Jannette Collins

Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition

As part of the ongoing Wisconsin Cystic Fibrosis (CF) Neonatal Screening Project, we had the unique opportunity to study the longitudinal relationship between Pseudomonas aeruginosa (Pa) acquisition and infection and developing lung disease in children with CF. The primary objective was to determine whether acquisition of Pa was associated with a measurable change in the progression of lung disease. Two outcome measures were used to study 56 patients who were diagnosed through newborn screening: 1) Wisconsin additive chest radiograph score (WCXR), based on the average of scores from a pulmonologist and a radiologist, and 2) the highest forced expired volume in 1 sec (FEV1)/forced vital capacity (FVC) ratio. We used two measures of Pa acquisition: 1) time of first positive protocol‐determined oropharyngeal (with cough) culture, and 2) the magnitude of antibody titer detected by ELISA assays, using as antigen a crude cell lysate, purified exotoxin A, or an elastase toxoid prepared from three Pa strains. Other predictor variables included age, pancreatic status, height‐for age, and weight‐for‐age‐percentiles.

Lifelong Learning in the 21st Century and Beyond

Lifelong learning is now recognized by educators, governing bodies, accreditation organizations, certification boards, employers, third-party payers, and the general public as one of the most important competencies that people must possess. Promoting lifelong learning as continuous, collaborative, self-directed, active, broad in domain, everlasting, positive and fulfilling, and applicable to ones profession as well as all aspects of ones life has emerged as a major global educational challenge. Meeting this challenge will require changes in the way teachers teach and learners learn, as teachers take on a more facilitative role and learners take more responsibility for setting goals, identifying resources for learning, and reflecting on and evaluating their learning. For physicians, this will require less dependence on traditional educational venues, such as passive continuing medical education activities, and greater participation in self-assessment, peer assessment, evaluation of performance in practice, documentation of practice-based learning and improvement activities, and learning at the point of care. Radiologists in an academic setting are exposed to multiple opportunities for practicing lifelong learning, such as teaching others, participating in multidisciplinary conferences and journal clubs, and engaging in research. All radiologists can participate in self-audits and group audits of performance and become active participants in national radiology societies, where they can learn from each other. Participation in the American Board of Radiologys Maintenance of Certification program reflects a commitment to actively engage in lifelong learning and is one way of demonstrating to the general public a commitment to maintaining competence.

Wisconsin cystic fibrosis chest radiograph scoring system: Validation and standardization for application to longitudinal studies †

This study was designed to achieve a final modeling, validation, and standardization plan for the Wisconsin cystic fibrosis (CF) chest radiographic scoring system. Sixty chest radiographs were selected to reflect a range of severity of lung pathology in children with CF. Seven experienced volunteer raters (three radiologists and four pediatric pulmonologists) from five institutions were recruited to evaluate and score the films. Analysis of scores revealed that the subcomponents of the Wisconsin system showed considerable variation from rater to rater, but reliability assessment indicated satisfactory Cronbachs alpha coefficients (0.83–0.90) among the seven raters. It was found that an additive method of total score computation is significantly more reliable (P < 0.05) than either the original multiplicative model or the traditional Brasfield scoring system. Comparison of radiologists and pulmonologists revealed a marked, systematic difference in scoring with the former group being more conservative in interpretation of abnormalities than the pulmonologists, and some of the raters showing very limited sensitivity.

General competencies in radiology residency training: definitions, skills, education and assessment.

The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project is a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs (http://www.acgme.org). The impetus for this project is a system of medical education that relies heavily on public funding and is therefore accountable to the public to meet public needs and prepare well-qualified new physicians as cost effectively as possible. The current model of accreditation focuses on the potential of a residency program to educate residents (ie, whether the program complies with the requirements, has established objectives and an organized curriculum, and evaluates the residents and itself). Examining structure and process, however, is not a direct way to measure the quality of a program’s educational outcomes. In future, accreditation will focus on a program’s actual accomplishments, through assessment of program outcomes (ie, whether residents achieve the stated learning objectives, whether the program provides evidence of this achievement, and whether it demonstrates continuous improvement in its educational process). The ACGME Outcome Project Advisory Committee identified six general competencies that were subsequently endorsed by the ACGME in February 1999: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. By July 2002 all Residency Review Committees (RRCs) must include minimum language regarding the general competencies and evaluation processes in their respective program requirements. A major activity of the Outcome Project was the identification and development of measurement tools for programs to use as part of an overall evaluation system. The ACGME and the American Board of Medical Specialties (ABMS) collaborated on developing a “Toolbox of Assessment Methods” (version 1.1, September 2000; ACGME/ABMS; http://www.acgme.org/outcome/assess /toolbox.asp). The Toolbox includes descriptions of instruments recommended for use by programs assessing the outcomes of their educational efforts, as well as information pertaining to the use, the psychometric qualities, and the feasibility and practicality of different assessment methods. A radiology “quadrad,” made up of representatives from the radiology RRC (including a resident member of the RRC), the American Board of Radiology (ABR), and the Association of Program Directors in Radiology (APDR), was formed in the spring of 2000 to interpret the six competencies as they relate to radiology. The Acad Radiol 2002; 9:721–726

Association between Mucoid Pseudomonas Infection and Bronchiectasis in Children with Cystic Fibrosis

PURPOSE To correlate the severity of bronchiectasis in children with cystic fibrosis with clinical and microbiologic variables in order to clarify risk factors for the development of irreversible lung disease. MATERIALS AND METHODS After institutional review board approval and parental informed consents were obtained, a HIPAA-compliant longitudinal epidemiologic evaluation was performed in patients with cystic fibrosis who were enrolled in the Wisconsin trial of newborn screening from 1985 to 2009. Thin-section chest computed tomography (CT) was used in a prospective cross-sectional design to study patients ranging in age from 6.6 to 17.6 years (mean, 11.5 years). Thin-section CT scores were determined objectively on coded images by multiple raters in a standardized fashion. Microbiologic data were obtained by means of culture of respiratory secretions by using methods for differentiation of Pseudomonas aeruginosa (PA) as either nonmucoid or mucoid. RESULTS Eighty-three percent of patients (68 of 82) showed bronchiectasis of varying severity. Of 12 potential risk factors, only respiratory infection with mucoid PA correlated significantly with bronchiectasis (P = .041). CONCLUSION The severity of bronchiectasis in children with cystic fibrosis is significantly related to respiratory infection with mucoid PA; attempts to prevent bronchiectasis should include reducing exposure to and early eradication of PA.

Risk factors for the progression of cystic fibrosis lung disease throughout childhood.

RATIONALE Previous studies of risk factors for progression of lung disease in cystic fibrosis (CF) have suffered from limitations that preclude a comprehensive understanding of the determinants of CF lung disease throughout childhood. The epidemiologic component of the 27-year Wisconsin Randomized Clinical Trial of CF Neonatal Screening Project (WI RCT) afforded us a unique opportunity to evaluate the significance of potential intrinsic and extrinsic risk factors for lung disease in children with CF. OBJECTIVES Describe the most important intrinsic and extrinsic risk factors for progression of lung disease in children with CF. METHODS Variables hypothesized at the onset of the WI RCT study to be determinants of the progression of lung disease and potential risk factors previously identified in the WI RCT study were assessed with multivariable generalized estimating equation models for repeated measures of chest radiograph scores and pulmonary function tests in the WI RCT cohort. MEASUREMENTS AND MAIN RESULTS Combining all patients in the WI RCT, 132 subjects were observed for a mean of 16 years and contributed 1,579 chest radiographs, and 1,792 pulmonary function tests. The significant determinants of lung disease include genotype, poor growth, hospitalizations, meconium ileus, and infection with mucoid Pseudomonas aeruginosa. The previously described negative effect of female sex was not seen. CONCLUSIONS Modifiable extrinsic risk factors are the major determinants of progression of lung disease in children with CF. Better interventions to prevent or treat these risk factors may lead to improvements in lung health for children with CF.

Diagnostic radiology milestones.

Kay H. Vydareny, MD, is Associate Executive Director for Diagnostic Radiology at the American Board of Radiology; E. Stephen Amis Jr, MD, is Professor and University Chair in the Department of Radiology, Albert Einstein College of Medicine/Montefiore; Gary J. Becker, MD, is Executive Director of the American Board of Radiology; James P. Borgstede, MD, is a Vice Chairman and Professor at the University of Colorado Hospital; Dorothy I. Bulas, MD, is in the Division of Diagnostic Imaging and Radiology, Children’s National Medical Center, and Professor of Radiology and Pediatrics at the George Washington University Medical Center; Jannette Collins, MD, is Ben Felson Professor and Chair of Radiology in the Department of Radiology, University of Cincinnati Medical Center; Lawrence P. Davis, MD, is Vice Chair and Program Director in the Department of Radiology, Long Island Jewish Medical Center; Jennifer E. Gould, MD, is Program Director and Assistant Professor of Radiology at the Mallinckrodt Institute of Radiology, Washington University; Jason Itri, MD, PhD, is Assistant Professor and Director of Quality and Safety in the Department of Radiology, University of Pittsburgh; Jeanne M. LaBerge, MD, is Professor of Radiology and Director of the VIR Fellowship Program at the University of California, San Francisco, School of Medicine; Lynne Meyer, PhD, MPH, is Executive Director for the Resident Committee of Diagnostic Radiology at the Accreditation Council for Graduate Medical Education; Duane G. Mezwa, MD, is Chair of Diagnostic Radiology and Molecular Imaging at the Oakland University-William Beaumont School of Medicine; Richard L. Morin, PhD, is Brooks-Hollern Professor in the Department of Radiology at the Mayo School of Graduate Medical Education; Steven P. Nestler, PhD, is Senior Consultant in the Education Department at the Accreditation Council for Graduate Medical Education; and Robert Zimmerman, MD, is Vice Chair for Education and Professor of Radiology at Weill Cornell Medical College.

Resident learning and knowledge retention from resident-prepared chest radiology conferences

RATIONALE AND OBJECTIVES The authors assessed resident learning and retention of knowledge from resident-prepared chest radiology conferences. MATERIALS AND METHODS Radiology residents presented five chest conferences to their peers during a 5-month interval; the conferences were modeled on a case presentation format. Tests were given 5 minutes before each conference (pretest) and immediately after each conference (posttest). The tests were readministered as a final examination 6 months later, at which time the residents were asked to evaluate the conference format. RESULTS Conference attendance ranged from six to 11 residents. Mean posttest scores were statistically significantly higher than mean pretest scores (P < .0001). Six-month retention scores were higher than pretest scores (P < .05) but lower than posttest scores (P < .05). On a scale of 1-6, with 1 representing strongly disagree and 6 strongly agree, residents strongly agreed that the conferences provided an excellent learning experience (mean score, 5.27). CONCLUSION Resident-prepared conferences are effective for teaching residents chest radiology. Resident testing at 6 months demonstrated retention of knowledge above pretest levels but lower than posttest levels.

Promotion Based on Teaching Efforts Requires Ongoing Documentation of Scholarly Teaching Activities

In 1990, Boyer (1) published a seminal work entitled Scholarship Reconsidered: Priorities of the Professoriate. In 1997, Glassick et al (2) expanded on Boyer’s work in their publication Scholarship Assessed: Evaluation of the Professoriate. Using these two publications as a springboard, the Association of American Medical Colleges (AAMC) Council of Academic Societies Task Force on Scholarship recently published a series of essays on scholarship (3). These essays define Boyer’s four areas of scholarship—the scholarship of discovery, the scholarship of integration, the scholarship of application, and the scholarship of teaching—as they relate to medical education. Clinical care is critical for the financial viability of academic medical centers, as approximately 40%–50% of their revenue is derived from this work (4). To support their academic missions, academic medical centers have hired clinician-educators to teach and provide clinical care. These clinician-educators often do not advance in academic rank, however, because excellence in clinical care and teaching alone is not considered adequate justification for advancement. Scholarship as it applies to the work of clinician-educators must be defined. In addition, institutional promotion guidelines must be restructured, and an organizational infrastructure must be created to support scholars in education. We used Boyer’s definition of the scholarship of teaching and the criteria of Glassick et al for judging scholarly work to create a model for documenting, recognizing, and rewarding the scholarship of teaching in radiology.

Blunt nonaortic chest trauma: radiographic and CT findings.

Following initial clinical evaluation and stabilization of a patient who has sustained blunt chest trauma, imaging has an important role in the evaluation of thoracic injuries. The initial study is the chest radiograph. However, chest CT is being used with increased frequency in the evaluation of blunt chest trauma. Although CT is used primarily to assess for traumatic aortic injuries, it is also useful in the evaluation of pulmonary and bronchial, airway, skeletal and diaphragmatic injury. The aim of this article is to review the characteristic imaging findings of pulmonary and bronchial, esophageal, thoracic, skeletal and diaphragmatic injuries.