Integration of Point-of-Care Ultrasound Education Into the Internal Medicine Core Clerkship Experience.

Point-of-care ultrasound (POCUS) is becoming an essential skill for internists. To date, there are no professional guidelines for how POCUS skills should be taught to medical students. A panel of POCUS experts from seven academic medical centers in the United States was convened to describe the components of independently developed IM clerkship POCUS training programs, identify areas of similarity and difference, and propose recommendations for alignment.

Lung Ultrasound: The Essentials.

Although US of the lungs is increasingly used clinically, diagnostic radiologists are not routinely trained in its use and interpretation. Lung US is a highly sensitive and specific modality that aids in the evaluation of the lungs for many different abnormalities, including pneumonia, pleural effusion, pulmonary edema, and pneumothorax. This review provides an overview of lung US to equip the diagnostic radiologist with knowledge needed to interpret this increasingly used modality. Supplemental material is available for this article. © RSNA, 2021.

The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures.

BACKGROUND: Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician-led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. OBJECTIVE: We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. METHODS: We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. RESULTS: Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. CONCLUSIONS: The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

Role of protein flexibility in the design of Bcl-X(L) targeting agents: insight from molecular dynamics.

Detailed understanding of protein-ligand interactions is crucial to the design of more effective drugs. This is particularly true when targets are protein interfaces which have flexible, shallow binding sites that exhibit substantial structural rearrangement upon ligand binding. In this study, we use molecular dynamics simulations and free energy calculations to explore the role of ligand-induced conformational changes in modulating the activity of three generations of Bcl-X(L) inhibitors. We show that the improvement in the binding affinity of each successive ligand design is directly related to a unique and measurable reduction in local flexibility of specific regions of the binding groove, accompanied by the corresponding changes in the secondary structure of the protein. Dynamic analysis of ligand-protein interactions reveals that the latter evolve with each new design consistent with the observed increase in protein stability, and correlate well with the measured binding affinities. Moreover, our free energy calculations predict binding affinities which are in qualitative agreement with experiment, and indicate that hydrogen bonding to Asn100 could play a prominent role in stabilizing the bound conformations of latter generation ligands, which has not been recognized previously. Overall our results suggest that molecular dynamics simulations provide important information on the dynamics of ligand-protein interactions that can be useful in guiding the design of small-molecule inhibitors of protein interfaces.

Private wealth and public health: a critique of Richard Epstein's defense of the "old" public health.

This article is a response to Richard Epstein's recent legal and economic critiques of contemporary public health law. The power of Epstein's critical position stems from the convergence of three problems, each with distinctive intellectual histories: (1) an age-old debate within political liberalism about the proper relationship of individual right and state power; (2) a somewhat more recent biomedical policy contest over the necessary scale and scope of public health interventions in modern societies; and (3) an ongoing legal-jurisprudential argument about the overall trajectory and implications of American constitutional history. My critique of Epstein's position follows this same tripartite format, moving from an initial discussion of the history of liberalism to the history of public health and, finally, to a critique of Epstein's general legal history of state regulation in America.