Congratulations Kate Pearson!

Congratulations to VCU medical student, Kate Pearson, recipient of the 2011 AOA (Alpha Omega Alpha) 2011 Carolyn L. Kuckein Student Research Fellowship award. This prestigious national award will provide research support for a continual period of a minimum of 8 to 10 weeks clinical investigation in epidemiology and health services research. 

Kate Pearson: 2011 AOA Student Research Award Winner

Kate will be part of our 2011 Honduras Medical Relief Trip and will take the lead in on of our IRB approved studies titled: Accessing Healthcare in a Rural Developing Nation: A Comparison of Two Communities in Northern Honduras, and The Role of the Honduras Outreach Medical Relief Brigada (HOMBRE) in Providing Medical Care.


To learn more about the VCU Honduras Global Health Initiative- click here.
 

MCAT: New and Improved?

The Medical College Admission Test (MCAT) remains a rite of passage for any doctor or want-to-be doctor.

A recent New York Times article titled A Better Medical School Admission Test reports on the 5th major revision of the test. As a test of knowledge, the MCAT functions well, however, it has a major short coming: it has been unable to consistently predict the personal and professional characteristics becoming a good doctor.

A good MCAT performance does not predict an empathic, personable and ethical physician. We all know that these too are essential professional qualities. I have trained many students who are good test takers but who are mediocre in patient care. 

The new exam will also test analytical and reasoning skills in ethics, philosophy and cross-cultural studies.

Progress? Possibly.

Nursing Homes and Infection Prevention: Trouble on the Horizon?

Infection prevention programs have traditionally focused on inpatient, critically ill patient populations. There is a growing body of literature on the special infection prevention needs in nursing homes and long term care facilities. This is with good cause.

The Centers for Medicare and Medicaid Services (CMS) requires that “the facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection”  An infection control program should include the following components: “(1) investigates, controls, and prevents infections in the facility; (2) decides what procedures, such as isolation should be applied to an individual resident; and (3) maintains a record of incidents and corrective actions related to infections."

A recent paper published in AJIC reports on nursing home deficiencies in infection control. Data was obtained  from 2000-2007 from the Online Survey, Certification, and Reporting data base, which contains information on both deficiency citations and facility characteristics. Using multivariable analysis, low staffing levels were highly predictive of infection prevention deficiencies. An average of 15% of all nursing homes received a deficiency citation for infection control each year from 2000 to 2007.

Source:AJIC: American Journal of Infection Control Volume 39, Issue 4 , Pages 263-269, May 2011- average number of deficiency citations used per nursing home in each state.

With a growing elderly population, resources for infection prevention in nursing homes must be made available.

Old age is looking less and less appealing.

Liposuction: Fat Lost and Found

Source: NY Times

Last Sunday, the New York Times published an article on liposuction by writer Gina Kolata.

The paper highlights an important finding from a recent study in the journal Obesity. In a prospective, randomized trial of abdominal liposuction in women, body fat was restored and redistributed mostly in the upper abdomen, shoulders and triceps of the arms, within the course of one year. What fat was lost was later found in new anatomic areas. It should be noted that participants agreed not to make any lifestyle changes that could potentially impact body fat.

Much of medical practice is not supported by robust evidence, rather by anecdotes of success and case series of low quality and questionable follow up time. As such, this study was novel in the body of literature for cosmetic surgery/liposuction.

Although I am no means an expert in this field of medicine, durable weight loss appears not amenable to a quick fix and matters of lifestyle changes still play a paramount role.

Another Day in the Hospital!

They do all the work so that we can take the credit. 

Acute Care Medicine Nursing Staff- Virginia Commonwealth University Medical Center

Antiretrovirals: A Hairy Proposition

The title of this paper definitely caught my eye.

What if physicians could measure adherence to HIV medications by a method analogous to HgB A1C testing for diabetics? Enter antiviral concentration sampling in patients on HIV medications as a predictor of viral load suppression.

424 female participants (51% African-American, 31% Hispanic) contributed occipital hair samples for analysis of atazanavir concentration levels. After adjusting for age, race, treatment experience, pretreatment viral load, CD4 count and AIDS status, and self-reported adherence, hair levels were the strongest predictor of viral load suppression. Women with atazanavir levels in the highest quintile had odds ratios (ORs) of 59.8 (95% confidence ratio, 29.0-123.2) for virologic suppression. Adequate atazanavir hair levels predictive of viral suppression were > 1.78ng/mg of hair.  

Hair Sampling for Atazanavir Analysis-Clin Infect Dis 2011 May; 52(10):1267-75

Possible benefits of hair sampling:

 -Hair analysis provides a measure of average serum atazanavir concentration over weeks to months rather than a single point of time such as with a serum viral load

- Hair collection is simple and non-invasive and does not require specific skills and poses little risk for percutaneous injury or exposure to blood and body fluids

- Hair can be store for prolonged periods of time, without precautions for biohazardous materials

However, does this method work with other retrovirals and non-protease inhibitor based regimens?

Also, what if the patient suffers from severe alopecia (male pattern baldness)?

Must retrovirals be prescribed with Rogaine for maximal benefit of hair analysis?   

Clinical Rotations: Traditional vs Longitudinal Approach?

Medical students, in many ways, are apprenticed doctors. Much of their time, especially in the 3rd and 4th years, is spent on direct patient care in the hospital and clinics. Mandatory rotations in surgery, medicine,pediatrics, neurology, obstetrics/gynecology and family medicine are completed typically in the 3rd year. With a change in rotation discipline comes a change in supervising physicians and mentors lending itself to a fragmented clinical experience.

It is no surprise that a recent paper in Medical Education comparing preceptors’ and students’ perceptions of student evaluation in block clerkships and longitudinal integrated clerkships favored longitudinal integrated clerkships. Longitudinal integrated clerkships are core clinical experiences that include longitudinal ambulatory preceptorships to facilitate continuity in students’ relationships with preceptors and patients over periods of 6 months to 1 year. This is in contrast to the traditional 4-12 week rotation. Both preceptors and students favored evaluation in the longitudinal clerkships on three factors: validity of evaluation process, quality of clinical skill evaluation, and willingness to provide constructive feedback.

There is no evidence, however, that a longitudinal clerkship experience will produce a more learned, better skilled and more empathic physician come graduation time. 

The finding is nevertheless important and highlights an important challenge. A student cannot complete a longitudinal experience across all specialties as this is simply not feasible given time and faculty constraints. The challenge lies in how to best choose a longitudinal clerkship such that the educational and future specialty choice of the student is best met without compromising meaningful learning experiences across the other required rotations.

Administratively and logistically, this is much easier said than done.