Cognitive load is a key mediator of cognitive processing that may impact clinical reasoning performance. The purpose of this study was to gather biologic validity evidence for correlates of different types of self-reported cognitive load, and to explore the association of self-reported cognitive load and physiologic measures with clinical reasoning performance. We hypothesized that increased cognitive load would manifest evidence of elevated sympathetic tone and would be associated with lower clinical reasoning performance scores. Fifteen medical students wore Holter monitors and watched three videos depicting medical encounters before completing a post-encounter form and standard measures of cognitive load. Correlation analysis was used to investigate the relationship between cardiac measures (mean heart rate, heart rate variability and QT interval variability) and self-reported measures of cognitive load, and their association with clinical reasoning performance scores. Despite the low number of participants, strong positive correlations were found between measures of intrinsic cognitive load and heart rate variability. Performance was negatively correlated with mean heart rate, as well as single-item cognitive load measures. Our data signify a possible role for using physiologic monitoring for identifying individuals experiencing high cognitive load and those at risk for performing poorly during clinical reasoning tasks.

Pyloric gland adenoma is a rare neoplasm of the gastrointestinal tract typically observed in the stomach with a substantial malignant potential warranting its resection. While isolated esophageal pyloric gland adenoma has been reported, there is no literature on the encounter of diffuse, multifocal esophageal pyloric gland adenoma or its management. We present a unique case of multifocal pyloric gland adenoma of the esophagus treated by circumferential endoscopic submucosal dissection. We demonstrate endoscopic submucosal dissection to be a feasible management option.

No abstract

Summary Background Non‐alcoholic fatty liver (NAFL) is accounting for an increased proportion of chronic liver disease (CLD). These patients have higher risk of complications after acute hepatitis A (HAV) or hepatitis B (HBV) infections, but studies have demonstrated low immunisation rates. Aims To assess HAV and HBV vaccination rates within a free access treatment facility among those with liver biopsy‐confirmed NAFL and implement quality improvement (QI) measures. Methods About 371 pre‐QI and 212 post‐QI cohort liver biopsies were examined for quality measures (QM): (a) whether vaccination status was assessed, (b) whether subjects had immunity and (c) whether appropriate recommendation for immunisation was made. QI measures were implemented across two post‐QI plan‐do‐study‐act (PDSA) cycles including: (a) patient‐focused posters; (b) formal presentations to providers; and (c) incorporating HAV/HBV immunisation into the electronic medical record (EMR). Results For HBV vaccination, in the pre‐QI cohort, 96% met QM#1, 34% met QM#2 and 9% met QM#3. In the first post‐QI cycle, 97% met QM#1, 30% met QM#2 and 30% met QM#3. In the second post‐QI cycle, 97% met QM#1, 37% met QM#2 and 85% met QM#3. For HAV vaccination, in the pre‐QI cohort, 25% met QM#1, 20% met QM#2 and 6% met QM#3. In the first post‐QI cycle, 31% met QM#1, 25% met QM#2 and 21% met QM#3. In the second post‐QI cycle, 52% met QM#1, 42% met QM#2 and 85% met QM#3. Conclusion Patients with NAFL have low vaccination rates despite having access to free healthcare. Educating patients and both primary care and subspecialty providers on hepatitis vaccination is important and effective.