Lipid treatment guidelines have continued to evolve as new evidence emerges. We sought to review similarities and differences of 5 lipid treatment guidelines from the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, European Society for Cardiology/European Atherosclerosis Society, U.S. Preventive Services Task Force, and U.S. Veterans Affairs/Department of Defense. All guidelines utilize rigorous evidentiary review, highlight statin therapy for primary and secondary prevention of atherosclerotic cardiovascular disease, and emphasize a clinician-patient risk discussion. However, there are differences in statin intensities, use of risk estimators, treatment of specific patient subgroups, and consideration of safety concerns. Clinicians should understand these similarities and differences in current and future guideline recommendations when considering if and how to treat their patients with statin therapy.
Background
Medical procedures are traditionally taught informally at patients' bedside through observation and practice using the adage “see one, do one, teach one.” This lack of formalized training can cause trainees to be unprepared to perform procedures independently. Simulation based education (SBE) increases competence, reduces complications, and decreases costs. We developed, implemented, and evaluated the efficacy of a right heart catheterization (RHC) SBE curriculum.
Methods
The RHC curriculum consisted of a pretest, video didactics, deliberate practice, and a posttest. Pre‐and posttest skills examinations consisted of a dichotomous 43‐item checklist on RHC skills and a 14‐item hemodynamic waveform quiz. We enrolled two groups of fellows: 6 first‐year, novice cardiology fellows at Northwestern University in their first month of training, and 11 second‐ and third‐year fellows who had completed traditional required, level I training in RHC. We trained the first‐year fellows at the beginning of the 2018–2019 year using the SBE curriculum and compared them to the traditionally‐trained cardiology fellows who did not complete SBE.
Results
The SBE‐trained fellows significantly improved RHC skills, hemodynamic knowledge, and confidence from pre‐ to posttesting. SBE‐trained fellows performed similarly to traditionally‐trained fellows on simulated RHC skills checklists (88.4% correct vs. 89.2%, p = .84), hemodynamic quizzes (94.0% correct vs. 86.4%, p = .12), and confidence (79.4 vs. 85.9 out of 100, p = .15) despite less clinical experience.
Conclusions
A SBE curriculum for RHC allowed novice cardiology fellows to achieve level I skills and knowledge at the beginning of fellowship and can train cardiology fellows before patient contact.
We report a case of coronary perforation during high-risk percutaneous coronary intervention with Impella (Abiomed, Danvers, Massachusetts) support that resulted in cessation of pulsatile arterial flow. Maintenance of systemic perfusion due to antecedent placement of Impella 2.5 allowed for successful treatment with pericardiocentesis and covered stent placement, early discharge, and complication-free follow-up. (
Level of Difficulty: Intermediate.
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