Improving Proficiency in Central Venous Catheter Insertion: Standardized Simulation Based Training for Internal Medicine House Staff

Objectives: The objectives of this study are to assess residents\u27 pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.https://jdc.jefferson.edu/patientsafetyposters/1063/thumbnail.jp

Pharmacologic Advances in the Treatment of Schizophrenia

The treatment of schizophrenia was revolutionized with the introduction of chlorpromaeine in 1952. The effectiveness of chlorpromazine in controlling psychotic symptoms lead to the dopamine Hypothesis of schizophrenia, which revolutionized our conceptualization of this illness. Since that time, numerous typical antipsychotic drugs have been developed for the treatment of schizophrenia. However, the introduction of clozapine in 1990 began a new era in the pharmacologic management of schizophrenia. Clozapine, an atypical antipsychotic drug, is effective in controlling the positive Symptoms of schizophrenia in a large number of otherwise treatment-resistant patients, and also improves the negative symptoms of the illness in marry patients. Clozapine is classified as an atypical antipsychotic drug because it has little potential for causing extrapyramidal side effects, and its effects on dopaminergic and serotonergic neurotransmitter systems are unique compared with those of typical antipsychotic medications. The effectiveness of clozapine and the explosion of research in neuroscience has led to the investigation of neurotransmitter systems other than dopamine as important in developing pharmacologic strategies for the treatment of schizophrenia. This paper will review current pharmacologic advances in the treatment of schizophrenia, and highlight the clinical findings and use of clozapine, the prototype of a new generation of antipsychotic drugs

The Forgotten Evaluation: Taking Competence Seriously

The medical literature devotes little attention to the application of competency to the general medical patient. Commonly, the only cases recognized as necessitating a competency evaluation are overtly psychotic patients, patients requiring written informed consent, and those patients who refuse treatments strongly recommended by their physician. Clarifying terminology and redefining competency provides a practical screening method for assessing competency in all patients. When physicians neglect the evaluation of competency, patient autonomy is compromised. Not only are all physicians capable of performing a competency evaluation, they are ethically and professionally required to do so

Adressing the Key Drivers of Burnout: Exploring Solutions in Education and Training

Research has shown that medical students, residents, and fellows experience high rates of burnout, depression, and suicidal ideation. What is it about the educational and training environment that fosters these problems? What is the impact on trainees and patients, and what can we do to fix it? Dr. West will review the research to date and propose solutions and best practices for improving the ways we train future generations of physicians.https://openworks.mdanderson.org/hrc_burnout_presentations/1015/thumbnail.jp

A Guide to Point of Care Ultrasound Lung and IVC Examination of a Volume Overloaded Patient

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care ultrasound (POCUS), there is no radiation risk and no delay in obtaining imaging. A systematic review and meta-analysis study by Maw et al. published in 2019 found that lung ultrasound diagnosis of pulmonary edema in the setting of clinical suspicion for acute decompensated heart failure had a pooled sensitivity of 0.88 and specificity of 0.9, which is superior to X-ray imaging which demonstrated a pooled sensitivity of 0.73 and a pooled specificity of 0.9.

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can significantly decrease the time to diagnosis and trigger an order for an urgent “formal” echocardiogram.1 A retrospective study by Hanson and Chan in 2021 found that POCUS led to an expedited average time to diagnosis of 5.9 hours compared to \u3e12 hours with other imaging. Those with a symptomatic pericardial effusion identified by POCUS had a significantly decreased time to treatment; time to pericardiocentesis of 28.1 hours compared to \u3e 48 hours with other diagnostic modalities.

A Guide to Point of Care Ultrasound Evaluation of Pneumonia

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.3 This study used CT imaging as a gold standard for comparison

Preventing Iatrogenic Pneumothorax “Just-In-Time”

In 2020 a high incidence of iatrogenic pneumothorax was noticed at TJUH after internal jugular central line insertion - Accepted rate is 0.1% With long periods of time between ICU rotations, residents suffer from significant procedural skill decay The COVID-19 pandemic brought with it an increase in the number of central lines placed During the COVID-19 pandemic, there has been a lack of large group training opportunities due to social distancing constraints By December 31st 2021, our intervention will improve rates of iatrogenic pneumothorax after US-guided internal jugular central line insertion by 50% of baseline, as measured by chart review via Epic EMR

A Guide to Point of Care Ultrasound Examination of Acute Decompensated Heart Failure

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis

Structural Interventions for Physician Burnout: What Do Evidence-Based Approaches Tell Us

These sessions provide symposium participants an opportunity to share their organizations\u27 experiences in addressing key drivers of burnout. What has worked? What hasn\u27t? What are the challenges in marshaling support from organizational leadership? What resources are needed? What strategies have proved effective in changing the culture of the organization? How can local and national organizations collaborate to address the key drivers of burnout? UT System faculty leaders will take notes and report a synopsis to the symposium on Tuesday morning.https://openworks.mdanderson.org/hrc_burnout_presentations/1016/thumbnail.jp