Patient education and recall regarding postsplenectomy immunizations.

BACKGROUND: The purpose of this study was to determine the rates of initial vaccinations after splenectomy for trauma, assess the effectiveness of patient education on reimmunizations, and evaluate patients' utilization of their knowledge regarding immunization after discharge. METHODS: From June 1996-December 2011, 144 patients underwent splenectomy after traumatic injury. A telephone survey was completed in 100 of 144 splenectomized patients (69%) at a mean of 7.9 y after their splenectomy. Questions were directed to determine the quality of patients' recall of the implications of splenectomy, the need for vaccinations, and the quality of the health information administered. Research electronic data capture tool was used for collecting data, and data were analyzed with Stata 11.2. RESULTS: Only 27% of participants recall receiving education on postsplenectomy vaccination and 41% of those patients rated their education as poor or minimal. Ninety-one percent of patients indicated that they would like more information in the form of a brochure. Our overall initial vaccination rates among patients who had splenectomy from 1996-2011 were 76%, 75%, and 68% for Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenza type b, respectively. Since 2004, 95% of those who had splenectomy between 2004 and 2007 received all three vaccines. Since 2008, our institution has maintained 100% initial vaccination rates for all three vaccines. The revaccination rates in this group of patients (from 1996-2007) were 39% and 15% for pneumococcal and meningococcal vaccines, respectively. CONCLUSIONS: Patients had poor recall of the information provided during hospitalization for splenectomy. There were low revaccination rates in our patient cohort. Specific educational and vaccination surveillance strategies are required to improve vaccination rates.

Crohn's disease but not diverticulitis is an independent risk factor for surgical site infections in colectomy.

INTRODUCTION: Surgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn's disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set. METHOD: NSQIP data from 2006 to 2011 were investigated, and segmental colectomy procedures performed for the diagnoses of Crohn's disease, DD, and colon malignancy were included. SSI complications were compared by diagnosis using univariate and multivariate analysis. RESULT: We included 35,557 colectomy cases in the analysis. CD had the highest rate of postoperative SSI (17 vs. 13% DD vs. 10% CC; p < 0.001). Using CC as the comparison group and controlling for multiple variables, the multivariate analysis showed that the CD group had an increased risk for acquiring at least one SSI (odds ratio (OR) = 1.38, p ≤ 0.001), deep incisional SSI (OR = 1.85, p = 0.03), and organ space SSI (OR = 1.51, p = 0.02). CONCLUSION: For patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.

Student voices in Readers' Theater: exploring communication in the hidden curriculum.

OBJECTIVE: During the clerkship years, students often discover a misalignment between formal preclinical communication skills teaching and the actual practices of housestaff and attending role models. We developed a workshop for medical educators to identify how the hidden curriculum models (or fails to model) effective communication skills. WORKSHOP DESIGN: Using Readers' Theater, participants enacted and then discussed a scenario designed to trigger reflection. The script was adapted from an in-depth student narrative describing her team's use of a derogatory term to label a patient. The student must decide whether and how to respond. WORKSHOP OUTCOMES: Participants discussed potential responses to breaches of professionalism medical hierarchy, ethical conflict centered on conforming pressure, "holding ambivalence", and gender inequality in medicine. A number of communication options for the student were considered, and role-played. CONCLUSION: The use of student narratives in medical education helps learners better understand the content and nuance of the hidden curriculum. Readers' Theater is a powerful tool to actively invite learners to step into the shoes of trainees in order to glean additional perspectives. Engaging educators in the task of collaborative solution building using this format can help improve learning environments.