Use of Virtual Reality to Educate Undergraduate Medical Students on Cardiac Peripheral and Collateral Circulation.

Many medical schools are looking to utilize virtual reality (VR); however, due to its novelty, we know little about how VR can be effectively used in medical education. This study evaluates a case-centered VR task that supported students with learning peripheral and collateral circulation, anatomical features that are not easily observed in cadavers. Data sources included a quiz, survey, and focus group. Based on quantitative and qualitative analyses, we support the claim that this activity was an effective use of VR and identify features that made it effective, which can guide other educators who are interested in developing VR activities.

Improving rural disaster response preparedness.

BACKGROUND: Disasters happen in all communities and negatively impact the health and safety of populations if not well managed. Rural health organizations face greater challenges when implementing emergency preparedness policies and need unique resources to help ensure the health of their communities. The purpose of this article is to describe the development and evaluation of an agricultural simulation scenario designed for rural health organizations. METHODS: The agricultural disaster scenario was developed after determining the desired content domains. Forty students from nursing, medicine, public health, and social work participated in a functional simulation using the scenario. Outcomes were measured using a pre-post measurement with one cohort design. Data were analyzed using paired-samples t-tests. RESULTS: Students reported a 30% increase in self-confidence, 38% increase in disaster competence, and 19% increase in interprofessional collaboration competence after the simulation. Statistically significant increases in student scores were noted on all surveys across professions. CONCLUSION: The agricultural disaster simulation is a valid scenario to use for disaster preparation using emergency operations plans.

Longitudinal Continuity Learning Experiences and Primary Care Career Interest: Outcomes from an Innovative Medical School Curriculum.

BACKGROUND: Medical students in the USA have negative perceptions of primary care careers, which are exacerbated by the hidden curriculum and medical school culture. Longitudinal integrated clerkships (LICs) have shown promise in ameliorating this situation by promoting student/preceptor continuity relationships and helping students maintain empathy. AIM: The aim of this study is to describe the Student Continuity of Practice Experience (SCOPE) program and demonstrate program outcomes using evaluation data from residency match results, course evaluations, and student grades. SETTING: University of Texas Medical Branch, an academic health center in Galveston, Texas. PARTICIPANTS: Undergraduate medical students. PROGRAM DESCRIPTION: Learners participate in a longitudinal curriculum designed to enhance their skills as primary care physicians. They regularly attend continuity clinic, establishing a panel of patients by their third year. Students receive frequent feedback from a faculty mentor on assignments and clinical performance. PROGRAM EVALUATION: SCOPE students have high primary care residency match rates and experience patient continuity rates comparable to an intern. Their interest in primary care increases between years one and three, a departure from typical medical student trends. DISCUSSION: SCOPE appears to promote and maintain primary care career interest in participants and has transferability to other institutions.

Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation.

BACKGROUND: Spontaneous intestinal perforation of the extremely low birth weight infant (< or = 1000 g) is associated with a high incidence of Candida and coagulase-negative Staphylococcus sepsis. Little is known about prenatal risk factors, and histopathologic examination of placentas in infants with spontaneous intestinal perforation has not been reported. OBJECTIVES: Our objective was to investigate maternal factors and specific placental findings in a sample of infants with spontaneous intestinal perforation. We compared the maternal factors and clinical outcomes to a matched control group. PATIENTS AND METHODS: This single-center, retrospective cohort study was conducted between January 2001 and December 2005. The records of extremely low birth weight infants with spontaneous intestinal perforation were reviewed (n = 16). Study infants were matched to 2 infants in the control group; any twin of a study patient was also included as a control subject (n = 35). Histopathologic examination of placentas included standard hematoxylin and eosin and methenamine silver stains. RESULTS: Infants with spontaneous intestinal perforation were more likely than control subjects to have severe placental chorioamnionitis with fetal vascular response (40% vs 12%); 2 placentas also tested positive for yeast versus none in the control subjects. Mothers of infants with spontaneous intestinal perforation were more likely than control subjects to have received antibiotics before or at delivery (93% vs 57%). Fifty percent of the infants had Candida, and 31% in the spontaneous intestinal perforation group had coagulase-negative Staphylococcus sepsis versus 6% in the control subjects. Finally, infants with spontaneous intestinal perforation had delayed enteral feeding (64 +/- 30 vs 31 +/- 10 days) and prolonged hospitalization (155 +/- 48 vs 108 +/- 36 days). CONCLUSIONS: Spontaneous intestinal perforation in the extremely low birth weight infant is a neonatal disease related to placental inflammation. We alert practitioners to the importance of placental findings, because they may be positive for yeast.

Intestinal zygomycosis due to Absidia corymbifera mimicking necrotizing enterocolitis in a preterm neonate.

Zygomycosis is a rare fungal disease that occurs in compromised human hosts, including the preterm infant. The three clinical forms of zygomycosis are cellulitis, disseminated, and gastrointestinal, and the last often mimics necrotizing enterocolitis (NEC), complicating the diagnosis. This report details a case of primary gastrointestinal zygomycosis due to Absidia corymbifera, mimicking NEC, in a preterm infant, and emphasizes features that may lead to earlier diagnosis and treatment of future cases.

Gardnerella vaginalis-infected scalp hematoma associated with electronic fetal monitoring.

Infections in the neonate caused by the vaginal commensal Gardnerella vaginalis are rare and mostly consist of bacteremia. A 4130-g term neonate developed an infection of a scalp hematoma with G. vaginalis. The infection developed in association with electronic fetal monitoring. The only clinical sign was an increase in size of the hematoma.

Mucocutaneous candidiasis.

Mucocutaneous infection with Candida in neonates ranges from such common conditions as thrush and diaper dermatitis to serious diseases with potential for systemic involvement, including congenital candidiasis and invasive fungal dermatitis. In premature infants, seemingly benign mucocutaneous involvement may precede systemic infection and thus warrants thoughtful attention. Skin involvement also may be seen as an expression of systemic disease. The physical appearance of these lesions is often characteristic, allowing easy diagnosis. The patients at risk differ by gestational age and postnatal age at presentation. Systemic candidiasis and invasive fungal dermatitis typically occur in premature infants, particularly those with extremely low birth weight (< or = 1,000 g), whereas thrush and diaper dermatitis may occur in infants of any gestational age or birth weight. Congenital candidiasis presents at birth, while invasive fungal dermatitis typically occurs within the first 2 weeks of life, and thrush, diaper dermatitis, and systemic candidiasis may occur at any time in infancy. Controversy exists concerning optimal therapy of mucocutaneous candidiasis.

Neonatal candidemia and end-organ damage: a critical appraisal of the literature using meta-analytic techniques.

OBJECTIVE: Neonatal candidemia is an increasing cause of infant morbidity and mortality. We evaluated the current medical literature in an effort to critique the literature and to document the reported prevalences of end-organ damage after neonatal candidemia. METHODS: We analyzed all peer-reviewed articles of neonatal candidemia published in the English language; inclusion criteria included a cohort limited to all neonatal intensive care unit admissions or all episodes of candidemia in neonates. Articles that also incorporated older patients, did not define a numerator and a denominator for at least 1 form of end-organ damage, included patients from other reports, or did not include all episodes of candidemia in the source population were excluded from the analysis. RESULTS: Thirty-four articles reported episodes of candidemia and mortality; 21 articles reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 articles reported prevalence for >4 forms of end-organ damage from the following list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% (interquartile range [IQR]: 0%-17%), of meningitis was 15% (IQR: 3%-23%), of brain abscess or ventriculitis was 4% (IQR: 3%-21%), of endocarditis was 5% (IQR: 0%-13%), of positive renal ultrasound was 5% (IQR: 0%-14%), and of positive urine culture was 61% (IQR: 40%-76%). The medical literature concerning end-organ evaluation after episodes of neonatal candidemia is heterogeneous and consists largely of single-center retrospective studies. Year that the data were collected and prevalence of neonates infected with Candida albicans were associated with observed heterogeneity. CONCLUSIONS: Given the heterogeneity of the medical literature, precise estimates of the frequencies of end-organ damage are not possible and a prospective multicenter trial is warranted, but the data from the published literature suggest that the prevalence of neonates with end-organ damage not only is greater than 0 but also is high enough that until such a prospective trial is completed, end-organ studies should be considered before the conclusion of antifungal therapy.

Primary osteomyelitis and suppurative arthritis caused by coagulase-negative staphylococci in a preterm neonate.

Coagulase-negative staphylococci are a major cause of nosocomial infections in neonatal intensive care unit patients. These infections are usually related to the presence of intravascular devices. An 1175-g preterm neonate developed primary osteomyelitis and septic arthritis by coagulase-negative staphylococci in the absence of any indwelling central catheters.

Bordetella pertussis causing otitis media: a case report.

OBJECTIVE/HYPOTHESIS: is an unusual cause of otitis media with effusion. We report a case in a neonate. STUDY DESIGN: Case report. METHODS: A case is presented. RESULTS: A 1-month-old infant girl was admitted because of respiratory distress and subsequently was found to have pertussis. On examination she was noted to have a middle ear effusion. Myringotomy was performed for culture. Culture confirmed. We were unable to find a previous report of otitis media. CONCLUSION: has been identified in the middle ear effusion of an infant with the pertussis syndrome.