, multidisciplinary teamwork, and ethics-based education.

Chemically modified silica gel with 1-{4-[(2-hydroxy-benzylidene)amino]phenyl}ethanone: synthesis, characterization and application as an efficient and reusable solid phase extractant for selective removal of Zn(II) from mycorrhizal treated fly-ash samples.

1-{4-[(2-hydroxy-benzylidene)amino]phenyl}ethanone functionalized silica gel was synthesized and used as a highly efficient, selective and reusable solid phase extractant for separation and preconcentration of trace amount of Zn(II) from environmental matrices. The adsorbent was characterized by fourier transform infrared spectroscopy (FT-IR), elemental analysis, 13C CPMAS NMR spectroscopy, scanning electron microscopy (SEM), thermogravimetric analysis (TGA) and BET surface area analysis. The dependence of zinc extraction on various analytical parameters such as pH, type and amount of eluent, sample flow rate and interfering ions were investigated in detail. The material exhibited superior adsorption efficiency for Zn(II) with high metal loading capacity of 1.0 mmol/g under optimum conditions. After adsorption, the recovery (> 98%) of metal ions was accomplished using 1.0 mol/L HNO3 as an eluent. The sorbent was also regenerated by microwave treatment in milder acidic environment (0.1 mol/L HNO3). The lower detection limit and preconcentration factor of the present method were found out to be 0.04 microg/L and 312.5 respectively. The modified silica surface possessed excellent selectivity for the target analytes and the adsorption/desorption process remained effective for at least ten consecutive cycles. The optimized procedure was successfully implemented for the extraction of Zn(II) from mycorrhizal treated fly ash and pharmaceutical samples with reproducible results.

Student perception of travel service learning experience in Morocco.

PURPOSE: This study explores the perceptions of health profession students participating in academic service learning in Morocco with respect to adapting health care practices to cultural diversity. METHODS: Authors utilized semi-structured, open-ended interviews to explore the perceptions of health profession students. Nine dental hygiene and nursing students who traveled to Morocco to provide oral and general health services were interviewed. After interviews were recorded, they were transcribed verbatim to ascertain descriptive validity and to generate inductive and deductive codes that constitute the major themes of the data analysis. Thereafter, NVIVO 8 was used to rapidly determine the frequency of applied codes. The authors compared the codes and themes to establish interpretive validity. Codes and themes were initially determined independently by co-authors and applied to the data subsequently. The authors compared the applied codes to establish intra-rater reliability. RESULTS: International service learning experiences led to perceptions of growth as a health care provider among students. The application of knowledge and skills learned in academic programs and service learning settings were found to help in bridging the theory-practice gap. The specific experience enabled students to gain an understanding of diverse health care and cultural practices in Morocco. CONCLUSION: Students perceived that the experience gained in international service learning can heighten awareness of diverse cultural and health care practices to foster professional growth of health professionals.