When the Reading Room Meets the Team Room: Resident Perspectives From Radiology and Internal Medicine on the Effect of Personal Communication After Implementing a Resident-Led Radiology Rounds.

OBJECTIVE: Current radiology and internal medicine (IM) residents have trained to varying degrees depending on program in the post picture archiving and communication systems implementation era and thus have largely missed out on the benefits of in-person, 2-way communication between radiologists and consulting clinicians. The purpose of this study is to broadly explore resident perspectives from these groups on the desire for personal contact between radiologists and referring physicians and the effect of improved contact on clinical practice. MATERIALS AND METHODS: A radiology rounds was implemented in which radiology residents travel to the IM teaching service teams to discuss their inpatients and review ordered imaging biweekly. Surveys were given to both cohorts following 9 months of implementation. RESULTS: A total of 23/49 diagnostic radiology (DR) and 72/197 IM residents responded. In all, 83% of DR and 96% of IM residents desired more personal contact between radiologists and clinicians. Of all, 92% of DR residents agree that contact with referring clinicians changes their approach to a study, 96% of IM residents agree that personal contact with a radiologist has changed patient management in a way that they otherwise would not have done having simply read a report, 85% of DR residents report that more clinician contact will improve resource use, and 96% report that it will improve care quality. Furthermore, 99% of IM residents report that increased access to a radiologist would make selecting the most appropriate imaging study easier in various clinical scenarios. A majority of IM residents prefer radiology reports that provide specific next-step recommendations and that include arrows/key-image series. CONCLUSION: We conclude that the newest generation of physicians is already attuned to the value of a radiologist who plays an active, in-person role in the clinical decision-making process.

Current status of surgical treatment for fulminant clostridium difficile colitis.

Mortality rates attributable to fulminant Clostridium difficile (C. difficile) colitis remain high and are reported to be 38%-80%. Historically, the threshold for surgical intervention has been judged empirically because level I evidence to guide decision making is lacking. Studies of the surgical management of C. difficile infection have been limited by small sample size and the lack of a standard definition of fulminancy. Multiple small and medium-sized series have examined the surgical management of C. difficile. However, because of a lack of prospective, randomized studies, it has been difficult to identify the optimal point for surgical intervention in patients with severe fulminant C. difficile colitis. Our goal was to analyze the existing body of literature in an attempt to define host constellations, which would predict the development of the more aggressive form of this disease and hence justify an early or earlier surgical intervention. A Pubmed search was conducted using the keywords "fulminant", "clostridium difficile", "surgery", and "colitis". Reviews and meta-analyses proposing indications for surgical consultation or operative management in patients with C. difficile colitis were included. After analyzing current literature, we identified a number of parameters that are associated with unfavorable outcomes. The parameters include age greater than 65 years old, peritoneal signs on physical examination, abdominal distension, signs of end-organ failure, hypotension less than 90 mmHg systolic blood pressure, tachycardia greater than 100 bpm, vasopressor requirement, elevated WBC count of greater than at least 16 × 10(9)/µL, serum lactate of greater than 2.2 mmol/L, and lastly, radiologic findings suggestive of pancolitis, ascites, megacolon, or colonic perforation. Even though fairly strong evidence exists in contemporary literature, we recommend use of these identified parameters with caution in clinical practice when it comes to the actual decision to treat certain patients more aggressively. The identified risk factors should be used to lower surgeons' threshold for operative treatment early in the course of the disease.