bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation Between Residency Program Characteristics and American Board of Obstetrics and Gynecology Certifying Examination Passage Rates [ID 2683567]
Authors: Holder Erik , VanArendonk Sarah H. , Creedon Douglas , Cheng CeCe , Page-Ramsey Sarah M. , Byrne John J.
Published: May 2024

INTRODUCTION:

The correlation between obstetrics and gynecology residency program size and type with certifying examination passage rates is not previously reported. Our objective was to evaluate the relationship between residency program size and type with American Board of Obstetrics and Gynecology (ABOG) certifying examination (CE) pass rates.

METHODS:

This is a cross-sectional study of ABOG specialty CE passage rates from 2020 to 2022. The CE passage rates were obtained from the ABOG website and stratified by program size (small 3–4, medium 5–7, large >8 residents per class) and type (community-based; community-based, university-affiliated; and university-based). Military-based programs were excluded, as were programs of unknown size. Passage rates were compared among groups using chi-squared test.

RESULTS:

During the study period, 3,766 candidates sat for the CE. Small programs accounted for 730 candidates (19.4%), 1,805 (47.9%) candidates from medium programs, and 1,231 candidates (32.7%) from large programs. Passage rates were higher among medium and large programs versus small programs (small [604/730; 82.7%], medium [1,656/1,805, 91.7%], and large [1,149/1,231; 93.3%]; P<.001). Passage rates among community-based candidates (299/347; 86.2% pass rate) and community-based university-affiliated candidates (962/1,100; 87.5% pass rate) were lower versus university-based candidates (2,148/2,319; 92.6% pass rate; P<.0001).

CONCLUSION:

During the study period, university-based programs and medium or large programs had higher CE passage rates. There are a number of limiting factors to the interpretation of the results such as academic differences upon entry to residency, resources available at each program, and amount of dedicated study time. A causal effect of program size and type cannot be assumed.
Applicant Use of Residency Program Websites During Virtual Interviews [ID 2683623]
Authors: Wells Alyssa , Heath Taylor , Coonrod Dean V. , Willey Alicia S.
Published: May 2024

INTRODUCTION:

Program websites are the most common online resource applicants use to access information about residency programs. During the COVID-19 pandemic, online resources have had to take place of site visits when interviews transitioned to the virtual setting. At this time, the Accreditation Council for Graduate Medical Education does not have a plan for a transition back to in-person interviews. The objective of this study is to assess applicant use, and information that is sought for development of high-quality residency websites.

METHODS:

A survey was shared to interviewees on their interview day with Creighton University–Phoenix obstetrics and gynecology residency during the 2022–2023 application cycle. To remove the possibility of influence or coercion, the survey was kept anonymous. This was found to be IRB exempt.

RESULTS:

Of the 88 survey respondents, 100% marked they visited the program website. Only 32 of the 88 respondents indicated they did not find the information they were looking. The most-sought information by respondents was current resident profiles (75% of respondents), hospital/training site information (68%), rotation schedule (63%), and faculty profiles (60%). Other notable categories respondents were hoping to find information about included the following: surgical training, family planning training, and benefits offered by the program.

CONCLUSION:

Program websites are highly utilized by residency applicants. Information traditionally shared on interview day is now found through online resources; most-sought information included resident and faculty profiles, rotation schedules, and training site information.
Trends and Predictors of Cost in the Obstetrics and Gynecology Residency Application Process [ID 2683644]
Authors: Manorot Amanda , White Joseph R. , Lenze Nicholas , Benjamin William J. , Mihalic Angela , Marzano David
Published: May 2024

INTRODUCTION:

Travel restrictions from the COVID-19 pandemic required residency programs to transition from an in-person to virtual interview process. Obtaining an obstetrics and gynecology residency position is known to be competitive and places a considerable financial burden on applicants. This study aims to quantify the total costs in the application process before and after virtual interviews were implemented.

METHODS:

The Texas STAR database was queried to identify obstetrics and gynecology residency applicants from 2019 to 2023. The primary outcome was applicant-reported spending on the residency application process. Descriptive statistics and linear regression models were used to evaluate for associations with sociodemographic, temporal, and geographic factors.

RESULTS:

A total of 2,315 obstetrics and gynecology applicants were included. Applicants reported significantly less average total spending on the residency application process after the start of the COVID-19 pandemic compared to the years prior ($2,515 [SD 2,055] versus $4,909 [SD 2,869]; P<.001). Applicants who identified as underrepresented in medicine (P=.022), had a DO degree (P<.001), completed a research year (P=.030), participated in the couples match (P<.001), or were from the Western region (P<.001) reported significantly more total spending. There was a significant positive correlation between total non-interview-related spending and the number of interviews received (P<.001).

CONCLUSION:

There was a significant reduction in applicant spending after the start of the COVID-19 pandemic, likely related to transition to virtual interviews and limitations on in-person away rotations. The association of applicant spending with the number of interview offers raises concern for possible equity implications.
Assessment of Second Victim Trauma Resources for Obstetrics and Gynecology Residents [ID 2683424]
Authors: Roy Amrita , Olson-Chen Courtney
Published: May 2024

INTRODUCTION:

Second victim trauma (SVT) encompasses psychological, cognitive, or physical symptoms experienced by health care providers after adverse events. Obstetrics and gynecology trainees may be more vulnerable to SVT given their exposure to adverse events and lack of experience. Our objective was to assess the background knowledge of SVT among obstetrics and gynecology residency program directors (PDs) and the curricula and resources available to support obstetrics and gynecology trainees.

METHODS:

An 18-question survey was developed and disseminated to all 295 obstetrics and gynecology PDs. The survey assessed baseline knowledge of SVT, psychological resources available, knowledge regarding the SVT validated screening tool, and personal experiences. Descriptive and statistical analysis was performed using STATA, Version 12.

RESULTS:

A total of 99 PDs completed the survey (34% response rate). 92% of PDs had heard of SVT, and 82% felt they could identify its signs/symptoms. 41% of programs had SVT in the curricula. 28% of programs exist in hospitals with an SVT program, and 60% have trained clinician peer supports. Program directors who have an SVT curriculum were twice as likely to be familiar with validated survey tools for SVT (P=.004), and 2.7 times more likely to identify warning signs that a resident may need additional support (P<.001). 86% of PDs would like additional education on SVT.

CONCLUSION:

The majority of obstetrics and gynecology residency PDs are aware of SVT and have an idea of how to identify this in their residents. The rates of embedded resources vary across the country. Additional education and curriculum development focused on SVT may benefit obstetrics and gynecology PDs and trainees.
Game On: Team-Based Competition to Enhance Engagement in Obstetrics and Gynecology Graduate Medical Education [ID 2683471]
Authors: Gregg Rebecca W. , Gottula Jessica , Medla Samantha A. , Chatfield Lindsay , Keyser Erin A.
Published: May 2024

INTRODUCTION:

Surgeon General Dr. Vivek Murthy called attention to what he declares a public health crisis of loneliness, isolation, and lack of connection in our country. Three years into the COVID pandemic, the medical profession has experienced a huge increase in burnout that has only exacerbated this crisis. Consistent with national trends, lack of faculty engagement and overall well-being was noted to have suffered on our 2022 Accreditation Council for Graduate Medical Education (ACGME) Resident Survey.

METHODS:

The Brooke Army Medical Center Gynecologic Surgery and Obstetrics residency program implemented a themed team competition for the 2022–2023 academic year, “GYN of Thrones.” Residents and staff were divided into five families, modeled after Game of Thrones to compete for the “Throne of Hysteros.” Points were awarded for participating in program activities, receiving kudos for patient care, and demonstrating clinical excellence. The data from the 2021–2022 and 2022–2023 ACGME surveys were compared to evaluate the effect of this new competition.

RESULTS:

Faculty interest in resident education increased 41% (P=.002), from 59% to 100% after implementation. Similarly, only 59% felt there was an appropriate amount of teaching in clinical and didactic activities in 2021–2022, whereas this improved to 89% in 2022–2023 (P=.041). Residents were also more satisfied with faculty feedback: 53% prior to the competition improved to 84% after (P=.047).

CONCLUSION:

Resident perception of faculty engagement in academics and quality of teaching drastically improved after implementation of this program-wide competition. Faculty well-being scores improved as well, indicating this may decrease burnout in the workforce and improve morale and connection.
How Do Women Vote: What Women Post About Home Birth Compared With Hospital Birth on Reddit and TikTok [ID 2683436]
Authors: Morris Kelsey , Lane Fiona , Nelson Anita L. , Stohl Hindi
Published: May 2024

INTRODUCTION:

Rates of home birth have been increasing as has reliance on social media as a source of medical advice and support. This is the first study that directly evaluates birthing women’s beliefs about home births in the public posts and comments on two popular social media platforms. We sought to identify major themes on perceptions, attitudes, and advice offered about home birth on Reddit and TikTok.

METHODS:

Posts were searched using the terms “home birth” and “home versus hospital birth.” Up to five themes were collected per post or comment and were categorized as supportive, opposing, or neutral. We included posts from the United States, in English, with at least 10 comments and 10 upvotes or likes. Institutional review board approval was waived.

RESULTS:

A total of 777 posts and 47,452 comments were evaluated for inclusion; 257 posts and 2,408 comments met criteria for thematic content analysis. Overall in posts, 69% supported, 20% opposed, and 11% were neutral toward home birth. In comments, 53% supported, 28% opposed, and 19% were neutral. Supportive themes included concerns about safety of hospital delivery and reassurance about home birth safety, patient control with home deliveries, and advice about preparing for home birth. Opposing themes included concerns about risks of home birth, negligence of those attempting it, reassurance that hospital birth offers women control, and that medical interventions can be lifesaving.

CONCLUSION:

These results can help physicians recognize some of women’s concerns about hospital births and what information they may find on social media guiding them in their birth decisions.
SHARP (SHort Answer, Rationale Provision): A New Item Format to Assess Clinical Reasoning
Authors: Runyon Christopher R. , Paniagua Miguel A. , Rosenthal Francine A. , Veneziano Andrea L. , McNaughton Lauren , Murray Constance T. , Harik Polina
Published: May 2024

Problem

Many non–workplace-based assessments do not provide good evidence of a learner’s problem representation or ability to provide a rationale for a clinical decision they have made. Exceptions include assessment formats that require resource-intensive administration and scoring. This article reports on research efforts toward building a scalable non–workplace-based assessment format that was specifically developed to capture evidence of a learner’s ability to justify a clinical decision.

Approach

The authors developed a 2-step item format called SHARP (SHort Answer, Rationale Provision), referring to the 2 tasks that comprise the item. In collaboration with physician-educators, the authors integrated short-answer questions into a patient medical record–based item starting in October 2021 and arrived at an innovative item format in December 2021. In this format, a test-taker interprets patient medical record data to make a clinical decision, types in their response, and pinpoints medical record details that justify their answers. In January 2022, a total of 177 fourth-year medical students, representing 20 U.S. medical schools, completed 35 SHARP items in a proof-of-concept study.

Outcomes

Primary outcomes were item timing, difficulty, reliability, and scoring ease. There was substantial variability in item difficulty, with the average item answered correctly by 44% of students (range, 4%–76%). The estimated reliability (Cronbach α) of the set of SHARP items was 0.76 (95% confidence interval, 0.70–0.80). Item scoring is fully automated, minimizing resource requirements.

Next Steps

A larger study is planned to gather additional validity evidence about the item format. This study will allow comparisons between performance on SHARP items and other examinations, examination of group differences in performance, and possible use cases for formative assessment. Cognitive interviews are also planned to better understand the thought processes of medical students as they work through the SHARP items.
The American Society of Addiction Medicine Clinical Practice Guideline Development Methodology
Authors: Weimer Melissa B. , Devoto Amanda , Kansagara Devan , Safarian Taleen , Brunner Emily , Stock Audra , Rastegar Darius A. , Nelson Lewis S. , Tirado Carlos F. , Korthuis P. Todd , Boyle Maureen P.
Published: May 2024

The American Society of Addiction Medicine (ASAM) has published clinical practice guidelines (CPGs) since 2015. As ASAM's CPG work continues to develop, it maintains an organizational priority to establish rigorous standards for the trustworthy production of these important documents. In keeping with ASAM's mission to define and promote evidence-based best practices in addiction prevention, treatment, and recovery, ASAM has rigorously updated its CPG methodology to be in line with evolving international standards. The CPG Methodology and Oversight Subcommittee was formed to establish and publish a methodology for the development of ASAM CPGs and to develop an ASAM CPG strategic plan. This article provides a focused overview of the ASAM CPG methodology.
Gastric Pressure Monitoring Unveils Abnormal Patient–Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study
Authors: Akoumianaki Evangelia , Vaporidi Katerina , Stamatopoulou Vaia , Soundoulounaki Stella , Panagiotarakou Meropi , Kondili Eumorfia , Georgopoulos Dimitris
Published: May 2024

Background

Patient–ventilator dyssynchrony is frequently observed during assisted mechanical ventilation. However, the effects of expiratory muscle contraction on patient–ventilator interaction are underexplored. The authors hypothesized that active expiration would affect patient–ventilator interaction and they tested their hypothesis in a mixed cohort of invasively ventilated patients with spontaneous breathing activity.

Methods

This is a retrospective observational study involving patients on assisted mechanical ventilation who had their esophageal pressure (Peso) and gastric pressure monitored for clinical purposes. Active expiration was defined as gastric pressure rise (ΔPgas) greater than or equal to 1.0 cm H2O during expiratory flow without a corresponding change in diaphragmatic pressure. Waveforms of Peso, gastric pressure, diaphragmatic pressure, flow, and airway pressure (Paw) were analyzed to identify and characterize abnormal patient–ventilator interaction.

Results

76 patients were identified with Peso and gastric pressure recordings, of whom 58 demonstrated active expiration with a median ΔPgas of 3.4 cm H2O (interquartile range = 2.4 to 5.3) observed in this subgroup. Among these 58 patients, 23 presented the following events associated with expiratory muscle activity: (1) distortions in Paw and flow that resembled ineffective efforts, (2) distortions similar to autotriggering, (3) multiple triggering, (4) prolonged ventilatory cycles with biphasic inspiratory flow, with a median percentage (interquartile range) increase in mechanical inflation time and tidal volume of 54% (44 to 70%) and 25% (8 to 35%), respectively and (5) breathing exclusively by expiratory muscle relaxation. Gastric pressure monitoring was required to identify the association of active expiration with these events. Respiratory drive, assessed by the rate of inspiratory Peso decrease, was significantly higher in patients with active expiration (median [interquartile range] dPeso/dt: 12.7 [9.0 to 18.5] vs 9.2 [6.8 to 14.2] cmH2O/sec; P < 0.05).

Conclusions

Active expiration can impair patient–ventilator interaction in critically ill patients. Without documenting gastric pressure, abnormal patient–ventilator interaction associated with expiratory muscle contraction may be mistakenly attributed to a mismatch between the patient’s inspiratory effort and mechanical inflation. This misinterpretation could potentially influence decisions regarding clinical management.

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Hospital Variation in Epinephrine Administration Before Defibrillation for Cardiac Arrest Due to Shockable Rhythm
Authors: Stewart Colten , Chan Paul S. , Kennedy Kevin , Swanson Morgan B. , Girotra Saket ,   for the American Heart Association’s Get With The Guidelines (GWTG) Resuscitation Investigators.
Published: May 2024

Objectives:

Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital cardiac arrest (IHCA), epinephrine administration before first defibrillation is common and associated with lower survival at a “patient-level.” Whether this practice varies across hospitals and its association with “hospital-level” IHCA survival remains unknown. The purpose of this study was to determine hospital variation in rates of epinephrine administration before defibrillation for shockable IHCA and its association with IHCA survival.

Design:

Observational cohort study.

Setting:

Five hundred thirteen hospitals participating in the Get With The Guidelines Resuscitation Registry.

Patients:

A total of 37,668 adult patients with IHCA due to an initial shockable rhythm from 2000 to 2019.

Interventions:

Epinephrine before first defibrillation.

Measurements and Main Results:

Using multivariable hierarchical regression, we examined hospital variation in epinephrine administration before first defibrillation and its association with hospital-level rates of risk-adjusted survival. The median hospital rate of epinephrine administration before defibrillation was 18.8%, with large variation across sites (range, 0–68.8%; median odds ratio: 1.54; 95% CI, 1.47–1.61). Major teaching status and annual IHCA volume were associated with hospital rate of epinephrine administration before defibrillation. Compared with hospitals with the lowest rate of epinephrine administration before defibrillation (Q1), there was a stepwise decline in risk-adjusted survival at hospitals with higher rates of epinephrine administration before defibrillation (Q1: 44.3%, Q2: 43.4%; Q3: 41.9%; Q4: 40.3%; p for trend < 0.001).

Conclusions:

Administration of epinephrine before defibrillation in shockable IHCA is common and varies markedly across U.S. hospitals. Hospital rates of epinephrine administration before defibrillation were associated with a significant stepwise decrease in hospital rates of risk-adjusted survival. Efforts to prioritize immediate defibrillation for patients with shockable IHCA and avoid early epinephrine administration are urgently needed.
High-Intensity, High-Frequency, Parallel Ultrasound Beams for Cellulite of the Buttocks and Thighs
Authors: Wang Jordan V. , Ugonabo Nkem , Bajaj Shirin , Jairath Neil , Munavalli Girish , Chapas Anne , Geronemus Roy G. , Kilmer Suzanne
Published: May 2024

BACKGROUND

Ultrasound energy can successfully treat fine lines and wrinkles, as well as lift the eyebrow and submentum. Ultrasound waves of high intensity induce thermal injury in the dermis with subsequent tissue remodeling.

OBJECTIVE

To examine the utility of a novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams to improve the clinical appearance of cellulite on the thighs and buttocks.

MATERIALS AND METHODS

A prospective, multicenter, clinical study investigated this novel ultrasound device using 2 treatments.

RESULTS

Sixty-five subjects completed both treatments. The mean age was 46 years, and 100% were women. Fitzpatrick skin types I to VI were represented. Assessments compared 3-month follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 89.2%. For Cellulite Severity Scale rating, there was significant improvement of 1.61 units (p< .001). For cellulite Global Aesthetic Improvement Scale (GAIS), 89.2% had improvement, with a mean of 0.87 units (p< .001). For Laxity Scale rating, there was significant improvement of 0.70 units (p< .001). For skin laxity GAIS, 89.2% had improvement, with a mean of 0.76 units (p< .001). No device-related adverse events occurred.

CONCLUSION

A novel ultrasound device that utilizes high-intensity, high-frequency, parallel ultrasound beams can safely and effectively improve the clinical appearance of cellulite on the thighs and buttocks.
Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol
Authors: Elkholy Yusuf A. , Mahboub Tarek , Zaki Amr A. , ElSharkawy Omar A. , Noaman Ayman
Published: May 2024

Background:

Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma.

Methods:

This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity.

Results:

The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm².

Conclusions:

Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient’s general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.
Humanitarian Facial Recognition for Rare Craniofacial Malformations
Authors: Hennocq Quentin , Bongibault Thomas , Garcelon Nicolas , Khonsari Roman Hossein
Published: May 2024

Children with congenital disorders are unfortunate collateral victims of wars and natural disasters. Improved diagnosis could help organize targeted medical support campaigns. Patient identification is a key issue in the management of life-threatening conditions in extreme situations, such as in oncology or for diabetes, and can be challenging when diagnosis requires biological or radiological investigations. Dysmorphology is a central element of diagnosis for craniofacial malformations, with high sensibility and specificity. Massive amounts of public data, including facial pictures circulate daily on news channels and social media, offering unique possibilities for automatic diagnosis based on facial recognition. Furthermore, AI-based algorithms assessing facial features are currently being developed to decrease diagnostic delays. Here, as a case study, we used a facial recognition algorithm trained on a large photographic database to assess an online picture of a family of refugees. Our aim was to evaluate the relevance of using an academic tool on a journalistic picture and discuss its potential application to large-scale screening in humanitarian perspectives. This group picture featured one child with signs of Apert syndrome, a rare condition with risks of severe complications in cases of delayed management. We report the successful automatic screening of Apert syndrome on this low-resolution picture, suggesting that AI-based facial recognition could be used on public data in crisis conditions to localize at-risk patients.
Epidemiology and Treatment of Patients With Primary Open Angle Glaucoma in Germany: A Health Claims Data Analysis
Authors: Manz Karina C. , Mocek Anja , Höer Ariane , Simantiri Christina , Heuck Alexander , Eberhardt Alice , Mrosowsky Thora , Zander Stefanie , Fritz Björn , Schuster Alexander K. , Erb Carl
Published: May 2024

Précis:

Based on a large administrative database of German claims data, our study provides current estimates of the prevalence and incidence of primary open angle glaucoma (POAG) in Germany and describes selected outcomes for prevalent patients with POAG.

Purpose:

To estimate the prevalence and incidence of POAG in Germany, to describe the patient population in terms of comorbidity burden, routine care, and overall healthcare resource utilization (HCRU) and associated costs, and to describe treatment patterns over time in patients undergoing relevant laser procedures.

Materials and Methods:

Based on anonymized German claims data, we carried out a retrospective, noninterventional study covering calendar years 2016–2021.

Results:

For the adult German population (≥18 y), we estimated a POAG 1-year prevalence of 1.70% and a 1-year incidence of 0.17% in 2018; both increased with age, peaking in 80- to 89-year-olds. Prevalence and incidence were lower in 2020 (1.65% and 0.16%, respectively), the first year of the SARS-CoV-2 pandemic. Most patients solely received topical treatment. Most surgically treated patients underwent laser trabeculoplasty, followed by laser iridotomy, trabeculectomy, and filtration operations with implant. In patients undergoing laser trabeculoplasty, the treatment regimen was nearly unchanged in the second year after, compared with 2 years before the procedure. Multimorbidity was commonly observed; 75.5% of patients had arterial hypertension and 50.0% had disorders of lipoprotein metabolism and other lipidemias, compared with 60.1% and 39.2%, respectively, in an age- and sex-matched control sample.

Conclusions:

Our study provides insights into epidemiology and routine care of POAG in Germany and HCRU in prevalent patients. There was little change in treatment regimens in patients who underwent laser trabeculoplasty, 2 years after the procedure. Most patients were multimorbid highlighting the need for comprehensive care.
Pneumonia in Children With Complex Chronic Conditions With Tracheostomy: An Emerging Challenge
Authors: García-Boyano Miguel , Climent Alcalá Francisco José , Rodríguez Alonso Aroa , García Fernández de Villalta Marta , Zubiaur Alonso Oihane , Rabanal Retolaza Ignacio , Quiles Melero Inmaculada , Calvo Cristina , Escosa García Luis
Published: May 2024

Background:

Despite respiratory infections being a leading cause of hospitalization in children with tracheostomy tubes, there are no published guidelines for their diagnosis and management. This study aims to outline the clinical, laboratory and microbiological aspects of pneumonia in these children, along with the antibiotics used and outcomes. Additionally, it seeks to determine pneumonia incidence and associated risk factors.

Methods:

We conducted a retrospective study using the medical records of tracheostomized children at La Paz University Hospital in Madrid from 2010 to 2021.

Results:

Thirty-three pneumonia cases were observed in 25 tracheostomized children. Pseudomonas aeruginosa was the predominant bacterium (52%), followed by Escherichia coli, Staphylococcus aureus and Serratia marcescens. The same microorganism isolated in the tracheal aspirate culture during pneumonia was previously isolated in 83% of cases that had a similar culture, with some growth obtained within 7–30 days prior. Multiplex respiratory PCR detected respiratory viruses in 73% of cases tested. Antibiotic treatment was administered in all cases except 1, mostly intravenously (81%), with piperacillin/tazobactam and meropenem being commonly used. Only 1 of the described episodes had a fatal outcome.

Conclusions:

It is advisable to include coverage for P. aeruginosa, E. coli, S. aureus, and S. marcescens in the empirical antibiotic treatment for pneumonia in tracheostomized children, along with the microorganisms identified in tracheal cultures obtained within 7–30 days prior, if available. A positive PCR for respiratory viruses is often discovered in bacterial pneumonia in tracheostomized children.
Per- and Polyfluoroalkyl Substances May Be Correlated With Chlamydia trachomatis
Authors: Taylor Brandie DePaoli , Noah Akaninyene I. , Adekanmbi Victor , Zhang Yuanyi , Berenson Abbey B.
Published: May 2024

Objective

Per- and polyfluoroalkyl substances (PFAS) alter immune function increasing infectious diseases risk. We examined the relationship between PFAS and chlamydia.

Methods

A total of 3965 nonpregnant adults ages 18–39 years from the National Nutrition Examination Survey 2003–2016 cycles were included. Poisson regression with robust error variance estimated the prevalence ratio and 95% confidence intervals for the association between PFAS and chlamydia. A g computation model was used to examine PFAS mixtures and chlamydia.

Results

In adjusted age and sex-stratified models, an increase in PFAS mixtures by one quintile was associated with chlamydia in older males and younger females. Associations were not observed before stratification.

Conclusions

PFAS exposure associated with higher chlamydia prevalence, but only in stratified models suggesting biological differences by gender and age. However, small sample sizes could have affected the precision of our models.
Novel locally nebulized indocyanine green for simultaneous identification of tumor margin and intersegmental plane
Authors: Jeon Ok Hwa , Kim Kyungsu , Kim Chang Geun , Choi Byeong Hyeon , Lee Jun Hee , Kim Beop-Min , Kim Hyun Koo
Published: May 2024

Background:

Segmentectomy, recommended for early-stage lung cancer or compromised lung function, demands precise tumor detection and intersegmental plane identification. While indocyanine green (ICG) commonly aids in these aspects using near-infrared imaging, its separate administrations through different routes and times can lead to complications and patient anxiety. This study aims to develop a lung-specific delivery method by nebulizing low-dose ICG to targeted lung segments, allowing simultaneous detection of lung tumors and intersegmental planes across diverse animal models.

Methods:

To optimizing the dose of ICG for lung tumor and interlobar fissure detection, different doses of ICG (0.25, 0.1, and 0.05 mg/kg) were nebulized to rabbit lung tumor models. The distribution of locally nebulized ICG in targeted segments was studied to evaluate the feasibility of detecting lung tumor and intersegmental planes in canine lung pseudotumor models.

Results:

Near-infrared fluorescence imaging demonstrated clear visualization of lung tumor margin and interlobar fissure using local nebulization of 0.1 mg/kg ICG for only 4 min during surgery in the rabbit models. In the canine model, the local nebulization of 0.05 mg/kg of ICG into the target segment enabled clear visualization of pseudotumor and intersegmental planes for 30 min.

Conclusions:

This innovative approach achieves a reduction in ICG dose and prolonged the visualization time of the intersegmental plane and effectively eliminates the need for the hurried marking of tumors and intersegmental planes. The authors anticipate that lung-specific delivery of ICG will prove valuable for image-guided limited resection of lung tumors in clinical practice.
Finding the minimum number of retrieved lymph nodes and negative lymph nodes in gastric cancer surgery: a real-world study
Authors: Liu Yingxue , Zhou Changming , Gan Lu , Zhang Qiyang , Chang Jinjia , Wang Xin , Wang Xu , Xu Midie , Chen Jie , Sheng Weiqi , Liu Fenglin
Published: May 2024

Background:

Lymph node retrieval deficiency can lead to understagement and postoperative cancer recurrence, it is crucial to establish the standard number of retrieved lymph nodes (rLNs) and negative lymph nodes (nLNs) for patients undergoing gastrectomy.

Methods:

Patients who has gastric adenocarcinoma and underwent either radical subtotal gastrectomy (RSG) or radical total gastrectomy (RTG) between 2000 and 2022 were retrospectively included. The authors utilized restricted cubic spline (RCS) analysis to determine the ideal threshold for rLNs and nLNs. Survival analysis was conducted using Kaplan–Meier (KM) curves, log-rank tests and forest plots. Propensity score matching (PSM) was utilized to balance parameters between two groups. The median follow-up time for this study was 3095 days.

Results:

Our study found that there are significant tumor characteristic differences between RSG and RTG. For patients with N0–N3a stage undergoing RSG, retrieving greater than or equal to 24 lymph nodes intraoperatively were associated with better prognosis both before and after PSM [overall survival (OS): P<0.001, P=0.019]; whereas for N3b stage, at least 32 rLNs were required (OS: P=0.006, P=0.023). Similarly, for patients with N0–N3a stage undergoing RTG, retrieving greater than or equal to 27 lymph nodes intraoperatively were associated with better prognosis both before and after PSM (OS: P<0.001, P=0.047); whereas for N3b stage, at least 34 rLNs were required (OS: P<0.001, P=0.003). Additionally, for patients undergoing RSG, having greater than or equal to 21 nLNs (OS: P<0.001, P=0.013), and for those undergoing RTG, having greater than or equal to 22 nLNs (OS: P<0.001, P<0.001), were also associated with better prognosis both before and after PSM.

Conclusions:

For patients receiving RSG, rLNs should reach 24 when lymph nodes are limited, and 32 when lymph node metastasis is more extensive, with a minimum number of nLNs ideally reaching 21. Similarly, for patients receiving RTG, rLNs should reach 27 when lymph nodes are limited, 34 when lymph node metastasis is more extensive, and a minimum number of nLNs ideally reaching 22.
The association between prehospital post–return of spontaneous circulation core temperature and survival after out-of-hospital cardiac arrest
Authors: Aziz Shadman , Clough Molly , Butterfield Emma , Starr Zachary , Lachowycz Kate , Price James , Barnard Ed B.G. , Rees Paul
Published: May 2024

Background and importance

Following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA), a low body temperature on arrival at the hospital and on admission to the ICU is reportedly associated with increased mortality. Whether this association exists in the prehospital setting, however, is unknown.

Objective

The objective of this study was to investigate whether the initial, prehospital core temperature measured post-ROSC is independently associated with survival to hospital discharge in adult patients following OHCA.

Design, setting and participants

This retrospective observational study was conducted at East Anglian Air Ambulance, a physician-paramedic staffed Helicopter Emergency Medical Service in the East of England, UK. Adult OHCA patients attended by East Anglian Air Ambulance from 1 February 2015 to 30 June 2023, who had post-ROSC oesophageal temperature measurements were included.

Outcome measure and analysis

The primary outcome measure was survival to hospital discharge. Core temperature was defined as the first oesophageal temperature recorded following ROSC. Multivariable logistic regression evaluated the adjusted association between core temperature and survival to hospital discharge.

Main results

Resuscitation was attempted in 3990 OHCA patients during the study period, of which 552 patients were included in the final analysis. The mean age was 61 years, and 402 (72.8%) patients were male. Among them, 194 (35.1%) survived to hospital discharge. The mean core temperature was lower in nonsurvivors compared with those who survived hospital discharge; 34.6 and 35.2 °C, respectively (mean difference, −0.66; 95% CI, −0.87 to −0.44; P < 0.001). The adjusted odds ratio for survival was 1.41 (95% CI, 1.09–1.83; P = 0.01) for every 1.0 °C increase in core temperature between 32.5 and 36.9 °C.

Conclusion

In adult patients with ROSC following OHCA, early prehospital core temperature is independently associated with survival to hospital discharge.
Socio-economic determinants influencing adherence to secondary prophylaxis in patients with rheumatic heart disease: a systematic review
Authors: Yadav Manish , Shah Newton Ashish , Bhandari Kritick , Iyer Aksharaa G. , Mishra Ashish , Lamichhane Pratik , Joshi Amir , Yadav Digraj , Singh Aanand K. , Shah Nischal , Yadav Samridhi
Published: May 2024

Introduction:

Rheumatic heart disease (RHD) poses a substantial global health challenge, especially impacting resource-limited nations, with over 40.5 million cases reported in 2019. The crucial role of Benzathine penicillin G in both primary and secondary prevention, particularly the latter, emphasizes its significance.

Method:

Following PRISMA guidelines, our systematic review explored Medline, Scopus, Google Scholar, and Embase databases from 1990 to 2022. Registered with PROSPERO ), the review utilized quality appraisal tools, including the PRISMA checklist, Cochrane bias tool and Newcastle–Ottawa scale. The objective was to identify and stratify the impact of socio-economic factors on adherence to secondary prophylaxis in RHD.

Results and discussion:

The impact of education on adherence has been found to be significant. Socially disadvantaged environments significantly influenced adherence, shaped by education, socio-economic status, and geographical location and access to healthcare. Surprisingly, lower education levels were associated with better adherence in certain cases. Factors contributing to decreased adherence included forgetfulness, injection-related fears, and healthcare provider-related issues. Conversely, higher adherence correlated with younger age, latent disease onset, increased healthcare resources, and easy access.

Conclusion:

Patient education and awareness were crucial for improving adherence. Structured frameworks, community initiatives, and outreach healthcare programs were identified as essential in overcoming barriers to secondary prophylaxis. Taking active steps to address obstacles like long-distance commute, waiting time, injection fears, and financial issues has the potential to greatly improve adherence. This, in turn, can lead to a more effective prevention of complications associated with RHD.
Coexistence of severe peripheral ulcerative keratitis and lichen planus: case report
Authors: Lazaar Hamza , Boutaj Taha , Sefrioui Meryem , ElMoubarik Najoua , Azarkan Boutayna , Benchekroun Saad , Amazouzi Abdellah , Boutimzine Noureddine , Cherkaoui Lalla Ouafa
Published: May 2024

Introduction and importance:

Ocular involvement in lichen planus is highly uncommon, primarily affecting the eyelids, conjunctiva, and less frequently, the cornea. Peripheral ulcerative keratitis (PUK), a rare subtype form of corneal lichen planus, has been reported only once in the literature.

Case presentation:

The authors report details of a 34-year-old man with confirmed cutaneous lichen planus who developed severe PUK, a rare ocular manifestation of lichen planus. Despite initial worsening with corticosteroids, successful resolution of PUK was achieved with topical Cyclosporin and azathioprine over 2 months but with a final visual acuity limited to light perception.

Clinical discussion:

To the best of our knowledge, very rare cases have been reported of the coexistence of severe PUK and lichen planus. Lichen planus should be considered in any case of PUKs associated with cutaneous-mucosal manifestations cyclosporin and azathioprine are crucial for effective management and favorable outcomes in such cases.

Conclusion:

This case aims to show the importance of dermatological examination in the presence of any peripheral ulcerative keratitis. It also sheds light on the therapeutic difficulties and the prognosis of this rare form of ocular lichen planus.
Molecular Imaging of Steroid Receptors in Breast Cancer
Authors: Keigley Quinton J. , Fowler Amy M. , O'Brien Sophia R. , Dehdashti Farrokh
Published: May 2024

Steroid receptors regulate gene expression for many important physiologic functions and pathologic processes. Receptors for estrogen, progesterone, and androgen have been extensively studied in breast cancer, and their expression provides prognostic information as well as targets for therapy. Noninvasive imaging utilizing positron emission tomography and radiolabeled ligands targeting these receptors can provide valuable insight into predicting treatment efficacy, staging whole-body disease burden, and identifying heterogeneity in receptor expression across different metastatic sites. This review provides an overview of steroid receptor imaging with a focus on breast cancer and radioligands for estrogen, progesterone, and androgen receptors.
Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa
Authors: Matthews Lynn T. , Jaggernath Manjeetha , Kriel Yolandie , Smith Patricia M. , Haberer Jessica E. , Baeten Jared M. , Hendrix Craig W. , Ware Norma C. , Moodley Pravi , Pillay Melendhran , Bennett Kara , Bassler John , Psaros Christina , Hurwitz Kathleen E. , Bangsberg David R. , Smit Jennifer A.
Published: May 2024

Objective:

We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures.

Design:

This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months.

Methods:

We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women.

Results:

Three hundred thirty women with median age 24 (IQR: 22–27) years enrolled. Partner HIV-serostatus was unknown by 96% (N = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24–7.30]). None had detectable plasma tenofovir.

Conclusion:

The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women.

Clinical Trial Number:

NCT03194308
Reconstruction of Scalp and Skull Defects by a Free Anterolateral Thigh Flap Combined With Fascia Lata and Vastus Lateralis Muscle
Authors: Zhang Juan , Pei Jiaomiao , Li Yang , Han Yan , Song Baoqiang
Published: May 2024

Background:

Reconstruction of composite scalp and skull defects is a great challenge for plastic surgeons, and this study aimed to report the therapeutic regimen of using free ALT flaps with fascia lata and vastus lateralis muscle to cover scalp and cranial defects.

Methods:

A retrospective analysis was performed including 10 patients with composite scalp and skull defects who were treated with a free ALT flap with fascia lata and vastus lateralis muscle from January 2012 to June 2020. All patients underwent a 1-stage operation and were followed up for 1 year with clinical data including sex, age, etiology, skull defect area, scalp defect area, flap area, dura mater involvement, recipient vessel, donor site repair, lumbar cistern drainage, and complications.

Results:

All flaps survived well, 2 patients developed complications, one had cerebrospinal fluid leakage, and another experienced partial skin graft necrosis; All patients were satisfied with both the appearance and functional outcomes of the procedure.

Conclusion:

Free tissue transplantation is an effective method for large defects of the scalp and skull. The combination of a free ALT flap with fascia lata and vastus lateralis muscle, which has a long pedicle, convenient flap designs, less donor-site morbidity, and effective prevention of cerebrospinal fluid leakage, is an ideal choice to repair the composite scalp and cranial defects in stage 1.
Does Condylar Morphology Affect Maxillary Repositioning in Bimaxillary Orthognathic Surgery?
Authors: Takahara Namiaki , Tomomatsu Nobuyoshi , Kachi Hirokazu , Iwasaki Takuya , Maruta Noboru , Yoda Tetsuya
Published: May 2024

This study aimed to measure the association between condylar morphology and a measure of the maxillary centroid following bimaxillary surgery using mandibular-dependent splints. The study included skeletal Class III and Class II malocclusion patients, excluding those with facial asymmetry. Based on computed tomography imaging patients were characterized into normal or abnormal temporomandibular joint (TMJ) groups. A computer-aided design/computer-aided manufacturing splints were fabricated to reposition the maxilla in Le Fort I osteotomy. The primary outcome measure was the absolute differences between the maxillary centroid’s the planned and actual postoperative positions calculated by superimposing computed tomography scans. The secondary outcome was the measure of other variations in linear and angular maxilla discrepancies. The demographic covariates included the age and sex of the patients. The operative covariates consisted of the dentofacial deformity and the planned movement of the maxilla. Seventy patients with skeletal maxillofacial deformities were included for analysis: 44 patients in the normal and 26 in the abnormal TMJ group. The average maxillary misalignment was 1.04±0.48 mm in the normal and 1.53±0.63 mm in the abnormal TMJ group (P<0.001). A statistically significant relationship existed between the discrepancies of the maxillary centroid and dentofacial deformity (η=0.656, P<0.001). These findings suggest an increased propensity for maxillary malposition in skeletal Class II patients. Furthermore, condylar morphology is a significant prognostic factor influencing maxillary repositioning errors in bimaxillary surgery with mandibular-dependent splints.