Sammy Zakaria

The use of social media to supplement resident medical education – the SMART-ME initiative

Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1-5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (p<0.001 for the change). The percentage of residents using the application at least once a week also increased from 11.4 to 60.0% (p<0.001). Almost all residents (38 of 40) felt that social media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Conclusion Residents believe social media could be used for medical education. After we launched a Twitter page for medical education, there was a significant increase in the use and frequency of Twitter for resident medical education over the ensuing 6 months. Further research should be performed to see if social media can impact overall medical knowledge and patient care, and whether longer term use is maintained.Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1–5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (p<0.001 for the change). The percentage of residents using the application at least once a week also increased from 11.4 to 60.0% (p<0.001). Almost all residents (38 of 40) felt that social media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Conclusion Residents believe social media could be used for medical education. After we launched a Twitter page for medical education, there was a significant increase in the use and frequency of Twitter for resident medical education over the ensuing 6 months. Further research should be performed to see if social media can impact overall medical knowledge and patient care, and whether longer term use is maintained.

Volume Overload in Heart Failure: An Evidence-Based Review of Strategies for Treatment and Prevention

Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure.

Brief report: antisynthetase syndrome-associated myocarditis.

BACKGROUND The antisynthetase (AS) syndrome is characterized by autoimmune myopathy, interstitial lung disease, cutaneous involvement, arthritis, fever, and antibody specificity. We describe 2 patients with AS syndrome who also developed myocarditis, depressed biventricular function, and congestive heart failure. METHODS AND RESULTS Both patients were diagnosed with AS syndrome based on clinical manifestations, detection of serum AS antibodies, and myositis confirmation with the use of skeletal muscle magnetic resonance imaging and skeletal muscle biopsy. In addition, myocarditis resulting in heart failure was confirmed with the use of cardiac magnetic resonance imaging and from endomyocardial biopsy findings. After treatment for presumed AS syndrome-associated myocarditis, one patient recovered and the other patient died. CONCLUSIONS AS syndrome is a rare entity with morbidity and mortality typically attributed to myositis and lung involvement. This is the first report of AS syndrome-associated myocarditis leading to congestive heart failure in 2 patients. Given the potentially fatal consequences, myocarditis should be considered in patients with AS syndrome presenting with heart failure.

Graduate Medical Education in the Freddie Gray Era

In the wake of the death of Freddie Gray and the protests over unjust treatment of black Americans, the internal medicine residency program at Johns Hopkins launched a curriculum aiming to provide tools for improving population health and reducing health disparities.

Laughter‐Induced Left Bundle Branch Block

Laughter‐Induced LBBB.  We present the case of a patient with ischemic heart disease and intermittent left bundle branch block, reproducibly induced by laughter. Following treatment of ischemia with successful deployment of a drug‐eluting stent, no further episodes of inducible LBBB were seen. Transient ischemia, exacerbated by elevated intrathoracic pressure during laughter, may have contributed to onset of this phenomenon. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1136‐1138, October 2012)

An unusual case of infective endocarditis involving a right coronary artery to superior vena cava fistula.

Coronary artery fistulas (CAFs) are rare and mostly congenital anomalous connections between a coronary artery and a cardiac chamber or great vessel. Most CAFs are small, asymptomatic, and found incidentally during cardiac imaging. However, they can lead to serious complications including myocardial infarction, congestive heart failure, arrhythmias, or fistula rupture. CAFs have been associated with infective endocarditis, but to our knowledge, this complication has never been reported involving an isolated CAF to an otherwise anatomically normal great vessel. We report the first case of this complication in a 49‐year‐old man with a presumed streptococcus vegetation found within an isolated large, tortuous CAF connecting the right coronary artery to the superior vena cava. After completing antibiotic treatment, transcatheter closure of the CAF was performed. Since then, the patient has remained symptom‐free. This case demonstrates that CAF closure is feasible following CAF‐associated endocarditis, and that closure may represent a viable strategy for reducing risk of recurrent infection.

Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit

Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine. Additionally, we outline the use of opioids and their role in potentiating other sedatives. We note that some sedatives are associated with increased delirium rates, and emphasize that judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality. We also discuss standardized sedation assessment scales and highlight the importance of sedation weaning. Finally, we offer recommendations for sedation use during therapeutic hypothermia, and discuss the use of adjuvant neuromuscular blocking agents.

A Novel Case of Transient Right Ventricular Failure in a Patient With Respiratory Distress

Right ventricular (RV) failure is characterized by an inability to pump blood into the pulmonary circulation and can often lead to hemodynamic instability. Common causes of RV failure include left ventricular (LV) failure, RV infarction, sepsis, cor pulmonale due to acute respiratory distress syndrome, pulmonary emboli, or pulmonary hypertension. We report the case of a 61-year-old woman with no significant pulmonary or cardiac disease who presented with hypoxic respiratory failure in the setting of opioid overdose. She remained obtunded despite naloxone treatment and required endotracheal intubation as well as norepinephrine therapy for persistent hypotension. A transthoracic echocardiogram demonstrated isolated severe RV dysfunction without any LV abnormalities. Cardiac catheterization showed no obstructive coronary artery disease, pulmonary hypertension, or elevated left atrial pressures, and chest imaging only revealed signs of aspiration. Over the next 6 days, the patient’s cardiac and respiratory function improved, and a repeat echocardiogram demonstrated complete normalization of RV function. This case demonstrates a novel finding that marked, but transient, RV dysfunction can occur in the setting of acute respiratory failure.

Atrial flutter associated with carboplatin administration.

Objective: To report a novel case of atrial flutter associated with carboplatin administration and review chemotherapy-related cardiac toxicities, focusing on platinum-containing compounds. Case Report: A 69-year-old man with extensive small cell lung cancer and asymptomatic cardiovascular and cerebrovascular disease was inconsistently adherent to his medication regimen. While undergoing carboplatin infusion, he developed atrial flutter. He had no other immediate arrhythmogenic causes of atrial flutter and the arrhythmia spontaneously reverted to sinus rhythm after 24 hours. His condition remained stable until he died 8 days later. The cause of death was unknown and the family declined postmortem examination. Discussion: Although this patients cardiac history and nonadherence to his medications may have increased his susceptibility to develop atrial arrhythmias, the Naranjo probability scale reveals a possible relationship between atrial flutter and Infusion of carboplatin. A literature search revealed other adverse cardiac events due to platinum compounds; however, to our knowledge, this case is the first to describe an association with atrial flutter. A definitive causal link cannot be determined, but this may have been the result of a direct arrhythmogenic effect of treatment or to a novel hypersensitivity reaction. Given the potential deleterious impact of drug-induced arrhythmias, we have reported this case to the Food and Drug Administration as a new adverse effect of carboplatin. Conclusions: Providers should consider cardiac monitoring during carboplatin infusion in patients with known cardiac disease or at high risk of cardiac complications.

Cardiologist perceptions of family-centred rounds in cardiovascular clinical care

Objective Few data exist regarding physician attitudes and implementation of family-centred rounds (FCR) in cardiovascular care. This study aimed to assess knowledge and attitudes among cardiologists and cardiology fellows regarding barriers and benefits of FCRs. Methods An electronic, web-based questionnaire was nationally distributed to cardiology fellows and attending cardiologists. Results In total, 118 subjects were surveyed, comprising cardiologists (n=64, 54%) and cardiology fellows (n=54, 46%). Overall, 61% of providers reported participating in FCRs and 64% felt family participation on rounds benefits the patient. Both fellows and cardiologists agreed that family rounds eased family anxiety (fellows, 63%; cardiologists, 56%; p=0.53), improved communication between the medical team and the patient and family (fellows, 78%; cardiologists, 61%; p=0.18) and improved patient safety (fellows, 59%; cardiologists, 47%; p=0.43). Attitudes regarding enhancement of trainee education were similar (fellows, 69%; cardiologists, 55%; p=0.19). Fellows and cardiologists felt that family increased the duration of rounds (fellows, 78%; cardiologists, 80%; p=0.18) and led to less efficient rounds (fellows, 54%; cardiologists, 58%; p=0.27). Conclusion The majority of cardiologists and fellows believed that FCRs benefited families, communication and patient safety, but led to reduced efficiency and longer duration of rounds.