Abstract As diagnostic algorithms for cystic fibrosis (CF) continue to evolve, education of general practitioners is essential to prevent delayed diagnosis of CF and allow prompt referral to CF centers. For patients suffering from allergic bronchopulmonary aspergillosis (ABPA), CF should be at the top of the differential diagnosis.
Few discussions regarding instructional methods incite as much passion as the debate over dissection versus prosection. Despite numerous analyses, few studies have isolated the impact of dissection versus prosection from the numerous variables that are involved in anatomy education. This study used a retrospective design to assess the effect of peer teaching with dissection or prosection on anatomical knowledge retention of the peer teachers. Exam scores were analyzed from three cohorts of students (N = 184) who were enrolled in a Musculoskeletal System course in an allopathic medical school between academic years 2014-2017. Students in the first 2 yr learned anatomy of an assigned region through traditional dissection, whereas students in the third year learned anatomy of the same regions on prosected specimens. The effect of these instructional methods on anatomical knowledge retention was measured by student performance on a teaching-readiness quiz, written exam, and practical examination. One advantage of this study is the stability of variables between cohorts. Student groups peer taught the same objectives; course sequencing and content remained consistent between years; students spent the same amount of time learning their material, regardless of learning modality (dissection or prosection); and students were tested in the same manner. Comparisons of student performance data suggest that anatomy knowledge was equivalent, regardless of the instructional method (dissection or prosected cadavers) but is strongly associated with prior anatomy experience. Findings from this study support previous studies that conclude that there are no disparities in the effectiveness of learning anatomy via dissection or prosection.
Few topics invoke as much passion in anatomy education as the role of dissection in laboratory instruction. In 2004, The Anatomical Record (Part B: New Anatomist) published their oft‐cited debate forum on the necessity of dissection. Subsequent studies comparing dissection to other methods have noted extensive variability between educational programs and student populations making comparisons problematic. In 2017, WMed underwent a rapid transition from dissection to prosection‐based musculoskeletal instruction. This change provided a unique opportunity to compare the impact of each instructional method on anatomical knowledge retention as measured by summative and practical examination. At WMed, students completed a reciprocal peer‐teaching (RPT) module during the musculoskeletal system course between 2015 and 2017. The RPT module assigned a regional content area (back, shoulder/arm, forearm/hand, hip/thigh, and leg/foot) to anatomy teams of 5–6 students. Students learned regional content and then assisted their peers in learning this content. The first two classes (n=112) learned content via traditional dissection, while the third class (n= 72) learned their regional content on prosected specimens. Students had five sessions (13 hours) prior to the start of the course to learn the content and for the dissection cohorts to prepare their specimen. All cohorts completed a pre‐course quiz to ensure readiness to peer‐teach. Anatomy content, instructional time, and class metrics remained relatively constant between cohorts, with the exception of a single optional procedure component offered in 2017. Due to annual differences in exams and performance of students, scores for region specific exam questions were normalized to scores on the overall exam. Data was analyzed using an independent T‐test. Students in the prosection and dissection cohorts passed their region‐specific quiz at equal rates (p = 0.11). Student knowledge on practical or summative exam content related to regions they taught was not significantly different between prosection and dissection cohorts (p = 0.62 and p = 0.38, respectively). To further examine if there were differences between dissection and prosection cohorts, we examined student knowledge acquisition in each of the five regions individually. There were no statistically significant differences in knowledge on either the practical or summative exam questions relating to a specific region when compared to performance on the overall exam. This data suggests that student acquisition of knowledge was comparable regardless of learning method, prosection or dissection. An advantage of this study is the stability of variables between cohorts. Student groups taught the same objectives, course sequencing and content remained consistent between years, and students were tested in the same manner (written exam with multiple choice questions and laboratory practical). This analysis supports previous studies that conclude there are no disparities in the effectiveness of dissection or prosection. The greatest advantage of this study is the direct comparison of the effectiveness of prosection or dissection in anatomical knowledge retention while minimizing the confounding variables that complicate other studies. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Introduction: Although a rare chronic condition with increasing recognition, evidence suggests that eosinophilic esophagitis (EoE) contributes significantly to healthcare cost for commercially insured individuals in the United States. However, there is limited information on the direct cost of inpatient care for patients with EoE. This study describes the epidemiology and costs of inpatient care for the US population with EoE. Methods: This is a cross-sectional case-control design utilizing the National Inpatient Sample (NIS) database between 2010 and 2013 from the Healthcare Cost and Utilization Project (HCUP). EoE cases were identified using ICD-9 discharge code 530.13. Three inpatient controls were randomly selected for each case of EoE, matched based on gender, age, and race. Control subjects with chronic conditions (e.g. chronic bronchitis, chronic renal disease, asthma) were further selected for analysis. We assessed length of stay (LOS), total charges, sources of payment, and cost of procedures including esophagogastroduodenoscopy (EGD), allergy testing and esophageal dilation. Results: There were 16,518 admissions associated with EoE over the four-year period, with increasing admission rates over time. Most of the patients were below 19 years of age (41%) and were Caucasian (80%). The median length of stay (LOS) and total cost of EoE inpatient care was approximately 2 days (interquartile range (IQR), 1-4) and $20,350 (IQR, $11,355 - $37, 207) respectively per patient, compared to controls with median LOS of 3 days (IQR, 1-5) and total cost of $20,441 ($10,572-$41,417). EGD with closed biopsy in EoE patients accounted for about 91% of the procedures during admission with average and median cost of $37,834 (+/-$1699) and $24,639 (IQR, $15,441 - $41,286) respectively. The sources of payment among EoE patients were mostly private insurance (56%) and Medicaid (20%). The peak admission periods were between March to May and August to October. Conclusion: Increasingly, EoE is being shown to constitute a significant health burden, necessitating prompt attention. The severity of this disorder may demand inpatient admission and close monitoring. This study describes the characteristics and cost of inpatient care including LOS, cost of procedure and total hospital charge. Our study suggests there is a significant increase in inpatient cost per day for individuals with EoE compared to controls. Development of non-invasive procedures for monitoring EoE disease progression will be critical to reduce the inpatient cost of care in this population.
Cancer is not infrequently detected in the Emergency Department (ED) and is sometimes even an incidental finding on imaging. Since the ED is designed to identify and treat acutely ill patients, the time providers can spend with patients and the depth of investigation into patient conditions is limited. However, Emergency Medicine physicians must ensure the appropriate follow-up for patients with presumptive diagnosis of cancer to ensure timely confirmatory testing, prompt treatment, and accurate prognosis. A 26-year-old woman presented to the ED for evaluation of abdominal pain and urinary complaints and was ultimately found to have a 36cm ovarian mass that was suspicious for neoplasm. The mass caused obstruction of urinary outflow leading the patient to develop a urinary tract infection. Emergency Medicine physicians are faced with the challenge of having limited time and short-lived doctor-patient relationships. In cases of suspicious findings, balancing the urgency of follow-up without causing undue harm from heightened anxiety for patients is essential. It is important to discuss findings that may be concerning for cancer with both clear verbal and written communication. Employ strategies such as direct communication with primary care physicians and outpatient specialists via phone consultation and electronic medical record messaging, as well as providing clear discharge instructions in-person and in-writing to the patient including whom to call and the time frame for follow-up.
In the past two decades, virtual reality (VR) technology has found use in a variety of clinical settings including pain management, physical medicine and rehabilitation, psychiatry, and neurology. However, little is known about the utility of VR in the palliative care setting. Moreover, previous investigations have not explored user perceptions of the VR experience in this population. Understanding user perceptions of the VR intervention will be critical for the development and delivery of effective VR therapies. To examine the utility of VR for palliative care patients, a pilot study of VR use was conducted with 12 adult patients diagnosed with life-limiting illness who were residents at a free-standing hospice facility. The intervention consisted of a one-time 30-minute VR experience. User perceptions were assessed through both quantitative and qualitative means, including participant responses to open-ended questions after the VR intervention. Acute changes in symptom burden were assessed using the revised Edmonton Symptom Assessment Scale. Participants found the VR experience to be both enjoyable and useful, and the intervention was well-tolerated overall. This study provides support for VR as a promising new therapeutic modality for patients undergoing palliative care.
