2007 American College of Physicians Poster Competition Winners
Each year, the state chapters of the American College of Physicians (ACP) invite medical students, residents, and fellows to participate in a scientific poster competition. Last year, the Minnesota chapter received more than 130 entries in the clinical vignette and research categories from residents and students at internal medicine training programs at Abbott Northwestern Hospital, Hennepin County Medical Center, Mayo Clinic, and the University of Minnesota.
Entries were judged by approximately 30 internists from clinics and academic medical centers around the state at the Minnesota chapter’s annual meeting on November 2, 2007, in Minneapolis. Each judge conducted poster rounds with a group of residents, allowing the judge as well as the presenter’s peers the opportunity to view the abstract being presented. Criteria used by judges included clinical relevance, originality, visual presentation, and verbal presentation.
The winners will have the opportunity to participate in the national competition at the ACP’s scientific meeting this May in Washington, D.C.
Congratulations to the winners and all who entered for their excellent work.
Research Winner
The Effect of Continuous Head-of-Bed Monitoring on Compliance with Semi-Recumbent Positioning in Patients on Mechanical Ventilation
By Laura E. Tilton, M.D., and Mitchell G. Kaye, M.D., Abbott Northwestern Hospital, Minneapolis
Purpose: Semi-recumbent positioning has been shown to decrease the incidence of ventilator-associated pneumonia (VAP), yet patients often do not have the head of their beds (HOB) consistently elevated. The purpose of this study was to determine whether continuous HOB monitoring using an indicator light increases the amount of time patients on mechanical ventilation have the HOB elevated above 30 degrees.
Methods: Ninety patients on mechanical ventilation were enrolled in this controlled, prospective study. The first 45 consecutive patients were enrolled in the control group, the next 45 in the intervention group. An electronic sensor was attached to the bed frame and provided continuous monitoring and recording of HOB angle; whenever HOB was >30 degrees, the sensor activated a light and timer on the monitor device. For the control group, the light was disabled, the monitor stored out of view, and the nursing staff blinded to the time measurements. For the intervention group, connections to the light were enabled and the monitor placed on top of the ventilator, where the light and timer were clearly visible to the nursing staff. To control for a possible training effect, data collection ceased at a maximum of 8,640 ventilator minutes (6 days).
Results: The percentage of time with the HOB elevated >30 degrees was significantly greater (P<0.0001) in the intervention group, with a median of 81% (interquartile range: 70% to 91%) versus a median of 17% in the control group (interquartile range: 4% to 51%). The intervention group had modestly longer median total ventilator time than the control group (4.1 days versus 3.0 days, P=0.1). However, analysis of variance showed that while the group assignment remained highly significant (P<0.0001), there was no relationship between total ventilator minutes and percentage of time with the HOB >30 degrees (P=0.83).
Conclusion: Continuous HOB monitoring utilizing an indicator light significantly increases the time mechanically ventilated patients have the HOB elevated >30 degrees. By improving compliance with semi-recumbent positioning, continuous HOB monitoring may decrease the incidence of VAP.