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Measurement of Cardiac Output by Point-of-Care Transthoracic Echocardiography

Talan, Jordan W; Mangalick, Keshav; Pradhan, Deepak; Sauthoff, Harald
Traditionally measured with invasive methods or specialized equipment, stroke volume and cardiac output can be determined reliably with transthoracic echocardiography. This video guides the viewer in a step-by-step fashion through the technical aspects of Doppler echocardiographic assessment of cardiac output.
PMCID:9885988
PMID: 36726703
ISSN: 2690-7097
CID: 5599392

Mistaken Identity: Frequency and Effects of Gender-Based Professional Misidentification of Resident Physicians

Berwick, Shana; Calev, Hila; Matthews, Andrew; Mukhopadhyay, Amrita; Poole, Brian; Talan, Jordan; Hayes, Margaret M; Smith, C Christopher
PURPOSE:Evaluation of the medical profession at all levels has exposed episodes of gender-based role misidentification whereby women physicians are disproportionately misidentified as nonphysicians. The authors of this study investigate this phenomenon and its repercussions, quantifying the frequency with which resident physicians experience role misidentification and the effect this has on their experience and behavior. METHOD:In 2018, the authors conducted a cross-sectional survey study of internal medicine, surgical, and emergency medicine residents at a single, large, urban, tertiary academic medical center. The survey tool captured both the self-reported frequency and effect of professional misidentification. The authors used a t test and linear multivariate regression to analyze the results. RESULTS:Of the 260 residents who received the survey, 186 (72%) responded, and the authors analyzed the responses of 182. All 85 of the women respondents (100%) reported being misidentified as nonphysicians at least once in their professional experience by patients or staff members, compared with 49% of the 97 men respondents. Of those 182 residents, 35% of women were misidentified more than 8 times per month by patients compared with 1% of men. Of the 85 women physicians responding to the survey, 38% felt angry and 36% felt less satisfied with their jobs as a result of misidentification compared with, respectively, 7% and 9% of men. In response to role misidentification, 51% of women changed their manner of attire and 81% changed their manner of introduction, compared with, respectively, 7% and 37% of men. CONCLUSIONS:These survey results demonstrate that women physicians are more likely than men physicians to be misidentified as nonphysicians and that role misidentification provokes gender-polarized psychological and behavioral responses that have potentially important professional ramifications.
PMID: 33735130
ISSN: 1938-808x
CID: 5262792

Communication Training in Adult and Pediatric Critical Care Medicine. A Systematic Review

Mendez, Michael P; Patel, Harin; Talan, Jordan; Doering, Michelle; Chiarchiaro, Jared; Sternschein, Rebecca M; Steinbach, Trevor C; O'Toole, Jacqueline; Sankari, Abdulghani; McCallister, Jennifer W; Lee, May M; Carlos, W Graham; Lyons, Patrick G
PMCID:8043309
PMID: 33870298
ISSN: 2690-7097
CID: 5262802

Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison

Roguski, Marie; Morel, Brent; Sweeney, Megan; Talan, Jordan; Rideout, Leslie; Riesenburger, Ron I; Madan, Neel; Hwang, Steven
OBJECT/OBJECTIVE:Traumatic head injury (THI) is a highly prevalent condition in the United States, and concern regarding excess radiation-related cancer mortality has placed focus on limiting the use of CT in the evaluation of pediatric patients with THI. Given the success of rapid-acquisition MRI in the evaluation of ventriculoperitoneal shunt malfunction in pediatric patient populations, this study sought to evaluate the sensitivity of MRI in the setting of acute THI. METHODS:Medical records of 574 pediatric admissions for THI to a Level 1 trauma center over a 10-year period were retrospectively reviewed to identify patients who underwent both CT and MRI examinations of the head within a 5-day period. Thirty-five patients were found, and diagnostic images were available for 30 patients. De-identified images were reviewed by a neuroradiologist for presence of any injury, intracranial hemorrhage, diffuse axonal injury (DAI), and skull fracture. Radiology reports were used to calculate interrater reliability scores. Baseline demographics and concordance analysis was performed with Stata version 13. RESULTS:The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). CONCLUSIONS:MRI may be as sensitive as CT scanning in the detection of THI, DAI, and intracranial hemorrhage, but missed skull fractures in 5 of 13 patients. MRI may be a useful alternative to CT scanning in select stable patients with mild THI who warrant neuroimaging by clinical decision rules.
PMID: 25700122
ISSN: 1933-0715
CID: 5262782

Spontaneous atraumatic vertebral artery occlusion due to physiological cervical extension: case report [Case Report]

Safain, Mina G; Talan, Jordan; Malek, Adel M; Hwang, Steven W
Vertebral artery (VA) occlusion is a serious and potentially life-threatening occurrence. Bow hunter's syndrome, a mechanical occlusion of the VA due to physiological head rotation, has been well described in the medical literature. However, mechanical VA compression due to routine flexion or extension of the neck has not been previously reported. The authors present the unique case of a woman without any history of trauma who had multiple posterior fossa strokes and was found to have dynamic occlusion of her right VA visualized via cerebral angiogram upon extension of her neck. This occlusion was attributed to instability at the occipitocervical junction in a patient with a previously unknown congenital fusion of both the occiput to C-1 and C-2 to C-3. An occiput to C-3 fusion was performed to stabilize her cervical spine and minimize the dynamic vascular compression. A postoperative angiogram showed no evidence of restricted flow with flexion or extension of the neck. This case emphasizes the importance of considering symptoms of vertebrobasilar insufficiency as a result of physiological head movement. The authors also review the literature on VA compression resulting from physiological head movement as well as strategies for clinical diagnosis and treatment.
PMID: 24438424
ISSN: 1547-5646
CID: 5262772