Giant right coronary artery aneurysm - A rare presentation.

Coronary artery aneurysm (CAA) is focal dilatation of a coronary artery 1.5 times or more its normal size (Res Cardiovasc Med, 2016; 5: e32086). Coronary artery aneurysm is found in 1.2-4.9% of diagnostic coronary angiography and 1.4% at post-mortem (Heart Views, 2014; 15: 13; Clin Cardiol, 2015; 29: 439). The proximal and middle segments of the right coronary artery (RCA) are most commonly involved, followed by the proximal left anterior descending (LAD) and the left circumflex arteries. The left main stem rarely develops aneurysms (Clin Cardiol, 2015; 29: 439). A giant aneurysm is a CAA> 2 cm. Giant coronary artery aneurysms (GCAA) are rare (incidence 0.02%) although cause serious complications. [4] Given the rarity of this disease, there is limited information in the literature on its presentation and there is no consensus on its optimal management option. We report a case of a GCAA with an atypical presentation and describe its management. This will add to the current small database on CAA to provide clinicians a better insight on the disease.

The Effects of Lower Extremity Strengthening Delivered in the Workplace on Physical Function and Work-Related Outcomes Among Desk-Based Workers: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to assess the effectiveness of a workplace leg-strengthening program on self-reported function, physical capacity, and work-related outcomes among desk-based workers. METHODS: Forty-three desk-based workers were randomized to a 12-week exercise program or no exercise control. The primary outcome was change in self-reported physical function on the Lower Extremity Functional Scale (LEFS) from baseline to follow-up. Secondary outcomes were physical capacity (mobility, strength), self-reported outcomes (pain, depressive symptoms), and work-related outcomes (resilience, work ability). RESULTS: The exercise group showed greater improvements in LEFS and mobility. No significant between-group differences existed in knee strength or remaining self-reported and work-related outcomes. CONCLUSION: Workplace implemented leg-strengthening exercises are effective at improving self-reported and physical health outcomes of desk-based workers. Moving forward, occupational exercise interventions may be essential to enhance worker longevity among the aging, sedentary workforce.

Identifying areas for curricular program improvement based on perceptions of skills, competencies, and performance.

OBJECTIVE: Educational program evaluation and program improvement are processes that can be enhanced by involving multiple stakeholders and measurement tools. The purpose of this study was to compare faculty and resident physician perceptions of both teaching quality and resident competence for 13 core psychiatric skills and the six Accreditation Council for Graduate Medical Education general competencies. Additionally, resident performance as assessed by portfolios was descriptively examined relative to these perceptions of skills and competencies. Using this combination of data, the authors propose a useful approach for identifying areas for improvement within a medical residency's program curriculum. METHODS: Ten teaching faculty members (100%) and 18 residents (82%) within a psychiatry department completed parallel surveys. Trained raters scored resident-completed portfolio entries. Nonparametric and descriptive analyses were used to compare the various data sources. RESULTS: In general, faculty and residents showed congruence in their perceptions about resident performance. They agreed on the quality of teaching skills and general competencies. General competency scores from the portfolios were congruent with this perspective. However, there were mismatches in perceptions and performance on portfolios for some areas. Of the 13 core psychiatric skills examined, only one area, neuropsychiatry, was rated below average by both faculty and residents, while the median portfolio performance score was below competent for four skills, including neuropsychiatry. Faculty rated resident competence significantly higher than residents rated themselves for biopsychosocial formulation and medical psychiatry. CONCLUSION: This study describes and highlights the usefulness of a multidimensional approach that includes resident and faculty perspectives and externally rated performance measures to assist in identifying potential target areas for curriculum improvement.

Can one portfolio measure the six ACGME general competencies?

OBJECTIVE: To determine that portfolios, useable by any program, can provide needed evidence of resident performance within the ACGME general competencies. METHODS: Eighteen residents constructed portfolios with selected entries from thirteen psychiatric skills. Two raters assessed whether entries reflected resident performance within the general competencies. They indicated no (0), some (1), or definite evidence (2) for each competency. Median scores were reported by competency and psychiatric skill. RESULTS: Eighty entries were rated: 100% of the psychiatric skills reflected some evidence for medical knowledge; 92% provided some evidence for patient care, communication and interpersonal skills, and professionalism; 77% provided some evidence for systems-based practice, and 31% provided some evidence for practice-based learning. Ten of the 13 skills reflected evidence for at least five of the competencies. CONCLUSIONS: Any combination of five entries reflects all competencies with the exception of practice-based learning. This deficit can be corrected with revision of portfolio guidelines.