The world is facing the extensive spread of severe acute respiratory syndrome-coronavirus 2. This epidemic puts intensive pressure on healthcare, economic, and social structures. Commitment to implementing effective approaches for public health will take bold interventions by public health professionals and strong leadership by the nation's governing bodies. During this crisis, lack of awareness, knowledge, and preparedness would put people and health care staff at risk. The dilemma is how to pass the knowledge of current disease statistics and its prevention to the general population at a rate equivalent to or better than the spreading epidemic. At the same time, a huge amount of health-threatening misinformation is spreading at a faster rate than the disease itself. The major proportion of this false rumor is disseminated in the web-2 era through social media. Thus, delivering fast, accurate and reliable information addressing critical problems of infection control is, therefore, of key importance. This review outlines both the positive and negative impact of social media during coronavirus epidemic on health-care professionals and on the general population. However, if used wisely and prudently, social media serves as a powerful tool for changing people's behavior and to promote the well-being of individual and public health. The following core competencies are addressed in this article: Medical knowledge, Interpersonal and communication skills, Practice-based learning.

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Descriptive statistics are used to summarize data in an organized manner by describing the relationship between variables in a sample or population. Calculating descriptive statistics represents a vital first step when conducting research and should always occur before making inferential statistical comparisons. Descriptive statistics include types of variables (nominal, ordinal, interval, and ratio) as well as measures of frequency, central tendency, dispersion/variation, and position. Since descriptive statistics condense data into a simpler summary, they enable health-care decision-makers to assess specific populations in a more manageable form. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

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As a key component of scientific research, hypothesis testing incorporates a null hypothesis (H₀) of no difference in a larger population and an alternative hypothesis (H₁or H_A) that becomes true when the null hypothesis is shown to be false. Two potential types of statistical error are Type I error (α, or level of significance), when one falsely rejects a null hypothesis that is true, and Type II error (β), when one fails to reject a null hypothesis that is false. To reduce Type I error, one should decrease the pre-determined level of statistical significance. To decrease Type II error, one should increase the sample size in order to detect an effect size of interest with adequate statistical power. Reducing Type I error tends to increase Type II error, and vice versa. Type III error, although rare, occurs when one correctly rejects the null hypothesis of no difference, but does so for the wrong reason. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

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As tattoos become more common, it is likely that practitioners will encounter adverse tattoo reactions with increasing frequency. While some tattoo-related complications (TRCs) may be nonspecific and challenging to diagnose, others present overtly and can be identified quickly by a well-informed practitioner. TRCs occur at both of these extremes, highlighting the need for better awareness and knowledge sharing regarding this heterogeneous group of morbidities. This review is a result of a compilation of the best available clinical evidence across various groupings of TRCs. The authors' intent was to provide the reader with a comprehensive overview of the topic while creating a rich repository of referenced knowledge for future investigations. From the standpoint of frontline health-care providers, effective recognition and management of TRCs require an open-mind, high degree of clinical suspicion, and nonjudgmental approach to a mainstream phenomenon that is still considered by many to be a taboo. The following core competencies are addressed in this article: Medical knowledge, Patient care, and Systems-based practice.

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A 58-year-old female presented with leg paresthesia and rash. On presentation, the rash was most consistent with cellulitis and cephalexin was started. The next day vesicles appeared which were presumed to be shingles and acyclovir was started. They evolved into a fully necrotic lesion on day 4 and had the classic presentation of a brown recluse spider bite. Bite marks were missed at presentation. Brown recluse spider bites are commonly misdiagnosed 80% of the time. Brown recluse venom contains a variety of toxins which can lead to skin necrosis (37% of patients) that occurs via an unknown mechanism dependent on host neutrophils. Skin changes progress over 12–36 h and necrosis develops within several days. Treatment recommendations call for exclusion of other diagnoses and conservative management with local wound care, tetanus prophylaxis, and debridement. Other forms of treatment should be avoided. Our patient was treated with a skin graft with good results. The following core competencies are addressed in this article: Patient care and medical knowledge.

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Low serum potassium has been linked to classic signs and symptoms including mental status changes, muscular dysfunction and paralysis, and cardiac arrhythmias. Frequently, it has been listed as a cause for paralytic ileus, and correcting electrolyte anomalies is one of the first steps in treatment of a patient with nonfunctioning bowels. However, our review of the literature does not support a clear causative link. Older studies cite potassium as one of the many factors to optimize to regain bowl function, while newer studies do not support hypokalemia as a cause of ileus. Current treatment of ileus supports focusing on reversal of the effect of opiates on the gut, while electrolyte therapeutic goals are directed to prevent complications outside of the gastrointestinal (GI) tract. We review the cellular physiology and clinical data to elucidate the nature of the link between low potassium values and its impact on GI motility. Patients: Patients with hypokalemia and ileus. Intervention: Potassium repletion. Comparison: Patients with normal potassium values. Outcomes: Resolution of ileus. Population, intervention, comparator, and outcomes questions: Does low serum potassium cause intestinal ileus, and will correction of this deficit correct the intestinal paralysis?. The following core competencies are addressed in this article: Practice-based learning and improvement of medical knowledge. This article addresses the evidence linking hypokalemia and ileus to improve medical knowledge and enable physicians to put this evidence into practice.

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We report a 68-year-old female who presented to the cardiology clinic with ventricular tachycardia and specific finger nail abnormalities including proximal capillary loops and proximal and periungual erythema. The patient had multiple underlying connective tissue disorders and pulmonary fibrosis. Finger nail changes are highly specific and are an indication for all healthcare providers that connective tissue diseases (CTDs) are likely underlying. We review the clinical signs and symptoms, review diagnostic criteria, and further testing to evaluate for CTDs. The following core competencies are addressed in this article: Patient care, Medical knowledge.

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The authors describe a case of a middle-aged male with ruptured Achilles tendon sustained while jumping. Bedside ultrasound was instrumental in making the diagnosis. The following core competencies are addressed in this article: Medical knowledge, Patient care. Reprinted with permission from: Peck J, Gustafson KE, Bahner DP. Bedside sonography primer: diagnosis of Achilles tendon rupture with ultrasound in the emergency department. OPUS 12 Scientist 2011;5(2):17-18.

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Background: It has been shown that music has effect on intellectual functions, behavioral aspects, and emotional aspects of students. The present study explores the role of music on these aspects of nursing students. The purpose of this study is to observe the effect of music listening on academic performance. Materials and Methods: Data were collected using a questionnaire. Sociodemographic data, study habits, home-related aspects, teacher-related aspects, and academic performance rating scale was used to analyze the academic performance of the students. Instrumental flute and violin music called Raag Shivaranjani and Raag Mohana were administered to the experimental group using a comfortable head set; it took 10 min for each sample. Music therapy was withheld from the control group. Posttest was conducted on 30^th day in both intervention and control group with the same tool to assess the effectiveness of music therapy. Results: Of the 191 participants, intervention arm in the music therapy group (91 nursing students) and in the control group (100 nursing students), the positive findings obtained were that listening to music during studying had positive effects on the concentration of students and improved the academic performance. In the posttest academic performance rating to assess the effectiveness of music therapy, “estimate the percentage of written Nursing Foundation (care plan and case study) work completed (regardless of accuracy) relative to classmates” and “estimate the accuracy completed written nursing foundation (care plan and case study) work (i.e., percent correct of work done)” there were statistically significant changes in academic performances on exposure to music therapy. Conclusions: The current study suggests that a sub-group of students can get benefitted when the music is used as an intervention to improve academic performance. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Interpersonal and communication skills.

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Maggot debridement therapy (MDT) has a long and well-documented history. Once a popular wound care treatment, especially prior to the discovery of antibiotics, modern dressings or debridement techniques, MDT fell out of favor after the 1940s. With the increasing prevalence of chronic medical conditions and associated complex and difficult-to-treat wounds, new approaches have become necessary to address emerging issues such as antibiotic resistance, bacterial biofilm persistence and the high cost of advanced wound therapies. The constant search for a dressing and/or medical device that will control pain, remove bacteria/biofilm, and selectively debride necrotic wound material, all while promoting the growth of healthy new tissue, remains elusive. On review of the current literature, MDT comes very close to addressing all of the previously mentioned factors, while at the same time remaining cost-effective. Complications of MDT are rare and side effects are minimal. If patients and providers can look past the obvious anxiety associated with the management and presence of larvae, they will quickly see the benefits of this underutilized modality for healing multiple types of wounds. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

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Retained surgical items (RSIs) are much dreaded, preventable complications associated with surgical and other invasive procedures. Despite much effort going into eliminating these “never events” and the associated heavy burden for patients, providers, and institutions, RSIs continue to occur. This manuscript reviews fundamental concepts related to RSI, including risk factors, prevention strategies, technology-assisted detection, team strategies, and pertinent safety education. In addition, we performed a secondary review of a database of all published case reports and series of RSI between 1909 and 2015, focusing on clinical presentation, symptomatology, morbidity, diagnostic workup, pathology findings, and temporal characteristics. Despite a vast body of knowledge regarding RSIs, more needs to be done to help further reduce and prevent these occurrences. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice based learning and improvement, Systems based practice, Professionalism, and Interpersonal skills and communication

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Background: Internationally, emergency medicine (EM) physicians are vulnerable to both physical and verbal violence. Few studies have examined or compared perceptions and the impacts of workplace violence in India and the United States (US). Objectives: To assess the perceived incidence of workplace violence and its implications on sleep, missed days of work, fear in the workplace, and overall job satisfaction. Materials and Methods: This was an anonymous, prospective, cross-sectional electronic survey of EM residents and physicians. A cohort of physicians in the US was matched to a cohort of physicians in India. Results: Overall, 286 physicians were eligible to participate, 177 responded (98 people from the US and 79 from Indian, for a 62% total response rate). In the US 100% of respondents witnessed verbal violence, whereas only 23% of verbal abuse cases were reported. In India, 89% of respondents witnessed verbal abuse, 46% of cases were reported. Respondents in the US both witnessed and experienced significantly more verbal and physical abuse (P < 0.001). Despite the differences in perceived rates of violence, there were no significant differences between country cohorts regarding the consequences of these incidents. This includes self-reported sleep, missed days of work, and fear of going to the workplace. US respondents were less satisfied with their jobs due to workplace violence as compared to their Indian colleagues (P = 0.041). Conclusion: ED workplace violence is common internationally, underreported, and results in poor job satisfaction, workplace fear, and loss of sleep. The following core competencies are addressed in this article: Patient care, Professionalism, Systems-based practice.

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It is common practice to assess the consistency of diagnostic ratings in terms of “agreement beyond chance.” The kappa coefficient is a popular index of agreement for binary and categorical ratings. This article focuses on the unweighted kappa statistic calculation by providing a stepwise approach that is supplemented with an example. The aim is that health care personnel may better understand the purpose of the kappa statistic and how to calculate it. The following core competencies are addressed in this article: Medical knowledge.

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Objective: To review emotional intelligence (EI) literature in the context of how its application can help mediate various stressors among medical students, physicians-in-training, and faculty. Also, discussed are potential barriers to why EI-based programs face challenges to full implementation in medical education. Literature Search: MEDLINE, PsychINFO, EMBASE, Google Scholar, and Web of Science were searched for English language articles using various combinations of the following terms: EI, medical students, medical education, graduate medical education, trainees (including intern, resident, and residency), practitioners, and physicians. Electronic publications and printed books referenced by primary sources were also included. Results: Although there is increasing evidence for EI implementation being favorably associated with physician wellness, decreasing burnout, building better physician-patient relationships, and even better patient outcomes, there has so far not been a large scale movement to integrate EI into medical school curricula. The main barriers to wider implementation of EI are general lack of awareness, insufficient time and resources, and paucity of qualified faculty. Conclusions: Despite a number of associated potential benefits, EI has been facing various implementation hurdles in the medical education setting. Increasing awareness of EI and its benefits could help medical schools and residency programs around the globe to more actively engage in the implementation of EI training into medical school and residency curricula. We expect that such interventions would have several desirable outcomes, including improved overall physician wellness, enhanced patient experience, and perhaps even improved patient outcomes. The following core competencies are addressed in this article: Practice-based Learning and Improvement, Patient care, Professionalism, Interpersonal and communication skills, Systems-based practice.

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Gitelman syndrome (GS) is an autosomal recessive tubular disorder with an incidence of 1 in 40,000. It is characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, with secondary hyperreninemia, which can easily be managed with a potassium (K⁺) sparing diuretic if correctly recognized, and with an understanding of the pathophysiology. A 17-year-old male patient presented to the emergency department after an episode of tonic-clonic seizure activity and subsequent loss of consciousness. Diagnosis of GS was made following persistent hypokalemia despite adequate repletion and further laboratory analysis. The patient was placed on a K⁺-sparing diuretic and had no further seizure activity. This case illustrates the importance of proper clinical and diagnostic evaluation of electrolyte abnormalities in all patients, especially in younger patients in whom early diagnosis can be crucial in preventing future complications. The following core competencies are addressed in this article: Medical knowledge, Patient care.

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In healthcare research, it is common to compare two methods of measurement to determine the overall degree of agreement. The Bland–Altman (BA) plot is an alternative to traditional correlational analyses. The BA plot portrays the agreement graphically by creating statistical limits of agreement using the mean and standard deviation of the differences between two measurements. The difference (Test #1 − Test #2) is constructed on the vertical axis while the mean ([Test #1 + Test #2]/2) is depicted on the horizontal axis. Within this plot, one can detect bias between the mean differences, as well as estimate an agreement interval. If the data points are normally distributed, 95% of differences will lie between the limits, but smaller sample sizes may be unreliable for estimating larger population parameters. Although nonparametric methods can estimate limits of agreement with nonnormally distributed data, they may be less reliable than logarithmically transforming the data before creating the plot. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

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Key points: (a) Gastrointestinal fistulae (GIF) continue to be associated with high morbidity and mortality; (b) Approximately 85% to 90% of GIF result from surgical procedures; (c) Spontaneous GIF (10% to 15%) most commonly result from inflammatory bowel disease, malignancy, and infection (i.e., diverticulitis); (d) Fistula classification and natural behavior are discussed; followed by (e) Discussion of diagnostic and treatment principles, as well as special issues encountered in GIF management. The following core competencies are addressed in this article: Medical knowledge and patient care. Republished with permission from: Stawicki SP, Braslow BM. Gastrointestinal fistulae. OPUS 12 Scientist 2008;2(1):13-16.

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The ultimate goal in trauma resuscitation is to promptly identify and treat all injuries. Despite clinical and technological advances in the diagnosis and treatment of trauma patients, missed injuries continue to significantly affect modern trauma services. Delayed diagnosis and missed injuries have the potential to exacerbate the severity of the initial insult, and may result in permanent disability or even mortality. Moreover, missed injuries add significantly to the length of hospitalization and overall costs of trauma patient care. This article will discuss the common themes associated with missed injuries, and will highlight steps that practitioners can take to minimize delays in diagnosis and to reduce the number of missed injuries. This article begins with basic definitions, followed by a discussion of literature pertaining to, and factors associated with, missed injuries. We will then focus on specific mechanisms and injury patterns, as well as the corresponding injury-specific diagnostic and treatment pitfalls that have to be considered in order to avoid missed injuries. The following core competencies are addressed in this article: Interpersonal and communication skills, Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice. Republished with permission from: Stawicki SP, Lindsey DE. Trauma Corner – Missed traumatic injuries: A synopsis. OPUS 12 Scientist 2009;3(2):35-43.

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Spinal cord stimulation (SCS) relies on the ability to create an overlap of paresthesia on the painful regions. Electrode implantation has historically been performed with awake intraoperative testing to allow the patient to report on the device-induced paresthesia. More recently, the use of neuromonitoring has come into favor and can be used for SCS placement, while the patient remains fully anesthetized throughout the surgery. This is a critical evaluation of the neuromonitoring technique and protocol with an in-depth description of neuromonitoring for SCS placement using electro-myography (EMG) responses in both cervical and thoracic electrode placement. There is an explanation for the interpretation of the EMG responses, as well as case reports of two patients. Neuromonitoring is used to determine myotomal coverage, as a marker that corresponds with dermatomal coverage. This article demonstrates some of the critical steps for both the surgeon and neuromonitoring group to implement this technique, as well as the clinical results of paresthesia coverage in patients. This protocol can be utilized in implementing neuromonitoring into a practice for those implanting SCS systems. The following core competencies are addressed in this article: Medical knowledge, patient care, practice-based learning and improvement, system-based practice, interpersonal and communication skills. This article addresses the gap in knowledge base to implement an approach to improve patient care and outcome.

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Learning is a process of changing behavior of learner. Teaching–learning process lasts the entire life span of each individual. Adult education is the intentional systematic process of teaching and learning by which person who occupies adult role acquires new value, attitude, knowledge, skill, and discipline. Art and science of helping adults in learning is called andragogy. Adult learners are autonomous, self-directed, reluctant to learn new things, and they focus mainly on immediate implementation of knowledge. The theories to explain adult learning are conditioning theory, theory of connectionism, and cognitive theory. Adult learning knowledge in medical education helps to keep update for recent advances in different fields. To improve teaching–learning, the principles of adult learning should be applied like active involvement of learner by allowing debate and challenge of ideas using audience response system technique. The adult learner should always be motivated and reinforced by positive feedback. Adults are usually goal oriented; so, we should always relate learning to participant's goal. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Professionalism, Systems-based practice.

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Acute perioperative abdominal complications of ventriculoperitoneal shunt placement are generally well understood and managed by general surgeons. Delayed complications occur at nontrivial rates and can masquerade as a variety of typical diagnoses such as adhesive bowel obstruction. In some rare cases, the presentation is quite unusual with the shunt protruding from the anus or urethral meatus. Preexisting neurologic conditions often make the history and examination less reliable. Diagnostic and treatment delay can have devastating effects. The variability of these delayed presentations and problems does not allow for evaluation protocols, and the care of these patients must be individualized. General surgery principles continue to apply and, combined with a high index of suspicion, will lead the surgeon to the appropriate diagnosis and treatment options. The barrier is a failure to consider the shunt as the source of the problem when its placement was not recent. A review of the literature and presentation of an unusual case highlight several of the common delayed presentations, diagnoses, and management options. The following core competencies are addressed in this article: Patient Care, Medical Knowledge, System-based Practice.

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