Faculty Bibliography

BACKGROUND: In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relatively few studies conducted in the outpatient setting. OBJECTIVES: To develop a structured transfer of care program in an academic outpatient continuity practice and evaluate whether this program improved patient safety as measured by the documented completion of patient care tasks at 3 months post-transition. DESIGN: Graduating residents and the corresponding incoming interns inheriting their continuity patient panels were randomized to the pilot structured transfer group or the standard transfer group. The structured transfer group residents were asked to complete written and verbal sign-outs with their interns; the standard transfer group residents continued the current standard of care. PARTICIPANTS: Thirty-two resident-intern pairs in an academic internal medicine residency program in New York City. MAIN MEASURES: Three months after the transition, study investigators evaluated whether patient care tasks assigned by the graduating residents had been successfully completed by the interns in both groups. In addition, follow-up appointments, continuity of care and house officer satisfaction with the sign-out process were evaluated. KEY RESULTS: Among patients seen during the first 3 months, the clinical care tasks were more likely to be completed by interns in the structured group (73 %, n = 49) versus the standard group (46 %, n = 28) (adjusted OR 3.21; 95 % CI 1.55-6.62; p = 0.002). This was further enhanced if the intern who saw the patient was also the assigned primary care provider (adjusted OR 4.26; 95 % CI 1.7-10.63; p = 0.002). CONCLUSIONS: A structured outpatient sign-out improved the odds of follow-up of important clinical care tasks after the year-end resident clinic transition. Further efforts should be made to improve residents' competency with regard to sign-outs in the ambulatory setting.

We report the case of a 44-year-old man presenting with abdominal pain and leukocytosis. His initial computed tomography demonstrated a pancreatic head mass concerning for pancreatic adenocarcinoma. However, on further review of the patient's imaging, the mass was determined to be an abscess caused by foreign body ingestion and gastric perforation rather than cancer. This report describes the clinical and radiographic distinctions between pancreatic neoplasia and abscess. It also reviews the pertinent medical literature on how such viscus perforations affect subsequent prognostication and clinical management.

America's medical schools have long used human cadavers to teach anatomy, but acquiring adequate numbers of bodies for dissection has always been a challenge. Physicians and medical students of the 18th and 19th centuries often resorted to robbing graves, and this history has been extensively examined. Less studied, however, is the history of body acquisition in the 20th century, and this article evaluates the factors that coalesced to transition American society from body theft to body donation. First, it describes the legislation that released the unclaimed bodies of those dying in public institutions to medical schools for dissection, thereby effectively ending grave robbery. Then it discusses midcentury journalistic exposes of excesses in the funeral industry-works that were instrumental in bringing alternatives, including the previously unpopular option of body donation, to public consciousness. Finally, it examines the rise of body transplantation, the Uniform Anatomical Gifts Act of 1968, and the subsequent state of willed-body programs at the turn of the 21st century. Body-donation programs have gradually stabilized since and currently provide most of the bodies used for dissection in American medical schools. Relying as they do on public trust, however, these programs remain potentially precarious and threatened by public scandals. Whether American medical schools will receive enough bodies to properly educate students in the future remains to be seen