Early warning scores (EWS) were introduced in early 2001 to identify patients at risk of deterioration in a busy clinical environment as a track-and-trigger system where an increasing score produced an escalated response. 1 EWS have demonstrated better capability in identifying deteriorating patients leading to improved clinical outcomes. 2 Furthermore, an EWS at admission can be used to determine in-hospital mortality and intensive care unit (ICU) transfer. 2-4 Our academic medical center developed a modified early warning score (MEWS) system in 2015 and it was rolled out hospital-wide the following year. Since serious adverse events in hospitalized patients are often preceded by signs of clinical deterioration, we believed MEWS scores could be used to predict events, such as cardiopulmonary arrest. As the coronavirus pandemic continues, could MEWS provide any usefulness in predicting ICU level care among hospitalized COVID-19 patients? A retrospective study was conducted at the University of Toledo Medical Center (Toledo, OH) on COVID-19 positive patients hospitalized from late March to the end of May 2020. All patients were confirmed for COVID-19 by real-time reverse transcription polymerase chain reaction. Patient demographics, biometrics, and comorbidities were gathered from the electronic medical record. The highest level of hospital disposition was used to create the medical floor and ICU groups. The MEWS scores, which are calculated hourly using the criteria in Fig. 1 , were retrieved from an electronic database. Initial MEWS scores were considered either at admission or prior to ICU transfer. Sequential organ failure assessment (SOFA)
Background Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective The objective of our study was to assess the improvement in internal medicine residents’ CRC screening knowledge via a pilot approach using a smartphone app. Methods We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents’ knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement ( P <.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents’ knowledge about CRC screening.
Background International medical graduates (IMGs) form a significant portion of the physician workforce in the United States and are vital in filling training slots due to a shortage of American medical graduates. Most often, IMGs require visa sponsorship, which must be solidified before applying for a residency or fellowship. Objective We examined the association of H-1B visa sponsorship on retention of physician trainees within the state of Ohio. Methods This was a single institutional study that examined all visa-sponsored residency and fellowship graduates who entered fully licensed clinical practice between 2006 and 2015. Practice location was ascertained immediately upon completion of training and at follow-up to determine which visa group (H-1B or J-1) were more likely to initially practice in Ohio after graduation and remain within the state. Results Of 103 visa-sponsored residency and fellowship graduates, 42 were H-1B sponsored and 61 were J-1-sponsored. Fifty-two percent (22) of H-1B visa-sponsored trainees and 31% (19) of J-1 visa-sponsored trainees were retained in Ohio after graduation. At follow-up, 40% (17) of H-1B and 26% (16) of J-1 visa holders remained in the state. Conclusions H-1B visa–sponsored trainees were more likely than those with J-1 visas to practice in the state of Ohio after graduation. Regardless of visa status, graduates tended not to change their geographical location over time.
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