Aug 022011
 

Development of a longitudinal integrated clerkship at an academic medical center.

Med Educ Online. 2011;16:

Authors: Poncelet A, Bokser S, Calton B, Hauer KE, Kirsch H, Jones T, Lai CJ, Mazotti L, Shore W, Teherani A, Tong L, Wamsley M, Robertson P

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

PMID: 21475642 [PubMed - indexed for MEDLINE]

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Aug 022011
 

A Clostridium difficile infection "intervention": Change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes.

Am J Infect Control. 2011 Jul 26;

Authors: Han Z, McMullen KM, Russo AJ, Copper SM, Warren DK, Dubberke ER

BACKGROUND: Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes. METHODS: Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change). RESULTS: Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01). CONCLUSIONS: The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.

PMID: 21794950 [PubMed - as supplied by publisher]

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Aug 022011
 

Validity of the AHRQ Patient Safety Indicator "central venous catheter-related bloodstream infections".

J Am Coll Surg. 2011 Jun;212(6):984-90

Authors: Cevasco M, Borzecki AM, O'Brien WJ, Chen Q, Shin MH, Itani KM, Rosen AK

"Central venous catheter-related bloodstream infections" (CR-BSIs) is one of the patient safety indicators (PSI 7) developed by the Agency for Healthcare Research and Quality (AHRQ) to screen for potential safety events. We sought to investigate the validity of this PSI using the medical record as the gold standard.

PMID: 21489833 [PubMed - indexed for MEDLINE]

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Aug 022011
 

Racial Differences in Venous Thromboembolism.

J Thromb Haemost. 2011 Jul 28;

Authors: Zakai NA, McClure LA

The incidence of venous thrombosis (VTE) varies by race, with African-Americans having over five-fold greater incidence than Asian-ancestry populations with intermediate risk for European and Hispanic populations. Known racial differences in genetic polymorphisms associated with thrombosis do not account for this gradient of risk, nor do known racial variations in environmental risk factors. Data on the incidence of and risk factors for VTE outside of Europe and North America and in non-European ancestry populations are sparse. Common genetic polymorphisms in European-Ancestry populations such as factor V Leiden and prothrombin G20210A and environmental risk factors such as obesity may account for some of the increased risk in European populations, and high factor VIII, high von Willebrand factor, low protein C, and increased prevalence of obesity may explain some of the increased risk in African-Americans. The low rates in Asian populations may be partially explained due to low clinical suspicion in a perceived low-risk population and lack of access to healthcare in other populations. As risk factors for thrombosis such as surgery and treatment for cancer are available to more people, as obesity increases in prevalence in the developing world, and as surveillance systems for VTE improve, VTE may increase in previously low risk populations. While differences in VTE by race due to genetic predisposition will likely always be present, understanding the reasons for racial differences in VTE will help providers develop strategies to minimize VTE in all populations.

PMID: 21797965 [PubMed - as supplied by publisher]

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Aug 022011
 

E/e' Ratio Is a Strong Prognostic Predictor of Mortality in Patients With Non-Valvular Atrial Fibrillation With Preserved Left Ventricular Systolic Function.

Circ J. 2011 Jul 28;

Authors: Park SJ, Lee SC, Jang SY, Chang SA, Choi JO, Park SW, Oh JK

Background: The purpose of this study was to investigate the prognostic values of the E/e' ratio and other echocardiographic and clinical parameters in patients with non-valvular atrial fibrillation (AF) with preserved left ventricular (LV) systolic function. Methods and Results: A total of 488 patients (322 men, age: 66±11 years) with non-valvular AF with preserved LV systolic function (LV ejection fraction >50%) were included. The E and e' velocities were measured in 5 consecutive heart beats and averaged. Mean follow-up duration after enrollment was 17.7±5.3 months. All-cause deaths occurred in 45 patients (cardiovascular deaths: n=29). There were significant differences in age (65.6±11.3 vs. 71.5±9.1, P<0.001) and hemoglobin concentration (13.6±2.9 vs. 11.5±3.4g/dl, P<0.0001) between the deceased group and the survivors. E/e' ratio in the deceased group was significantly higher than that in the survivors (17.67±3.39 vs. 10.8±3.30, P<0.001). Survival analysis showed that a high E/e' ratio (>15.0) represents a poorer prognosis (P<0.001 by Log-Rank test) than an E/e' ratio of 15 and below. Multivariate analysis identified 2 significant variables that were predictive of all-cause deaths: hemoglobin (hazard ratio (HR)=0.806, 95% confidence interval (CI)=0.733-0.886, P<0.0001), and E/e'>15 (HR=3.064, 95%CI=1.38-6.804, P=0.006). Conclusions: E/e' ratio is a useful independent prognostic parameter for predicting mortality in patients with AF with preserved LV systolic function.

PMID: 21799276 [PubMed - as supplied by publisher]

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Aug 022011
 

E/e' Ratio Is a Strong Prognostic Predictor of Mortality in Patients With Non-Valvular Atrial Fibrillation With Preserved Left Ventricular Systolic Function.

Circ J. 2011 Jul 28;

Authors: Park SJ, Lee SC, Jang SY, Chang SA, Choi JO, Park SW, Oh JK

Background: The purpose of this study was to investigate the prognostic values of the E/e' ratio and other echocardiographic and clinical parameters in patients with non-valvular atrial fibrillation (AF) with preserved left ventricular (LV) systolic function. Methods and Results: A total of 488 patients (322 men, age: 66±11 years) with non-valvular AF with preserved LV systolic function (LV ejection fraction >50%) were included. The E and e' velocities were measured in 5 consecutive heart beats and averaged. Mean follow-up duration after enrollment was 17.7±5.3 months. All-cause deaths occurred in 45 patients (cardiovascular deaths: n=29). There were significant differences in age (65.6±11.3 vs. 71.5±9.1, P<0.001) and hemoglobin concentration (13.6±2.9 vs. 11.5±3.4g/dl, P<0.0001) between the deceased group and the survivors. E/e' ratio in the deceased group was significantly higher than that in the survivors (17.67±3.39 vs. 10.8±3.30, P<0.001). Survival analysis showed that a high E/e' ratio (>15.0) represents a poorer prognosis (P<0.001 by Log-Rank test) than an E/e' ratio of 15 and below. Multivariate analysis identified 2 significant variables that were predictive of all-cause deaths: hemoglobin (hazard ratio (HR)=0.806, 95% confidence interval (CI)=0.733-0.886, P<0.0001), and E/e'>15 (HR=3.064, 95%CI=1.38-6.804, P=0.006). Conclusions: E/e' ratio is a useful independent prognostic parameter for predicting mortality in patients with AF with preserved LV systolic function.

PMID: 21799276 [PubMed - as supplied by publisher]

Link to Article at PubMed

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