Leclercia Adecarboxylata Causing Necrotizing Fasciitis in an Immunocompetent Athlete Injecting Illicit Testosterone Supplements.

Leclercia adecarboxylata (L. adecarboxylata) is an uncommon and often misdiagnosed cause of multiple infection types including skin and soft tissue, cholecystitis, and septicemia. It commonly afflicts immunocompromised hosts or individuals who experience trauma in aquatic environments.

Acute liver injury induced by red yeast rice supplement.

A 64-year-old woman previously taking no medications presented with acute hepatitis 6 weeks after starting a red yeast rice supplement to decrease her cholesterol. Red yeast rice is commonly used for hyperlipidaemia as an alternative to statins as it contains monacolin K, the same active chemical in lovastatin. Infectious, toxic and autoimmune causes for injury were ruled out, and liver biopsy was consistent with drug induced liver injury.

Assessing Correlation of Residency Applicants' Interview Dates With Likelihood of Matching.

Objectives: This study aimed to determine whether the timing of an interview relative to the recruitment season was associated with being ranked or matched at an academic medical center.

Methods: Eleven specialties (anesthesiology, diagnostic radiology, emergency medicine, family medicine, general surgery, internal medicine, neurology, neurosurgery, obstetrics-gynecology, orthopedic surgery, and psychiatry) that participated in the National Resident Matching Program were included in the study. Each program's total number of interview days during the October 2014-January 2015 interview season were divided equally into three interview time periods.

Does Timing of Internal Medicine Residency Interview Affect Likelihood of Matching?

Objectives: Applicants to our internal medicine (IM) residency program consistently have shared concerns about whether the interview date influences their ability to match via the National Residency Matching Program. We performed a retrospective study to assess whether interview timing was associated with successful matching at our IM program.

Methods: We identified all of the applicants who interviewed for a first-year position with our IM residency program from 2010 to 2014.

Mapping Direct Observations From Objective Structured Clinical Examinations to the Milestones Across Specialties.

Background: Little is known about residents' performance on the milestones at the institutional level. Our institution formed a work group to explore this using an institutional-level curriculum and residents' evaluation of the milestones.

Objective: We assessed whether beginner-level milestones for interpersonal and communication skills (ICS) related to observable behaviors in ICS-focused objective structured clinical examinations (OSCEs) for postgraduate year (PGY) 1 residents across specialties.

Continuity Clinic Model and Diabetic Outcomes in Internal Medicine Residencies: Findings of the Educational Innovations Project Ambulatory Collaborative.

Background: Efforts to improve diabetes care in residency programs are ongoing and in the midst of continuity clinic redesign at many institutions. While there appears to be a link between resident continuity and improvement in glycemic control for diabetic patients, it is uncertain whether clinic structure affects quality measures and patient outcomes.

Methods: This multi-institutional, cross-sectional study included 12 internal medicine programs.

Racial and Economic Disparities in Diabetes in a Large Primary Care Patient Population.

Objective: We sought to determine if, after adjusting for economic status, race is an independent risk factor for glycemic control among diabetic patients in a large primary care patient population.

Design Setting Participants: We performed a retrospective chart review of 264,000 primary care patients at our large, urban academic medical center to identify patients with a diagnosis of diabetes (n=25,123). Zip code was used to derive median income levels using US Census Bureau demographic information.

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

Aim: The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate.

Methods: Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR.

Internship and Empathy: Variations Across Time and Specialties.

Objectives: To assess whether any differences exist in Interpersonal Reactivity Index (IRI) scores among postgraduate year 1 (PGY-1) residents across specialties.

Methods: PGY-1 residents representing 11 specialties at our academic institution were invited to take a Web-based IRI survey at three time points. The specialties were condensed into several binary groups for analysis: internal medicine (IM) versus non-IM; primary care (IM, family medicine) versus nonprimary care; emergency medicine (EM, including the combined IM/EM) versus non-EM; surgical specialties (general surgery, obstetrics and gynecology, otolaryngology, orthopedics, urology) versus nonsurgical specialties (EM, family medicine, IM, neurology, pathology, and psychiatry); men versus women; and age groups.

Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative.

Background: Many internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown.

Methods: Our multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative.

Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative.

Background: Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear.

Methods: This multi-institutional, cross-sectional study included 713 IM residents from 12 programs.

Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit.

Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU.

Clinic design, key practice metrics, and resident satisfaction in internal medicine continuity clinics: findings of the educational innovations project ambulatory collaborative.

Background: Internal medicine programs are redesigning ambulatory training to improve the resident experience and answer the challenges of conflicting clinical responsibilities. However, little is known about the effect of clinic redesign on residents' satisfaction.

Objective: We assessed residents' satisfaction with different resident continuity clinic models in programs participating in the Educational Innovations Project Ambulatory Collaborative (EPAC).

Bilateral supernumerary kidneys: how much is too much?

A middle aged African-American woman with a stable history of carnitine palmitoyl transferase II (CPT II) deficiency presented with myalgias for 1 week. Physical examination and laboratory findings were consistent with severe sepsis secondary to pyelonephritis leading to rhabdomyolysis. Subsequent CT of the abdomen revealed bilateral supernumerary kidneys with non-obstructive calculi within the supernumerary kidneys.

Symptomatic ileofemoral deep vein thrombosis due to May-Thurner syndrome.

A 33-year-old woman with no medical history reported an acute onset of left leg and thigh swelling. A review of her medications revealed that she had started oral contraceptives 2 months previously. Ultrasonography and subsequent venography demonstrated extensive ileofemoral clot burden.

Simulation modeling of change to breast cancer detection age eligibility recommendations in Ontario, 2002-2021.

Purpose: The purpose of this project was to demonstrate the development and use of a decision support tool based on simulation modeling of breast cancer screening to evaluate the implications for the provision of health services and the economic impact of extending routine radiographic screening for breast cancer to women in the 40-49 age group between 2002 and 2021.

Methods: The main method was computer simulation with a Markov model that used published estimates of population size by age group, breast cancer prevalence and incidence, screening program participation rate, sensitivity and specificity of the screening test and diagnostic test, stage transition probabilities, directed diagnosis rates and costs.

Findings: The model predicted that changes to age eligibility requirements would result in the detection of an additional 6610 women with breast cancer in Ontario requiring treatment, at an additional cost of 795 Canadian per case.