Factors leading to neonatal mortality due to neonatal purpura fulminans through the lens of a child death review

A case of neonatal death due to neonatal purpura fulminans (NPF) was brought to community physicians’ notice by the auxiliary nurse midwife in her catchment area as part of the routine demographic health surveillance. The community physician then conducted the child death review in the community. The neonate was born out of consanguineous marriage (mother married to her first-degree maternal cousin) with spontaneous conception. This neonate was fourth in the birth order. The second-order and third-order births had also suffered from NPF and died. The baby was delivered in a tertiary care setting, and the paediatric surgeon planned debridement of the affected part on the third day of the birth, as per the mother. However, due to inadequate counselling regarding the procedure, mother left the hospital without seeking care against medical advice, and the child died at home.

REVIEW ARTICLE ABOUT PERINATALAND NEONATAL MANAGEMENT FOR THE PREVENTION AND CONTROL OF THE 2019 NOVEL CORONAVIRUS INFECTION

An epidemic of new coronavirus 2019 (COVID-19) has emerged in China since December 2019. WHO declared it as a pandemic on March 2020 as it has spread worldwide. Several cases among neonate were observed with rst reported 36 hours after birth. Due to the possibility of the infection and the immature immune system of the neonate there should be preventive and control measures at Neonatal Intensive Care Units. According to WHO guideline and other published articles in COVID-19 in infants and neonate a technical working group including community physician and Pediatricians has put measures for clinical management, prevention and control of COVID-19 in neonates.

Overcoming clinical trial accrual barriers at UPMC: A successful experience.

e14152 Background: UPMC Hillman Cancer Center Medical Oncology Network is one of the largest integrated community oncology network in the United States. A large gap exists between trial participation rates and the willingness of patients and physicians. There are numerous barriers to clinical trial accrual in the medical oncology community. UPMC identified and created solutions to overcome barriers, and thus dramatically increase clinical trial accrual in 2019. Methods: A physician led advisory board was created to identity problems and find solutions to increase clinical trial accrual in the community. Processes that were implemented in the community to increase physician engagement included identifying more community friendly clinical trials, highlighting high impact clinical trials, and reprioritizing available clinical trials. Also, community physician champions were selected and directly linked with the academic faculty by disease site at UPMC Hillman Cancer Center. Other marketing tools were utilized like a newly developed mobile clinical trial app, community physician dedicated clinical trial retreat, and clinical trial newsletter. High volume community sites were identified as flagship clinical trial accrual centers. Results: With the implementation of physician led initiatives, total (interventional + non interventional) clinical trial accrual increased in the UPMC medical oncology network from 216 in 2018 to 660 in 2019. In 2019 there were 631 interventional trial accruals and 363 therapeutic trial accruals. In 2018 there were only 186 interventional trial accruals and 46 therapeutic trial accruals. Conclusions: The community oncology-directed initiatives created a culture change among the community physicians. UPMC implemented new processes in the medical oncology network that significantly increased clinical trial accrual. [Table: see text]

Assessing community physician ability to identify and manage immune-mediated adverse events (imAEs) through online continuing medical education (CME).

78 Background: Immune checkpoint inhibitors (ICIs) produce a wide variety of imAEs that differ dramatically from chemotherapy adverse events. This study assessed whether online CME activities improve the knowledge, competence, and confidence of community physicians across disciplines in guideline management of imAEs in patients receiving ICI therapy. Methods: Data from a series of online, CME-certified, educational activities consisting of case-based video discussion between expert faculty were analyzed to determine the efficacy of education among oncologists and other specialists regarding imAE recognition, management, and referral. Three multiple-choice knowledge/competence questions and 1 confidence question were presented to learners before and immediately after each activity. A pre-/post-assessment study design was used. Chi-square tests assessed educational effect for each activity. The activities launched online in March 2018. Data were collected through July 15, 2018. Results: Over 18,000 community physicians completed the assessment questions and were included in the study. Results are summarized by discipline in the table. Conclusions: This study demonstrates the success of online, case-based video discussions on improving knowledge, competence, and confidence of community-based specialists related to diagnosis and management of imAEs among patients who are receiving ICI-based therapy. [Table: see text]

Knowledge and science are not enough

Knowledge and science are the basis of neurology, while competence, skills, and possession of a virtue synthetically referred to as ‘phronesis’ are also expected in clinical practice. There is an increasing awareness of the importance of ‘soft facts’, which are well-formulated in the CanMEDs and belong to the neurologist’s spectrum of abilities. This spectrum embraces several aspects of the ability to work and communicate within a team and a community. Physician advocacy for patients is implicit in many of the agendas of a practising neurologist, but is often related to individual- and patient-based (micro) aspects. Meso and macro aspects are often neglected. This disregard can be due to a lack of awareness but also to a lack of attention. Management and communication skills, compassion, sympathy, empathy, and ‘passion’ are often mentioned, and are implicitly part of successful advocacy.

The Development of Newly Recruited Clinical Teachers at a Unique Regional Medical School Campus

Background Physicians who become clinical educators need to transform their clinical knowledge to be effective teachers. The objective of this year-long qualitative study was to understand new physician preceptors’ development as clinical teachers. We explored preceptors’ and students’ insights with regard to meaningful teaching and learning interactions to provide evidence for the developmental journey. Methods Semi-structured interviews with the 9 new community hospital physicians and 37 medical students occurred at the beginning, weekly and at the end of the year. Weekly rounding observations were also completed. Interview recordings and observation notes were transcribed confidentially and analyzed using inductive thematic analysis. Results Irby’s forms of knowledge were selected as the underlying structure for presenting the results. For preceptors, the strongest areas were knowledge of medicine, patients and context. For students, knowledge of medicine was strongest. Knowledge of pedagogy and learners was an area of weakness for preceptors and more work is needed to continue their developmental growth. Conclusion This study provides evidence that new teacher-physicians experience learning processes similar to that of 3rd year students learning the clinical practice of medicine: it develops and deepens over time. New community physician preceptors require a robust, ongoing faculty development plan to enable more effective interactions for teaching and learning.

Reliability and validity of ICPC-2-R encoding by medical students

Objective: To estimate how reliably and validly can medical students encode reasons for encounter and diagnoses using the International Classification of Primary Care, revised 2nd edition (ICPC-2-R). Methods: For every encounter they supervised during an entire semester, three family and community physician teachers entered the reasons for encounter and diagnoses in free text into a form. Two of four medical students and one teacher encoded each reason for encounter or diagnosis using the ICPC-2-R. In the beginning of the study, two three-hour workshops were held, until the teachers were confident the students were ready for the encoding. After all the reasons for encounter and the diagnoses had been independently encoded, the seven encoders resolved the definitive codes by consensus. We defined reliability as agreement between students and validity as their agreement with the definitive codes, and used Gwet’s AC1 to estimate this agreement. Results: After exclusion of encounters encoded before the last workshop, the sample consisted of 149 consecutive encounters, comprising 262 reasons for encounter and 226 diagnoses. The encoding had moderate to substantial reliability (AC1, 0.805; 95% CI, 0.767–0.843) and substantial validity (AC1, 0.864; 95% CI, 0.833–0.891). Conclusion: Medical students can encode reasons for encounter and diagnoses with the ICPC-2-R if they are adequately trained.