Krill's Disease: A Newer Management Option.

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Defining Their Own Success: Scholars' Views After a Faculty Development Program.

OBJECTIVE: Educator roles in medicine are expanding yet career paths and definitions of successful careers are not uniformly agreed upon. Educator success from their own perspective has not been broadly explored as these studies usually occur from the institutional or organizational viewpoint. This study examined the impact of a national educational faculty development program (FDP) for academic pediatricians on educators' self-description of their own professional and personal success. METHODS: This was a cross-sectional, qualitative study of FDP alumni between 2019-2021. Interviews explored participants perspectives on their professional success, and supports and barriers. Using an iterative process, thematic analysis of the data identified 6 themes. RESULTS: Fourteen scholars were interviewed. All felt they were successful citing both outcome and impact measures categorized into 6 themes: personal attributes, adequate resources and barriers, foundational skill development, experiencing strong mentoring and networking, engaging, and being connected to a community of practice and self-identifying as a medical educator. To view the data holistically, a model incorporating 3 frameworks was developed. CONCLUSIONS: These educators viewed themselves as successful academic educators. While papers, promotions and positions were important, educators viewed impact in mentoring and collaborations with others, along with acquired expertise and an expanded viewpoint of the field and themselves as equally important. Educators and leaders could use these elements for their own self-assessment and support, FDP development and enhancement, and for investment in programs and faculty educators.

Development and Implementation of a Peer Curbside Consult Service for Pediatric Hospitalists.

OBJECTIVE: To describe the development and implementation of a Peer Curbside Consult Service (PCCS) for a pediatric hospital medicine (PHM) division. METHODS: We developed a pilot intervention with hospitalists at a freestanding children's hospital to provide peer consultation services for challenging clinical cases. Postconsultation surveys collected from both the requesting and consulting hospitalists provided feedback about the program. The 12-point Template for Intervention Description and Replication (TIDieR) checklist is used to describe the process for program creation and implementation. RESULTS: The PCCS has provided 60 consultations in the first 2 years since implementation in April 2020 and supports a large PHM division with >75 members who practice at a tertiary care, freestanding children's hospital and 7 affiliate sites. Hospitalists request peer consultation for challenging clinical cases. The consultations were typically conducted in person or via telephone. Currently, 11 PHM faculty members within the division volunteer as consultants, with 2 assigned per week. Electronic postconsultation experience surveys were received from 70% of requesting and 89% of consultant hospitalists. We also provide preliminary data from this pilot intervention in the Supplemental Information. CONCLUSIONS: We successfully established a peer consult service that provided just-in-time clinical decision support across the various practice sites. Through transparent reporting using the TIDieR checklist, other divisions may be able to replicate and adapt their own peer consult program.

BEVACIZUMAB FOR POST VITRECTOMY CYSTOID MACULAR EDEMA IN A SILICONE OIL-FILLED EYE.

PURPOSE: To report the safety and efficacy of intravitreal bevacizumab (IVB) in a case of cystoid macular edema (CME) in a silicone oil-filled eye. METHODS: A man, aged 51 years, reported with poor visual improvement in the right eye (RE) after pars plana vitrectomy with oil injection performed 2 months back for a pseudophakic, macula-off rhegmatogenous retinal detachment. His best-corrected visual acuity in the RE was counting fingers 2 m. Fundus examination of the RE showed a silicone oil-filled eye with attached retina, and CME was confirmed on spectral-domain optical coherence tomography. He was advised to undergo IVB injection, which was given a few days later. RESULTS: One week after IVB, the central macular thickness had decreased to 437 µ m. Seven weeks later, the macular edema subsided completely with a final central macular thickness of 219 µ m. His vision improved by seven lines to 6/24 and was stable for another 2 months. He underwent removal of silicone oil after 3 months, wherein his visual acuity improved further by one line to 6/18. DISCUSSION: This case demonstrates the use IVB for CME in a silicone oil-filled eye. It was found that IVB was safe and effective in CME associated with a silicone oil-filled eye.

Optimizing Investigations for Evaluation of Enlargements of the Roots, Plexuses and Nerves: A Study of 133 Patients.

BACKGROUND AND AIMS: A wide variety of neurological diseases result in clinical and/or radiological enlargement of nerves, roots and plexuses. With the advancement in techniques and use of magnetic resonance neurography (MRN), aided by electrophysiology, proximal segments of the lower motor neuron (LMN) can be well studied. The relative merits of investigative modalities have not been well defined and comprehensive information on this subject is sparse. METHODS: This retrospective study included data from January 2010 to June 2018. Patients having clinical and/or radiological enlargements of lower motor neuron were included. Clinical and laboratory work up, electrophysiology, MRN and biopsy studies were documented and analyzed. RESULTS: 133 patients fulfilled the inclusion criteria. The diagnostic categories were of leprosy (32%), immune neuropathies (27.8%), nerve infiltrations (8.2%), inherited neuropathies (9%), diabetic radiculopathies (9%) and others (12.7%). MRN was essential to diagnosis in 24.8% and supportive in 31.5% patients. Electrophysiology was essential in diagnosis in 70.6%, biopsy in 45.8% and genetic studies in 6.4% patients. CONCLUSION: The manuscript presents a large cohort of diseases causing enlargement of LMN with clinical and investigative aspects of 7 patients of the most unusual condition of chronic immune sensorimotor polyradiculopathy (CISMP) and details of 7 other patients with chronic mononeuropathies at non-entrapment sites. A table of comparative utility and an algorithm depicting the optimization of investigations has been presented.

Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers.

OBJECTIVES: Hospitals are employing more nurse practitioners and physician assistants on inpatient pediatric units. With this study, we compared patient outcomes in high-volume inpatient diagnoses on pediatric hospital medicine services staffed by attending physician hospitalists and residents (hospitalist and resident service [HRS]) with 1 staffed by attending physician hospitalists and advanced practice providers (HAPPS). METHODS: A historical cohort study was implemented by using administrative data for patients admitted to HRS and HAPPS from 2007 to 2011 with asthma, bronchiolitis, cellulitis, and pneumonia with severity levels 1 and 2 for all-patient refined diagnosis-related groups. Length of stay, readmission, ICU transfer, and hospital charges were compared. RESULTS: After controlling for clinical, demographic, and socioeconomic differences, the average probability of discharge was 10% greater each day (event ratio [ER] = 1.1 [1.06-1.14]) on HAPPS compared with HRS. By diagnosis, this trend persisted with asthma (ER = 1.07 [1.02-1.12]), cellulitis (ER = 1.2 [1.1-1.3]), and pneumonia (ER = 1.17 [1.08-1.28]) but not for bronchiolitis (ER = 0.99 [0.92-1.06]). Both 3- and 30-day readmissions were higher for HRS discharges with bronchiolitis (odds ratio = 5.9 [1.3-28.6] and 2.0 [1.3-3.3], respectively) but not for the other diagnoses. Hospital charges were 13% higher for patients on HRS than HAPPS. ICU transfers did not differ statistically. CONCLUSIONS: Within the limitations of the design, HAPPS performed at least as well as HRS with respect to length of stay, readmissions, ICU transfers, and charges for 4 of the most common inpatient diagnoses with severity levels 1 to 2. Indicated in these results is that in this configuration, advanced practice providers on pediatric hospitalist services represent a viable model for other institutions to consider and test.

Children With Medical Complexity: A Web-Based Multimedia Curriculum Assessing Pediatric Residents Across North America.

OBJECTIVE: No standardized curricula exist for training residents in the special needs of children with medical complexity. We assessed resident satisfaction, knowledge, and behavior after implementing a novel online curriculum composed of multimedia modules on care of children with medical complexity utilizing virtual simulation. METHODS: We conducted a randomized controlled trial of residents across North America. A Web-based curriculum of 6 self-paced, interactive, multimedia modules was developed. Readings for each topic served as the control curriculum. Residents were randomized to 1 of 2 groups, each completing 3 modules and 3 sets of readings that were mutually exclusive. Outcomes included resident scores on satisfaction, knowledge-based assessments, and virtual simulation activities. RESULTS: Four hundred forty-two residents from 56 training programs enrolled in the curriculum, 229 of whom completed it and were included in the analysis. Subjects were more likely to report comfort with all topics if they reviewed modules compared to readings (P ≤ .01 for all 6 topics). Posttest knowledge scores were significantly higher than pretest scores overall (mean increase in score 17.7%; 95% confidence interval 16.0, 19.4), and the mean pre-post score increase for modules was significantly higher than readings (20.9% vs 15.4%, P < .001). Mean scores on the verbal handoff virtual simulation increased by 1.1 points (95% confidence interval 0.2, 2.0, P = .02). There were no significant differences found in pre-post performance for the device-related emergency virtual simulation. CONCLUSIONS: There was high satisfaction, significant knowledge acquisition, and specific behavior change after participating in this innovative online curriculum. This is the first multisite, randomized trial assessing satisfaction, knowledge impact, and behavior change in a virtually simulated environment with pediatric trainees.

The current state of pediatric hospital medicine fellowships: A survey of program directors.

BACKGROUND: Pediatric hospital medicine (PHM) fellowship programs have grown rapidly over the last 20 years and have varied in duration and content. In an effort to standardize training in the absence of a single accrediting body, PHM fellowship directors now meet annually to discuss strategies for standardizing and enhancing training. OBJECTIVES: To explore similarities and differences in curricular structure among PHM fellowship programs in an effort to inform future curriculum standardization efforts. METHODS: An electronic survey was distributed by e-mail to all PHM fellowship directors in April 2014. The survey consisted of 30 multiple-choice and short-answer questions focused on various curricular aspects of training developed by the authors. RESULTS: Twenty-seven of 31 fellowship programs (87%) responded to the survey. Duration of most programs was 2 years (63%), with 6, 1-year programs (22%) and 4 (15%) 3-year programs making up the remainder. The average amount of clinical time among programs was 50% (range approximately 20%-65%). In addition to general inpatient pediatric service time, most programs require other clinical rotations. The majority of programs allow fellows to bill independently for their services. Most programs offer certificate courses, courses for credit or noncredit courses, with 11 programs offering masters' degrees. Twenty-one (81%) programs provide a scholarship oversight committee for their fellows. Current fellows' primary areas of research are varied. CONCLUSION: Though variability exists regarding program length, clinical composition, and nonclinical offerings, several common themes emerged that may help inform the development of a standard curriculum for use across all programs. This information provides a useful starting point if pediatric hospital medicine obtains formal subspecialty status. Journal of Hospital Medicine 2016;11:324-328. © 2016 Society of Hospital Medicine.

Development of a Curriculum on the Child With Medical Complexity: Filling a Gap When Few Practice Guidelines Exist.

BACKGROUND: Pediatric hospitalists are increasingly involved in the clinical management of children with medical complexity (CMC), specifically those with neurologic impairment and technology dependence. Clinical care guidelines and educational resources on management of the diseases and devices prevalent in CMC are scarce. The objective of this study was to develop and evaluate a web-based curriculum on care of CMC for hospitalists at our institution using a novel approach to validate educational content. METHODS: Junior faculty collaborated with senior hospitalist peer mentors to create multimedia learning modules on highly-desired topics as determined by needs assessment. Module authors were encouraged to work with subspecialty experts from within the institution and to submit their modules for external peer review. Pilot study participants were asked to complete all modules, associated knowledge tests, and evaluations over a 4-month period. RESULTS: Sixteen of 33 eligible hospitalists completed the curriculum and associated assessments. High scores with respect to satisfaction were seen across all modules. There was a significant increase in posttest knowledge scores (P < 0.001) with sustained retention at 6 months posttest (P < 0.013). Participants were most likely to make changes to their teaching and clinical practice based on participation in this curriculum. CONCLUSIONS: We used a novel approach for content development in this curriculum that incorporated consultation with experts and external peer review, resulting in improved knowledge, high satisfaction, and behavior change. Our approach may be a useful method to improve content validity for educational resources on topics that do not have established clinical care guidelines.