A competency based development of knowledge and skills in Benign Hematology through clinical experience, bedside teaching, didactic conferences and readings to achieve competence, proficiency and the foundation for mastery.
Clinical Information and Didactics - Residents will function as integral members of the Benign Hematology Consult Service; contact the consult pager at the start of the rotation
- Residents will attend all scheduled clinics. Residents are expected at 8:30 after Morning Report/Grand Rounds. When not in clinic, residents should be available for consults.
Click here Practice Based Learning and Improvement PGY1: Incorporate regular chart review and patient follow up to learn from your clinical care. Teach and mentor students. PGY2/3: Incorporate evidence based medicine into clinical decision making. Review the latest research pertaining to your your patients. Teach and mentor students and interns. Systems Based Practice PGY1: Work in a multi-disciplinary team to provide high quality coordinated care. Ensure accurate and timely documenation through the use of the electronic medical record. PGY2/3: Use knowledge and skills in quality improvement and patient safety to deliver safe and effective care. Apply team leadership skills in appropriate settings. Practice cost effective medicine with an awareness of health care economics and patient insurance status. Interpersonal Skills and Communication PGY1: Use effective listening skills with patients and health care providers. Elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. PGY2/3: Develop interpersonal and communication skills necessary to run an effective clincal team in the ambulatory. Role model and teach effective communication techniques. Professionalism PGY1: Carry out your professional responsibilities in a timely manner. Adhere to the ethical principles of a patient-centered practice. Be sensitive to a diverse patient population and health care staff. PGY2/3: Understand how biases influence clinical care, patient-physician interactions and health team interactions. Role model and provide feedback to students and interns the principles of humanism in medicine. Patient Care and Medical Knowledge PGY1 - Understand the diagnosis and management of common hematologic disorders complicating internal medicine and surgical practice.
- Learn management of both acute and chronic coagulation problems.
- Learn the proper indications and potential complications of transfusion of RBC's, platelet and plasma products.
- Become familiar with the use of flow cytometry in hematologic diagnosis.
PGY2,3 - Evaluate and initiate management of common hematologic disorders complicating internal medicine and surgical practice.
- Evaluate and initiate management of both acute and chronic coagulation problems.
- Describe the proper indications and potential complications of transfusion of RBC's, platelet and plasma products.
- Become familiar with the use of flow cytometry in hematologic diagnosis.
Topics Anemia Acquired platelet disorders Approach to the bleeding patient Inherited disorders Acquired disorders Approach to the clotting patient/VTE (2 LECTURES) DVT/PE (Anticoagulants) Duration of treatment IVC filters Thrombophilias Transfusion medicine Antihemostatic/antithrombotic agents Antiplatelet agents Anticoagulants Thrombolytics New directions
Myeloproliferative disorders (focused)
1. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of
pulmonary embolism diagnosis (PIOPED). JAMA, May 1990; 263: 2753-2759. (Available in the journal stacks at the Galter Library) The Original PIOPED. All about VQ scans, intermediate/low probabilities, etc. In retrospect, this is probably what gave VQ scans a bad name, especially when CT came along, due to that annoying "intermediate probability" scan. 2. Stein P. D., Fowler S. E., Goodman L. R., Gottschalk A., Hales C.A., Hull R. D., Leeper K. V. Jr., Popovich J. Jr., Quinn D. A., Sos T. A., Sostman H. D., Tapson V. F., Wakefield T. W., Weg J. G., Woodard P. K., the PIOPED II Investigators. Multidetector Computed Tomography for Acute Pulmonary Embolism. N Engl J Med 2006; 354:2317-2327, Jun 1, 2006. Using CT scans to rule out PE--slightly more realistic about how good CT scans are than we are as clinicians. Not quite as grand in scale as PIOPED the first. 3. Writing Group for the Christopher Study Investigators. Effectiveness of Managing Suspected Pulmonary Embolism Using an Algorithm Combining Clinical Probability, D-Dimer Testing, and Computed Tomography. JAMA, January 11, 2006; 295: 172 - 179. One of many articles regarding clinical decision making in suspected PE. 4. Decousus H., Leizorovicz A., Parent F., Page Y., Tardy B., Girard P., Laporte S., Faivre R., Charbonnier B., Barral F.-G., Huet Y., Simonneau G., The Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis. N Engl J Med 1998; 338:409-416, Feb 12, 1998. The article that always gets cited about how IVC filters increase DVT risk, decrease PE risk, and do not change mortality. 5. Simonneau G., Sors H., Charbonnier B., Page Y., Laaban J.-P., Azarian R., Laurent M., Hirsch J.-L., Ferrari E., Bosson J.-L., Mottier D., Beau B., The Thésée Study Group. A Comparison of Low-Molecular-Weight Heparin with Unfractionated Heparin for Acute Pulmonary Embolism. N Engl J Med 1997; 337:663-669, Sep 4, 1997. One of many articles invoked to justify lovenox use in treating pts with PE so you can avoid IV UFH with the associated pain of chasing PTT and a hospital stay. 6. Wells P. S., Anderson D. R., Rodger M., Forgie M., Kearon C., Dreyer J., Kovacs G., Mitchell M., Lewandowski B., Kovacs M. J. Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis. N Engl J Med 2003; 349:1227-1235, Sep 25, 2003. Another decision-making type article that discusses how to manage DVT/PE probability via D-Dimer. 7. Adams R. J., McKie V. C., Hsu L., Files B., Vichinsky E., Pegelow C., Abboud M., Gallagher D., Kutlar A., Nichols F. T., Bonds D. R., Brambilla D., Woods G., Olivieri N., Dr iscoll C., Miller S., Wang W., Hurlett A., Scher C., Berman B., Carl E., Jones A. M., Roach E. S., Wright E., Zimmerman R. A., Waclawiw M. Prevention of a First Stroke by Transfusions in Children with Sickle Cell Anemia and Abnormal Results on Transcranial Doppler Ultrasonography. N Engl J Med 1998; 339:5-11, Jul 2, 1998. How to prevent stroke in patients with Sickle Cell Disease. 8. The Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) Trial Investigators. Discontinuing Prophylactic Transfusions Used to Prevent Stroke in Sickle Cell Disease. N Engl J Med 2005;353:2769-2778, Dec 29, 2005. It's not safe to stop exchange transfusions in patients with Sickle Cell who had abnormal TCD in the first place. 9. Mayer S. A., Brun N. C., Begtrup K., Broderick J., Davis S., Diringer M. N., Skolnick B. E., Steiner T., the Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage. N Engl J Med 2005; 352:777-785, Feb 24, 2005. Could Recombinant Factor VII be used to benefit people with ICH? 10. Lee, AY et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003 349;2:146-53 Collection by Dr. Raman Khanna For an extended list of references with direct article links, sign in to the Galter Health Library website at: http://www.galter.northwestern.edu/guides/expand/resident-reading-lists | 
