Objectives
The purpose of this study was to determine the prevalence and scope of point‐of‐care ultrasound (US) education in internal medicine, pediatric, and medicine‐pediatric residency programs nationwide.
Methods
Program directors were surveyed between January and June 2016 with a 15‐item online questionnaire to assess the state of point‐of‐care US training in their programs. The survey aimed to identify whether programs had an established point‐of‐care US curriculum and, if not, what reasons may have existed for a lack of point‐of‐care US training in their programs.
Results
The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point‐of‐care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point‐of‐care US training as reported by internal medicine (n = 64) and medicine‐pediatric (n = 24) respondents showed formal point‐of‐care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point‐of‐care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point‐of‐care US training at all. The most common reasons for lack of a point‐of‐care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%).
Conclusions
Less than half of residents with internal medicine training will have trained at a program with a point‐of‐care US curriculum, and point‐of‐care US training in pediatrics is even more limited. The major reason for the lack of point‐of‐care US education is a lack of trained faculty or instructors.
PurposeThe purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known.MethodsWe conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers.ResultsOur search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS.ConclusionOur results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.
Purtscher-like retinopathy is an occlusive microvasculopathy that causes sudden onset vision loss of varying severity. The condition is a rare complication of acute pancreatitis and is scarcely documented in the literature. In addition, it is vision-threatening, and there are no evidence-based therapies available. We report a 37-year-old woman presenting with abdominal pain and nausea in the setting of heavy alcohol use. She was diagnosed with acute pancreatitis. During hospitalization, she developed acute visual disturbance and was found to have significantly diminished visual acuity. A dilated funduscopic examination demonstrated multiple retinal cotton wool spots bilaterally and macular edema. The patient was diagnosed with Purtscher-like retinopathy in the setting of acute pancreatitis. Although the prognosis for her vision was guarded, given the ischemic nature of the insult, she had subjective improvement in visual acuity during the remainder of the hospital course with symptomatic management.
ProblemMedical students experience high levels of burnout and face barriers to accessing support services. However, few studies have considered the feasibility and/or effectiveness of one-on-one peer support programs for medical students.
Metastatic gut lesions from primary gastric carcinoma occur via hematogenous, lymphatic, or peritoneal seeding. We report an unusual case of large bowel obstruction secondary to rectal stenosis due to metastatic signet ring cell gastric cancer. A 61-year-old woman with a history of 8 weeks' duration of alternation in bowel movements presented with symptoms of bowel obstruction. Computed tomography revealed rectal wall thickening, and sigmoidoscopy demonstrated edematous and fibrotic rectal mucosa. Superficial biopsies were negative for malignant disease. Because of worsening of obstructive symptoms, an emergent surgical diversion was performed. Surgical biopsies were consistent with poorly differentiated adenocarcinoma. Gastroscopy established diagnosis of gastric adenocarcinoma with signet ring type cells. Rectal stenosis on examination and demonstration of rectal wall thickening on imaging should raise suspicion for Schnitzler's metastasis, and an upper endoscopy should be performed.
The varicella zoster virus is highly infectious, spreading via direct contact or respiratory droplets, and can lead to life-threatening complications. Although disseminated disease tends to occur most commonly in immunocompromised patients, we present a peculiar case of varicella zoster esophagitis in a healthy, immunocompetent adult. To provide prompt treatment, clinicians should be aware that the varicella zoster virus could cause severe esophagitis, even in immunocompetent patients.
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