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Inside AWAMC, July 2009
No full textAurora West Allis Medical Center, West Allis, WI: Inside AWAMC is a monthly newsletter for employees, volunteers, and guests of the hospital. This issue has a feature on FAST Stroke education.https://institutionalrepository.aah.org/alldocuments/2213/thumbnail.jp
Trends and characteristics of early-onset colorectal cancer in the state of Florida, 2002-2021
No full textBackground: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is a growing public health concern. Despite increasing national incidence among younger adults, state-specific analyses for Florida remain limited. Florida\u27s large and demographically unique population necessitates investigation into EOCRC trends and patient characteristics.
Methods: This population-based study utilized colorectal cancer incidence data for Florida residents aged 25-49 diagnosed between 2002 and 2021, from the Florida Cancer Data System and National Program of Cancer Registries. Joinpoint regression evaluated age-adjusted incidence trends across demographic and clinical factors. Age-period-cohort analysis explored generational effects, while multivariate logistic regression identified factors associated with advanced-stage diagnosis (regional or distant).
Results: Among 16,318 EOCRC cases identified during 2002-2021, overall incidence increased significantly (AAPC=1.48 %, P \u3c .001), driven primarily by colon cancers (AAPC=1.53 %, P \u3c .001), while rectal cancers showed non-significant increase (AAPC=0.53 %, P = 0.185). A concerning shift toward advanced stages at diagnosis emerged (P \u3c 0.001), with localized disease decreasing from 32.8 % to 26.2 %, while regional (34.6-41.0 %) and distant metastases (21.9-26.8 %) increased substantially. This stage migration was confirmed by significant increases in regional (AAPC=2.10 %, P \u3c .001) and distant disease (AAPC=2.71 %, P \u3c .001) incidence. Strong birth cohort effects, indicating increasing risk with rate ratios exceeding 2.0 for recent cohorts, were evident predominantly in non-Hispanic White individuals. Conversely, Hispanic and non-Hispanic Black patients showed no significant cohort effects but consistently presented with higher odds of advanced-stage disease compared to non-Hispanic Whites (AOR=1.13 and AOR=1.11, respectively). Uninsured (AOR=1.23) and Medicaid-covered patients (AOR=1.52) faced significantly higher odds of advanced presentation compared to privately insured individuals.
Conclusion: Florida experienced sustained EOCRC incidence increases from 2002 to 2021, accompanied by advanced-stage diagnosis increases and notable disparities. Birth cohort effects primarily drove increased risk in non-Hispanic White populations, while barriers to timely care, including insurance status, likely contributed to delayed diagnoses in minority communities, underscoring urgent needs for targeted interventions
A multimodel, resident‐run medical student curriculum in obstetrics and gynaecology: Does it improve NBME (National Board of Medical Examiners) exam scores?
No full textBackground: There is variability in clinical rotations for the third year medical students. Many factors (i.e., clinical location, patient volume and medical school didactics) can affect how well the student learns the material needed to succeed on the NBME (National Board of Medical Examiners) exam.
Objectives: The goal of this study was to design and implement a multimodel, resident-run medical student curriculum and evaluate the effectiveness of the curriculum in improving Obstetrics and Gynaecology NBME exam scores.
Study design: This 2-year medical education quality improvement project went from October 2022 to 2024. The length of the curriculum was 6 weeks, and students met with a resident for two 30-min sessions per week. Each session was designed as a case study for students to answer questions and discuss specific patient scenarios. There was also a weekly plan with supplemental resources for students to review beforehand. A total of 55 students had a reported NBME score and were included in the analysis.
Results: There was a statistically significant increase in mean NBME scores when compared to the mean score from previous years before the implementation of the curriculum. This was consistent across two medical student groups from two different medical schools.
Conclusion: This study showed high student satisfaction with the newly implemented curriculum. This may have been due to the multimodel approach and the supplemental material provided for different learning styles. Future studies that are adequately powered and have appropriate controls are needed to better evaluate whether a multimodel approach truly does improve exam performance and to better tease out which specific aspect of the multimodel approach is most helpful
Pecto-intercostal fascial plane block with or without rectus sheath block in cardiac surgery: A prospective, randomized, double-blind placebo-controlled study
No full textBackground: Median sternotomy and chest tube sites drive pain following cardiac surgery. Prior research has demonstrated that pecto-intercostal fascial plane blocks (PIFBs) reduce median sternotomy pain after cardiac surgery. Prior studies examining the addition of a rectus sheath block (RSB) to localize the insertion site of subxiphoid chest tubes have had mixed results.
Methods: In this single-center, randomized, double-blind, placebo-controlled trial, 62 patients undergoing cardiac surgery with median sternotomy and subxiphoid chest tubes were randomized to receive PIFB and RSB with local anesthetic versus PIFB with local anesthetic and RSB with saline placebo. The primary outcome was pain at rest and with deep breathing in the first 24 hours after surgery. Secondary outcomes included total opioid consumption at 24 and 48 hours, performance on incentive spirometry in the first 24 hours, time to extubation, hospital and intensive care unit length of stay, and Quality of Recovery-15 score.
Results: There was no statistically significant difference between groups for the primary outcome, with mean area under the curve (AUC) for pain at rest in the first 24 hours 93.37±41.38 (sample mean±sample SD) in the placebo group versus 86.11±42.78 in the bupivacaine group (p=0.51), and mean AUC for pain with deep breathing 135.55±43.74 in the placebo group versus 128.78±47.08 in the bupivacaine group (p=0.57). There were no differences in secondary outcomes between groups.
Conclusions: Adding bilateral RSB to bilateral PIFB did not improve pain control or other outcomes for patients undergoing cardiac surgery
What gastroenterologists should know about microplastics and nanoplastics
No full textGlobal production and widespread use of plastics are increasing dramatically. With current limited recycling and recovery options, microplastics and nanoplastics (MNPs) persist in the natural environment. Due to their ubiquity, human exposure to MNPs is inevitable. In addition to their inherent toxic effects, MNPs can adsorb harmful contaminants and act as vectors for microorganisms, compounding toxicological effects. After entering the body, bioaccumulation occurs in several tissues and organs, including the liver and the gastrointestinal (GI) tract. Proposed clinical effects of MNP absorption include endocrine disruption, alteration of the GI microbiome, and promotion of chronic inflammatory conditions. MNPs can also influence energy metabolism, activate inflammatory pathways, and increase oxidative stress leading to apoptosis. The GI tract is a major site of bioaccumulation for the MNPs in animals and humans. In this editorial, the current understanding of how MNPs are processed is discussed. Discussion on MNP effects on internal microflora, and their proposed role in developing inflammatory bowel diseases, MNP toxicokinetics, and their significance in health and disease are also reviewed. There is a need to understand the impact of MNP exposure on gut health and gut microbiota and identify current research gaps
Health disparities in rheumatology in the United States
No full textObjective:Underserved populations are often at risk of experiencing systematic healthcare disparities. Existing disparities in care access, quality of care received, and treatment outcomes among patients with rheumatic disease are not well understood.
Methods:We conducted a targeted literature review to understand disparities in health outcomes, treatment patterns, and healthcare management faced by rheumatology patients in the United States, with a focus on rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).
Results:The findings of this review indicate that disparities in RA, PsA, and AS affect several historically underserved populations, including underrepresented racial and ethnic groups, persons with lower socioeconomic status (SES), persons experiencing homelessness, and patients with Medicare or Medicaid insurance types. The disparities experienced by these populations include greater disease activity and severity, decreased or delayed access to specialist care, decreased likelihood of receiving advanced therapeutics, and worse clinical outcomes.
Conclusion:To provide equitable healthcare for all patients with RA, PsA, and AS, multiple closely linked health disparities must be addressed. Possible solutions include partnerships between healthcare systems and community-based organizations, targeted outreach tailored to patients with low SES, interventions to improve patient adherence and knowledge, and interventions to improve access to care for rural-residing and unhoused patients. In all, the findings of this literature review underscore the need for mitigation of health disparities in rheumatology care and may serve as a foundation for developing strategies to reduce disparities
A Message to Our 2024 Peer Reviewers: Thank You
No full textLike all peer-reviewed journals, we rely heavily on our diverse pool of academic and clinical reviewers who generously volunteer their time to help rigorously gatekeep original manuscript submissions to the Journal of Patient-Centered Research and Reviews (JPCRR). Indeed, the high-quality science and patient-centered focus of our published articles are a testament to the hard work that these scholarly reviewers devote to the journal. Listed in this citable acknowledgment are the names of each of our peer reviewers from the past 12 months, and we sincerely thank them for their valuable contributions to JPCRR and our goal of advancing patient-centered practices, health outcomes, and patient experiences
Dreyer Heartbeat, 1992-1993 December-January
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1907/thumbnail.jp