DigitalCommons@KCU (Kansas City Univ.)
Not a member yet
2803 research outputs found
Sort by
Evaluation of Diversity, Equity, and Inclusion Information on US Neurosurgery Residency Program Websites
No full textObjective: The objective of this study was to determine the prevalence of diversity, equity, and inclusion (DEI) information on neurosurgery residency program websites and examine the association between program size, ranking, and DEI information presence.
Methods: A cross-sectional review of 115 US neurosurgery residency program websites was conducted from January 1 to March 2, 2024. Websites were evaluated based on six DEI criteria: 1) diversity commitment in mission/leadership statements, 2) separate diversity mission statement, 3) rotations/fellowships for underrepresented minority students, 4) diversity initiatives, 5) diversity page/section, and 6) appointed diversity leadership positions. Associations between program size, ranking, and DEI information were analyzed.
Results: Among the 115 programs, only 35 (30.43%) met at least one DEI criterion. Specifically, 18.26% had a separate diversity mission statement and 15.65% included a DEI statement in mission/leadership messages. Programs with more than 13 residents were significantly more likely to meet at least one DEI criterion (OR 2.96, 95% CI 1.16-7.56; p = 0.022) and to include a DEI statement in mission/leadership messages (OR 5.38, 95% CI 1.71-24.72; p = 0.018). Top 25-ranked programs by U.S. News & World Report were more likely to have diversity initiatives (OR 6.23, 95% CI 1.78-23.97; p = 0.007). Programs meeting any DEI criterion had a higher percentage of female (29.67% vs 22.55%, p = 0.013) and Black (7.85% vs 4.49%, p = 0.019) residents. There was no statistically significant difference in the percentage of White residents (p = 0.206) across programs, and programs with a mention of DEI in the mission statement had a lower percentage of Asian residents (24.08% vs 33.29%, p = 0.042).
Conclusions: Most US neurosurgery residency programs lack DEI information on their websites. Larger programs and those with higher rankings are more likely to include DEI content, particularly standalone statements. Programs meeting DEI criteria tend to have a higher representation of female and Black residents. These findings highlight the need for greater transparency and commitment to DEI in neurosurgery residency programs, ensuring prospective applicants have access to comprehensive DEI information
Meeting Physical Activity Guidelines for Persons with Multiple Sclerosis Reduces Fatigue Severity and Impact: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
No full textObjective: Regular physical activity is a recommended behavioral goal for persons with multiple sclerosis. This review aimed to determine the effect of interventions that met physical activity guidelines for persons with multiple sclerosis on fatigue measures and to compare the magnitudes of the effect sizes for meeting these guidelines with the minimal clinically important differences for fatigue measures.
Methods: The search was conducted in PubMed, EMBASE, Web of Science, SPORTDiscus, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO from inception to October 2024. Only randomized clinical trials that explicitly met physical activity guidelines and evaluated fatigue were included. Two independent reviewers screened articles for inclusion and evaluated the risk of bias of included trials using the Cochrane risk-of-bias tool for randomized trials. Findings were summarized, and a meta-analysis was conducted. Fatigue measures included the Fatigue Severity Scale, Fatigue Impact Scale, and modified Fatigue Impact Scale. The Grading of Recommendations, Assessment, Development and Evaluation was used to evaluate the quality of the evidence. The review protocol was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42023387305).
Results: Twenty-two randomized clinical trials with 920 participants were included in the review; 17 studies were included in the meta-analysis. Findings indicated that interventions meeting physical activity guidelines for at least 4 weeks significantly reduced fatigue severity (standardized mean difference = -1.46; 95% CI = -2.11 to -0.81) and fatigue impact measured with the modified Fatigue Impact Scale (mean difference = -11.88; 95% CI = -20.57 to -3.19) and Fatigue Impact Scale (mean difference = -21.08; 95% CI = -31.01 to -11.15). All findings were clinically relevant, with effect sizes exceeding the established minimal clinically important differences for the fatigue measures. Some methodological concerns were noted, and the evidence level ranged from very low to moderate.
Conclusions: Evidence suggests that engaging in physical activity for at least 150 min/wk or 2 sessions of 10 to 30 minutes of moderate-intensity aerobic training plus 2 sessions of resistance training per week results in clinically significant reductions in fatigue severity and impact necessary to improve the quality of life of persons with multiple sclerosis.
Impact: Fatigue is a highly prevalent symptom associated with poor outcomes including falls, activity restrictions, pain, cognitive problems, functional limitations, and mortality risk among persons with multiple sclerosis. Our study suggests that adhering to physical activity guidelines developed for persons with multiple sclerosis clinically reduces the severity and impact of fatigue. This regimen includes engaging in physical activity for at least 150 min/wk or participating in 2 sessions of 10 to 30 minutes of moderate-intensity aerobic training plus 2 sessions of resistance training per week
Temporal and Regional Trends of Fractures in the United States: A Review of the Global Burden of Disease Database
No full textBackground: Musculoskeletal diseases, including bone fractures, are a significant contributor to global disability. Understanding temporal and regional trends in bone fractures is crucial for effective healthcare planning and resource allocation. We sought to analyze recent epidemiological trends of different types of fractures in the United States and determine correlations and associations between fracture trends and potential influencing demographic factors (i.e. age, sex, regional-specific).
Methods: Data from the Global Burden of Disease Database were analyzed to examine fracture incidence, prevalence, and years lived with disability (YLDs). Statistical analyses were conducted to determine temporal trends and sex-based differences.
Results: The analysis revealed significant increases in hip fractures and decreases in pelvic fractures over time. Fractures of the patella, tibia, fibula, and ankle remain prevalent across all regions and sexes, with notable variations.
Conclusions: These findings underscore the importance of targeted interventions and resource allocation to address the burden of fractures on public health. Despite limitations, this study provides critical insights into fracture epidemiology, guiding future prevention and management strategies
Creating a Framework for Minimizing Opioid Consumption after Office Based Surgery
No full textPurpose of review: Herein we review recent trends in opioid prescribing, the rise in office-based surgeries, and propose a framework to minimize opioid consumption following such procedures.
Recent findings: Outpatient surgical procedures are increasing year over year in the United States. This observed increase is expected to continue due to the financial incentives to perform outpatient procedures. Office-based surgery is a setting that is expected to have tremendous growth. Still, currently there are scant safety guidelines concerning how to manage perioperative pain related to surgeries in this setting safely and effectively. Opioid abuse is rampant across the United States, and we anticipate that an increase in outpatient procedures will create a rise in opioid prescribing without appropriate discourse and planning. There are a variety of systematic factors in play to minimize opioid consumption after office-based surgery that must be considered at each operative phase. Careful planning and consideration of the multitude of factors can increase patient satisfaction while minimizing opioid prescriptions
Beyond Buzzwords -Updated Recommendations for Evaluating Patients Presenting Without La Belle Indifference and Diagnosing Functional Neurological Symptom Disorder: A Case Report
Get PDFLa belle indifference-absence of psychological distress despite presence of significant neurological symptoms-is often highlighted in current literature as a key diagnostic criterion for functional neurological symptom disorder. However, as exemplified with this case, functional neurological symptom disorder may present without la belle indifference more commonly than previously believed. A distressed 60-year-old female presented with abdominal pain, then suddenly lost ability to speak and developed rapid, rhythmic mandible movements. Multidisciplinary examination including diagnostic evaluation of the heart, head, and neck was largely unremarkable. Following her extensive evaluation, it was revealed that she had experienced similar symptoms previously, during times of high psychological stress. A diagnosis of functional neurological symptom disorder was established, and her symptoms resolved with minimal intervention. To best serve our patients, clinicians are encouraged to perform thorough history collection and physical examination prior to obtaining costly and time-consuming diagnostic studies whenever possible. By asking about risk factors of functional neurological symptom disorder early in the patient encounter, clinicians may be able to reduce unnecessary diagnostic testing, thus minimizing patient exposure to potential risks associated with extensive diagnostic evaluation and decreasing healthcare costs
Antibiotic Monotherapy vs Dual-drug Therapy in Perforated Appendicitis: Single-center Retrospective Review
No full textBackground: There is no consensus on the optimal antibiotic regimen in perforated appendicitis. We aimed to evaluate the outcomes of patients with perforated appendicitis when treated with Piperacillin-Tazobactam (PT) monotherapy versus Ceftriaxone and Metronidazole (CM) dual-drug therapy. We hypothesized that there is no difference in the rate of intraabdominal abscess (IAA) formation with antibiotic monotherapy, as opposed to our institutional standard dual-drug therapy.
Methods: Single institution retrospective review of children \u3c 18 years old with perforated appendicitis from October 2019 to March 2020 and October 2021 to May 2022 at a free-standing pediatric hospital. The primary outcome was 30-day postoperative IAA formation.
Results: One hundred and seventeen patients were identified during the study periods; N = 77 in the CM group and N = 40 in the PT group. No differences in symptom duration, postoperative length of stay (LOS), duration of intravenous antibiotic treatment, or discharge oral antibiotic treatment were identified. Compared to the PT group, those treated with CM had fewer IAA (13% vs 20%, P = 0.32) and fewer emergency room visits (14.3% vs 27.5%, P = 0.08) but did not have statistically significant differences. Multivariate logistic regression analysis did not find antibiotic choice to be a significant predictor for developing IAA [OR 1.78, P = 0.21].
Conclusions: In children with perforated appendicitis, postoperative monotherapy with PT and standard dual-drug therapy with CM are equivalent with respect to IAA formation at our institution
Discerning the Effects of Death Anxiety and Communication Apprehension About Death on Willingness to Work With Older Adults
No full textAs the proportion of older adults grows, so will the need for psychologists who work with them. Psychologists will encounter clients facing death-related issues as the population ages; therefore, doctoral psychology students need to be comfortable treating elderly clients. There are no known studies on death anxiety and willingness to work with older adults (willingness) that include the factor of communication apprehension about death. This study addressed communication apprehension about death, as effective communication about death-related topics is critical to working with older adults. Hypotheses included: (1) students who have more death anxiety will be less willing to work with older adults, (2) students who have more communication apprehension about death will be less willing to work with older adults, and (3) the relationship between death anxiety and willingness will be affected by the level of student communication apprehension. This survey research study used a convenience sample of 83 clinical psychology doctoral students across the U.S. Willingness was analyzed in relation to death anxiety and communication apprehension about death using linear regressions and a mediation analysis. The linear regressions demonstrated that students with more death anxiety and more communication apprehension about death are less willing to work with older adults. The mediation analysis demonstrated that students’ communication apprehension about death does not mediate the relationship between death anxiety and willingness. A follow up multiple linear regression explored factors affecting the no mediation finding, which demonstrated that the tests measuring the constructs of death anxiety and communication apprehension overlap, invalidating the mediation. These findings contribute to an understanding of the influence of different factors that affect trainees’ decision to work with older adults and allows for graduate level training to incorporate these factors into training to increase willingness to work with older adults
Bumps on My Head-A Case of Acute T-Cell Lymphoblastic Lymphoma
No full textT-cell lymphoblastic lymphoma (T-LBL) is an aggressive, rare neoplasm of immature T-cell precursors, typically presenting with lymphadenopathy, a mediastinal mass, and bone marrow involvement. We report the case of a 25-year-old man who presented with plaques and subcutaneous nodules on the scalp, forehead, and left cheek, accompanied by posterior cervical lymphadenopathy. Immunohistochemical studies of intralesional punch, lymph node, and bone marrow biopsies confirmed a diagnosis of T-LBL. In addition, NOTCH1 oncogene mutations, a common feature of T-LBL, were detected. Although cutaneous involvement in T-LBL is rare and uncommonly the most prominent symptom, this case highlights a rare presentation with predominantly cutaneous manifestations. This emphasizes the importance of early recognition when malignancy is suspected to prevent the development of more severe complications
The Hidden Link Between HIV and Cardiomyopathy: Unraveling HIV\u27s Impact on the Heart
No full textThis comprehensive review examines the complex relationship between human immunodeficiency virus (HIV) and cardiomyopathy, focusing on the underlying molecular mechanisms, clinical manifestations, diagnostic approaches, and treatment strategies. It highlights the significant global health burden posed by HIV and its potential to cause long-term cardiovascular complications. The review investigates the pathogenesis of HIV-associated cardiomyopathy. It elucidates the intricate cellular and molecular pathways involved, including the actions of neutrophils, monocytes, macrophages, and lymphocytes in cardiac inflammation. Key signaling pathways such as TNF-NF-κB and the caspase-1 inflammasome are detailed, as they contribute to cardiac infection and injury. The clinical manifestations of HIV-associated cardiomyopathy are discussed, including fatigue, dyspnea, peripheral edema, and arrhythmias. The review outlines essential diagnostic methods, highlighting the importance of cardiac biomarkers, electrocardiography, and imaging techniques such as echocardiography and cardiac MRI. Treatment strategies are explored, encompassing lifestyle modifications, pharmacological interventions, and advanced therapies. The review underscores the importance of addressing micronutrient deficiencies, particularly selenium, in the management of HIV-associated cardiomyopathy. It also discusses the role of antiretroviral therapy and the potential benefits of intravenous immunoglobulin therapy. Furthermore, this review addresses the evolving perspective on heart transplantation for individuals with HIV. It notes that while HIV was once considered a contraindication for transplantation, recent advancements in antiretroviral therapy have led to a re-evaluation of this stance. Finally, the review identifies future research directions, emphasizing the need for biomarkers to detect at-risk patients, exploration of nutritional factors predisposing individuals to cardiomyopathy, and further investigation into advanced therapies for HIV-associated cardiomyopathy. This review significantly enhances the understanding of HIV-associated cardiomyopathy, providing valuable insights for clinicians and researchers in the fields of infectious diseases and cardiology