N Kevin Krane - Academia.edu (original) (raw)

Papers by N Kevin Krane

Research Square (Research Square), Aug 12, 2020

Background: The COVID-19 pandemic disrupted the United States (US) medical education system with ... more Background: The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy. Methods: The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations. Results: 741 (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted, as per national recommendations. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had signi cantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%). Conclusions: The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Once weekly subcutaneous erythropoietin is an effective maintenance therapy in the treatment of anemia of end stage renal disease in patients on CAPD

PubMed, 1991

The efficacy of once weekly subcutaneous erythropoietin (SC EPO) was evaluated by reviewing recor... more The efficacy of once weekly subcutaneous erythropoietin (SC EPO) was evaluated by reviewing records of twelve continuous ambulatory peritoneal dialysis (CAPD) patients age 27-66 years after achieving a goal hematocrit (hct) greater than 30%. Patients had a mean hct of 22.8% (range: 19.1-29.5) and were placed on a thrice weekly SC EPO dose of 4000 international units (IU) (37-74 IU/KG, [mean of 57 IU/kg]) until a goal hct greater than 30% was achieved. This hct ranged from 30.8-37% (mean 33.2%) and was achieved in a mean of 11.5 weeks (range: 4.1-29 weeks). Patients were then maintained on the same SC EPO dose given only once weekly. 11/12 (92%) patients have maintained a mean hct of 34% (range: 29-38.4%) on once weekly SC EPO over a mean period of 14 weeks (range: 1.4-36 weeks). The mean serum ferritin was 484; only two patients required parenteral iron dextran therapy. One patient did not reach the goal hct due to poor compliance. There was no significant increase in blood pressure or in serum potassium level. We conclude that SC EPO is effective in treating anemia in these patients and can be given once weekly to maintain a hct greater than 30%.

Neisseria meningitidis peritonitis in a CAPD patient: first case report and review of the literature

PubMed, 1995

Only 15 cases of any etiology of Neisseria meningitidis peritonitis have been reported in the wor... more Only 15 cases of any etiology of Neisseria meningitidis peritonitis have been reported in the world literature since the first case in 1917. We report the first case in a continuous ambulatory peritoneal dialysis (CAPD) patient presenting with abdominal pain and cloudy peritoneal dialysis fluid. A lumbar puncture was normal. The patient died despite therapy with ceftriaxone. Autopsy confirmed this was a case of primary N. meningitidis peritonitis. Of the 15 cases of N. meningitidis reported as a cause of peritonitis, 9 patients were less than age 35 with no underlying diseases. Five cases were associated with cirrhosis or alcohol abuse. Two cases were associated with meningitis, and 1 patient was on steroid therapy for systemic lupus erythematosus. Nine of 15 patients recovered. In conclusion, N. meningitidis should be considered as another rare cause of peritonitis in patients on CAPD.

The American Journal of the Medical Sciences, Jun 1, 1989

Clinically Unsuspected Pheochromocytomas

Archives of internal medicine, 1986

Thirty-two histopathologically confirmed pheochromocytomas were diagnosed at Henry Ford Hospital,... more Thirty-two histopathologically confirmed pheochromocytomas were diagnosed at Henry Ford Hospital, Detroit, between 1951 and 1982. Eleven (34%) of these cases were clinically unsuspected exhibiting none of the typical symptoms of palpitation, diaphoresis, or headache, and only five were hypertensive. These pheochromocytomas may be discovered during computed tomography of the abdomen while evaluating multiple endocrine neoplasia, abdominal pain, and abdominal masses, or they may present at autopsy, at surgery, or as a mass lesion without paroxysmal symptoms or hypertension. Before 1962, 53% of these tumors were undiagnosed before surgery or autopsy; however, since 1962 only 18% of pheochromocytomas have remained clinically unsuspected. By maintaining a higher index of suspicion and using newer biochemical and imaging techniques, the incidence of clinically unsuspected pheochromocytomas should be reduced.

Azathioprine and Hypersensitivity Vasculitis

Annals of Internal Medicine, Jul 1, 1988

Letters submitted for possible publication must be identified as such and submitted with a signed... more Letters submitted for possible publication must be identified as such and submitted with a signed trans-fer-of-copyright form (see Contents page for location of form). Text length must not exceed 400 words. No more than five references may be used; reference for-mat must be that ...

Public and Population Health in U.S. Medical Education: A Review of Guidance in Extraordinary Times

Academic Medicine

The Journal of Urology, Nov 1, 1986

Acute renal failure is seen in patients with pre-existing renal disease and acute pyelonephritis.... more Acute renal failure is seen in patients with pre-existing renal disease and acute pyelonephritis. The use of nonsteroidal antiinflammatory agents in a patient with a urinary tract infection also may produce impairment of renal function. Discontinuation of the anti-inflammatory agent results in improved renal function. The 4 cases presented tend to support the hypothesis. The authors proffer some interesting concepts concerning the mechanisms involved. J. A. A.

Edematous States

Suki and Massry’s THERAPY OF RENAL DISEASES AND RELATED DISORDERS, 1998

A young man with acute renal failure

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society, 1998

A 34-year-old man, over a 2-week period, had an increase in serum creatinine from 5.0 mg/dL to 11... more A 34-year-old man, over a 2-week period, had an increase in serum creatinine from 5.0 mg/dL to 11.0 mg/dL. A renal biopsy was performed.

BMC nephrology, Jan 21, 2018

There are limited data on the associations of circulating angiogenic factors with chronic kidney ... more There are limited data on the associations of circulating angiogenic factors with chronic kidney disease (CKD). We investigate the associations of circulating vascular endothelial growth factor (VEGF)-A, angiopoietin-1, angiopoietin-1/VEGF-A ratio, VEGF receptor 1 (VEGFR-1), VEGFR-2, and pentraxin-3 with CKD. We recruited 201 patients with CKD and 201 community controls without CKD from the greater New Orleans area. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m or presence of albuminuria. Multivariable quantile and logistic regression models were used to examine the relationship between angiogenesis-related factors and CKD adjusting for confounding factors. After adjusting for covariables including traditional cardiovascular disease (CVD) risk factors, C-reactive protein, and history of CVD, the medians (interquartile range) were 133.08 (90.39, 204.15) in patients with CKD vs. 114.17 (72.45, 170.32) pg/mL in controls without CKD (p = 0.002 for ...

The American Journal of the Medical Sciences, 2006

Background: Hurricane Katrina resulted in partial or complete devastation of dialysis services th... more Background: Hurricane Katrina resulted in partial or complete devastation of dialysis services throughout the Gulf Coast, including the New Orleans metropolitan area. In the immediate aftermath, dialysis had to be provided to patients by surrounding communities in Louisiana, and ultimately by dialysis programs throughout the nation. Peritoneal dialysis patients, though typically more independent, also endured challenges in continuing dialysis following Hurricane Katrina. Hurricane Rita caused similar damage to the western Gulf Coast at Lake Charles, Louisiana and Beaumont, Texas and further delayed recovery of dialysis services in the New Orleans metropolitan area. Setting: A review of the problems created by the disaster provided many opportunities to improve healthcare delivery and to prepare for recovery from the event. Understanding what happened to the delivery of dialysis and chronic kidney disease services allows the opportunity to develop better systems to support this particularly vulnerable population of patients. Conclusion: Many lessons can be learned from these events to minimize future interruption of dialysis services in the face of natural disasters such as hurricanes.

Medical Science Educator, 2018

Background The AAMC has called for research exploring causes of health disparities and the value ... more Background The AAMC has called for research exploring causes of health disparities and the value of educating health care providers about population health. Research on best practices for educating medical students about social determinants of health is limited. Methods During academic year 2015-2016, we implemented a required 4-week community health clerkship for all fourth-year medical students at Tulane University not concurrently seeking an MPH. The 15-h classroom component of the course included discussion of reading materials and didactic instruction on social determinants of health, principles of prevention, health disparities, racism, cultural humility, and community health workers' (CHWs) roles in improving population health. Students also spent 80 h at a community agency doing non-clinical work. In addition to course evaluations, students completed pre-and post-course surveys that included 15 items measuring knowledge and attitudes about patient care and community health on a 4-point Likert scale. Post-course surveys also contained ten open-ended questions. Results Students were highly satisfied with the course. There were significant changes in 11 of 15 items related to knowledge and attitudes about patient care and community health. Students reported better understanding of chronic disease causes, physicians' roles in health promotion, and the roles of CHWs. Students expressed intent to improve their communication skills, address health literacy, contextualize care based on social circumstances, and respond to patients' cultural health beliefs. Discussion This required 4-week course resulted in significant changes in fourth-year students' attitudes and knowledge of community health principles. Conclusion This course may be a model for other institutions.

Medical Science Educator, 2019

The Liaison Committee on Medical Education now expects all allopathic medical schools to develop ... more The Liaison Committee on Medical Education now expects all allopathic medical schools to develop and adhere to a documentable continuous quality improvement (CQI) process. Medical schools must consider how to establish a defensible process that monitors compliance with accreditation standards between site visits. The purpose of this descriptive study is to detail how ten schools in the Association of American Medical Colleges' (AAMC) Southern Group on Educational Affairs (SGEA) CQI Special Interest Group (SIG) are tackling practical issues of CQI development including establishing a CQI office, designating faculty and staff, charging a CQI committee, choosing software for data management, if schools are choosing formalized CQI models, and other considerations. The information presented is not meant to certify that any way is the correct way to manage CQI, but simply present some schools' models. Future research should include defining commonalities of CQI models as well as seeking differences. Furthermore, what are components of CQI models that may affect accreditation compliance negatively? Are there Bworst practices^to avoid? What LCME elements are most commonly identified for CQI, and what are the successes and struggles for addressing those elements? What are identifiable challenges relating to use of standard spreadsheet software and engaging information technology for support? How can students be more engaged and involved in the CQI process? Finally, how do these major shifts to a formalized CQI process impact the educational experience?

Membranoproliferative Glomerulonephritis in Pregnancy

The American journal of the medical sciences, 2017

Membranoproliferative glomerulonephritis (MPGN) is an uncommon form of glomerulonephritis and it ... more Membranoproliferative glomerulonephritis (MPGN) is an uncommon form of glomerulonephritis and it can be particularly difficult to predict outcomes and manage women with this disorder during pregnancy. The management of 3 successful pregnancies in women with MPGN from 1 center and previously described cases from the world literature are reviewed. This includes a number of large studies of pregnancy in women with underlying glomerular disease as well as small case series and individual reports. Courses of these pregnancies, maternal and fetal outcomes, and management, when described, were included in this review. Some successful outcomes used antiplatelet therapy and plasmapheresis, but high-dose intravenous, followed by oral, corticosteroid therapy was used most frequently in patients with successful outcomes. The data provided is meant as a guide for clinicians who provide care for women with MPGN who are considering pregnancy or women who present with this disorder while pregnant.

This study investigated the influence of role expectations, as defined by tenure status, on medic... more This study investigated the influence of role expectations, as defined by tenure status, on medical school faculty attitudes toward professional development activities. A total of 226 full-time faculty within a medical school completed a 15-item professional development goals questionnaire. The study found that full-time faculty perceptions of professional goals differed based on their tenure status, and that the teaching goals and research goals scales of the questionnaire predicted tenure status effectively and reliably. It also found that tenure-track faculty placed higher importance on professional development goals for teaching than for research, whereas non-tenure-track faculty placed higher importance on professional development goals for research than for teaching. (Contains 15 references.) (MDM)

American Journal of Kidney Diseases, 1989

• Control of changes in the intracranial pressure in patients who have suffered brain injury is e... more • Control of changes in the intracranial pressure in patients who have suffered brain injury is essential in preventing further neurological deterioration. In a patient requiring dialysis with intracerebral bleeding, intracranial pressure was measured directly during hemodialysis and peritoneal dialysis. This provided the opportunity to provide therapeutic maneuvers to control the increases in intracranial pressure occurring during hemodialysis. Dialytic changes in intracranial pressure were best prevented by peritoneal dialysis. When hemodialysis is necessary, therapy with osmotic agents to minimize the osmotic gradient between the CSF and plasma urea was most effective in preventing directly measured changes in the intracranial pressure.

Designing a Course

An Introduction to Medical Teaching, 2014

This chapter discusses the principles of overall course design, emphasizing the concept of backwa... more This chapter discusses the principles of overall course design, emphasizing the concept of backward design: outlining what should students be able to do by the end of the course, and then determining what they must learn in order to achieve the target levels of knowledge and performance. From this specification will come the course goals and objectives, which must be consistent with the overall curricular goals and objectives. Learning resources must be identified, and the appropriate teaching methods for the course must be determined. Finally, but no less important, appropriate assessment and feedback approaches must be selected.

Medical education online, 2015

Derived from multiple disciplines and established in industries outside of medicine, Implementati... more Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS) seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Utilizing IS in medical education can help us better achieve ch...

Renal biopsy in a young man with hematuria

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society, 1997

A 24-year-old man was referred for evaluation of microscopic hematuria. Urologic work-up was unre... more A 24-year-old man was referred for evaluation of microscopic hematuria. Urologic work-up was unremarkable. A renal biopsy was performed.