Clinical Skills Muse #19: Appendicitis and CT

Acute appendicitis represents the most common specific identifiable cause of an acute abdomen worldwide. Accurate diagnosis of acute appendicitis is often difficult clinically. Although there is some continuing controversy in the surgical and clinical literature, a consensus is emerging regarding the utility of routine CT for most, if not all, adult patients with suspected acute appendicitis. Increasing evidence suggests that even young adult men should routinely undergo CT rather than initial surgical exploration, and there is no convincing evidence-based data that the routine use of CT increases the perforation rate. CT, regardless of the protocol used, permits diagnosis or exclusion of appendicitis and alternative diagnoses accurately compared with the historical 20% negative appendectomy rate.

Furthermore, CT establishes the severity of appendicitis. The paradox is that the increased use of CT may have made accurate diagnosis more difficult in some patients, especially those in the earlier stages of appendicitis. Because patients are being scanned earlier, and because findings may therefore be more subtle or false-negative on unenhanced CT or on CT with oral/rectal contrast only, IV contrast should be considered routinely for imaging all patients with suspected appendicitis. Thin cuts, cine review of images on a monitor, and careful review of the right lower quadrant anatomy, as well as routine scanning of the entire abdomen and pelvis, should be performed in all cases. Radiologists need to appreciate the overlap of normal and abnormal appendiceal sizes, and should use all the CT findings present to make or exclude the diagnosis of appendicitis.

Click here for more information.

Maynard Luterman

PBL Muse #19: So you think you're smart

So here's this week’s question......how well does IQ equate to doing well in school?

Correlations of this magnitude tell us that IQ tests, on their best days, predict 40-50% of school achievement (Applied Psychometrics 101 – square the correlations and multiply by 100 to get the percent of variance explained). This is very good. Yet…50-60% of a person’s school achievement is still related to factors “beyond IQ!”

Today, IQ testing is one of the most common tools in the school system for assessing cognitive ability, classroom placement, need for accommodations and cognitive expectations. But good gracious, 50-60% achievement is beyond IQ! Rather than using IQ to tell us about our limitations, we should look for strengths that tell us what to build on.

What are some of the other predictors? Organization, will, desire, interest, are but a few. So while being smart is a good start its not the end all and be all.

Click here for more information.

Maynard Luterman

Clinical Skills Muse #18: Diabetes Part 2 - DKA

As an ER Doc the lowest pH I have seen in a living human was 6.83....DKA patients are quite sick when they present....today's questions are about DKA....
1) What is the incidence of DKA?
2) What is the pathophysiology of DKA?
3) What are the precipitating conditions of DKA?
4) What's the differential?

For more information, click here.

Maynard

PBL Muse #18: Concentration

Karl and I met with the students. The feedback was very positive. The students recognized everyone's keen interest in making our campus successful and they were very grateful for the interest everyone is showing. We want to express thanks to each of you who have participated thus far and who will be participating in the future. 

Today’s topic is concentration. As we all know our ability to concentrate changes from day to day. Some days it’s easier to focus than others. 

There are many reasons why your mind might wander in class or during homework. Some of the most common factors are non-medical and simple, and they can be treated by making small changes in our routines. Click here to see the article.

Bottom line....sleep, eat, exercise and share your feelings.....

Maynard 

New events in the calendar

Hi all. I've posted links in the calendar to all of the upcoming CME sessions that are happening through the NHS. These are the events organized by Rick Horne. His contact information is listed in the links to the flyers for the events.

It's clear there is a lot happening in the Region when it comes to CME!

Regarding Faculty Development, we are organizing a session for PBL tutors and clinical skills preceptors that will likely happen in May. If you belong to one of these groups, stay tuned.

The next large group faculty development session will be held on Wednesday, June 24th.

We also hope to hold several small group teaching sessions with a focus on skills development. There is a teaching series on Medical Education that is based on the successful "Problem-Based Small Group" Learning Program developed by the Foundation for Medical Practice Education. Follow the link and take a look at the available modules (we have all of them). If you or your group are interested in using any, you could let me know by e-mail. You could also express interest by commenting on this post -- there may be others who are also interested that you did not know about!