Impact of Student Experiences in Team-based Practice in a Student-run Outreach Clinic

If trainees from differing health professions work together in a team-based setting to provide quality care to underserved individuals, they may be more inclined to work in an interprofessional collaborative health care team. The purpose of the study was to learn about student experiences at the Indiana University Student Outreach Clinic (IUSOC) as it relates to caring for underserved individuals. The IUSOC is a free clinic run out of the Neighborhood Fellowship Church in Indianapolis, Indiana. The IUSOC clinic provides primary care-based medical services free of charge for the uninsured and underserved within the community. The patient population includes individuals with medical problems of varying acuity. Health profession students from dentistry, medicine, nursing, pharmacy, public health, and social work co-located in the clinic recently agreed to move more intentionally into interprofessional collaborative care to more effectively address a variety of patient needs. This specific assessment is the result of a unique collaboration between the IUSOC, the Indiana Area Health Education Center Network, IU School of Medicine Office of Diversity Affairs, and the IU Center for Interprofessional Health Education and Practice. The goal was to determine if students volunteering in the IUSOC are leaving with the willingness and ability to serve vulnerable populations in an interprofessional collaborative manner. In the spring of 2016, a pilot assessment was conducted with 269 health profession student volunteers. The 18-question survey assessed student’s perception of their experience serving in an interprofessional team, working with individuals from diverse backgrounds, understanding of the unique needs of underserved individuals, and their future practice intents. The results of this pilot assessment is critical as we determine how to maximize the student experience at the IUSOC so that they are equipped with the competencies necessary to practice in an interprofessional collaborative manner with diverse teams throughout the healthcare community. Objectives: By the end of this interactive discussion, participants will: Identify the value of evaluating program outcomes in assessing the effectiveness of interprofessional education within a community-based student experience. Describe the value of using a collaborative partnership to maximize the opportunity for interprofessional/team based education among health profession students in a clinical learning environment. Identify strategic next steps for assessing student competence in interprofessional team-based care

Sydenham Chorea: Rare Consequence of Rheumatic Fever

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On T2* Magnetic Resonance and Cardiac Iron

Background-Measurement of myocardial iron is key to the clinical management of patients at risk of siderotic cardiomyopathy. The cardiovascular magnetic resonance relaxation parameter R2* (assessed clinically via its reciprocal, T2*) measured in the ventricular septum is used to assess cardiac iron, but iron calibration and distribution data in humans are limited. Methods and Results-Twelve human hearts were studied from transfusion-dependent patients after either death (heart failure, nϭ7; stroke, nϭ1) or transplantation for end-stage heart failure (nϭ4). After cardiovascular magnetic resonance R2* measurement, tissue iron concentration was measured in multiple samples of each heart with inductively coupled plasma atomic emission spectroscopy. Iron distribution throughout the heart showed no systematic variation between segments, but epicardial iron concentration was higher than in the endocardium. The meanϮSD global myocardial iron causing severe heart failure in 10 patients was 5.98Ϯ2.42 mg/g dry weight (range, 3.19 to 9.50 mg/g), but in 1 outlier case of heart failure was 25.9 mg/g dry weight. Myocardial ln[R2*] was strongly linearly correlated with ln [Fe] (

Stool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids

Objective: To evaluate the effect of hemorrhoids on noninvasive stool test performance for colorectal cancer (CRC) screening. Patients and Methods: We conducted a retrospective cohort study of test characteristics for the fecal immunochemical test (FIT) and the multitarget stool DNA (mt-sDNA) test, on the basis of hemorrhoid status, recorded at the time of colonoscopy, among patients enrolled in the pivotal prospective study for mt-sDNA that was conducted from June 2011, to May 2013. Test characteristics (sensitivity, specificity, positive, and negative predictive values) for FIT and mt-sDNA (performed < 90 days before colonoscopy) were stratified by the presence of hemorrhoids and compared. Results: Hemorrhoids were found in 51.7% (5163 of 9989) of the study cohort. Across all test characteristics, there were no statistically significant differences for FIT or mt-sDNA when stratified by hemorrhoid status. Analysis revealed mt-sDNA sensitivity of 44% and 41% for advanced precancerous lesions in nonhemorrhoidal and hemorrhoid patients, respectively (P=.41). The FIT sensitivity among the same lesion category was 24.9% in patients without hemorrhoids and 22.8% in those with hemorrhoids (P=.48). The mt-sDNA specificity was 86.4% in patients without hemorrhoids vs 87.7% in those with hemorrhoids (P=.67), although FIT specificity was 95.0% among patients without hemorrhoids vs 94.7% in those with hemorrhoids (P=.44). Conclusion: The presence of asymptomatic hemorrhoids did not adversely affect test performance in this large clinical study. These findings suggest that in the absence of overt gastrointestinal bleeding, FIT and mt-sDNA are options for CRC screening, irrespective of hemorrhoid status. Trial Registration: clinicaltrials.gov Identifier: NCT0139774

ON T2* MAGNETIC RESONANCE AND CARDIAC IRON

Background: Measurement of myocardial iron is key to the clinical management of patients at ris

Effect of Triage-Based Use of the Ottawa Foot and Ankle Rules on the Number of Orders for Radiographic Imaging.

CONTEXT: Reducing unnecessary testing lessens the cost burden of medical care, but decreasing use depends on consistently following evidence-based clinical decision rules. The Ottawa foot and ankle rules (OFARs) are validated, longstanding evidence-based guidelines to predict fractures. Frequently, radiography is automatically ordered for acute ankle injuries despite findings from OFARs suggesting no fracture. OBJECTIVES: First, to determine whether implementation of protocol-driven use of the OFARs at triage would decrease the number of radiography orders and length of stay (LOS) in the emergency department. Second, to quantify the incidence of OFARs use at triage and to assess patient expectations of radiography use and patient satisfaction as rated by both patients and clinicians. METHODS: In this prospective, 2-stage sequential pilot study, patients with acute ankle and foot injuries were screened in the emergency department between January 2013 and October 2013. In the first stage, clinicians (physician assistants, residents, and attending physicians) performed their usual practice habits for radiography use in the control group. For the second stage, they were educated to appropriately apply the OFARs before ordering radiography. For patients who were suspected of having a fracture at triage, nursing staff ordered radiography. For patients who were not suspected of having a fracture at triage, a clinician reassessed them using the OFARs after their triage assessment. Radiography was then ordered at the discretion of the clinician. Results gathered after training in the OFARs comprised the intervention group. After discharge, patients were surveyed regarding their expectations and satisfaction, and clinicians were surveyed on their perceptions of patient satisfaction. RESULTS: A total of 131 patients were screened, 62 patients were enrolled in the study after consent was obtained, and 2 patients withdrew from the study prematurely, leaving 30 patients in each group. Fifty-eight of the 60 patients (97%) underwent radiography. Emergency department LOS decreased from 103 minutes to 96.5 minutes (P=.297) after the OFARs were applied. There was also a decrease in LOS in patients with a fracture (137 minutes vs 103 minutes [P=.112]). Radiography was expected to be ordered by 27 of 30 patients in the control group (90%) and 24 of 30 in the intervention group (80%) (P=.472). Patients were equally satisfied among the groups (54 of 60 [90%]) (with no difference between groups), and 27 of 30 (90%) vs 30 of 30 (100%) clinicians in the control and intervention groups, respectively, perceived that patients were satisfied with their treatment. CONCLUSION: There was no statistical evidence that application of the OFARs decreases the number of imaging orders or decreases LOS. This observation suggests that even when clinicians are being observed and instructed to use clinical decision rules, their evaluation bias tends toward recommendations for testing