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Cooper AZ, Jain S, Santhosh L, Carlos WG. Eye on the Prize: Patient Outcomes Research in Medical Education. ATS Sch 2024; 5:8-18. [PMID: 38585575 PMCID: PMC10995853 DOI: 10.34197/ats-scholar.2023-0046ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 04/09/2024] Open
Abstract
The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.
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Affiliation(s)
- Avraham Z. Cooper
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lekshmi Santhosh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California; and
| | - W. Graham Carlos
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Pfeifle D, Bagley B, Carlos WG. Virtual Is the New Reality: How Are We Matching Up Postpandemic? ATS Sch 2024; 5:5-7. [PMID: 38587215 PMCID: PMC10994224 DOI: 10.34197/ats-scholar.2024-0012ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Affiliation(s)
- Dan Pfeifle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brent Bagley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Kelm DJ, Neumeier A, Hinkle LJ, Adamson R, Heath JK, Stewart NH, Niroula A, Chiarchiaro J, Denson JL, Holden VK, Soffler M, Carlos WG. Build It and They Shall Come: Medical Education Communities of Practice. ATS Sch 2023; 4:207-215. [PMID: 37538078 PMCID: PMC10394712 DOI: 10.34197/ats-scholar.2022-0124in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/22/2023] [Indexed: 08/05/2023] Open
Abstract
Background Producing scholarship in education is essential to the career development of a clinician-educator. Challenges to scholarly production include a lack of resources, time, expertise, and collaborators. Objective To develop communities of practice for education scholarship through an international society to increase community and academic productivity. Methods We developed multi-institutional scholarship pods within the American Thoracic Society through the creation of a working group (2017-2019). Pods met virtually, and meetings were goal focused to advance education scholarship within their area of interest. To understand the impact of these scholarship pods, we surveyed pod leaders and members in 2021 and analyzed the academic productivity of each pod via a survey of pod leaders and a review of the PubMed index. Results Nine pods were created, each with an assigned educational topic. The survey had a response rate of 76.6%. The perceived benefits were the opportunity to meet colleagues with similar interests at other institutions, production of scholarly work, and engagement in new experiences. The main challenges were difficulty finding times to meet because of competing clinical demands and aligning times among pod members. Regarding academic productivity, eight publications, four conference presentations, and one webinar/podcast were produced by six of the nine pods. Conclusion The development of communities of practice resulted in increased multi-site collaboration, with boosted academic productivity as well as an enhanced sense of belonging. Multiple challenges remain but can likely be overcome with accountability, early discussion of roles and expectations, and clear delegation of tasks and authorship.
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Affiliation(s)
- Diana J. Kelm
- Division of Pulmonary and Critical Care
Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anna Neumeier
- Division of Pulmonary Sciences and
Critical Care Medicine, University of Colorado, Denver, Colorado
| | - Laura J. Hinkle
- Division of Pulmonary, Critical Care,
Sleep, and Occupational Medicine, Indiana University School of Medicine,
Indianapolis, Indiana
| | - Rosemary Adamson
- Section of Pulmonary, Critical Care, and
Sleep Medicine, Veterans Affairs Puget Sound Healthcare System, Seattle,
Washington
- Division of Pulmonary, Critical Care, and
Sleep Medicine, University of Washington School of Medicine, Seattle,
Washington
| | - Janae K. Heath
- Department of Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy H. Stewart
- Division of Pulmonary, Critical Care, and
Sleep Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Abesh Niroula
- Division of Pulmonary, Allergy, Critical
Care, and Sleep Medicine, Emory University School of Medicine, Atlanta,
Georgia
| | - Jared Chiarchiaro
- Division of Pulmonary, Allergy, and
Critical Care Medicine, Oregon Health & Science University, Portland,
Oregon
| | - Joshua L. Denson
- Section of Pulmonary Diseases, Critical
Care, and Environmental Medicine, Department of Medicine, Tulane University
School of Medicine, New Orleans, Louisiana
| | - Van K. Holden
- Division of Pulmonary and Critical Care
Medicine, Department of Medicine, University of Maryland School of Medicine,
Baltimore, Maryland; and
| | - Morgan Soffler
- Division of Pulmonary, Critical Care,
and Sleep Medicine, Westchester Medical Center, Valhalla, New York
| | - W. Graham Carlos
- Division of Pulmonary, Critical Care,
Sleep, and Occupational Medicine, Indiana University School of Medicine,
Indianapolis, Indiana
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Burns KEA, Moss M, Lorens E, Jose EKA, Martin CM, Viglianti EM, Fox-Robichaud A, Mathews KS, Akgun K, Jain S, Gershengorn H, Mehta S, Han JE, Martin GS, Liebler JM, Stapleton RD, Trachuk P, Vranas KC, Chua A, Herridge MS, Tsang JLY, Biehl M, Burnham EL, Chen JT, Attia EF, Mohamed A, Harkins MS, Soriano SM, Maddux A, West JC, Badke AR, Bagshaw SM, Binnie A, Carlos WG, Çoruh B, Crothers K, D'Aragon F, Denson JL, Drover JW, Eschun G, Geagea A, Griesdale D, Hadler R, Hancock J, Hasmatali J, Kaul B, Kerlin MP, Kohn R, Kutsogiannis DJ, Matson SM, Morris PE, Paunovic B, Peltan ID, Piquette D, Pirzadeh M, Pulchan K, Schnapp LM, Sessler CN, Smith H, Sy E, Thirugnanam S, McDonald RK, McPherson KA, Kraft M, Spiegel M, Dodek PM. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey. Crit Care Med 2022; 50:1689-1700. [PMID: 36300945 PMCID: PMC9668381 DOI: 10.1097/ccm.0000000000005674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN Cross-sectional survey using four validated instruments. SETTING Sixty-two sites in Canada and the United States. SUBJECTS Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.
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Affiliation(s)
- Karen E A Burns
- Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Moss
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Edmund Lorens
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Claudio M Martin
- Division of Critical Care, London Health Sciences, London Health Sciences Centre, London, ON, Canada
| | - Elizabeth M Viglianti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Alison Fox-Robichaud
- Division of Critical Care, McMaster University, Department of Medicine, Hamilton, ON, Canada
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathleen Akgun
- Section of Pulmonary, Critical Care & Sleep Medicine, VA Connecticut Healthcare System, West Haven, CT
| | - Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Hayley Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sangeeta Mehta
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Sinai Health, Toronto, ON, Canada
| | - Jenny E Han
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Gregory S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Janice M Liebler
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Polina Trachuk
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York University Langone Health, New York, NY
| | - Kelly C Vranas
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR
| | | | - Margaret S Herridge
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON, Canada
| | | | - Michelle Biehl
- Departments of Critical Care Medicine and Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jen-Ting Chen
- Harborview Medical Center, University of Washington, Seattle, WA
| | - Engi F Attia
- Division of Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Amira Mohamed
- Division of Pulmonary, Critical Care and Sleep, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY
| | - Michelle S Harkins
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Sheryll M Soriano
- OSF Medical Group Pulmonary and Critical Care Division, Order of St Francis (OSF) Healthcare, Peoria, IL
| | - Aline Maddux
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Julia C West
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andrew R Badke
- Pulmonary and Critical Care, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandra Binnie
- Department of Critical Care Medicine at William Osler Health System, William Osler Health System, Toronto, ON, Canada
| | - W Graham Carlos
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Affairs Puget Sound Health Care, Seattle, WA
| | - Frederick D'Aragon
- Department of Anesthesia, University de Sherbrooke, Sherbrooke, QC, Canada
| | - Joshua Lee Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA
| | - John W Drover
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Gregg Eschun
- Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Anna Geagea
- Division of Critical Care, Department of Medicine, North York General Hospital, Toronto, ON, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia. Vancouver, BC, Canada
| | - Rachel Hadler
- Department of Anesthesia, University of Iowa Hospital and Clinics, Iowa City, IA
| | | | - Jovan Hasmatali
- Department of Critical Care, Health Sciences Centre, Winnipeg, MB, Canada
| | - Bhavika Kaul
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA
| | - Meeta Prasad Kerlin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rachel Kohn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott M Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Peter E Morris
- University of Kentucky College of Medicine, Lexington, KY
| | - Bojan Paunovic
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ithan D Peltan
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Krishna Pulchan
- Division of Critical Care Medicine, Horizon Health Network, Fredericton, NB, Canada
| | - Lynn M Schnapp
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Curtis N Sessler
- Department of Medicine, Section of Critical Care, Virginia Commonwealth University Health System, Richmond, VA
| | | | - Eric Sy
- Regina General Hospital, Regina, SK, Canada
| | | | | | - Katie A McPherson
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Monica Kraft
- University of Arizona College of Medicine, Tucson, AZ
| | - Michelle Spiegel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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Abstract
The COVID-19 pandemic has changed the face of education for undergraduate and graduate medical trainees. Lectures, clinical clerkships, and testing have all been impacted significantly because of patient care needs and concern for the health and safety of trainees. While traditional teaching strategies have been upended, the challenges posed by the pandemic have also created unique opportunities for trainees. In this article, the authors summarize lessons trainees can learn from the ongoing pandemic in the following areas: public health, disaster preparedness, and resource allocation; reinventing professional and personal roles to meet the needs of the health care system; flexibility in navigating testing, licensure, and certification; appraising scientific evidence quickly and accurately; balancing a physician's call to duty with fear for personal safety; combating moral injury; interprofessional collaboration; and advocating for oneself and one's colleagues. Focusing on these lessons can help educators steer their efforts to better prepare future physicians for unforeseen challenges that may come up in their personal and professional lives as well as in society as a whole.
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Affiliation(s)
- Snigdha Jain
- S. Jain is a fellow, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - W. Graham Carlos
- W.G. Carlos III is bicentennial and associate professor, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Heath JK, Wang T, Santhosh L, Denson JL, Holmboe E, Yamazaki K, Clay AS, Carlos WG. Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones. Acad Med 2021; 96:1603-1608. [PMID: 34010863 DOI: 10.1097/acm.0000000000004165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones. METHOD A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017-2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression. RESULTS The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = -0.67, P = .003; ICS02: β = -0.70, P = .001; ICS03: β = -0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = -0.57, P = .007). CONCLUSIONS Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship.
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Affiliation(s)
- Janae K Heath
- J.K. Heath is assistant professor, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0533-3088
| | - Tisha Wang
- T. Wang is associate professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lekshmi Santhosh
- L. Santhosh is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Joshua L Denson
- J.L. Denson is assistant professor, Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana; ORCID: https://orcid.org/0000-0002-8654-7765
| | - Eric Holmboe
- E. Holmboe is adjunct professor, Department of Medicine, Yale University, New Haven, Connecticut, and Chief Research, Milestone Development, and Evaluation Officer for the Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Kenji Yamazaki
- K. Yamazaki is senior analyst, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Alison S Clay
- A.S. Clay is assistant professor, Department of Medicine, Duke University, Durham, North Carolina
| | - W Graham Carlos
- W.G. Carlos is associate professor, Department of Medicine, Indiana University, Indianapolis, Indiana
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Carroll CL, Kaul V, Dangayach NS, Szakmany T, Winter G, Khateeb D, Carlos WG, Kudchadkar SR. Comparing the Digital Footprint of Pulmonary and Critical Care Conferences on Twitter. ATS Sch 2021; 2:432-441. [PMID: 34667991 PMCID: PMC8518662 DOI: 10.34197/ats-scholar.2021-0041oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Pulmonary and critical care societies, including the American Thoracic Society, the American College of Chest Physicians, and the Society of Critical Care Medicine have large memberships that gather at academic conference events, attracting thousands of attendees. Objective: With the growth of social media use among pulmonary and critical care clinicians, our goal was to examine the Twitter presence and digital footprint of these three major medical society conferences. Methods: We used Symplur Signals (Symplur, LLC) to track the tweets and most active participants of the 2017-2019 annual conferences of American Thoracic Society, American College of Chest Physicians, and the Society of Critical Care Medicine. Attendance records of participants were obtained from each society. Results: During the study period, there was growth in the number of tweets, participants, and impressions for all three society conferences. Across all conferences, the amount of original content generated was less than the retweets, which comprised 50-72% of all tweets. Individuals physically attending each conference were more likely to post original content than those not in attendance (53-68% vs. 32-47%). For each society and at each meeting, clinicians made up the largest group of participants (44-60%), and most (59-82%) were physicians. A small cohort of participants was responsible for a large share of the tweets, with more than half of the participants at each conference for each society tweeting only once and only between 5-8% of participants tweeting more than 10 times. Seventy-eight individuals tweeted more than 100 times at one or more of the conferences. There was significant overlap in this group, with 32 of these individual participants tweeting more than 100 times at two or more of these conferences. Conclusion: Growth in conference digital footprints is largely due to increased activity by a small group of prolific participants that attend conferences by multiple academic societies. Original content makes up the smallest proportion of posts, suggesting that amplification of content is more prevalent than posting of original content. In a postpandemic environment, engagement of users producing original content may be even more important for medical societies.
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Affiliation(s)
| | - Viren Kaul
- Crouse Health/SUNY Upstate Medical University, Syracuse, New York
| | | | - Tamas Szakmany
- Critical Care Directorate, Aneurin Bevan University Health Board, Grange University Hospital, Llanyravon, Cwmbran, United Kingdom
- Division of Population Medicine, Department of Anaesthesia, Intensive Care and Pain Medicine, Cardiff University, Cardiff, United Kingdom
| | - Gretchen Winter
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dina Khateeb
- Berks Schuylkill Respiratory Specialists, Reading, Pennsylvania
| | - W. Graham Carlos
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine
- Department of Pediatrics, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Carlos WG, Gross JE, Cruz CD, Jamil S. Monoclonal Antibodies: Medical Uses for the Prevention and Treatment of Disease. Am J Respir Crit Care Med 2021; 203:P26-P27. [PMID: 33861166 DOI: 10.1164/rccm.2021c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jamil S, Shafazand S, Pasnick S, Carlos WG, Maves R, Cruz CD. Genetic Variants of SARS-CoV-2: What Do We Know So Far? Am J Respir Crit Care Med 2021; 203:P30-P32. [PMID: 33970826 DOI: 10.1164/rccm.2021c5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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10
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Carlos WG, Gross JE, Cruz CD, Jamil S. Monoclonal Antibodies: Medical Uses for the Prevention and Treatment of Disease. Am J Respir Crit Care Med 2021. [DOI: 10.1164/rccm.20212p26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gandotra S, Stewart NH, Khateeb D, Garcha P, Carlos WG, Carroll CL, Kaul V. Understanding the "Social" in "Social Media". An Analysis of Twitter Engagement of Pulmonary and Critical Care Fellowship Programs. ATS Sch 2021; 2:202-211. [PMID: 34409415 PMCID: PMC8357066 DOI: 10.34197/ats-scholar.2020-0100oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Social media is ubiquitous as a tool for collaboration, networking, and dissemination. However, little is known about use of social media platforms by pulmonary and critical care medicine fellowship programs. Objective: We identify and characterize pulmonary and critical care fellowship programs using Twitter and Instagram, as well as the posting behaviors of their social media accounts. Methods: We identified all adult and pediatric pulmonary, critical care medicine (CCM), and combined pulmonary and critical care medicine (PCCM) programs in the United States using the Electronic Residency Application Service. We searched for Twitter profiles for each program between January 1, 2018, and September 30, 2018. Tweets and Twitter interactions were classified into the following three types: social, clinical, or medical education (MedEd) related. We collected data about content enhancements of tweets, including the use of pictures, graphics interchange format or videos, hashtags, links, and tagging other accounts. The types of tweets, content enhancement characteristics, and measures of engagement were analyzed for association with number of followers. Results: We assessed 341 programs, including 163 PCCM, 36 adult CCM, 20 adult pulmonary, 67 pediatric CCM, and 55 pediatric pulmonary programs. Thirty-three (10%) programs had Twitter accounts. Of 1,903 tweets by 33 of the 341 programs with Twitter accounts, 476 (25%) were MedEd related, 733 (39%) were clinical, and 694 (36%) were social. The median rate of tweets per month was 1.65 (interquartile range [IQR], 0.4-6.65), with 55% programs tweeting more than monthly. Accounts tweeting more often had significantly more followers than those tweeting less frequently (median, 240 followers; 25-75% IQR, 164-388 vs. median, 107 followers; 25-75% IQR, 13-188; P = 0.006). Higher engagement with clinical and social Twitter interactions (tweets, retweets, likes, and comments) was associated with more followers but not for the MedEd-related Twitter interactions. All types of content enhancements (pictures, graphics interchange format/videos, links, and tagging) were associated with a higher number of followers, except for hashtags. Conclusion: Despite the steadily increasing use of social media in medicine, only 10% of the pulmonary and critical care fellowship programs in the United States have Twitter accounts. Social and clinical content appears to gain traction online; however, additional evaluation is needed on how to effectively engage audiences with MedEd content.
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Affiliation(s)
- Sheetal Gandotra
- Pulmonary, Allergy, Critical Care Medicine, University of Alabama, Birmingham, Alabama
| | - Nancy H. Stewart
- Pulmonary, Critical Care and Sleep, University of Kansas Medical Center, Kansas City, Kansas
| | - Dina Khateeb
- Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Puneet Garcha
- Critical Care Medicine, Pulmonology and Sleep, Baylor College of Medicine, Houston, Texas
| | - W. Graham Carlos
- Pulmonary Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher L. Carroll
- Pediatric Critical Care, Connecticut Children’s Medical Center, Hartford, Connecticut; and
| | - Viren Kaul
- Pulmonary and Critical Care Medicine, Crouse Health/Upstate Medical University, Syracuse, New York
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Sockrider M, Jamil S, Santhosh L, Carlos WG. COVID-19 Infection versus Influenza (Flu) and Other Respiratory Illnesses. Am J Respir Crit Care Med 2020; 202:P27-P28. [PMID: 33021812 DOI: 10.1164/rccm.2020c16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Brown W, Santhosh L, Brady AK, Denson JL, Niroula A, Pugh ME, Self WH, Joffe AM, O'Neal Maynord P, Carlos WG. A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit. Crit Care 2020; 24:621. [PMID: 33092615 PMCID: PMC7583182 DOI: 10.1186/s13054-020-03317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
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Affiliation(s)
- Wade Brown
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
| | - Lekshmi Santhosh
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna K Brady
- Division of Pulmonary and Critical Care Medicine, Oregon Health Science University, Portland, OR, USA
| | - Joshua L Denson
- Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Abesh Niroula
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Meredith E Pugh
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - P O'Neal Maynord
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, TN, USA
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Pasnick S, Carlos WG, Dela Cruz CS, Gross JE, Garrison G, Jamil S. SARS-CoV-2 Transmission and the Risk of Aerosol-Generating Procedures. Am J Respir Crit Care Med 2020; 202:P13-P14. [DOI: 10.1164/rccm.2024p13] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Mendez MP, Patel H, Talan J, Doering M, Chiarchiaro J, Sternschein RM, Steinbach TC, O’Toole J, Sankari A, McCallister JW, Lee MM, Carlos WG, Lyons PG. Communication Training in Adult and Pediatric Critical Care Medicine. A Systematic Review. ATS Sch 2020; 1:316-330. [PMID: 33870298 PMCID: PMC8043309 DOI: 10.34197/ats-scholar.2019-0017re] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/12/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Interpersonal and communication skills are essential for physicians practicing in critical care settings. Accordingly, demonstration of these skills has been a core competency of the Accreditation Council for Graduate Medical Education since 2014. However, current practices regarding communication skills training in adult and pediatric critical care fellowships are not well described. Objective: To describe the current state of communication curricula and training methods in adult and pediatric critical care training programs as demonstrated by the published literature. Methods: We performed a systematic review of the published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Three authors reviewed a comprehensive set of databases and independently selected articles on the basis of a predefined set of inclusion and exclusion criteria. Data were independently extracted from the selected articles. Results: The 23 publications meeting inclusion criteria fell into the following study classifications: intervention (n = 15), cross-sectional survey (n = 5), and instrument validation (n = 3). Most interventional studies assessed short-term and self-reported outcomes (e.g., learner attitudes and perspectives) only. Fifteen of 22 publications represented pediatric subspecialty programs. Conclusion: Opportunities exist to evaluate the influence of communication training programs on important outcomes, including measured learner behavior and patient and family outcomes, and the durability of skill retention.
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Affiliation(s)
- Michael P. Mendez
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Harin Patel
- Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jordan Talan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, New York
| | | | - Jared Chiarchiaro
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rebecca M. Sternschein
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Trevor C. Steinbach
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, Washington
| | - Jacqueline O’Toole
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abdulghani Sankari
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Division of Pulmonary Critical Care Medicine, Wayne State University, Detroit, Michigan
- Department of Medical Education, Ascension Providence Health System, Southfield, Michigan
| | - Jennifer W. McCallister
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - May M. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California Keck School of Medicine, Los Angeles, California; and
| | - W. Graham Carlos
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick G. Lyons
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
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Carlos WG, Dela Cruz CS, Cao B, Gross JE, Pasnick S, Jamil S. COVID-19: How Do We Stay Safe? Am J Respir Crit Care Med 2020. [PMID: 32650649 DOI: 10.1164/rccm.2020c12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- W Graham Carlos
- Indiana University School of Medicine, 12250, Pulmonary and Critical Care, Indianapolis, Indiana, United States;
| | - Charles S Dela Cruz
- Yale University, Pulmonary and Critical Care Medicine, New Haven, Connecticut, United States
| | - Bin Cao
- Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Jane E Gross
- National Jewish Health, 2930, Denver, Colorado, United States
| | - Susan Pasnick
- UCSF, Medicine, San Francisco, California, United States
| | - Shazia Jamil
- University of California San Diego, 8784, La Jolla, California, United States
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Pasnick S, Carlos WG, Dela Cruz CS, Gross JE, Garrison G, Jamil S. SARS-CoV-2 Transmission and the Risk of Aerosol Generating Procedures. Am J Respir Crit Care Med 2020. [PMID: 32603230 DOI: 10.1164/rccm.2020c11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Susan Pasnick
- UCSF, Medicine, San Francisco, California, United States
| | - W Graham Carlos
- Indiana University School of Medicine, 12250, Pulmonary and Critical Care, Indianapolis, Indiana, United States
| | - Charles S Dela Cruz
- Yale University, Pulmonary and Critical Care Medicine, New Haven, Connecticut, United States
| | - Jane E Gross
- National Jewish Health, 2930, Denver, Colorado, United States
| | - Garth Garrison
- University of Vermont College of Medicine, 12352, Pulmonary and Critical Care Medicine, Burlington, Vermont, United States;
| | - Shazia Jamil
- University of California San Diego, 8784, La Jolla, California, United States
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Carlos WG, Crotty Alexander LE, Gross JE, Dela Cruz CS, Keller JM, Pasnick S, Jamil S. Vaping-associated Pulmonary Illness (VAPI). Am J Respir Crit Care Med 2020; 200:P13-P14. [PMID: 31532695 DOI: 10.1164/rccm.2007p13] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Carlos WG, Crotty Alexander LE, Gross JE, Dela Cruz CS, Keller JM, Pasnick S, Jamil S. ATS Health Alert-Vaping-associated Pulmonary Illness (VAPI). Am J Respir Crit Care Med 2020; 200:P15-P16. [PMID: 31532698 DOI: 10.1164/rccm.2007p15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dela Cruz CS, Pasnick S, Gross JE, Keller J, Carlos WG, Cao B, Jamil S. Adenovirus Infection and Outbreaks: What You Need to Know. Am J Respir Crit Care Med 2020; 199:P13-P14. [PMID: 30932693 DOI: 10.1164/rccm.1997p13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Santhosh L, Brown W, Ferreira J, Niroula A, Carlos WG. Practical Tips for ICU Bedside Teaching. Chest 2019; 154:760-765. [PMID: 30290929 DOI: 10.1016/j.chest.2018.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/02/2018] [Accepted: 06/25/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA.
| | - Wade Brown
- Department of Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Juliana Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - W Graham Carlos
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
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McPherson K, Carlos WG, Emmett TW, Slaven JE, Torke AM. Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature. J Hosp Med 2019; 14:303-310. [PMID: 30794145 PMCID: PMC6625435 DOI: 10.12788/jhm.3137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
When life-sustaining treatments (LST) are no longer effective or consistent with patient preferences, limitations may be set so that LSTs are withdrawn or withheld from the patient. Many studies have examined the frequency of limitations of LST in intensive care unit (ICU) settings in the past 30 years. This systematic review describes variation and patient characteristics associated with limitations of LST in critically ill patients in all types of ICUs in the United States. A comprehensive search of the literature was performed by a medical librarian between December 2014 and April 2017. A total of 1,882 unique titles and abstracts were reviewed, 113 were selected for article review, and 36 studies were fully reviewed. Patient factors associated with an increased likelihood of limiting LST included white race, older age, female sex, poor preadmission functional status, multiple comorbidities, and worse illness severity score. Based on several large, multicenter studies, there was a trend toward a higher frequency of limitation of LST over time. However, there is large variability between ICUs in the proportion of patients with limitations and on the proportion of deaths preceded by a limitation. Increases in the frequency of limitations of LST over time suggests changing attitudes about aggressive end-of-life-care. Limitations are more common for patients with worse premorbid health and greater ICU illness severity. While some differences in the frequency of limitations of LST may be explained by personal factors such as race, there is unexplained wide variability between units.
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Affiliation(s)
- Katie McPherson
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver Colorado
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas W Emmett
- Ruth Lilly Medical Library at Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexia M Torke
- Indiana University Center for Aging Research, Indianapolis Indiana
- Daniel F. Evans Center for Spiritual and Religious Values in Healthcare and Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana
- Corresponding Author: Alexia M Torke, MD, MS; E-mail: ; Telephone: 317-274-9221; Twitter: @AlexiaMTorke
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Carroll CL, Dangayach NS, Khan R, Carlos WG, Harwayne-Gidansky I, Grewal HS, Seay B, Simpson SQ, Szakmany T, Ackerman AD, Bhar AS, Bruno K, Clay AS, DePriest A, Duprey MS, Hawkins WA, Kandel S, Kashyap R, Lough ME, Raju SV, Riordan B, Schulman DA, Wu A. Lessons Learned From Web- and Social Media-Based Educational Initiatives by Pulmonary, Critical Care, and Sleep Societies. Chest 2019; 155:671-679. [DOI: 10.1016/j.chest.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022] Open
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Jamil S, Carlos WG, Leard L, Wang A, Santhosh L, Balmes J, Seam N, Dela Cruz CS. Wildfires Disaster Guidance: Tips for Staying Healthy during Wildfires. Am J Respir Crit Care Med 2019; 199:P3-P4. [PMID: 30644780 DOI: 10.1164/rccm.1992p3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Smith J, Carlos WG, Johnson CS, Takesue B, Litzelman D. A pilot study: a teaching electronic medical record for educating and assessing residents in the care of patients. Med Educ Online 2018; 23:1447211. [PMID: 29506459 PMCID: PMC5844037 DOI: 10.1080/10872981.2018.1447211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We tested a novel, web-based teaching electronic medical record to teach and assess residents' ability to enter appropriate admission orders for patients admitted to the intensive care unit. The primary objective was to determine if this tool could improve the learners' ability to enter an evidence-based, comprehensive initial care plan for critically ill patients. METHODS The authors created three modules using de-identifed real patient data from selected patients that were admitted to the intensive care unit. All senior residents (113 total) were invited to participate in a dedicated two-hour educational session to complete the modules. Learner performance was graded against gold standard admission order sets created by study investigators based on the latest evidence-based medicine and guidelines. RESULTS The session was attended by 39 residents (34.5% of invitees). There was an average improvement of at least 20% in users' scores across the three modules (Module 3-Module 1 mean difference 22.5%; p = 0.001 and Module 3-Module 2 mean difference 20.3%; p = 0.001). Diagnostic acumen improved in successive modules. Almost 90% of the residents reported the technology was an effective form of teaching and would use it autonomously if more modules were provided. CONCLUSIONS In this pilot project, using a novel educational tool, users' patient care performance scores improved with a high level of user satisfaction. These results identify a realistic and well-received way to supplement residents' training and assessment on core clinical care and patient management in the face of duty hour restrictions.
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Affiliation(s)
- Joshua Smith
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, WI, USA
| | - W. Graham Carlos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, IN, USA
| | | | - Blaine Takesue
- Department of Medicine, Regenstrief Institute, Inc, IN, USA
- Department of Medicine, Division of General Internal Medicine, Indiana University School of Medicine, IN, USA
| | - Debra Litzelman
- Department of Medicine, Regenstrief Institute, Inc, IN, USA
- Department of Medicine, Division of General Internal Medicine, Indiana University School of Medicine, IN, USA
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Gross JE, Carlos WG, Dela Cruz CS, Harber P, Jamil S. Sand and Dust Storms: Acute Exposure and Threats to Respiratory Health. Am J Respir Crit Care Med 2018; 198:P13-P14. [DOI: 10.1164/rccm.1987p13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cochard E, Fulkerson Z, Carlos WG. Implementation of a point-of-care ultrasound skills practicum for hospitalists. Ultrasound 2018; 27:38-44. [PMID: 30774697 DOI: 10.1177/1742271x18791317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists' confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access.
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Affiliation(s)
- Emily Cochard
- Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary Fulkerson
- Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - W Graham Carlos
- Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Carlos WG, Gross JE, Jamil S, Dela Cruz CS, Damby D, Tam E. Volcanic Eruptions and Threats to Respiratory Health. Am J Respir Crit Care Med 2018; 197:P21-P22. [PMID: 29905516 DOI: 10.1164/rccm.19712p21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hopper MK, Wright SM, Carroll M, Bauer E, Carlos WG. Atypical use of audience response system provides opportunity to formatively assess teaching and improve learning outcomes. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.lb226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Erich Bauer
- Medical EducationIU School of MedicineIndianapolisKS
| | - W. Graham Carlos
- Division of Pulmonary, Critical Care, Sleep and Occupational MedicineIU School of MedicineIndianapolisIN
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Affiliation(s)
- Christen K Dilly
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - W Graham Carlos
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - Krista Hoffmann-Longtin
- Office of Faculty Affairs and Professional Development; Indiana University School of Medicine; Indianapolis Indiana USA
| | - John Buckley
- Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - Anna Burgner
- Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee USA
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Kittelson S, Heineke J, Carlos WG. My Cup Runneth Over. J Palliat Med 2017; 21:279. [PMID: 29112464 DOI: 10.1089/jpm.2017.0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sheri Kittelson
- 1 Division of Palliative Care, Department of Medicine, University of Florida , Gainesville, Florida
| | - Janelle Heineke
- 2 Department of Operations and Technology, Boston University Questrom School of Business , Boston, Massachusetts
| | - W Graham Carlos
- 3 Department of Clinical Medicine, Pulmonary/Critical Care, Indiana University School of Medicine , Indianapolis, Indiana
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McSparron JI, Hayes MM, Poston JT, Thomson CC, Fessler HE, Stapleton RD, Carlos WG, Hinkle L, Liu K, Shieh S, Ali A, Rogers A, Shah NG, Slack D, Patel B, Wolfe K, Schweickert WD, Bakhru RN, Shin S, Sell RE, Luks AM. ATS Core Curriculum 2016: Part II. Adult Critical Care Medicine. Ann Am Thorac Soc 2016; 13:731-40. [PMID: 27144797 PMCID: PMC5461968 DOI: 10.1513/annalsats.201601-050cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/16/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jakob I McSparron
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Margaret M Hayes
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jason T Poston
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carey C Thomson
- 3 Division of Pulmonary and Critical Care, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry E Fessler
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Renee D Stapleton
- 5 Division of Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - W Graham Carlos
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Hinkle
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathleen Liu
- 7 Division of Nephrology, Department of Medicine, and
- 8 Division of Critical Care Medicine, Department of Anesthesia, University of California San Francisco, San Francisco, California
| | - Stephanie Shieh
- 9 Division of Nephrology, Department of Medicine, Saint Louis University, Saint Louis, Missouri
| | - Alyan Ali
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Angela Rogers
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nirav G Shah
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Donald Slack
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Bhakti Patel
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Krysta Wolfe
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - William D Schweickert
- 12 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita N Bakhru
- 13 Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Stephanie Shin
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Rebecca E Sell
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Andrew M Luks
- 15 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
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Gupta S, Van Nostrand K, Rissing S, Carlos WG, Noor A. "Hole-hearted" hemoptysis. Am J Respir Crit Care Med 2013; 188:872. [PMID: 24083860 DOI: 10.1164/rccm.201212-2175im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shikha Gupta
- 1 Division of Pulmonary, Allergy, Critical Care, Occupational Medicine and Sleep, and
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Strausburg MB, Djuricich AM, Carlos WG, Bosslet GT. The influence of the residency application process on the online social networking behavior of medical students: a single institutional study. Acad Med 2013; 88:1707-1712. [PMID: 24072117 DOI: 10.1097/acm.0b013e3182a7f36b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To evaluate medical students' behavior regarding online social networks (OSNs) in preparation for the residency matching process. The specific aims were to quantify the use of OSNs by students to determine whether and how these students were changing OSN profiles in preparation for the residency application process, and to determine attitudes toward residency directors using OSNs as a screening method to evaluate potential candidates. METHOD An e-mail survey was sent to 618 third- and fourth-year medical students at Indiana University School of Medicine over a three-week period in 2012. Statistical analysis was completed using nonparametric statistical tests. RESULTS Of the 30.1% (183/608) who responded to the survey, 98.9% (181/183) of students reported using OSNs. More than half, or 60.1% (110/183), reported that they would (or did) alter their OSN profile before residency matching. Respondents' opinions regarding the appropriateness of OSN screening by residency directors were mixed; however, most respondents did not feel that their online OSN profiles should be used in the residency application process. CONCLUSIONS The majority of respondents planned to (or did) alter their OSN profile in preparation for the residency match process. The majority believed that residency directors are screening OSN profiles during the matching process, although most did not believe their OSN profiles should be used in the residency application process. This study implies that the more medical students perceive that residency directors use social media in application screening processes, the more they will alter their online profiles to adapt to protect their professional persona.
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Affiliation(s)
- Matthew B Strausburg
- Mr. Strausburg is a fourth-year medical student, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Djuricich is associate professor, Departments of Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Carlos is assistant professor, Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Dr. Bosslet is assistant professor, Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Sajjad H, Van Nostrand K, Carlos WG. A Cursed Case of Respiratory Failure. Chest 2013. [DOI: 10.1378/chest.1675147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Smith J, Carlos WG. A Hole New Kind of COPD Exacerbation. Chest 2013. [DOI: 10.1378/chest.1701997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Van Nostrand K, Smith J, Carlos WG, Noor A. Double Vision May Mean Double Trouble. Chest 2013. [DOI: 10.1378/chest.1703795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hinkle L, Carlos WG, Bosslet G. Fusariosis Masquerading as Aspergillosis. Chest 2013. [DOI: 10.1378/chest.1684102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Human metapneumovirus (hMPV) is an emerging human pulmonary pathogen that is genetically related to respiratory syncytial virus. It has been increasingly associated with respiratory illnesses over the last few decades. Immunocompromised patients are particularly susceptible with resultant morbidity and mortality. We describe our experience with 9 immunocompromised patients diagnosed with pneumonia secondary to hMPV, 2 of whom were successfully treated with aerosolized and oral ribavirin along with intravenous immunoglobulin (IVIG). We suggest that hMPV should be considered in the differential diagnosis of immunocompromised patients with acute respiratory illness. Ribavirin (oral and aerosolized) with IVIG is potentially an effective treatment option for those with severe disease.
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Affiliation(s)
- S Shahda
- Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA.
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Abstract
BACKGROUND The endemic region of blastomycosis historically has included the state of Indiana. However, few published reports of blastomycosis exist to substantiate this distinction. A surge of patients with blastomycosis in central Indiana (Indianapolis and surrounding counties) beginning in 2005 prompted us to review our local experience. We propose that this surge was related to major highway construction around Indianapolis. METHODS We reviewed all microbiologically confirmed cases from four hospitals serving central Indiana. Chart review was completed for adult patients, and data were collected on clinical presentations, methods of diagnosis, comorbidities, radiologic findings, treatment, and outcomes. We plotted patient residence addresses with sites of highway construction. RESULTS Fifty-nine patients were identified from laboratory results and physician referral. Interestingly, a surge of blastomycosis incidence occurred in 34 patients between 2005 and 2008 during which time major highway projects were under way around the Indianapolis metropolitan area. The majority of these patients presented acutely and with pulmonary involvement. Fungal culture and antigen testing were the most sensitive means to diagnosis. Antifungal therapy was highly effective. CONCLUSIONS This urban outbreak of blastomycosis in Indianapolis should prompt clinicians to consider blastomycosis in this highly endemic area of histoplasmosis.
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Affiliation(s)
- W Graham Carlos
- Pulmonary-Critical Care and Infectious Diseases, Roudebush VA Medical Center and Indiana University, Indianapolis, IN 46202, USA.
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