Alien Registration- Lesky, William (Portland, Cumberland County)

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ACCEPT Medical Student Handoff Workshop: The Patient Safety Curriculum Starts in Undergraduate Medical Education

This workshop is an educational intervention designed to improve student skills in patient handoffs. It consists of a one-hour, interactive, small-group session facilitated by a faculty member. The workshop focuses on the importance of specific handoff skills to patient safety and is centered around the principles embodied in the ACCEPT mnemonic: Accurate, Complete (but concise), Clear, Efficient, Presented in writing, and Told in person. Students are provided with a standardized format for both an oral and written handoff along with a pocket card highlighting the required elements. A standardized patient case allows for participants to practice these skills, receive feedback, and undergo formal evaluation. The primary goal of the workshop is to provide a brief but effective handoff-skills training session that can be targeted to participants as early as the third year of medical school. The purpose of this resource is to provide a framework for those considering incorporating handoff teaching in the undergraduate medical curriculum. At George Washington University, we conducted a quasi-randomized study of third-year internal medicine clerks receiving a standardized handoff skills training. Students were followed into their fourth year to assess the durability of the training and the transfer of skills from the simulated setting into the clinical environment. At the core of the training was a one-hour workshop developed by a group of medical educators and hospitalists aimed at teaching third-year medical students a standardized approach to handoffs in the inpatient setting. The workshop was designed to be time efficient, limit faculty resource utilization, and have a lasting impact. Using a handoff evaluation tool, we found that students who participated in the workshop demonstrated an improvement in their oral handoff skills. After an average follow-up of nine months, trained students performed statistically significantly better than untrained controls. Lastly, trained students transferred the skills they were taught to the clinical setting and performed statistically significantly better than untrained controls when assessed doing real-time handoffs during their acting-internship. A retrospective pre-post self-assessment found that 72% of students felt at least somewhat unprepared to perform an effective handoff prior to participating in the educational workshop, while 75% of students felt well prepared or very well prepared after the educational intervention. Eighty-six percent of the students felt the educational intervention to be effective. No student reported that the workshop was ineffective. AAMC MedEdPORTAL publication ID 10302. Link to original

Geschlechtsspezifische Beeinträchtigungen der exekutiven Funktionen bei Diabetes Mellitus Typ 1 und Typ 2 Patienten unter Berücksichtigung affektiver Parameter

Die Literatur weist auf Defizite der exekutiven Funktionen hin, welche die Diabeteserkrankung mit sich bringt und die in weiterer Folge die Güte der Behandlung in unterschiedlicher Hinsicht negativ beeinflussen können. In der vorliegenden Untersuchung standen die geschlechtsspezifischen Unterschiede hinsichtlich der exekutiven Funktionen von Diabetes Mellitus Patienten im Mittelpunkt des Interesses. Weiters wurde untersucht, ob und wie kognitive Faktoren, medizinische-, affektive und soziodemographische Parameter die exekutiven Funktionen beeinflussen. Die affektiven Parameter Depression, Angst und Apathie wurden bezüglich deren geschlechts- und typspezifischen Unterschiede untersucht. In der untersuchten Stichprobe konnten keine Unterschiede in den exekutiven Funktionen hinsichtlich des Geschlechts und des Diabetestyps festgestellt werden. Die Güte der exekutiven Funktionen nahm mit dem Alter ab. Die Ergebnisse zeigten einen Zusammenhang zwischen dem abstrakt-schlussfolgernden Denken bzw. der visuelle Informationsverarbeitung und der kognitive Flexibilität, der Verarbeitungsgeschwindigkeit, als auch der formal-lexikalischen und semantisch-kategoriellen Wortflüssigkeit und dem Kategorienwechsel. Hinsichtlich der affektiven Parameter konnte kein geschlechtsspezifischer, aber ein typspezifischer Unterschied festgestellt werden. So wiesen Patienten mit Diabetes Mellitus Typ 2 häufiger depressive Verstimmung und Angstsymptomatik auf als Patienten mit Diabetes Mellitus Typ 1. Hinsichtlich der Angstsymptomatik zeigte sich eine signifikante Wechselwirkung zwischen dem Geschlecht und dem Diabetestyp

A Very Rare Cause of Pancytopenia.

INTRODUCTION: Levetiracetam (Keppra) is a pyrrolidone derivative and acts as an anti-epileptic medication by modulating neurotransmitter release. Pancytopenia is a very rare adverse effect caused by levetiracetam. There are fewer than four case reports in the medical literature discussing the association between levetiracetam and pancytopenia. The pathogenesis behind this relationship is unclear. Therefore, this case will serve to spread awareness of a rare cause of pancytopenia and to hypothesize how this medication causes pancytopenia. CASE REPORT: A brain MRI of a 79-year-old female with a medical history of hypertension, Type II diabetes, and CVA revealed a right temporoparietal mass. She was started on dexamethasone prior to surgery due to the extensive amount of vasogenic edema. She underwent a temporal craniotomy with resection of the mass and was started on levetiracetam as seizure prophylaxis. Postoperatively, her blood count remained stable. She was on levetiracetam, dexamethasone, pantoprazole, and enoxaparin as prophylaxis. She was noted to have an episode of melena and anemia on the fifth day postoperatively, which resulted in a transfusion of two units of blood with an appropriate response. No acute gastroenterological intervention was deemed necessary. The patient was also noted to develop thrombocytopenia and leukopenia. Thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, and heparin-induced thrombocytopenia were ruled out. Pantoprazole and enoxaparin were discontinued without any improvement in cell counts. The patient received a total of five units of platelets due to a platelet count of less than 100,000. Levetiracetam was changed to lacosamide on day ten post-operative, and dexamethasone was continued without change. Within 24 hours of discontinuing levetiracetam, the platelet counts improved and continued to trend upward. A noticeable increase in white blood cells and hemoglobin were seen five days after that. DISCUSSION: Levetiracetam was approved by FDA for partial seizure, myoclonic seizure, and generalized tonic-clonic seizure. It is used off-label as seizure prophylaxis. This medication is associated with a few side effects that include behavioral changes, headache, drowsiness, and weakness. Hematologic adverse effects are rarely caused by this therapy. These effects include anemia, thrombocytopenia, and leukopenia. Our patient developed pancytopenia induced by levetiracetam and was resolved after we discontinued this medication. Her hemolysis profile and blood smear did not reveal any signs of hemolysis. Therefore, we hypothesize that levetiracetam induces pancytopenia by causing bone marrow suppression. CONCLUSION: Clinicians should be aware that levetiracetam induces severe pancytopenia. We should consider changing levetiracetam to lacosamide in patients who develop pancytopenia with negative hemolysis profile. Further studies need to understand how levetiracetam induces bone marrow suppression and to find a blood test for diagnosis