Objectives: Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm. Design: Prospective, randomized-control study. Setting: A tertiary care university children’s hospital simulation room, featuring a high-fidelity pediatric patient simulator. Subjects: Forty-six upper-level pediatric residents. Interventions: Simulation training using rapid cycle deliberate practice or reflective debriefing. Measurements and Main Results: Knowledge was assessed with a quiz on core sepsis management topics. The application of knowledge was assessed with a sepsis management checklist during the simulated scenario. The residents were assessed before and after the intervention and again at a follow-up session, 3–4 months later, to evaluate retention. Both groups had similar pre-intervention scores. Post-intervention, the rapid cycle deliberate practice group had higher checklist scores (rapid cycle deliberate practice 18 points [interquartile range, 18–19] vs reflective debriefing 17 points [interquartile range, 15–18]; p < 0.001). Both groups had improved quiz scores. At follow-up, both groups continued to have higher scores compared with the pre-intervention evaluation, with the rapid cycle deliberate practice group having a greater change in checklist score from pre-intervention to follow-up (rapid cycle deliberate practice 5 points [interquartile range, 3.5–7] vs reflective debriefing 3 points [interquartile range, 1.5–4.5]; p = 0.019). Both groups reported improved confidence in diagnosing and managing septic shock. Conclusions: Both rapid cycle deliberate practice and reflective debriefing are effective in training pediatric residents to apply the sepsis algorithm and in improving their confidence in the management of septic shock. The rapid cycle deliberate practice method was superior immediately post-training; however, it is unclear if this advantage is maintained over time. Both methods should be considered for training residents.

DES implantation at first catheter intervention appears to be associated with improved vein survival but may not result in improved patient survival. However, reintervention appears to be associated with improved patient survival and vein patency, suggesting that despite mode of treatment, frequent surveillance is important in the care of these patients.

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The objective of this study was to characterize organ damage in lupus patients enrolled in the Dallas Regional Autoimmune Disease Registry (DRADR). Retrospective chart review was carried out on 99 patients with 4 or more diagnostic criteria for systemic lupus erythematosus (SLE) and 15 with less than 4 of these criteria, who were designated as having incomplete lupus (ILE). The majority of patients (84%) were African American or Hispanic/Latino; mean disease duration was 9.5 years. The mean damage score was 1.57 (range 0 to 8) and a damage score greater than 0 was present in 64% of the patients. The ILE group had lower mean damage scores (0.67) than the SLE group (1.67; P=0.04), explained in part by the shorter disease duration in the ILE patients (4.33 years vs. 10.24 years; P=0.003). The most prevalent damage category was renal, present in 24% of patients. Malignancies occurred in individuals who were significantly older than those who had renal or peripheral vascular damage (P=0.0007). The findings confirm clinical impressions that the DRADR includes a high-risk lupus population. The ILE patients have less damage but also shorter disease duration, suggesting that this might represent an earlier disease stage. These results are consistent with the hypothesis that ILE patients include a subset that is likely to experience progressive organ damage. Longitudinal study of these patients has significant likelihood of tracking the changes that are correlated with disease progression to SLE.

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