Outcomes of a Near-Peer Intern Orientation Boot Camp.

BACKGROUND: Interns experience challenges in their transition from medical school to residency. Orientation is traditionally delivered by faculty and administrators and often does not address practical skills needed by interns during the transition. OBJECTIVES: The objective is to address traditional orientation gaps and improve incoming interns' transition experience.  Methods: We identified opportunities with our intern orientation using a quality improvement methodology. Plan Do Study Act (PDSA) cycle 1 consisted of a pilot boot camp. PDSA cycle 2 was conducted over two weeks, June 9-23, 2021, at the Detroit Medical Center, Detroit, MI. Participation was voluntary. Residents were assigned incoming interns on a 1:1 basis. Five virtual sessions were conducted addressing: daily workflow, documentation, presentation skills, and utilization of the Electronic Health Record (EHR). All participants received pre- and post-program surveys.  Results: Twenty-two rising second- and third-year residents (26%) and 22 incoming interns (58%) participated. There was a significant improvement in the understanding of daily workflow (mean improvement 0.957, p=0.003), and most tasks associated with EHR including comfort with the sign-out process (mean improvement 1.21; p=0.002), accessing specific team lists (mean improvement 1.75, p=0.001), writing orders (mean improvement 1.41; p=0.002), composing documentation (mean improvement 1.23; p=0.001). Writing notes improved significantly (mean improved by 0.52; p=0.04). Nearly all (93.2%) stated the program achieved its overall goals and believed (92.9%) the program should be continued for incoming intern classes. CONCLUSION: A targeted orientation bootcamp led by near-peers positively impacted the intern experience improving understanding of day-to-day responsibilities and comfort utilizing the electronic health record.

Need for inpatient rehabilitation and skilled nursing services in COVID-19 patients post hospitalization: a retrospective cohort study.

BACKGROUND: The need for rehabilitation and skilled nursing services for coronavirus disease 2019 (COVID-19) survivors has been speculated from the beginning of the pandemic. However, real-world data describing utilization of these services post COVID-19 hospitalization and the factors associated with the same is limited. This retrospective cohort study on COVID-19 patients aims to identify the patients discharged to inpatient rehabilitation or nursing facilities post-hospitalization and the factors associated with the same. METHODS: A retrospective cohort study on COVID-19 patients during second wave of the pandemic in the state of Michigan. Primary outcome was discharge disposition. Binary logistic regression was conducted to identify the factors associated with discharge to a facility. RESULTS: A total of 559 COVID-19 patients [median age 64 years, interquartile range (IQR) 53-73 years, 48.5% males (n=271), 67.6% Blacks (n=378)] were included in the study. During hospitalization, 17.4% of the patients (n=97) died. Around 65% (n=365) patients were discharged home whereas 12.5% (n=70) were discharged to a facility for inpatient rehabilitation/nursing services. Older patients, males, those with longer hospital stay, and patients who needed new percutaneous endoscopic gastrostomy (PEG) tube, tracheostomy, initiation of hemodialysis or continuous renal replacement therapy (CRRT), or had an acute stroke during admission were more likely to be discharged to a facility post-hospitalization. CONCLUSIONS: About 12.5% of hospitalized COVID-19 patients needed discharge to a facility for inpatient rehabilitation/nursing services. Knowledge of the factors associated with discharge to a facility can optimize discharge planning, efficient resource allocation, and improve long-term COVID-19 care.

Severe Sinus Bradycardia: An Unusual Cardiac Manifestation of COVID-19.

There has been an accumulating evidence of association between COVID-19 (coronavirus disease 2019) infection and cardiovascular complications. We describe a case of a 58-year-old lady with a history of systolic heart failure and COVID-19 infection, who developed persistent symptomatic bradycardia, requiring pacemaker placement as unusual conductive tissue involvement of this novel coronavirus.

Changes in Nup62 content affect contact-induced differentiation of cultured myoblasts.

Differentiation of cultured skeletal myoblasts is induced by extrinsic signals that include reduction in ambient mitogen concentration and increased cell density. Using an established murine myoblast cell line (C2C12), we have found that experimental reduction of the nucleoporin p62 (Nup62) content of myoblasts enhances differentiation in high-mitogen medium, while forced expression of Nup62 inhibits density-induced differentiation. In contrast, differentiation of myoblasts induced by low-mitogen medium was unaffected by ectopic Nup62 expression. Further analyses suggested that Nup62 content affects density-induced myoblast differentiation through a mechanism involving activation of p38 MAP kinase. Nuclear pore complex (NPC) composition, in particular changes in NUP62 content, may be altered during viral infection, differentiation, and in neoplastic growth. The results support a functional role for changes in Nup62 composition in NPCs and density-induced myogenic differentiation, and suggest a link between loss of Nup62 content and induction of an intracellular stress signaling pathways.

Gastric Parastomal Hernia: A Case Report of a Rare yet Fascinating Clinical Entity.

A 58-year-old female with the prior history of diabetes mellitus (DM) presented with nausea, malaise, and abdominal pain of two days duration. Also, in the past, she was treated for a necrotized rectum from a retroperitoneal infection leading to a colostomy in the left lower quadrant (LLQ) of the abdomen. The physical examination findings were highly suggestive for a parastomal hernia. As a part of her workup and treatment, the initial abdominal CT demonstrated the presence of the gastric contents into the hernia sac leading to the gastric obstruction. The patient responded well to the conservative management using nasogastric (NG) suction, intravenous (IV) line maintenance, clinical assessment, frequent vital sign monitoring, and initiating the nothing per oral (NPO) regimen. Following the successful conservative approach, the patient opted to undergo surgical treatment in the future. This case report and associated literature search represent a rare case of a parastomal hernia with protruding gastric contents, which was successfully treated with conservative management.

A method of evaluating helmet rotational acceleration protection using the Kingston Impact Simulator (KIS Unit).

OBJECTIVE: Helmet use is the primary form of head protection against traumatic brain injury. Although helmet designs have proven to be effective in reducing the incidence of skull fracture and major traumatic brain injury, there is little evidence that helmets protect against concussion. Linear and rotational accelerations are important mechanisms underlying concussion, yet current testing protocols do not account for rotational acceleration. Technical considerations have prevented a valid, accurate, and reproducible testing paradigm. Our objectives were to design a novel helmet-testing methodology that accurately and reliably measures rotational acceleration at injury-relevant impact forces, locations, and planes and to evaluate differences in rotational force protection in commercially available helmets. SETTING: Laboratory study. INTERVENTION: The Kingston Impact Simulator (KIS unit) was used to study 10 commercially available hockey helmets. The rotational acceleration force protection was measured in the horizontal, coronal, and sagittal planes at each of 12 predetermined impact locations. RESULTS: Mean peak unhelmeted and helmeted accelerations at all impact locations and planes ranged from 63 to 28.6 g and from 26.8 to 8.0 g, respectively. The percent reduction in rotational acceleration for all test helmets ranged from 6.4% to 84%. Statistically significant differences in rotational acceleration between manufacturers and within a helmet brand were identified. CONCLUSIONS: KIS is a novel testing methodology that identifies rotation force protection within and between hockey helmet models and manufacturers at different impact location and planes. This information may be useful in improving future helmet design and construction to provide maximal protection against the forces causing concussion.

Performance of Eye Protectors for Squash and Racquetball.

In brief Although squash and racquetball eye protectors are available and many people wear them, eye injuries still exist. The authors studied the ability of the 13 eye protectors currently available in Canada to protect the players' eyes. The eye guards were mounted on a headform, and balls were thrown at it at speeds from 50 to 100 mph. This was recorded on high-speed film that was analyzed to determine ball speed, lens or frame deformation, and damage during impact. Eye contact with protectors having lenses was confirmed only once in 54 impacts. All 17 hits to the open eye guards produced ball-eye contact. The authors suggest that standards for eye protectors should be established.

The Ice Hockey Helmet: How Effective Is It?

Thicker liners, fewer openings, and more protection over the temporal area in newer models of ice hockey helmets have made them more effective in reducing the potential for serious head injury.