Women in the peripartum period can develop headache with a variety of etiologies that require a multidisciplinary approach if unresponsive to treatment (Stella et al. 2007). Neuroimaging needs to be undertaken even occasionally in the absence of focal neurologic signs to rule out life-threatening causes of headache. We present the case of a 23-year-old woman who presented postpartum with severe frontal headache without other neurologic symptoms. Treatment was initiated for tension type, then subsequently postdural puncture headache (PDPH), and finally preeclampsia. When CT venogram was obtained ten days later, the diagnosis of cerebral venous thrombosis (CVT) was made. She was started on anticoagulation and achieved complete recovery.
Objective: To evaluate the American College of Surgeons (ACS) surgical risk calculator's reliability in predicting outcomes in hysterectomies.Methods: This is a prospective cohort study at a large community-based hospital.Twenty-one preoperative and postoperative criteria were abstracted from the electronic medical record and entered into the online ACS calculator to determine a risk score. Logistical regression was used to determine the association between risk score and actual outcome. The prediction capability was analyzed with c-statistic, Hosmer-Lemeshow, and Brier score.Results: A total of 634 hysterectomies were performed during the study period from January to April 2019. Patients were predominantly 55 years old, white (53%) and overweight (body mass index 30). Predicted perioperative adverse events were significantly higher than actual adverse events across all domains. In all, 54/634 (8.5%) patients experienced postoperative urinary tract infection. C-statistics for return to operating room, renal failure, and readmission were 0.607 (95% C Statistic index [CI] 0.370-0.845), 0.882 (95% CI 0.802-0.962), 0.637 (95% CI 0.524-0.750), respectively.
INTRODUCTION:
Tracking clinical experiences is important toward progression of entrustable professional activities required by medical schools. The purpose of this study was to determine the effectiveness of using an innovative real-time mobile device tracker for medical student clinical experiences compared with the traditional tracking using a passport log.
METHODS:
A prospective single cohort observational study was performed using third year medical students in obstetrics and gynecology rotations. Participants downloaded the obstetrics and gynecology (OBG) tracker and recorded their clinical experiences; procedures, number, and degree of involvement. Results were compared with data from the passport log. Outcomes included data comparison from both tracking methods and end of clerkship student surveys. Internal review board exemption was obtained. Paired t-tests were used for data analysis.
RESULTS:
Thirty-six students participated in the study over 6 months. The OBG tracker recorded 269 entries, the passport recorded 187. The OBG tracker recorded higher numbers of procedures compared to the passport (procedure type, 56 OBG tracker, 8 passport, p<0.001; degree of involvement, 30 OBG tracker, 0 passport, p<0.001). OBG tracker also tabulated student involvement in cases; 40.2% vaginal deliveries, 41.2% delivered placentas, 62.0% coached patients, 50.9% inserted catheters, 35.8% sutured, 33.3% pelvic exam, 23.3% breast exams. Student surveys rated OBG tracker more useful than the passport (OBG tracker 1.29, passport 4.06, p<0.001).
CONCLUSION:
The use of a mobile device tracker for clinical experiences allowed for more meaningful real-time data of learners than the traditional passport logs. Tracking detailed experiences and degree of involvement is important to entrustment decisions in medical education.
BACKGROUND:
Lower urinary tract injuries present serious challenges for the obstetrician gynecologist. Recently, innovative surgical techniques have been employed to improve visualization and dissection of pelvic anatomy. Despite these advances, lower urinary tract injury during hysterectomy is still our greatest peril. Intraoperative recognition and immediate surgical repair can greatly reduce post-operative morbidity and medical-legal ramifications.
METHODS:
Participants were junior residents (PGY-1 and PGY-2) in the OBGYN Residency Program at Inova Fairfax Medical Campus. The cystoscopy curriculum consisted of a 1 hour didactic session and a 3 hour simulation session. The didactic session examined characteristic properties of the bladder, including an overview of the procedure. The simulation session incorporated a skills workshop with repeated practice on low fidelity models. Pre- and post-assessments included a cognitive exam, a confidence survey, and validated checklists (OSATS). After 6 months, final acquisition of skill was tested in the operating room.
RESULTS:
PGY-1 and PGY-2 residents showed significant cognitive (P=.0008/.003) and confidence (P=.04) improvement, with no difference between groups. For checklist items, there was significant improvement within groups for Cystoscope Assembly (P=.007), Bladder Survey (P=.0002), Total Score (P<.0001), Global Rating (P<.0001), with no differences between groups.
DISCUSSION:
The simulation based curriculum was effective in training junior residents the basic skills of cystoscopy. This curriculum can be utilized as a teaching tool for residents to become confident and proficient in the aspects of diagnostic cystoscopy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.