Situation, Background, Assessment, Recommendation (SBAR) Education for Health Care Students: Assessment of a Training Program.

Introduction: Interprofessional communication failures are estimated to be a factor in two-thirds of serious health care-related accidents. Using a standardized communication protocol during transfer of patient information between providers improves patient safety. An interprofessional education (IPE) event for first-year health professions students was designed using the Situation, Background, Assessment, Recommendation (SBAR) tool as a structured communication framework. IPE literature, including a valid measurement tool specifically tailored for SBAR, was utilized to design the Interprofessional Team Training Day (ITTD) and evaluate learner gains in SBAR skills. Methods: Learners from six educational programs participated in ITTD, which consisted of didactics, small-group discussion, and role-play using the SBAR protocol. Individual learners were assessed using the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) on SBAR communication skills before and after the ITTD event. Learners received a written clinical vignette and submitted video recordings of themselves simulating the use of SBAR to communicate to another health care professional. Pre- and postrecordings were scored using the SBAR-LA rubric. Normalized gain scores were calculated to estimate the improvement attributable to ITTD. Results: SBAR-LA scores increased for 60% of participants. For skills not demonstrated before the event, the average learner acquired 44% of those skills from ITTD. Learners demonstrated statistically significant increases for five of 10 SBAR-LA skills. Discussion: The value to patient safety of utilizing structured communication between health care providers is proven; however, evaluating IPE teaching of communication skills effectiveness is challenging. Using SBAR-LA, communication skills were shown to improve following ITTD.

Pancreatoblastoma: a rare tumor still evolving in clinical presentation and histology.

CONTEXT: Pancreatoblastoma is a rare neoplasm in adults with a total of only 24 cases that have been reported in the literature. Adult pancreatoblastomas are large tumors and majority are larger than 8 cm at the time of diagnosis. Metastasis is seen in 26% of adults and usually involves the liver and then the lymph nodes. Metastasis is usually observed in cases where the primary tumor measures more than 10 cm. Pancreatoblastoma is named after its resemblance to fetal pancreatic tissue in the seventh week of life. The presence of squamoid corpuscles with a morular appearance is the most characteristic feature of the tumor. Pancreatoblastomas can have mixed features of both endocrine and exocrine cells; however, acinar differentiation is the most prevalent feature. CASE REPORT: We present a case of a 27-year-old female with a 3.6 cm pancreatoblastoma with metastasis to the liver and lungs as well as to the breast. This case has several distinguishing features from previously reported cases. Such widespread metastasis is unusual given the small size of the primary tumor. Also, metastasis to the breast from a pancreatoblastoma has been previously undescribed in literature. The histological features in our case of pancreatoblastoma were atypical, characterized by the absence of acinar component, supported by the lack of staining for both trypsin and lipase in the tumor, which has not been described in literature. Additionally, the nests of squamous cells in this tumor had a pilomatricoma like morphology as opposed to the morular appearance of the squamoid corpuscles seen in classical cases. CONCLUSION: Pancreatoblastoma can have an atypical clinical picture and a small primary with extensive metastasis to unusual sites may present a diagnostic challenge. Given its rarity, a high index of suspicion is required to correctly diagnose this condition. The histology reported on this case is unique and has not been reported in the literature.

Lung cancer masquerading as a paraneoplastic neurologic syndrome without a primary lung mass: Case report and review of literature.

Paraneoplastic and autoimmune encephalitis (AIE) syndromes describe a range of inflammatory disorders of the brain. "Classic" paraneoplastic encephalitis syndromes occur due to a remote neoplasm and are associated with antibodies that target intracellular neuronal proteins while the more recently described AIE syndromes are not always paraneoplastic and occur in association with antibodies that target cell-surface neuronal receptors (e.g., anti-NMDA receptor, anti-LGI1, anti-GABAB receptor).[1] Diagnosis can be difficult and delayed due to nonspecific clinical, imaging, and laboratory findings, and in those syndromes associated with a neoplasm, the neurologic syndromes often precede the cancer diagnosis. We present a case of a 64-year-old patient diagnosed with anti-GABAB receptor encephalitis that subsequently revealed an underlying small cell lung cancer without a primary lung tumor. This case highlights the clinical challenge in diagnosing immune-mediated encephalitis, its methodical work up, and subsequent management.

Invasive modalities for the diagnosis of peripheral lung nodules.

INTRODUCTION: Lung nodules are being increasingly discovered either incidentally or through lung cancer screening chest CT scans. Some of these will turn out to be malignant and therefore it is important to obtain an accurate and timely diagnosis of lung cancer when suspected. AREAS COVERED: This review will cover various invasive diagnostic modalities available to sample lung nodules. Data from key studies, obtained from PubMed searches, will be reviewed. Emerging technologies such as cone-beam CT and robotic-assisted bronchoscopies will be discussed along with ddata available currently to support their use. EXPERT OPINION: The best approach to diagnosing a lung nodule - whether found incidentally or because of lung cancer screening - is continuously evolving. While CT-guided lung nodule biopsy has a high diagnostic yield, the risk of pneumothorax is often a concern. Bronchoscopy has a better safety profile, but diagnostic ability falls short of CT-guided biopsy. Existing technologies such as electromagnetic navigation have not demonstrated a high diagnostic yield. Factors responsible for this relatively lower low diagnostic yield will be discussed in detail. Emerging technologies such as cone-beam CT scan and robotic bronchoscopy have addressed some of these issues and initial experience has demonstrated better diagnostic yield.

SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment.

Introduction: Structured communication tools are associated with improvement in information transfer and lead to improved patient safety. Situation, Background, Assessment, Recommendation (SBAR) is one such tool. Because there is a paucity of instruments to measure SBAR effectiveness, we developed and validated an assessment tool for use with prepractice health professions students. Methods: We developed the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) by starting with a preliminary list of items based on the SBAR framework. During an interprofessional team training event, students were trained in the use of SBAR. Subsequently, they were assigned to perform a simulated communication scenario demonstrating use of SBAR principles. We used 10 videos from these scenarios to refine the items and scales over two rounds. Finally, we applied the instrument on another subset of 10 students to conduct rater calibration and measure interrater reliability. Results: We used a total of 20 out of 225 videos of student performance to create the 10-item instrument. Interrater reliability was .672, and for eight items, the Fleiss' kappa was considered good or fair. Discussion: We developed a scoring rubric for teaching SBAR communication that met criteria for validity and demonstrated adequate interrater reliability. Our development process provided evidence of validity for the content, construct, and response process used. Additional evidence from the use of SBAR-LA in settings where communication skills can be directly observed, such as simulation and clinical environments, may further enhance the instrument's accuracy. The SBAR-LA is a valid and reliable instrument to assess student performance.

Primary pulmonary leiomyosarcoma -- a case report.

Sarcomas are mesenchymal tumors that originate from the stromal elements of the bronchial wall or from interstices of lung parenchyma. Pulmonary sarcomatous neoplasms are a rare and diagnostically challenging group of tumors. They constitute only 0.2%-0.5% of all primary lung malignancies. Primary pulmonary leiomyosarcomas are subdivided into those originating from pulmonary parenchyma, bronchial tree or pulmonary arteries. Here we present a case of 43-year-old African-American female who with chronic cough, fatigue and weight loss. Early detection is the key to the successful management of these patients. The available treatment option is complete resection of tumor. These cases provide an interesting juxtaposition to the management of typical lung cancer.

Successful use of nitazoxanide in the treatment of recurrent Clostridium difficile infection.

A 78-year-old, retired Caucasian male presented in emergency room with 3 days history of progressive watery diarrhoea. Two weeks earlier, he received intravenous levofloxacin for community acquired pneumonia. The patient was diagnosed as severe Clostridium difficile infection based on clinical presentation, labs and imaging studies. The patient was initially treated with intravenous metronidazole and oral vancomycin. While awaiting subacute rehabilitation placement, the patient relapsed twice. After first recurrence the patient was treated with 2 weeks of oral nitazoxanide. After second recurrence, the patient was treated 2 weeks of nitazoxanide followed by tapering dose of vancomycin. The patient was followed and no relapse was reported at 1 year follow-up visit.

Leiomiosarcoma pulmonar primario: presentación de un caso / Primary pulmonary leiomyosarcoma - A case report

Los sarcomas son tumores mesenquimatosos que tienen su origen en los componentes de estroma de la pared bronquial o en el intersticio del parénquima pulmonar. Las neoplasias sarcomatosas pulmonares son un grupo de tumores muy poco frecuentes y difíciles de diagnosticar. Constituyen tan solo el 0,2-0,5% del total de enfermedades malignas primarias del pulmón. Los leiomiosarcomas pulmonares primarios se subdividen en los que se originan en el parénquima pulmonar, los derivados del árbol bronquial y los que proceden de arterias pulmonares. Presentamos aquí el caso de una mujer afroamericana de 43 años que presentaba tos crónica, fatiga y pérdida de peso. La detección temprana es la clave del tratamiento eficaz de estos pacientes. La opción de tratamiento existente es la resección completa del tumor. Estos casos proporcionan una yuxtaposición interesante con el tratamiento del cáncer de pulmón habitual(AU)

Sarcomas are mesenchymal tumors that originate from the stromal elements of the bronchial wall or from interstices of lung parenchyma. Pulmonary sarcomatous neoplasms are a rare and diagnostically challenging group of tumors. They constitute only 0.2%-0.5% of all primary lung malignancies. Primary pulmonary leiomyosarcomas are subdivided into those originating from pulmonary parenchyma, bronchial tree or pulmonary arteries. Here we present a case of 43-year-old African-American female who with chronic cough, fatigue and weight loss. Early detection is the key to the successful management of these patients. The available treatment option is complete resection of tumor. These cases provide an interesting juxtaposition to the management of typical lung cancer(AU)