User engagement analysis of visual vs text-based summaries of new medical research in the general medical community (Preprint)

BACKGROUND In the digital age of publication and era of social media, there is increased need for precise and concise reporting of medical manuscripts to educate students, physicians, and other health professionals. Both visual abstracts (VAs) and textual reports (TRs) have been utilized online, but there is a paucity of study about whether VAs really boost user engagement through visual representation of key study findings. Furthermore, prior studies have focused on specialty journals content as opposed to the general medical community. OBJECTIVE The current study was designed to analyze the effectiveness of standardized VAs across the general medical community. METHODS In this prospective case-control study, we used Twitter to publish 18 pairs of VAs and TRs from an open-access, physician-run medical news organization with healthcare professional readership across all medical specialties in order to investigate the effect of VAs on user engagement. Each VA/TR pair, which generally covered new research applicable to the general internist, was published on the same day, covered the same content, and had the same title on Twitter; posts for TRs had a nonspecific control image and link to a text abstract, while VA posts had a partial preview and link to the full VA. The outcomes studied were views, engagement rate, and percent change in engagement rate. RESULTS Results showed that while there was no difference in number of views on Twitter (P=.83), VAs had significantly higher engagement rates (P=.002), with an average fold change of 2.75 (95% CI 1.83 to 3.67). CONCLUSIONS Our results show that Twitter posts containing previews and links to VAs had more user engagement than posts with no visual content and links to TRs, which suggests that VAs are more effective tools for promoting engagement with medical content.

Spontaneous Tumor Lysis Syndrome in Blastoid-Variant Mantle Cell Lymphoma: Considerations for the General Internist

Spontaneous tumor lysis syndrome (SPTLS) is a rare phenomenon that can manifest in rapidly proliferating hematological malignancies and solid tumors prior to initiating cytotoxic therapy. We encountered a patient who originally presented with diffuse lymphadenopathy, abdominal distention, and dyspnea, who had laboratory abnormalities suggestive of SPTLS. His peripheral flow cytometry and lymph node biopsy revealed blastoid-variant mantle cell lymphoma. Prior to initiating chemotherapy, acute kidney injury (AKI) and uric acid had improved with intravenous fluids and the initiation of allopurinol. However, after beginning chemotherapy, the patient developed a second AKI concerning for tumor lysis syndrome (TLS). He went on to have renal recovery and did not require renal replacement therapy. With the exception of case reports, there is limited evidence to guide general medicine clinicians who encounter cases of SPTLS. Expert-based guidelines are available to guide use of rasburicase, an uricase enzyme, before initiation of chemotherapy for certain malignancies when risk for TLS is considered high. Despite these guidelines, the role of rasburicase in preventing AKI remains controversial after inconclusive results in a meta-analysis. The causative relationship between uric acid and AKI in TLS is based on a mechanism of tubular obstruction. There are also mechanisms by which uric acid may cause AKI without tubular obstruction related to acute hyperuricemic nephropathy. Further characterization of the role of uric acid in causing AKI in patients without tubular obstruction may identify new mechanisms of injury and offer insight into new treatment strategies.

The primacy of ultrasound in the assessment of muscle architecture: precision, accuracy, reliability of ultrasonography. Physiatrist, radiologist, general internist, and family practitioner's experiences

SUMMARY OBJECTIVE: With high-resolution real-time ultrasonography we investigated the muscle architectural parameters of vastus lateralis in healthy volunteers. PURPOSES: We determined the reproducibility and validity of ultrasonography and the role of the ultrasonographer in assessing muscle architecture. We proposed the most appropriate clinical parameters for objective measurements and an ultrasound protocol of muscle architecture. METHODS: We conducted an intraobserver and interobserver study. We investigated 21 healthy male volunteers. The subjects were independently evaluated by four different operators using high-resolution real-time ultrasonography. To assess the reproducibility of ultrasound examinations, four operators repeated measurements using the same ultrasound device. Muscle thickness, muscle volume, muscle fiber pennation angle, and subcutaneous adiposity of the vastus lateralis muscle were measured. RESULTS: Intra-observer (ICC 0.92-0.97), interobserver (ICC 0.78-0.92) reproducibility was good to excellent for all measurements. CONCLUSION: Simple, reproducible, non-invasive ultrasound measurements of muscle structure easily demonstrated differences in muscle morphology. With a protocol and with objective and repeatable measurements, sonographers from different backgrounds could obtain an objective measurement of ultrasound images with little differences and low variability in results, thanks to the upgrading of diagnostic ultrasound imaging and their clinical skills.

Point of Care Ultrasound for the General Internist: Pleural Effusions

Pleural effusions are a common finding in many clinical settings and have important diagnostic and therapeutic implications. They may be identified by physical exam, chest radiography, chest computerized tomography (CT) scans or point of care ultrasonography (POCUS). The use of POCUS for the diagnosis and management of pleural effusions offers several advantages relevant to the practice of the general internist. For the diagnosis of pleural effusion, POCUS has superior sensitivity and specificity when compared to chest radiography and physical exam. Abnormal sonographic features of the pleural fluid and the adjacent pleura may suggest the presence of an exudative or malignant effusion. POCUS can be used to quickly estimate the size of a pleural effusion. Lastly, the use of ultrasound guidance when performing a thoracentesis reduces the risk of pneumothorax and hemorrhage.

Feedback Credibility in a Formative Postgraduate Objective Structured Clinical Examination: Effects of Examiner Type

ABSTRACT Background Resident perspectives on feedback are key determinants of its acceptance and effectiveness, and provider credibility is a critical element in perspective formation. It is unclear what factors influence a resident's judgment of feedback credibility. Objective We examined how residents perceive the credibility of feedback providers during a formative objective structured clinical examination (OSCE) in 2 ways: (1) ratings of faculty examiners compared with standardized patient (SP) examiners, and (2) ratings of faculty examiners based on alignment of expertise and station content. Methods During a formative OSCE, internal medicine residents were randomized to receive immediate feedback from either faculty examiners or SP examiners on communication stations, and at least 1 specialty congruent and either 1 specialty incongruent or general internist faculty examiner for clinical stations. Residents rated perceived credibility of feedback providers on a 7-point scale. Results were analyzed with proportional odds models for ordinal credibility ratings. Results A total of 192 of 203 residents (95%), 72 faculty, and 10 SPs participated. For communication stations, odds of high credibility ratings were significantly lower for SP than for faculty examiners (odds ratio [OR] = 0.28, P < .001). For clinical stations, credibility odds were lower for specialty incongruent faculty (OR = 0.19, P < .001) and female faculty (OR = 0.45, P < .001). Conclusions Faculty examiners were perceived as being more credible than SP examiners, despite standardizing feedback delivery. Specialty incongruency with station content and female sex were associated with lower credibility ratings for faculty examiners.

The outpatient assessment of patients with anemia by a general internal medicine service

At the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, 2,400-2,800 new outpatient referrals for hematology consultation are received annually and approximately 10% of these referrals are specifically for isolated anemia. In recent years, such referrals have been sent from hematology to general internal medicine (GIM) for assessment and management. A retrospective chart review was conducted of a cohort of 99 patients from 2013 to describe the demographics, assessment, management and outcome of these patients, as well as to inform whether this practice should continue. The median age of patients was 60.3 years (min 19.4, max 97.6) and 62% were female. The median hemoglobin level was 109.0 g/L (min 66, max 137) at the time of referral and the median wait time was 53 days (min 8 days, max 171 days). Pearson’s correlation analysis revealed that those with lower hemoglobin levels were seen more quickly. The patients had an additional 2.8 comorbidities on average, and were significantly more likely to receive non-anemia related adjustment to care with increasing number of comorbidities. A small proportion of patients (n = 5, 5.1%) were referred from GIM back to hematology, whereas 21% were referred to gastroenterology. A small number of patients (n = 5, 5.1%) underwent a bone marrow aspirate and biopsy. The most common diagnoses identified in the initial clinic letters were iron deficiency anemia (n = 59, 59.6%) and anemia of chronic disease (n = 8, 8.1%). 26.3% did not have a diagnosis identified. These findings support our practice to have patients with an isolated anemia evaluated by a general internist rather than a hematologist. Most of these patients had iron deficiency anemia or the anemia of chronic disease and received additional care for their comorbid conditions in the GIM clinic. Further work will help to define how such patients can be most effectively assessed and treated.