Rhode Island medical journal (2013)最新文献

Objective: The COVID-19 pandemic affected driving and activity, and therefore risk for trauma. We describe the most common injuries, falls and motor vehicle injuries (MVA), admitted to our Level-1 Trauma Center before and during the pandemic.

Method: We retrospectively evaluated pre-pandemic with pandemic trauma admissions from January 2017 to February 2023, for patients 65 years and older, following falls and MVAs.

Results: Of 12,098 falls and MVAs, falls occurred similarly frequently before and during the pandemic while MVA admissions declined from the pre-pandemic period. Odds for pandemic surgical and infectious complications increased 1.77 [1.11-2.80] vs 1.62 [1.02-2.59] as did LOS and 30-day mortality (mean 6.6±6.4 vs 6.2±5.8, adjusted p-value=0.0432, and 1.27[1.03-1.56] respectively). Thirty- day readmission (0.79[0.66-0.94]) decreased.

Conclusion: Injuries from falls and MVAs remain the commonest cause for trauma admission in older adults, with declining MVA. This informs resource utilization, and clinical focus, including fall-risk evaluation and driving assessment for older adults.

The management of Alzheimer's disease (AD) is in the process of transitioning into a new era, enabled by 50 years of scientific progress elucidating biological and clinical aspects of the AD continuum. Newly FDA-approved disease modifying therapies have driven greater access to amyloid positron emission tomography imaging, and fluid biomarker technology has produced the first blood-based biomarkers for AD that are currently entering the marketplace. Community practitioners are increasingly finding themselves on the front lines of advanced AD biomarker decision-making that was in the very recent past the domain of subspecialty memory center providers. The goal of this brief review is to orient community practitioners to fundamental principles necessary for informed AD diagnostic decision-making as biomarker technologies evolve and point out some emerging diagnostic challenges that have arisen as a consequence of more readily available advanced diagnostic options.

The behavioral variant of frontotemporal dementia (bvFTD) is a progressive, neurodegenerative disorder, characterized by profound changes in personality, behavior, and social comportment. Diagnosis of bvFTD is challenging, and it is frequently misdiagnosed as an idiopathic psychiatric disorder (e.g., major depressive disorder, bipolar disorder) or another neurodegenerative disease (e.g., Alzheimer's disease dementia). The diagnostic challenge is exacerbated by a lack of reliable in vivo biological markers of disease pathology, which means that, at present, diagnosis relies largely on detailed behavioral and cognitive assessments. In this article, we discuss how clinical diagnostic criteria for bvFTD have evolved over the past three decades, and emphasize the diagnostic uncertainty that can arise when trying to distinguish between bvFTD and primary psychiatric disorders or other neurodegenerative diseases. In highlighting the strengths and limitations of the revised diagnostic criteria, and taking into account current diagnostic predicaments, we provide evidence-based recommendations for clinicians facing this diagnostic question. Finally, we touch on the importance of early (i.e., prodromal) diagnosis, and explain the utility of biomarkers for bvFTD diagnosis, with a nod to exciting research developments in this area.

Vancomycin-Resistant-Enterococcus (VRE) prosthetic valve endocarditis leading to a ruptured aortic root abscess and an aortopulmonary fistula is rare. A 77-year-old woman with recent VRE prosthetic valve (TAVR) endocarditis being treated with ampicillin and daptomycin for two weeks presented with bradycardia and hypotension in the setting of marked hypokalemia. Her hospital course was complicated by acute kidney injury. On day two of her hospitalization, she developed expressive aphasia, and an MRI was performed, which showed a corona radiata stroke. A transesophageal echocardiogram was pursued to assess for an embolic cause of her stroke. The echocardiogram showed a ruptured root abscess with an aortopulmonary fistula. After a risk and benefits discussion, the patient elected to pursue medical management. She was considered a high-risk surgical candidate in light of her recent stroke and worsened renal function. Moreover, her quality-of-life goals did not align with a prolonged or aggressive treatment approach. Optimal management strategies for patients with prosthetic valve infective endocarditis complicated by multiple comorbidities have not been elucidated. Treatment options require a careful balance of risks and benefits. Clinicians must astutely tailor recommendations to each patient based on their comorbidities.

Background: The objective of this study was to evaluate obstetrician/gynecologist (OB/GYN) protocols regarding single-visit intrauterine device (IUD) insertion in Rhode Island.

Study design and methods: We conducted an online cross-sectional study of OB/GYNs in Rhode Island regarding IUD insertion protocols. The primary outcome was the proportion of respondents who provided single-visit IUDs.

Results: The response rate was 70% (80/114). Forty- two percent (42%) (95% CI, 30.3-55.2) of OB/GYNs reported they would provide an IUD with one clinical visit for counseling and insertion. However, only 22% (95% CI, 12.5-34.0%) reported that patients in their practice typically have a single visit for IUD placement. More OB/GYNs would add an IUD to an annual visit if they were presented with a Black patient vignette compared to a White patient vignette (58% vs 24%, p = 0.01). Barriers to single-visit IUD insertion included scheduling constraints and insurance and billing concerns.

Conclusion: In Rhode Island, access to OB/GYNs willing to provide IUDs in a single visit as part of usual practice is low.

Background: Novel therapies have increased life expectancy for people with cystic fibrosis (pwCF), shifting care to adult providers with limited CF experience. Hospitalizations expose trainees to CF care, but educational tools for managing CF exacerbations are scarce.

Methods: A six-year longitudinal study assessed internal medicine resident physician trainees' (RPTs) experience managing hospitalized pwCF. A mixed-method survey of RPTs informed the creation of educational and workflow tools, including a video didactic and order set. A targeted knowledge assessment measured the effectiveness of these tools. Multidisciplinary team meetings also tracked challenges and outcomes.

Results: Among 48 RPTs surveyed, 83% cared for pwCF during training. Most reported less comfort managing pwCF compared to diseases like chronic obstructive pulmonary disease (COPD). Immediately after implementing targeted educational tools, knowledge scores improved, particularly in CF-related diabetes management (38.4% correct pre vs 61.5% correct post, p=0.04).

Conclusion: Rare disease education requires focused assessments of learners' needs, sustained reinforcement, and adaptable tools to maintain effectiveness.

Physicians and advanced practice providers often lack structured opportunities to develop personal and professional skills, critical for reducing burnout and enhancing job satisfaction. To address this, Brown Medicine's Division of General Internal Medicine introduced the Personal Development Empowerment Series, a cost- effective faculty development initiative integrated into the existing schedule. The series includes sessions that focus on topics like imposter syndrome, assertiveness, and time management, blending education with interactive activities to promote practical application. Facilitated by psychologists and motivated peers, the lectures have been well received, with faculty appreciating its emphasis on reflection and cognitive-behavioral strategies. This replicable initiative fosters a supportive work culture, boosts morale, and highlights the importance of personal growth. This program demonstrates that affordable, home-grown interventions can significantly impact well-being and organizational culture.

Introduction: In physicians, burnout is highest during training, with 60.3% of residents reporting at least one symptom of burnout. The Accreditation Council for Graduate Medical Education Common Program Requirements establishes standards to promote well-being. We developed a professional development curriculum to target this requirement.

Methods: 60-minute post-graduate year (PGY)-specific professional development workshops were offered to internal medicine-pediatrics (Med-Peds) PGY-1-PGY-4 residents at a large academic institution. We applied descriptive statistics for quantitative data using Likert-scale questions.

Results: Eight Med-Peds professional development (PROuD) sessions occurred from July 2023-June 2024, with 44 residents participating in 1-2 sessions comprising 5-10 residents per session. The survey response rate was 53% (n=62), and 45% reported feeling 'less stressed' or 'no stress at all' after attending. 93% of participants viewed the workshop favorably and 96% expressed interest in future sessions.

Discussion: This pilot study demonstrated that residents experienced decreased stress and increased interest in future sessions after attending targeted PGY professional development workshops.

Physician burnout is a pressing issue in healthcare that demands effective wellness interventions. Enhancing wellness resources is challenging and this article highlights key insights for successful initiatives. It emphasizes the importance of evidence-based and user-centered design, which involves engaging physicians in the development and implementation of wellness programs. For example, mindfulness training programs designed with clinician input were tailored to fit their busy schedules and addressed their specific needs, resulting in significant reductions in cynicism and emotional exhaustion among participants. Additionally, the article advocates for a dual approach that targets both organizational and individual factors to effectively combat burnout. By fostering a culture of self-care and resilience in both education and the workplace, healthcare systems can improve well-being and engagement among current and future employees. Ultimately, collaborative and sustained efforts to implement validated interventions are essential for achieving lasting improvements in healthcare environments.

Narrative Medicine is an international discipline at the intersection of humanities, the arts, clinical practice and healthcare justice. This discipline aims to deepen skills of self-awareness, presence, attention and creative capacities and evokes our capacity to attend to the emotional undercurrents of narrative stories both in spoken and written form. Through group discussion and human connection of sharing stories/writing and creative exchange, we expand justice, equity, attention to self and others, and how we interact with our complex healthcare system. A one-hour narrative medicine workshop has been developed with the goal and intention for other medical educators, faculty, and leaders in the field of well-being to be able to reference this step-by-step curriculum and replicate it in their home programs in order to mitigate burnout and promote well-being, connection and community.