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Required Art-Based Curriculum Improves Essential Qualities in Medical Students: A Three-Year Study With In-Person and Remote Art Observation Experiences
Full text linkMedical education is increasingly challenged to develop a curriculum that addresses ambiguity, empathy, and perspective-taking. We developed a required art-based curriculum for all first-year medical students to address this need. Within this course, students use art observation and the Visual Thinking Strategies (VTS) question framework to explore interprofessional collaborative practice, ambiguity in healthcare, and perspective-taking. The purpose of this study was to examine if the art-based curriculum was associated with changes in tolerance for ambiguity, perspective-taking, and empathy in medical students. Changes in these qualities were evaluated between in-person, emergency remote, and planned remote sessions.
From September 2018 to May 2021, 794 first-year medical students from two campuses participated in a two-hour art observation session where VTS was used to prompt discussion. All participants were surveyed in pre- and post-art observation activities in tolerance for ambiguity, empathy, and perspective-taking. A linear mixed-effects regression model was used to measure pre/post changes for each learning modality (in-person, emergency remote, planned remote).
The two-hour art observation activity using VTS was associated with an increase in tolerance for ambiguity of 0.19 (95% CI: 0.15 to 0.23) average TFA scale points. We observed no difference in outcomes across academic years, museums, emergency remote, or planned remote experiences. We did not detect significant differences in either perspective-taking or empathy.
We have developed a curriculum that improves qualities that are essential for practice in complex and evolving health systems. These improvements are observed independent of learning modality (in an art museum, emergency remote teaching, or planned remote teaching), creating an opportunity to engage with students and programs across the spectrum of health professions education, independent of location. Providing access to educational programming that addresses essential qualities and behaviors of healthcare providers has the potential to improve patient outcomes through team-based healthcare and interprofessional collaborative practice
Changes in Quality of Life and Mental Health Outcomes Related to Vaping Cessation Among US Adults
No full textObjectives: Vaping cessation has important public health implications. This study seeks to assess longitudinal changes in quality of life and mental health associated with vaping cessation.
Methods: Data were drawn from the longitudinal wave 5 (December 2018-November 2019) and wave 6 (March 2021-November 2021) of the Population Assessment of Tobacco and Health study, a nationally representative sample of US adults aged 18 and older. The study sample included participants who reported exclusive use of e-cigarettes at baseline. The difference-in-difference models were performed to assess changes in self-reported quality of life and mental health outcomes between those who quit e-cigarettes and those who continued vaping at the follow-up, stratified by baseline internalising and externalising problems.
Results: Among 912 participants who reported exclusive e-cigarette use at baseline, 331 (33.4%) reported quitting e-cigarettes at the 2-year follow-up. Individuals with previous smoking history (vs no) had lower cessation rates (26.8% vs 42.5%, p\u3c0.01), as did participants who reported daily e-cigarette use (vs someday use, 22.2% vs 54.4%, p\u3c0.01). Vaping cessation was associated with a significant improvement in quality of life (adjusted b(SE)=0.22 (0.08), p=0.01) and mental health outcomes (adjusted b(SE)=0.27 (0.10), p=0.01). Participants with high/moderate internalising or externalising problems (vs low) had comparable vaping cessation rates and experienced improved quality of life and mental health after vaping cessation.
Conclusions: This study demonstrates that vaping cessation is associated with improved quality of life and mental health. Future research should continue to explore long-term health outcomes and develop targeted interventions for vaping cessation
Interconnected Anatomy and Clinical Relevance of the Dorsal Scapular and Long Thoracic Nerves: A Donor Study
Full text linkBackground: The dorsal scapular nerve (DSN) and the long thoracic nerve (LTN) exhibit variable anatomical pathways, which may contribute to upper back pain and impaired scapular movement in affected patients. This study investigates these variations to enhance clinicians’ diagnostic and surgical approaches.
Methods: The bilateral cervical regions of 32 formalin-embalmed donors (64 sides) were dissected to document the origin of the DSN, the relationship with the scalene muscles of the DSN, and anatomical connections between the DSN and LTN. Measurements of the distance between the mastoid process and the piercing point of the DSN to the scalene muscle were obtained with digital calipers. Additional measurements were obtained from the medial border of the scapula at two specific locations: the scapular spine (zone 1) and the midpoint between the scapular spine and the inferior angle of the scapula (zone 2).
Results: The DSN demonstrated four distinct cervical spinal nerve root origins and five unique scalene muscle piercing patterns. The average distance between the DSNs’ scalene muscle piercing point and the mastoid process was 94.87 ± 10.09 mm, with significantly greater distances observed in male donors compared to female donors (p \u3c 0.001). Connections between the DSN and LTN were identified in 65.2% of the examined cervical regions. The mean distance of the DSN from the medial border of the scapula at zone 2 was significantly greater than at zone 1 (p \u3c 0.001).
Conclusions: The anatomical variation findings and classification of the DSN provide valuable insights, offering guidance for conducting clinical procedures of the scalene and rhomboid musculature in a way that minimizes the risk of iatrogenic injury. The documented variations may also assist in the diagnosis and management of DSN-related pathologies such as DSN neuropathy
Increasing the Awareness of Contact Allergens in Eczema-Friendly Products for Pediatric Patients with Atopic Dermatitis
No full textReducing Postoperative Opioids in Pediatric Laparoscopic Cholecystectomy: A Retrospective, Single-Center Cohort Study
No full textIntroduction: Overprescribing of opioid pain medications can lead to adverse outcomes and contributes to the opioid crisis. We previously reported eliminating opioids in select patients. This retrospective study aimed to compare outcomes in pediatric patients undergoing laparoscopic cholecystectomy (LC) who were and were not prescribed opioid pain medications.
Methods: A retrospective review of pediatric patients \u3c18 ys of age who underwent LC from 2016 to 2022 was performed. Patients who underwent open cholecystectomy or additional surgical procedures performed simultaneously were excluded. Patient demographics, operative details, medication usage, and postoperative complications were recorded. Patients prescribed opioid pain medication at discharge were compared to those who were treated with nonopioid pain medications (i.e., acetaminophen, ibuprofen, and ketorolac).
Results: In total, 511 patients were included, of which 76.9% were prescribed opioids. Patients who were not prescribed opioids more commonly received intravenous ketorolac (81.4% versus 35.6%, P \u3c 0.001), used less postoperative morphine milligram equivalents per kilogram (MME) (0.3 versus 0.4 MME/kg, P = 0.044), had lower rates of postoperative phone calls for pain (6.8% versus 18.8%, P = 0.002), and reported less pain at follow-up (6.8% versus 18.8%, P = 0.002). There were no differences in emergency department visits or hospital readmissions within 30 ds of discharge. Institutional rates of opioid prescriptions following LC decreased over the study duration (97.8% in 2016 to 28.4% in 2022, P \u3c 0.001).
Conclusions: Nonopioid postoperative pain control in pediatric patients undergoing LC is well-tolerated and may be effective in reducing opioid use. In this cohort, nonopioid and opioid pain management modalities had similar postoperative hospital resource utilization. Therefore, opioid use and its resultant complications may potentially be able to be reduced
Retraction: A Case Report of Grisel\u27s Syndrome Complicating the Postoperative Course of Craniotomy for a Massive Cystic Brain Lesion
Full text linkLongitudinal Management Trends of Basilar Thumb Arthritis: A National Epidemiologic Analysis
No full textPurpose: Osteoarthritis (OA) of the first carpometacarpal (CMC) joint, or basilar thumb arthritis, is the most common symptomatic hand arthritis, leading to significant healthcare costs. This study analyzed trends in managing basilar thumb arthritis and determined approaches linked to favorable outcomes to guide future treatments.
Methods: This retrospective cohort study queried the TriNetX United States Collaborative Network from 2013 to 2023. Patients with primary OA of the first CMC joint were identified using International Classification of Diseases-10 codes, and surgical interventions were classified using Current Procedural Terminology codes. Patients were stratified by surgical status and age groups (18-59 years and 60 years or older). Baseline demographic characteristics, risk factors, and mortality rates were compared between surgical and non-surgical cohorts. The incidence and prevalence of surgical interventions for basilar thumb arthritis were also determined.
Results: The study included 213,881 patients with primary basilar thumb arthritis (12,923 in the operative group and 195,820 in the non-operative cohort). Obesity (BMI 30-39), nicotine dependence, and Type 2 diabetes mellitus were more prevalent in the operative group (p \u3c 0.01). The non-operative cohort had a lower average BMI (20-29, p = 0.04). Surgery incidence rose from 0.13 % in 2013 to 1.13 % by 2023, while prevalence increased from 0.45 % to 5.93 %. The matched odds ratios were 0.652 for 1-year, 0.763 for 3-year, and 0.818 for 5-year mortality.
Conclusions: Management of basilar thumb arthritis is shifting towards more surgical interventions. Identifying optimal patient profiles for surgery will refine management strategies for this condition
