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Ophthalmic disease encountered in the intensive care unit (ICU) has a wide spectrum of prevalence and severity. Prolonged exposure of the cornea is common and preventable. Trauma, glaucoma, infection, vascular disease, and burns are among the potential causes of vision loss. Patients are predisposed to ocular complications by the ICU environment and critical illness itself. Critically ill patients require prioritization of life-sustaining interventions, and less emphasis is placed on ophthalmic disease, leading to missed opportunities for vision-saving intervention. It is therefore imperative for intensivists, nurses, and other providers to have an increased awareness and understanding of the broad range of ocular conditions potentially seen in the ICU.

Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.

Measles, also known as rubeola, is a disease caused by the measles virus. Before routine measles vaccination began in 1963, nearly everyone got infected with measles during childhood. Once the measles vaccine became widespread, the number of measles cases dropped to fewer than 150 cases per year from 2001 to 2010. Since 2012, however, the number of U.S. as well as worldwide measles cases has increased dramatically. This is a major public health concern because of how easily the virus spreads and how serious the infection can be.

Few data have been published regarding scoring tools for selection of postgraduate medical trainee candidates that have wide applicability. The authors present a novel scoring tool developed to assist postgraduate programs in generating an institution-specific rank list derived from selected elements of the U.S. Electronic Residency Application System (ERAS) application. The authors developed and validated an ERAS and interview day scoring tool at five pulmonary and critical care fellowship programs: the ERAS Application Scoring Tool-Interview Scoring Tool. This scoring tool was then tested for intrarater correlation versus subjective rankings of ERAS applications. The process for development of the tool was performed at four other institutions, and it was performed alongside and compared with the \"traditional\" ranking methods at the five programs and compared with the submitted National Residency Match Program rank list. The ERAS Application Scoring Tool correlated highly with subjective faculty rankings at the primary institution (average Spearman's r = 0.77). The ERAS Application Scoring Tool-Interview Scoring Tool method correlated well with traditional ranking methodology at all five institutions (Spearman's r = 0.54, 0.65, 0.72, 0.77, and 0.84). This study validates a process for selecting and weighting components of the ERAS application and interview day to create a customizable, institution-specific tool for ranking candidates to postgraduate medical education programs. This scoring system can be used in future studies to compare the outcomes of fellowship training.

Objective: We tested a novel, web-based teaching electronic medical record to teach and assess residents' ability to enter appropriate admission orders for patients admitted to the intensive care unit. The primary objective was to determine if this tool could improve the learners' ability to enter an evidence-based, comprehensive initial care plan for critically ill patients. Methods: The authors created three modules using de-identifed real patient data from selected patients that were admitted to the intensive care unit. All senior residents (113 total) were invited to participate in a dedicated two-hour educational session to complete the modules. Learner performance was graded against gold standard admission order sets created by study investigators based on the latest evidence-based medicine and guidelines. Results: The session was attended by 39 residents (34.5% of invitees). There was an average improvement of at least 20% in users' scores across the three modules (Module 3-Module 1 mean difference 22.5%; p = 0.001 and Module 3-Module 2 mean difference 20.3%; p = 0.001). Diagnostic acumen improved in successive modules. Almost 90% of the residents reported the technology was an effective form of teaching and would use it autonomously if more modules were provided. Conclusions: In this pilot project, using a novel educational tool, users' patient care performance scores improved with a high level of user satisfaction. These results identify a realistic and well-received way to supplement residents' training and assessment on core clinical care and patient management in the face of duty hour restrictions.

Dust storm exposure may cause or worsen: * Coughing and wheezing * Lower respiratory tract infections (viral, bacterial and fungal including coccidioidomycosis) * Obstructive airway diseases (asthma, bronchitis, COPD) * Lung fibrosis (sand and dust storm-associated silicosis) * Interstitial lung disease * Cardiovascular diseases What is a sandstorm and what are the symptoms following exposure? A sandstorm is created when strong wind lifts sand particles (60 microns or greater) from the ground into the air. [...]upper airway and mucus membrane irritation is the most common health effect. References and Additional Resources: Global Assessment of Sand and Dust Storms * https://library.wmo.int/doc_num.php?explnum_id=3083 National Weather Service * https://www.weather.gov American Lung Association Particle Pollution * http://www.lung.org/our-initiatives/healthy-air/outdoor/airpollution/particle-pollution.html AirNow * https://airnow.gov/index.cfm?action=airnow.main Centers for Disease Control and Prevention Climate Effects on Health * https://www.cdc.gov/climateandhealth/effects/default. htm#factsheets Respirator Fit Testing * Fit testing facts https://www.cdc.gov/niosh/docs/2018-129/ pdfs/2018-129.pdf?id=10.26616/NIOSHPUB2018129 * Fit testing video https://www.osha.gov/video/respiratory_ protection/fittesting.html * Cherrie JW et al.

It is important for attending physicians to know which behaviors influence learner perceptions. To date, two studies focusing on general medicine attending physicians have been published addressing internal medicine residents' perceptions of attending physicians; there are no data on intensive care unit (ICU) attending physicians. We sought to expand the evidence regarding this topic through a multicenter study at four geographically diverse academic medical centers. Our study focused on identifying the teaching behaviors of ICU physicians that learners observe in attending physicians who they value as effective educators. The study was conducted at Indiana University (Indianapolis, IN), Johns Hopkins University (Baltimore, MD), University of California-San Francisco (San Francisco, CA), and University of Washington (Seattle, WA). Internal medicine residents completed an anonymous online survey rating the importance of behaviors of ICU attending physician role models. We created a 37-item questionnaire derived from prior studies and from the Clinician Teaching Program from the Stanford Faculty Development Center for Medical Teachers. This questionnaire included behaviors, current and past, that residents observed in their ICU attending physicians. A total of 260 of 605 residents responded to the survey (overall response rate of 43%). The five behaviors of attending physicians most commonly rated as \"very important\" to residents were: (1) enjoyment of teaching; (2) demonstrating empathy and compassion to patients and families; (3) ability to explain clinical reasoning and differential diagnoses; (4) treating nonphysician staff members respectfully; and (5) enthusiasm on rounds. Behaviors that trainees rated as less important were having numerous research publications, having served as chief resident, sharing personal life with residents, and organizing end-of-rotation social events. Our study provides new information to attending physicians striving to influence resident education. Although prior data demonstrated that learners valued attending physicians having served as chief resident and sharing personal information with learners, our study did not replicate this. We confirmed that learners appreciated teachers who are perceived to enjoy teaching. We discovered that behaviors, such as expression of empathy, explanation of clinical reasoning, and qualities of professionalism, were commonly seen in esteemed teaching attending physicians. Our study was limited by lack of correlation to objective performance metrics and a low response rate. Future work may include assessing the impact of faculty development on identified behaviors.