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Effectiveness of the Introduction to Critical Care in Emergency Medicine Curriculum\u27s Implementation Among Trainees Interested in Intensive Care
Get PDFBackground: Emergency physicians and trainees provide the initial care for critically ill patients. In times of emergency department boarding, this care may extend beyond the first few hours. To meet the needs of this population, a standardized novel critical care curriculum targeting third- and fourth-year medical students was developed. Objectives: We hypothesized that the institution of such a curriculum is feasible and will provide an increased understanding of the underlying critical care principles within this learner population. Methods: We developed a 2-month-long critical care curriculum (February–April) and carried out the course twice from 2022–2023. Our pilot study deployed this curriculum to medical students interested in critical care through the American Academy of Emergency Medicine/Resident and Student Association. The primary outcome included was the overall composite score comparison of the pre- and post-course evaluations, with a higher score indicating that the student improved their comprehension. Secondary outcomes included the individual factors of the pre- and post-course surveys. Results: Fifty-one trainees completed the pilot course, including 11/51 (21.6%) third-year medical students and 40/51 (78.4%) fourth-year medical students. Overall, 39 had “no experience” in critical care and 12 indicated that they had “previous experience.” The students’ baseline pre-course from the pooled 2022 and 2023 Introduction to Critical Care in Emergency Medicine (ICCEM) curriculum data was 3 (interquartile range 4–3) and their post-course score was 9 (interquartile range 9–9), p-value 0.015 for the 51/54 students who completed the course. Conclusions: The novel curriculum was found to be effective during its implementation in third- and fourth-year medical students. As such, it indicated that a critical care fundamentals course improves confidence in these topics for students with and without prior experience. Further work is necessary to understand the generalizability and knowledge retention of the proposed pilot curriculum
Healthcare Delivery under Alternative Medicare Plans: Insights from Patient Records and Physician Interviews
Get PDFThis study investigates differences in annual healthcare services usage by enrollees in various Medicare and Medicare Advantage plans with consideration of the major factors that should account for such differences. Using the Centers for Medicare and Medicaid Services’ detailed patient-encounter and diagnostic records for a random sample of one million Missouri Medicare beneficiaries, we compared healthcare services received by individuals insured under different Medicare and Medicare Advantage plans. With complementary information about patient demographics and access to healthcare resources, we examine the factors affecting healthcare services received. The results show that plan and provider choices relate to significant utilization variances even after considering enrollee attributes, access to medical providers, and terms of their insurance plans. There also is evidence that agency relationships between payers and risk-sharing providers may be a contributing factor to those variances. These results merit careful consideration by all parties involved in healthcare financing and delivery as they develop health policy, negotiate insurance arrangements, plan facilities, install equipment, and staff for services. Further research to identify successful and replicable payer-provider arrangements offers opportunities for significant Medicare program savings
Vitamin C: Is it Relevant or Obsolete in the Modern Era?
Get PDFPurpose: In this review, we discuss the historic background of vitamin C, vitamin C’s physiology, its dietary sources, and how deficiency can manifest. We also discuss modern studies investigating the role of Vitamin C in immunity, in cardiovascular disease, and in chronic conditions. Summary: In the body, vitamin C acts as an essential cofactor in several enzymatic reactions including, but not limited to, neurotransmitter synthesis, hormone amidation, collagen synthesis, hypoxic transcription factor modification, and epigenetic modifications. Scurvy, caused by severe vitamin C deficiency, is an infamous disease recorded in historical documents, with patients presenting with joint ache, bleeding gums, depression, and hysteria. Since humans are unable to naturally synthesize ascorbic acid, they must rely on dietary sources such as fruits and vegetables in order to maintain their vitamin C levels and avoid such manifestations. Maintaining stable vitamin C levels remains increasingly important in the modern era, particularly for the vulnerable pediatric patient with chronic conditions or critical illness. Regulating vitamin C levels could decrease morbidity and mortality in the chronic and critically ill pediatric population. Moving forward, there is a need for more head-to-head trials pertaining to vitamin C’s role in improving immunity, modifying cardiovascular risk, and altering cancer prognosis
A Distributed, High-Channel-Count, Implanted Bidirectional System for Restoration of Somatosensation and Myoelectric Control
Get PDFObjective. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count, implanted system.Approach.We have developed the implanted Somatosensory Electrical Neurostimulation and Sensing (iSens®) system to support peripheral nerve stimulation through up to 64, 96, or 128 electrode contacts with myoelectric recording from 16, 8, or 0 bipolar sites, respectively. The rechargeable central device has Bluetooth® wireless telemetry to communicate to external devices and wired connections for up to four implanted satellite stimulation or recording devices. We characterized the stimulation, recording, battery runtime, and wireless performance and completed safety testing to support its use in human trials.Results.The stimulator operates as expected across a range of parameters and can schedule multiple asynchronous, interleaved pulse trains subject to total charge delivery limits. Recorded signals in saline show negligible stimulus artifact when 10 cm from a 1 mA stimulating source. The wireless telemetry range exceeds 1 m (direction and orientation dependent) in a saline torso phantom. The bandwidth supports 100 Hz bidirectional update rates of stimulation commands and data features or streaming select full bandwidth myoelectric signals. Preliminary first-in-human data validates the bench testing result.Significance.We developed, tested, and clinically implemented an advanced, modular, fully implanted peripheral stimulation and sensing system for somatosensory restoration and myoelectric control. The modularity in electrode type and number, including distributed sensing and stimulation, supports a wide variety of applications; iSens® is a flexible platform to bring peripheral neuromodulation applications to clinical reality. ClinicalTrials.gov ID NCT04430218
From Guidelines to Radiology Practice: Navigating the 2023 ASCO Guidelines for Advanced Gastroesophageal Cancer and Beyond
Get PDFThe American Society of Clinical Oncology (ASCO) updated the guidelines for the treatment of advanced gastroesophageal (GE) cancer in 2023, signifying a major shift towards targeted therapeutics and precision medicine. This article serves as an imaging-based review of recent developments in the care of patients with GE cancer. We cover the epidemiology, the developing treatment paradigms, and the imaging assessment of GE malignancy. In addition, this review aims to familiarize radiologists with the unique adverse effects pertaining to therapeutics, surgeries, radiation therapies, and associated imaging corollaries. A case-based approach will be used to both explore the efficacy of modern treatments and demonstrate their adverse effects, such as chemotherapy-associated pneumonitis, radiation esophagitis, and anastomotic failure. With this comprehensive exploration of gastroesophageal cancer, radiologists will be equipped with the essential tools to inform the treatment decisions made by medical oncologists, radiation oncologists, and surgical oncologists in the new era of precision medicine. Graphical abstract: (Figure presented.
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