Intravenous iodinated contrast is not associated with acute kidney injury in adult patients with nephrotic syndrome

A critical appraisal and clinical application of Tao SM, Kong X, Schoepf UJ, et al. Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study. European Radiology. 2018;28(4):1585-1593. doi: 10.1007/s00330-017-5109-

Introducing IR to Medical Students Interested in Primary Care Specialties

Introduction: Over the last several years, interventional radiologists have become increasingly recognized as part of a collaborative healthcare team. At the same time, interventional radiology (IR) is a field poorly represented in many medical school curricula. As IR management options are increasingly incorporated into the clinician’s arsenal, representation during medical education is critical. Several studies have demonstrated that interventional radiology interest group (IRIG) presentations and demonstrations increase knowledge and excitement about the specialty amongst medical students. However, current literature investigating the effect of these presentations on students interested in primary care specialties is lacking. Our study demonstrates that presenting cases specifically targeted toward students interested in primary care specialties increases their knowledge about the role of IR in their future practice.Methods: Case presentations were given to students who attended interest group meetings in family medicine, emergency medicine, pediatrics, and internal medicine. Presentations were developed specifically to consist of cases that are relevant to each interest group’s respective field. The majority of students were in their preclinical years and interested in a variety of non-radiology specialties. Surveys were administered prior to the presentation and following the presentation (7 questions each). All questions were answered on a Likert scale of 1-5 (1—disagree and 5—agree). Questions were centered around general knowledge of IR, the role of IR within their field, and the benefits of IR to their future practice. Descriptive statistics were calculated based on these results.Results: Responses from 81 participants to every question suggested an overall increase in the knowledge of the field of IR following the case presentation. The mean value to the question “I understand the role of IR in my specialty of interest” increased from 2.7 to 3.6 after the presentation. Students’ average response to the question, “I understand some IR procedures” increased 1.3 points on the scale.Conclusions: Medical students are generally not exposed to IR as a specialty despite its expanding role in clinical practice. Increasing medical student familiarity with IR is essential to producing physicians with a broad understanding of the management options at their disposal. Targeted case presentations given to pre-clinical and clerkship-level medical students interested in primary care specialties were effective in increasing understanding of the role of IR in their specialty of interest. Student-led presentations using interest groups as a networking platform are an effective method for forming first impressions and exposing future doctors to the applications of interventional radiology in their practice.https://scholarlycommons.henryford.com/merf2019edu/1001/thumbnail.jp

Understanding the role of the perivascular space in cerebral small vessel disease

Small vessel diseases are a group of disorders that result from pathological alteration of the small blood vessels in the brain, including the small arteries, capillaries and veins. Of the 35-36 million people that are estimated to suffer from dementia worldwide, up to 65% have an SVD component. Furthermore, SVD causes 20-25% of strokes, worsens outcome after stroke and is a leading cause of disability, cognitive impairment and poor mobility. Yet the underlying cause(s) of SVD are not fully understood.Magnetic resonance imaging (MRI) has confirmed enlarged perivascular spaces (PVS) as a hallmark feature of SVD. In healthy tissue, these spaces are proposed to form part of a complex brain fluid drainage system which supports interstitial fluid exchange and may also facilitate clearance of waste products from the brain. The pathophysiological signature of PVS, and what this infers about their function and interaction with cerebral microcirculation, plus subsequent downstream effects on lesion development in the brain has not been established. Here we discuss the potential of enlarged PVS to be a unique biomarker for SVD and related brain disorders with a vascular component. We propose that widening of PVS suggests presence of peri-vascular cell debris and other waste products that forms part of a vicious cycle involving impaired cerebrovascular reactivity (CVR), blood-brain barrier (BBB) dysfunction, perivascular inflammation and ultimately impaired clearance of waste proteins from the interstitial fluid (ISF) space, leading to accumulation of toxins, hypoxia and tissue damage.Here, we outline current knowledge, questions and hypotheses regarding understanding the brain fluid dynamics underpinning dementia and stroke through the common denominator of SVD

The Paravascular Pathway for Brain Waste Clearance: Current Understanding, Significance and Controversy

The paravascular pathway, also known as the “glymphatic” pathway, is a recently described system for waste clearance in the brain. According to this model, cerebrospinal fluid (CSF) enters the paravascular spaces surrounding penetrating arteries of the brain, mixes with interstitial fluid (ISF) and solutes in the parenchyma, and exits along paravascular spaces of draining veins. Studies have shown that metabolic waste products and solutes, including proteins involved in the pathogenesis of neurodegenerative diseases such as amyloid-beta, may be cleared by this pathway. Consequently, a growing body of research has begun to explore the association between glymphatic dysfunction and various disease states. However, significant controversy exists in the literature regarding both the direction of waste clearance as well as the anatomical space in which the waste-fluid mixture is contained. Some studies have found no evidence of interstitial solute clearance along the paravascular space of veins. Rather, they demonstrate a perivascular pathway in which waste is cleared from the brain along an anatomically distinct perivascular space in a direction opposite to that of paravascular flow. Although possible explanations have been offered, none have been able to fully reconcile the discrepancies in the literature, and many questions remain. Given the therapeutic potential that a comprehensive understanding of brain waste clearance pathways might offer, further research and clarification is highly warranted

Aneroid Blood Pressure Manometer Calibration Rates of Devices Used in Home Health

Hypertension is associated with cardiovascular disease, stroke, and a range of other medical sequelae. Accurate blood pressure (BP) readings, which depend on the integrity and calibration of the measuring device, are essential to identifying suboptimal BP. This study describes calibration rates of aneroid BP devices (a) utilized in home healthcare (HHC) and (b) having the needle resting within the zero accuracy indicator. BP devices from one branch of a home care agency were inspected and checked for calibration according to the protocol set forth by the European Society of Hypertension. Of the 125 devices measured, 78.4% were in calibration. Of the 94 devices with the gauge needle resting in the zero accuracy indicator, 11.7% were not in calibration; whereas, 51.6% of the 31 devices with the gauge needle resting outside the zero accuracy indicator were found not in calibration. Twenty-one devices were not checked for calibration due to inflation bulb malfunction, tubing tears, or excessive wear. Furthermore, visual inspection of the needle placement did not confirm a device as being in or out of calibration. Proper maintenance and routine calibration of BP equipment is foundational to assuring accuracy of BP readings obtained by HHC providers

Targeted case presentations introducing interventional radiology to medical students interested in primary care specialties

Purpose: Interventional radiology (IR) is increasingly utilized through consultation as part of a collaborative health care team. However, formal education in this type of collaboration is limited in medical school curriculum and medical students lack confidence in requesting consultations. Studies have shown that IR interest group presentations and demonstrations increases medical student knowledge and excitement about the field. Our study demonstrates that IR interest group case presentations specific to medical students interested in primary care specialties increases their familiarity with IR, improves medical student collaboration and raises confidence when requesting consults. Materials: Specific cases requiring IR consultation were prepared for internal medicine, family medicine and emergency medicine interest groups. The educational content included an overview of the field of IR, basic principles and techniques of IR, the role of an IR in a multidisciplinary team, IR case presentations specific to the primary care specialty and indications for and benefits of IR consultation. Surveys were administered to students prior to and after the presentation to assess change in knowledge following the presentation using a Likert scale. McNemar’s test was used to examine differences in pre- and postsurvey responses. Statistical analyses were conducted using STATA Corp v.14.2. Results: 70 pre-post surveys were completed by first- and second-year medical students (n = 70). There was a statistically significant increase in knowledge and familiarity in all areas from baseline (P \u3c0.0016). Additionally, nearly 33% of first and second year medical students indicated they were interested in 2 or more specialties or undecided (Table 1). Conclusions: Medical students are not exposed to IR and lack confidence when requesting consults for their patients. Increasing medical student familiarity with IR is essential to producing physicians with a broad understanding of the management options at their disposal. Targeted case presentations for preclinical medical students interested in primary care specialties were effective in increasing their familiarity with IR, improving confidence when requesting consults