Browsing by Author "Desy, Janeve"

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    A case of hypercalcemia from Pneumocystis jirovecii in an immunosuppressed non-HIV patient
    (2024-04-24) Gulhati, Vishrut; Desy, Janeve; Thornton, Christina S.
    Abstract Background The prevalence of non-HIV related Pneumocystis jirovecii pneumonia (PJP) is increasing with use of immunosuppressive therapies. There are case reports of solid organ transplant recipients on immunosuppressive therapy presenting with mild hypercalcemia, leading to a diagnosis of PJP. Recent studies have shown efficacy of PJP prophylaxis for patients treated with rituximab with a favourable adverse effect profile. Case Presentation A 78-year-old male with a history of PR3-ANCA vasculitis, chronic kidney disease and heart failure with reduced ejection fraction presented to our tertiary care hospital with a two-week history of confusion and non-productive cough. Background immunosuppression with rituximab was completed every six months. The patient was found to have hypercalcemia and new infiltrates and ground glass opacities on cross-sectional imaging. Bronchoscopy was performed that was positive for Pneumocystis jirovecii. He was treated with 21 days of trimethoprim-sulfamethoxazole and prednisone with resolution of symptoms and hypercalcemia. Conclusions Herein, we present a novel case of PJP in a non-transplant recipient preceded by hypercalcemia. Our case demonstrates the importance for a high suspicion for PJP in chronically immunosuppressed patients on rituximab presenting with PTH-independent hypercalcemia.
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    Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions
    (2020-04-19) Wong, Jonathan; Montague, Steven; Wallace, Paul; Negishi, Kay; Liteplo, Andrew; Ringrose, Jennifer; Dversdal, Renee; Buchanan, Brian; Desy, Janeve; Ma, Irene W Y
    Abstract Background Point-of-care ultrasound (POCUS) is increasingly used in internal medicine, but a lack of trained faculty continues to limit the spread of POCUS education. Using a framework based on organizational change theories, this study sought to identify barriers and enablers for hospital-based practicing internists to learn and use POCUS in clinical practice. Methods We invited practicing internists at six North American institutions to participate in an electronic survey on their opinions regarding 39 barriers and enablers. Results Of the 342 participants invited, 170 participated (response rate 49.3%). The top barriers were lack of training (79%), lack of handheld ultrasound devices (78%), lack of direct supervision (65%), lack of time to perform POCUS during rounds (65%), and lack of quality assurance processes (53%). The majority of participants (55%) disagreed or strongly disagreed with the statement “My institution provides funding for POCUS training.” In general, participants’ attitudes towards POCUS were favourable, and future career opportunities and the potential for billing were not considered significant factors by our participants in the decision to learn or use POCUS. Conclusions This survey confirms the perceived importance of POCUS to practicing internists. To assist in closing faculty development gap, interventions should address training, supervision, quality assurance processes, availability of handheld devices, as well as dedicated time to perform POCUS during clinical care.
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    Musculoskeletal Ultrasound in Canadian Rheumatology Training Programs: Towards a National Curriculum
    (2023-08-15) Powell, Maria; Ma, Irene W.Y.; McLaughlin, Kevin; Thomson, Steven; Desy, Janeve
    Introduction: In 2019 the Royal College of Physicians and Surgeons of Canada added educational experiences in MSUS to the core competencies in rheumatology as an optional training experience. Many Canadian rheumatology programs offer MSUS training for residents, but there is currently no national ultrasound curriculum in Canada outside of externally available courses. Objectives: This thesis had two objectives. Objective one was to explore how educators prioritize competencies while developing educational content for a rheumatology MSUS curriculum. Objective two was to define the expert consensus recommendations for MSUS in Canadian post-graduate rheumatology training programs. Methods: To address objective one, we invited educators with rheumatology MSUS expertise to participate in a modified nominal group technique (NGT) with a sequential mixed methods design. For objective two, we assembled a MSUS working group including educators with rheumatology MSUS expertise, rheumatology residents, and rheumatology program directors. We used a three-stage consensus design including a modified NGT, modified Delphi technique, and structured online focus group to establish consensus among the MSUS working group on MSUS competencies that should be included in a national rheumatology resident curriculum. Results: We identified seven themes that represent key elements educators consider when prioritizing competencies during the curriculum development process, which balance two key factors: clinical utility and learnability. We used these themes to develop a conceptual framework that can be used to help guide educators when curricular content must be prioritized. For the consensus recommendations, key rheumatology MSUS stakeholders agreed that it should be mandatory for all Canadian post-graduate rheumatology trainees to learn basic ultrasound skills; how to perform a focused MSUS exam of the hands, wrists, and feet for features of inflammatory arthritis; and perform a limited MSUS exam of the knee and ankle to identify a joint effusion. Conclusion: This thesis used a hybrid of consensus methods to advance MSUS education in Canadian post-graduate rheumatology training programs. We hope that this work can contribute to the goal of a national MSUS curriculum for all Canadian post-graduate rheumatology trainees.
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    The association of attentional foci and image interpretation accuracy in novices interpreting lung ultrasound images: an eye-tracking study
    (2023-09-11) Lee, Matthew; Desy, Janeve; Tonelli, Ana C.; Walsh, Michael H.; Ma, Irene W. Y.
    Abstract It is unclear, where learners focus their attention when interpreting point-of-care ultrasound (POCUS) images. This study seeks to determine the relationship between attentional foci metrics with lung ultrasound (LUS) interpretation accuracy in novice medical learners. A convenience sample of 14 medical residents with minimal LUS training viewed 8 LUS cineloops, with their eye-tracking patterns recorded. Areas of interest (AOI) for each cineloop were mapped independently by two experts, and externally validated by a third expert. Primary outcome of interest was image interpretation accuracy, presented as a percentage. Eye tracking captured 10 of 14 participants (71%) who completed the study. Participants spent a mean total of 8 min 44 s ± standard deviation (SD) 3 min 8 s on the cineloops, with 1 min 14 s ± SD 34 s spent fixated in the AOI. Mean accuracy score was 54.0% ± SD 16.8%. In regression analyses, fixation duration within AOI was positively associated with accuracy [beta-coefficients 28.9 standardized error (SE) 6.42, P = 0.002). Total time spent viewing the videos was also significantly associated with accuracy (beta-coefficient 5.08, SE 0.59, P < 0.0001). For each additional minute spent fixating within the AOI, accuracy scores increased by 28.9%. For each additional minute spent viewing the video, accuracy scores increased only by 5.1%. Interpretation accuracy is strongly associated with time spent fixating within the AOI. Image interpretation training should consider targeting AOIs.