Clinical Instructor, Pediatrics
Board Certification: American Board of Pediatrics, Pediatrics (2022)
Residency: Stanford University Pediatric Residency at Lucile Packard Children's Hospital (2022) CA
Medical Education: Stanford University School of Medicine (2019) CA
Fat Embolism Syndrome After Knee Arthroscopy in a Pediatric Patient.
2023; 163 (3): e107-e110
Fat embolism syndrome describes a constellation of symptoms that follow an insult and that results in a triad of respiratory distress, neurologic symptoms, and petechia. The antecedent insult usually entails trauma or orthopedic procedure, most frequently involving long bone (especially the femur) and pelvic fractures. The underlying mechanism of injury remains unknown but entails biphasic vascular injury with vascular obstruction from fat emboli followed by an inflammatory response. We present an unusual case of a pediatric patient with acute onset of altered mental status, respiratory distress, hypoxemia, and subsequent retinal vascular occlusions after knee arthroscopy and lysis of adhesions. Diagnostic findings most supportive of the fat embolism syndrome included anemia, thrombocytopenia, pulmonary parenchymal, and cerebral pathologic findings on imaging studies. This case highlights the importance of fat embolism syndrome as a diagnostic consideration after an orthopedic procedure, even absent major trauma or long bone fracture.
View details for DOI 10.1016/j.chest.2022.10.018
View details for PubMedID 36894263
Breakthrough Trichosporon asahii in a Patient With New Diagnosis B-ALL on Echinocandin Prophylaxis: A Case Report.
Journal of pediatric hematology/oncology
2022; 44 (2): e514-e517
Invasive fungal disease is a difficult to diagnose complication of therapy in patients with hematologic malignancy. Antifungal prophylaxis is recommended in high-risk populations, but its use in other populations is less clear. This brief report describes a patient with Trisomy 21 on caspofungin prophylaxis who died of disseminated Trichosporon asahii during induction therapy for new diagnosis low-risk B-cell acute lymphoblastic leukemia, accompanied by a review of similar cases in the literature. Her case highlights the utility of relatively novel diagnostic modalities and reinforces the need for caution in placing patients on antifungal prophylaxis.
View details for DOI 10.1097/MPH.0000000000002339
View details for PubMedID 35200226
Patient mistreatment of health care professionals.
BMC medical education
2022; 22 (1): 133
BACKGROUND: Mistreatment of health care professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare health care professionals for mistreatment by patients.METHODS: Lessons learned from 15 interviews and 2 focus groups with health care professionals were distilled into a multi-modal curriculum including didactics, simulation videos and role-play scenarios aimed to improve confidence in addressing mistreatment. This curriculum was disseminated at five educational workshops to health care professionals of various training groups and experience levels. Pre- and post-surveys were distributed to assess changes in participant's perspectives on readiness to address mistreatment. The signed-rank test was implemented to compare pre- and post- data.RESULTS: Participants were more likely to agree post-workshop that they had the right words to say, had a plan for what to do, and were more willing to speak up when they themselves or someone else was mistreated (p<.001). They were also more likely to agree post-workshop that there was something they could do to address patient mistreatment (p<.001).CONCLUSIONS: Participant familiarity and confidence in responding to patient mistreatment increased. Our curriculum may serve as a foundation for institutions seeking to equip their educators, health care professionals, and trainees with strategies for addressing this important issue.
View details for DOI 10.1186/s12909-022-03198-w
View details for PubMedID 35227253
- The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents ACADEMIC PEDIATRICS 2019; 19 (5): 555–60
The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents.
OBJECTIVE: The ACGME calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at three institutions.METHODS: Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants (RAs) administered the CAT to eligible patients/families in pediatric ward, intensive care (ICU), and outpatient settings from July-October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a five-point Likert scale.RESULTS: 860/1413 (61%) patients completed the CAT. Completion rates in the pediatric ward and ICU settings were 45% and 38% respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. 93.4% of patients were satisfied or very satisfied with using the CAT. 6.36 hours of RA time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting.CONCLUSIONS: While collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher-yield than the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.
View details for PubMedID 30576788
THE EFFECT OF FACULTY COACHING ON RESIDENT ATTITUDES, CONFIDENCE, AND PATIENT-RATED COMMUNICATION: A MULTI-INSTITUTION STUDY.
OBJECTIVE: Despite a national focus on physician-patient communication, there is a paucity of literature on how patient and family feedback (PFF) can be used as a tool to help residents learn communication skills. The purpose of this study was to assess the effect of coaching on residents' attitudes towards PFF, self-confidence in communication, and patient-rated communication skills.METHODS: This was an IRB-approved, randomized-controlled trial with pediatric residents at three institutions in 2015-2016. Pre- and post-intervention, residents completed a self-assessment of their attitudes and self-confidence in communication. PFF was collected for each resident using the Communication Assessment Tool (CAT), which has been validated in other medical disciplines. Intervention group residents reviewed their baseline PFF with a faculty coach; control group residents reviewed their PFF independently.RESULTS: 114 residents completed the study, 57 in each arm. Intervention group residents were significantly more likely to ask for PFF compared with control group residents (mean change 0.36 vs. -0.11, p=.01). There were no other significant differences in resident attitudes, confidence, or patient-rated communication between groups. Both groups had increased self-confidence over time and with increasing PGY level. Patient ratings of resident communication did not differ over time or between groups.CONCLUSIONS: Residents who reviewed PFF with a faculty coach were significantly more likely to report they would ask patients for feedback than residents who reviewed PFF independently, suggesting review of feedback with a coach may enhance appreciation of patient feedback. Though self-confidence improved over time in both groups, patient ratings of resident communication skills were not significantly different over time or between groups.
View details for DOI 10.1016/j.acap.2018.10.004
View details for PubMedID 30368034