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Journal of Surgical Education 2022Understand the characteristics of residents' favorite rotations to improve the ability of educators to maximize positive learning experiences.
OBJECTIVE
Understand the characteristics of residents' favorite rotations to improve the ability of educators to maximize positive learning experiences.
DESIGN
Novel cross-sectional survey developed through thematic analysis of focus groups with residents using 4-point Likert scales ranked from "Not at all important" to "Extremely important."
SETTING
Single university-affiliated urban hospital PARTICIPANTS: Clinical surgical residents BACKGROUND: Resident assessments of learning experiences vary between rotations leading to the development of "favorite" rotations.
MATERIALS AND METHODS
A novel survey instrument containing 31 characteristics divided into 4 thematic categories was developed following analysis of surgical resident focus groups. Clinical surgical residents were asked how important each characteristic was for determining their favorite rotation on a 4-point Likert Scale from "not at all important" to "extremely important." Two-sided independent sample T-tests were used.
RESULTS
The response rate was 59% (33/56) with proportional representation of postgraduate levels. Overall, 67% (22/33) of residents reported their favorite rotation was in their preferred specialty, 70% (23/33) reported their favorite rotation required >70 hours per week in the hospital, and 97% (32/33) of residents reported their favorite rotation required <2 days of clinic. Overall, the average ranking of the categories from most to least important was content (mean = 2.84, SD = 0.48), learning environment (mean = 2.67, SD = 0.57), working environment (mean = 2.38, SD = 0.56), and accomplishment (mean = 2.31, SD = 0.57). The only category with a statistically significant difference between junior and senior resident was content with seniors ranking it most important (mean = 3.35, SD = 0.93) compared to junior residents who ranked it least important (mean = 2.21, SD = 1.25), p = 0.01. Personal characteristics such as "Attendings cared about my learning" (mean = 3.56, SD = 0.50) and "I felt good at my job" (mean = 3.45, SD = 0.67), tended to be more important than structural characteristics such as "call schedule" (mean = 2.71, SD = 0.86), "formal didactics" (mean = 2.67, SD = 1.04), and "work-life balance" (mean = 2.70, SD = 0.99).
CONCLUSIONS
This study demonstrates a novel understanding of the factors that contribute to resident preferences for certain rotations. Junior and senior residents attribute importance differently, which may provide the basis for level-appropriate improvements. Personal factors tended to be more contributory than structural factors, highlighting additional dimensions to examine when considering how to optimize certain rotations.
Topics: Humans; Internship and Residency; Cross-Sectional Studies; Learning
PubMed: 35907699
DOI: 10.1016/j.jsurg.2022.07.009 -
The Laryngoscope Dec 2022Comparing Derkay anatomical score at time of procedure, disease characteristics, and mean treatment interval among adult and pediatric patients with recurrent...
OBJECTIVES/HYPOTHESIS
Comparing Derkay anatomical score at time of procedure, disease characteristics, and mean treatment interval among adult and pediatric patients with recurrent respiratory papillomatosis (RRP).
STUDY DESIGN
Restrospective study.
METHODS
Retrospective review of juvenile-onset (JO) and adult-onset (AO) RRP patients treated longitudinally at pediatric and adult institutions from 1999 to 2019. Patients were included if they had a tissue diagnosis of papilloma and had at least a 12-month follow-up.
RESULTS
One hundred and twelve patients met inclusion criteria (68 JO-RRP and 44 AO-RRP). All patients were stratified into either potassium titanyl phosphate (KTP) (n = 42), CO (n = 21), or microdebrider (n = 49) treatment groups. The Derkay score improved between first and last procedure in the KTP group (mean difference, 3.5; P < .001), CO group (mean difference, 4.4; P < .001), and microdebrider group (mean difference, 4.1; P < .001), but overall improvement did not differ across groups (P = .73). Baseline mean to last mean Derkay score improved for nine patients during bevacizumab treatments (mean difference, 3.0; P = .01) but did not improve for these same patients during an interval prior to receiving bevacizumab treatments. Baseline mean to last mean Derkay score improved for 19 patients during cidofovir treatments (mean difference, 3.84; P < .001) but did not improve for these same patients during the interval prior to receiving cidofovir treatments. The AO-RRP population had more patients with dysplasia (50%) compared to JO-RRP population (10%) (P < .001).
CONCLUSION
Various surgical modalities appear to be equally effective treatments for RRP. Adult and pediatric patients have decreased recurrent disease burden when receiving bevacizumab or cidofovir. AO-RRP patients have more concomitant dysplasia.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:2420-2426, 2022.
Topics: Adult; Child; Humans; Cidofovir; Bevacizumab; Carbon Dioxide; Papillomavirus Infections; Respiratory Tract Infections
PubMed: 35119691
DOI: 10.1002/lary.30042 -
Environmental Science and Pollution... Jan 2021This experiment was conducted to provide a better insight into the plant responses to nitric oxide (NO) and selenium nanoparticle (nSe). Chicory seedlings were sprayed...
Nitric oxide and selenium nanoparticles confer changes in growth, metabolism, antioxidant machinery, gene expression, and flowering in chicory (Cichorium intybus L.): potential benefits and risk assessment.
This experiment was conducted to provide a better insight into the plant responses to nitric oxide (NO) and selenium nanoparticle (nSe). Chicory seedlings were sprayed with nSe (0, 4, and 40 mg l), and/or NO (0 and 25 μM). NO and/or nSe4 improved shoot and root biomass by an average of 32%. The nSe40 adversely influenced shoot and root biomass (mean = 26%), exhibiting moderate toxicity partly relieved by NO. The nSe and NO treatments transcriptionally stimulated the dehydration response element B1A (DREB1A) gene (mean = 29.6-fold). At the transcriptional level, nSe4 or NO moderately upregulated phenylalanine ammonia-lyase (PAL) and hydroxycinnamoyl-CoA quinate transferase (HCT1) genes (mean = sevenfold). The nSe4 + NO, nSe40, and nSe40 + NO groups drastically induced the expression of PAL and HCT1 genes (mean = 30-fold). With a similar trend, hydroxycinnamoyl-CoA Quinate/shikimate hydroxycinnamoyl transferase (HQT1) gene was also upregulated in response to nSe and/or NO (mean = 25-fold). The activities of nitrate reductase and catalase enzymes were also induced in the nSe- and/or NO-treated seedlings. Likewise, the application of these supplements associated with an increase in ascorbate concentration (mean = 31.5%) reduced glutathione (mean = 35%). NO and/or nSe enhanced the PAL activity (mean = 36.4%) and soluble phenols (mean = 40%). The flowering was also influenced by the supplements in dose and compound dependent manner exhibiting the long-time responses. It appears that the nSe-triggered signaling can associate with a plethora of developmental, physiological, and molecular responses at least in part via the fundamental regulatory roles of transcription factors, like DREB1A as one the most significant genes for conferring tolerance in crops.
Topics: Antioxidants; Cichorium intybus; Gene Expression; Nanoparticles; Nitric Oxide; Risk Assessment; Selenium
PubMed: 32902749
DOI: 10.1007/s11356-020-10706-2 -
Toxics Apr 2022This study provides baseline information on the concentrations of antibiotics in influent and effluent from two wastewater treatment plants in regular operation in the...
This study provides baseline information on the concentrations of antibiotics in influent and effluent from two wastewater treatment plants in regular operation in the State of Kuwait. Wastewater samples were collected from the influent and effluent streams of two WWTPs, over four sampling campaigns and analyzed for a broad range of antibiotics. The mean influent concentrations of sulfamethoxazole, ciprofloxacin, clarithromycin, and cefalexin were 852 ng/L, 672 ng/L, 592 ng/L), and 491 ng/L, respectively, at Umm Al Hayman WWTP. At the Kabd WWTP, the influent concentration of clarithromycin was highest with a mean of 949 ng/L, followed by ciprofloxacin (mean, 865 ng/L), cefalexin (mean, 598 ng/L), and sulfamethoxazole (mean, 520 ng/L). The dominant compounds in the effluent from Umm Al Hayman were sulfamethoxazole (mean, 212 ng/L), ciprofloxacin (mean, 153 ng/L), ofloxacin (mean, 120 ng/L), dimetridazole (mean, 96 ng/L), and metronidazole (mean, 93 ng/L). Whereas, at the Kabd WWTP, the dominant compounds were sulfamethoxazole (mean, 338 ng/L), dimetridazole (mean, 274 ng/L), cefalexin (mean, 213 ng/L), ciprofloxacin (mean, 192 ng/L), and clarithromycin (189 ng/L). The mean influent concentrations of all compounds were higher than those measured in the effluents. The concentrations of antibiotic compounds were not significantly different between the two WWTPs (p > 0.05). The removal efficiencies of the various antibiotics over the four sampling campaigns for the Kabd and Umm Hayman WWTPs ranged between 10.87 and 99.75% and also showed that they were variable and were compound dependent. The data clearly show that the concentrations of antibiotics measured in the influents of both WWTPs were highest in samples collected during the winter-summer (September samples) transition followed by the concentrations measured during the winter-summer (March samples) transition period. This is possibly linked to the increased prescription of these medications to treat infectious diseases and flu prevalent in Kuwait during these periods. This study provides the first reported concentrations of antibiotics in the dissolved aqueous influents and effluents of WWTPs in Kuwait. Additional studies are required to evaluate the environmental impact that antibiotic residues may cause since treated wastewater is used in irrigation, and often there are instances when untreated wastewater is discharged directly into the marine environment.
PubMed: 35448435
DOI: 10.3390/toxics10040174 -
Naunyn-Schmiedeberg's Archives of... Sep 2023Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased...
Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased appetite due to antidepressant treatment, or due to direct pharmacological effects of mirtazapine is unknown. The aim of this analysis is to complement our previously published results of the effect of mirtazapine on metabolism and energy substrate partitioning from a proof-of-concept, open-label clinical study (ClinicalTrials.gov NCT00878540) in 12 healthy males (20-25 years). We report the effect of a seven-day administration of mirtazapine 30 mg per day on weight and lipid metabolism in healthy men under highly standardized conditions with respect to diet, physical activity and day-night-rhythm and under continuous clinical observation. After a 7-day administration of mirtazapine 30 mg, we observed a statistically significant increase in triglyceride levels (mean change + 4.4 mg/dl; 95% CI [- 11.4; 2.6]; p = 0.044) as well as TG/HDL-C ratio (mean change + 0.2; 95% CI [- 0.4; 0.1]; p = 0.019) and a decrease in HDL-cholesterol (mean change - 4.3 mg/dl; 95% CI [2.1; 6.5]; p = 0.004), LDL-cholesterol (mean change - 8.7 mg/dl; 95% CI [3.8; 13.5]; p = 0.008), total cholesterol (mean change - 12.3 mg/dl; 95% CI [5.4; 19.1]; p = 0.005), and non-HDL-C (mean change - 8.0 mg/dl; 95% CI [1.9; 14.0]; p = 0.023). Notably, weight (mean change - 0.6 kg; 95% CI [0.4; 0.8]; p = 0.002) and BMI (mean change - 0.2; 95% CI [0.1; 0.2]; p = 0.002) significantly decreased. No change in waist circumference (mean change - 0.4 cm; 95% CI [- 2.1; 2.9]; p = 0.838) or waist-to-hip-ratio (mean change 0.0; 95% CI [- 0.0; 0.0]; p = 0.814) was observed. This is the first study showing unfavorable changes in lipid metabolism under mirtazapine in healthy individuals despite highly standardized conditions including dietary restriction, and despite the observation of a decrease of weight. Our findings support the hypothesis that mirtazapine has direct pharmacological effects on lipid metabolism. ClinicalTrials.gov: NCT00878540.
Topics: Humans; Male; Antidepressive Agents; Cholesterol, HDL; Dyslipidemias; Fasting; Mirtazapine; Triglycerides; Weight Gain
PubMed: 36890393
DOI: 10.1007/s00210-023-02448-y -
Neurosurgical Focus Aug 2021For currently available augmented reality workflows, 3D models need to be created with manual or semiautomatic segmentation, which is a time-consuming process. The...
OBJECTIVE
For currently available augmented reality workflows, 3D models need to be created with manual or semiautomatic segmentation, which is a time-consuming process. The authors created an automatic segmentation algorithm that generates 3D models of skin, brain, ventricles, and contrast-enhancing tumor from a single T1-weighted MR sequence and embedded this model into an automatic workflow for 3D evaluation of anatomical structures with augmented reality in a cloud environment. In this study, the authors validate the accuracy and efficiency of this automatic segmentation algorithm for brain tumors and compared it with a manually segmented ground truth set.
METHODS
Fifty contrast-enhanced T1-weighted sequences of patients with contrast-enhancing lesions measuring at least 5 cm3 were included. All slices of the ground truth set were manually segmented. The same scans were subsequently run in the cloud environment for automatic segmentation. Segmentation times were recorded. The accuracy of the algorithm was compared with that of manual segmentation and evaluated in terms of Sørensen-Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and 95th percentile of Hausdorff distance (HD95).
RESULTS
The mean ± SD computation time of the automatic segmentation algorithm was 753 ± 128 seconds. The mean ± SD DSC was 0.868 ± 0.07, ASSD was 1.31 ± 0.63 mm, and HD95 was 4.80 ± 3.18 mm. Meningioma (mean 0.89 and median 0.92) showed greater DSC than metastasis (mean 0.84 and median 0.85). Automatic segmentation had greater accuracy for measuring DSC (mean 0.86 and median 0.87) and HD95 (mean 3.62 mm and median 3.11 mm) of supratentorial metastasis than those of infratentorial metastasis (mean 0.82 and median 0.81 for DSC; mean 5.26 mm and median 4.72 mm for HD95).
CONCLUSIONS
The automatic cloud-based segmentation algorithm is reliable, accurate, and fast enough to aid neurosurgeons in everyday clinical practice by providing 3D augmented reality visualization of contrast-enhancing intracranial lesions measuring at least 5 cm3. The next steps involve incorporation of other sequences and improving accuracy with 3D fine-tuning in order to expand the scope of augmented reality workflow.
Topics: Algorithms; Augmented Reality; Brain Neoplasms; Humans; Image Processing, Computer-Assisted
PubMed: 34333477
DOI: 10.3171/2021.5.FOCUS21200 -
BMC Public Health May 2020Female genital mutilation/cutting (FGM/C) is a clear violation of women's rights and can have adverse and irreversible health effects as well. Worldwide, more than 200...
BACKGROUND
Female genital mutilation/cutting (FGM/C) is a clear violation of women's rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world.
METHODS
In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied.
RESULTS
The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1-0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31-45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts.
CONCLUSION
FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.
Topics: Adult; Circumcision, Female; Cost-Benefit Analysis; Cross-Sectional Studies; Female; Humans; Iran; Middle Aged; Pregnancy; Socioeconomic Factors; Surveys and Questionnaires; Young Adult
PubMed: 32471405
DOI: 10.1186/s12889-020-08947-4 -
Journal of Cancer Research and... Dec 2022The aim was to assess the potential reduction in the doses to organs at risk (OARs) and target organ volume by doing replanning on repeat computed tomography (CT) scan...
AIM OF STUDY
The aim was to assess the potential reduction in the doses to organs at risk (OARs) and target organ volume by doing replanning on repeat computed tomography (CT) scan during the 4 week of radiation therapy (RT).
MATERIALS AND METHODS
Twenty-four histologically proven patients of inoperable esophagus carcinoma were studied. All patients received induction chemotherapy followed by concurrent chemotherapy and radiotherapy. CT simulation with proper immobilization was done, and images were transferred to the treatment planning system. Delineation of target volumes and OARs was done, and two plans were generated for 60 Gy in 30 fractions and 40 Gy in 20 fractions with intensity-modulated RT keeping the doses to OARs within the tolerance limits. Replanning for 20 Gy in 10 fractions was done on repeat CT scan during the 4 week of radiotherapy treatment, and potential reduction in doses to OARs and target organ volume was assessed.
RESULTS
A total of 24 cases were analyzed for the adaptive plan with the coverage of the 95% prescription isodose for planning target volume. Statistical analysis was done by t-test. The difference in the doses received by the OARs was analyzed and was seen that due to re CT scan, the doses were reduced to the left lung V (mean 19.23 Gy vs. 17.35 Gy) and D (mean 16.03 Gy vs. 14.25 Gy), right lung V (mean 18.38 Gy vs. 16.66 Gy) and D (mean 15.70 Gy vs. 13.97 Gy), heart V (mean 38.72 Gy vs. 35.32 Gy) and D (mean 26.40 Gy vs. 22.74 Gy), and spine 1% volume (mean 36.54 Gy vs. 33.39 Gy) and D (mean 39.81 Gy vs. 34.34 Gy), gross tumor volume (GTV) (mean 67.37 cm vs. 24.58 cm ) and were all significantly smaller for the adaptive plan.
CONCLUSION
By doing adaptive radiotherapy in the 4 week of treatment using repeat CT scan, along with the response evaluation, there is a significant reduction in the volume of GTV, and replanning of treatment on repeat CT scan also helps us in reducing doses to the OARs resulting in reduced toxicity.
Topics: Humans; Radiotherapy Planning, Computer-Assisted; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Organs at Risk; Tomography, X-Ray Computed; Carcinoma; Lung Neoplasms
PubMed: 36510979
DOI: 10.4103/jcrt.JCRT_162_20 -
Journal of Voice : Official Journal of... Mar 2022Patients with chronic cough are some of the most challenging to treat. This preliminary study is the first to examine the effects of a single exercise muscle strength...
OBJECTIVES
Patients with chronic cough are some of the most challenging to treat. This preliminary study is the first to examine the effects of a single exercise muscle strength training program to reduce cough severity in patients who failed other treatments.
METHODS
A total of 19 females were included in this study, ranging from age 24 to 80. The maximum phonation time (MPT), laryngeal airway resistance (LAR), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), Voice Handicap Index-10, (VHI-10) and the Cough Severity Index (CSI) values were obtained pre- and post-treatment. ANOVA two-factor without replication was used to compare values pre- and post-treatment.
RESULTS
MIP (Mean of 62.00 to a mean of 78.53) and MEP (Mean of 90.00 to a mean of 112.16) showed significant increase post-treatment. In addition, LAR (Mean of 73.30 to a mean of 60.67) and CSI (Mean of 19.37 to a mean of 15.00) significantly decreased post-treatment. General changes in pre- and post-treatment values were identified with MPT (Mean of 14.89 to a mean of 16.17) and VHI-10 (Mean of 8.00 to a mean of 6.76). A follow-up questionnaire indicated that the majority of patients felt their cough was better after 4 weeks.
CONCLUSIONS
Muscle strength training provides a tool to aid in the control of cough for patients who are refractory to medical and other behavioral treatments. Improvement in cough may be associated with a reduction in subglottic pressure and increased air flow resulting in lower laryngeal airway resistance.
PubMed: 35260288
DOI: 10.1016/j.jvoice.2022.01.011 -
Clinical Orthopaedics and Related... May 2022Lateralized reverse shoulder arthroplasty (RSA) has emerged as an attempt to improve on some of the drawbacks of conventional RSA, such as glenoid notching and decrease...
BACKGROUND
Lateralized reverse shoulder arthroplasty (RSA) has emerged as an attempt to improve on some of the drawbacks of conventional RSA, such as glenoid notching and decrease in ROM. Although this new design is being used in clinical practice, the evidence is mostly limited to case series and has not been systematically reviewed.
QUESTIONS/PURPOSES
(1) How much did patient-reported outcome measures (PROMs) and ROM improve among patients who receive a lateralized RSA implant? (2) What proportion of shoulders experience complications, revision surgery, or scapular notching?
METHODS
The PubMed and EMBASE databases were searched from database inception to January 31, 2020. We included clinical studies that reported the PROMs and/or ROM of patients with insufficient rotator cuffs undergoing RSA with a lateralized implant. All other types of studies and those including patients with fractures, instability or escape, infection, rheumatologic disease, neurologic disease, or revision surgeries as an indication for RSA were excluded. PROMs and ROM were collected and are reported as mean values and ranges. Complications, revision surgery, and scapular notching are presented as proportions. The percentage of the mean change relative to the minimum clinically important difference (MCID) was calculated using the anchor-based value for each outcome. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. The initial search yielded 678 studies; 61 full-text articles were analyzed according to our eligibility criteria. After a detailed analysis, we included nine studies that evaluated 1670 patients (68% of whom [1130] were women) with a mean age of 71.8 ± 0.6 years. The mean follow-up period was 41.1 ± 5.6 months. The mean MINORS score was 12 ± 4.
RESULTS
Active ROM improved for forward flexion (mean change 47° to 82°; MCID 12°), abduction (mean change 43° to 80°; MCID 7°), external rotation (mean change 8° to 39°; MCID 3°), and internal rotation (mean change -2 to 1 points). PROM scores also improved, including the American Shoulder and Elbow Surgeons score (mean change 20 to 50; MCID 20.9 points), Constant score (mean change 28 to 40; MCID 5.7 points), Simple Shoulder Test score (mean change 3 to 7; MCID 2.4 points), and VAS score (mean change -1.8 to -4.9; MCID -1.6 points). The proportion of shoulders with complications ranged from 0% (0 of 44) to 21% (30 of 140), and the proportion of shoulders with scapular notching ranged from 0% (0 of 76) to 29% (41 of 140). The proportion of patients undergoing revision ranged from 0% (0 of 44) to 13% (10 of 76) at short-term follow-up.
CONCLUSION
Lateralized RSA is a reasonable alternative to medialized implants for patients with rotator cuff insufficiency because it might reduce the likelihood of scapular notching without apparently compromising PROMs or ROM. More studies are required to determine whether there is a direct correlation between the amount of lateralization and PROMs or ROM.
Topics: Aged; Arthroplasty, Replacement, Shoulder; Female; Humans; Male; Range of Motion, Articular; Retrospective Studies; Shoulder Joint; Shoulder Prosthesis; Treatment Outcome
PubMed: 34904964
DOI: 10.1097/CORR.0000000000002065