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Changing Health Care for Good: Building Resilience to Tackle Burnout and Suicide for Physicians and Students
No full textThe Role of PIK3CA in Advanced and Metastatic Colorectal Cancer and the Therapeutic Potential and Efficacy of PIK3CA Inhibitors
No full textColorectal cancer (CRC) is one of the most prevalent malignancies globally and is the leading cause of cancer mortality worldwide. Advanced and metastatic CRC is associated with poor prognosis due to high rates of metastases and resistance to standard therapies. With the advent of next-generation sequencing, there has been increased interest in molecularly targeted treatments. One such molecular target is the PIK3CA gene, a key component of the phosphatidylinositol 3-kinase (PI3K) pathway, which has been linked to promoting tumor survival and proliferation in cancer cell populations. PIK3CA mutations are detected in approximately 10–20% of CRC cases. The presence of these mutations has both prognostic and predictive implications, particularly in regards to providing resistance to standard-of-care CRC therapies. Targeting PIK3CA with selective PI3K inhibitors has shown modest results: in the Copanlisib NCI-MATCH trial, objective responses were observed in 16% of patients with PIK3CA-mutant tumors, although CRC patients experienced only disease stabilization without tumor shrinkage. Similarly, in the Taselisib phase II basket study, median progression-free survival was 3.1 months with no complete or partial responses in CRC cohorts. These findings highlight the limited therapeutic efficacy of PI3K inhibitors in CRC, driven by factors including toxicity, adaptive resistance, pathway crosstalk, and tumor co-mutation profiles. The current research is focused on optimizing combination strategies, refining patient selection through biomarkers, targeting specific isoforms within the PI3K pathway, and overcoming resistance mechanisms to unlock the full therapeutic potential of PI3K-targeted therapies for advanced and metastatic CRC
Top 100 Cited Articles in Osteopathic Medical Education: A Bibliometric Analysis
No full textContext
Bibliometric analysis is a method for analyzing the existing literature of a specific research area. Because it provides information about current research trends, the analysis can highlight attributes of frequently cited articles and identify areas for future research. To our knowledge, no such investigation has been conducted for osteopathic medical education.
Objective
To conduct a bibliometric analysis of the 100 top-cited articles in osteopathic medical education to identify characteristics of the articles and to explore the thematic structure and connections among common topics.
Methods
In October 2020, the Web of Science (WOS) Core Collection was searched for osteopathic medical education articles authored by faculty associated with U.S. colleges of osteopathic medicine (COMs). Search results included articles from 1975 to the present, based on the available dates of the indexes. Only articles in English were included in the search. Articles were identified using a three-stage search strategy and group consensus. Once identified, the following bibliometric characteristics were collected: journal name, journal impact factor, year of publication, article title, medical education research topic, authors, number of citations, and the authors’ COM affiliation. Articles were then hand searched in several non-indexed osteopathic-related journals, collecting the same data and using Google Scholar for the number of citations. The 100 top-cited articles were extracted and included in our analysis. Bibliometric metrics were calculated and summarized to assess performance and impact. Science mapping by topics was conducted to assess article contents. Specifically, network analysis and clustering were used to explore the structure and relationship of topics covered in the articles.
Results
Our WOS search identified 193,381 records. The highest 50,000 top-cited results were downloaded for screening, and an additional 89 records were identified from journal website searches. After initial screening and removal of duplicates, the title and abstract of 134 records were independently screened by each team member. Of those, 28 were excluded because they were not a U.S. study, authored by a non-COM author, or outside our study scope; six did not meet our exclusion criteria. The top-cited article was a systematic review that was cited 107 times. The journal with the most top-cited articles (28) was Academic Medicine, but BMC Medical Education had the highest number of citations per article (37.8). The Philadelphia College of Osteopathic Medicine and Ohio University Heritage College of Osteopathic Medicine tied for the highest number (15) of top-cited articles, but Lake Erie College of Osteopathic Medicine had the highest number of citations per article (39.8). Network analysis and clustering identified four thematic groupings: humanistic and whole-person care; clinical science and training; educational technology; and health-care systems. The topics within each cluster were cohesive, yet clusters also communicated with each other.
Conclusion
Results of the current study provided valuable information about the most frequent osteopathic medical education topics published by authors affiliated with COMs and suggested that journal impact factor was not a direct contributor to number of citations per article. The cluster analysis also provided insight about interconnected topics in osteopathic medical education. Results from this bibliometric analysis may be useful to inform future research, encourage collaboration, and provide guidance for advancing osteopathic medical education research in the United States
Netherton Syndrome: A Systematic Review of the Challenges of Diagnosis and Treatment
No full textNetherton syndrome is an autosomal recessive genodermatosis caused by biallelic mutations in the SPINK5 gene, a gene that codes for lymphoepithelial Kazal-type-related inhibitor 1 (LEKT1) protein. This disorder is characterized by erythroderma, ichthyosis, hair shaft abnormalities, and immune dysregulation. While there is increasing research and recognition of Netherton syndrome, much remains unknown, with limited knowledge of the history, manifestations, and responses to therapies. The purpose of this study was to review case reports of Netherton’s to draw conclusions from patient demographics, symptoms, treatment, and outcomes. A systematic review of 30 case reports and clinical studies on Netherton syndrome was conducted, including only patient-level clinical data of studies in English. Data were extracted via full-text review, organized into comparative tables, and analyzed for common patterns in symptoms, diagnostic techniques, and treatments. Biologic therapies consistently reduced Netherton syndrome effects with improvements in symptoms and infection rates. No cases of complete remission have been reported from the cases examined. With no standardized treatment in place, larger studies are needed. While biologic therapies have offered improvement of symptoms for patients with Netherton syndrome, remission is still not achievable. Treatment outcomes are variable and require an individualized technique in patient care. Genetic testing is the most valuable for diagnosis, but it is not always accessible. Lack of standardized therapy exhibits a need for larger studies to be conducted in order to improve patient care
Assessing Proximal Humerus Cortical Bone Thickness for Total Shoulder Arthroplasty: A Cadaveric Study
No full textBackground
In reverse total shoulder arthroplasty, a humeral osteotomy is typically performed at the anatomic neck. The quality and quantity of cancellous and cortical bone impacts sizing of implants. Little-to-no information exists characterizing the transition of this bone quality at this location. This cadaveric study focused on measuring and analyzing the transition zone of the proximal humerus bone quality to better understand the implications of utilizing different implant sizes during reverse total shoulder arthroplasty. This assessment was conducted through the usage of a newly designed indentation depth probe.
Methods
An Exactech, Inc. designed indentation depth probe was used to assess the transition from cancellous to cortical bone in 45 cadavers after a humeral osteotomy was performed. The thickness of the cortical rim was measured in regard to superior, inferior, anterior, and posterior quadrants. Linear regressions were utilized to evaluate the relationship between anatomic location in regard to cortical bone thickness. Independent sample two-tailed t-tests were also conducted to examine the relationship between spring force and bone thickness. Finally, independent sample two-tailed t-tests or Mann-Whitney U tests were utilized to examine the relationship between cortical thickness and variables including sex, age, osteoporosis, and a diagnosis of cancer.
Results
All linear regressions were found to be insignificant excluding the relationships between inferior to anterior (p = 0.003) and inferior to posterior (p = 0.001). All t-tests and Mann-Whitney U tests were found to be insignificant, except for the relationship between age and the posterior aspect (p = 0.04).
Conclusions
In our cohort, cortical bone thickness was not impacted by sex, diagnosis of osteoporosis, or diagnosis of cancer. Interestingly, age was found to only have an impact on the posterior aspect of the cortical bone rim. Differences in cortical bone thickness were also found in regard to both the inferior to anterior and inferior to posterior comparisons.
Clinical relevance
This suggests that differences in cortical bone thickness can occur, and that one point of assessment might not be sufficient
Continuous Quality Improvement in Social Needs Screening: Evaluation of an Intervention in Bariatric Specialty Care
Full text linkIntroduction:
With growing recognition of the influence that social risks, such as food insecurity and housing instability, have on individual and population health, social risk screening and social care interventions have proliferated across the health system. Social needs intervention research on screening and referral in specialty care is limited, despite evidence that social needs influence access to and outcomes of surgical and specialty care. Methods:
This study is a qualitative, formative evaluation of a quality improvement-oriented social needs screening and referral pilot program implemented in a bariatric surgery practice and aims to share lessons related to the structure and process components of a quality improvement (QI) framework. Results:
Semistructured interviews revealed variation in patient eligibility for resources and highlighted the need for enhanced staff capacity and data system integration. In addition, process-related themes including patient hesitation toward referrals, variability in screening pathways, and uncertainty surrounding communication practices emerged in qualitative analyses. Conclusions:
Implementation of social needs screening and referral programs in specialty care setting is feasible but requires unique structure and process-related considerations. Incorporating QI infrastructure into these programs allows for continuous evaluation of program processes and can be used to evaluate the impact of these programs on health outcomes
Survival Against the Odds: Successful Treatment of Incomplete Traumatic Hemipelvectomy in a 29-Year-Old Woman Following a Boating Accident
Full text linkTraumatic hemipelvectomy (THP) is a rare, life-threatening injury characterized by the dislocation of the hemipelvis, often resulting from high-energy trauma. It carries a high mortality risk due to severe vascular injuries, with survival contingent on rapid hemorrhage control and a multidisciplinary approach. Limb salvage is rarely achievable due to the extent of the injury and complications such as infection and tissue nonviability. We present a case of incomplete THP in a 29-year-old woman who sustained severe soft tissue, bony, and vascular injuries following a boating accident. On arrival, the patient was in critical condition with a massive hemorrhage, requiring immediate intervention. A multidisciplinary approach was implemented, including damage control surgery, vascular ligation, massive transfusion protocol (MTP), and selective embolization. Despite initial efforts, her left lower extremity was deemed unsalvageable, and a left hemipelvectomy was performed. Postoperative care involved managing pedicle flap congestion with sequential wound debridement and hyperbaric oxygen therapy. The patient’s recovery included multiple surgical interventions for wound care and flap viability. Over time, viable tissue demarcation allowed for more definitive closure. This case underscores the complexity of managing THP, highlighting the importance of timely, coordinated surgical efforts, aggressive hemorrhage control, and postoperative care to prevent infection and optimize functional outcomes
Trends in Osteopathic Medical Education: A Scoping Review
Full text linkContext: Following the transition to a single graduate medical education (GME) accreditation system in 2020, leaders at American Association of Colleges of Osteopathic Medicine (AACOM) were interested in learning more about the research being done about osteopathic medical education leading up to that point in time.
Objectives: The objective of this scoping review was to identify trends in undergraduate and graduate osteopathic medical education and to determine where this information was being disseminated and the institutions who were creating the content.
Methods: Searches were conducted in eight databases: PubMed (National Center for Biotechnology Information [NCBI]), MEDLINE (Ovid), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature ([CINAHL], EBSCO), Education Research Complete (EBSCO) OSTMED.DR, Education Resources Information Center ([ERIC], Ovid), and Scopus (Elsevier). Gray literature sources were also identified. All 10 authors were involved in the search. Search terms were identified by utilizing Medical Subject Headings (MeSH), the Yale MeSH Analyzer, and through consultation with an expert searcher. Sources were excluded if they were not in English, were based outside of the United States, did not fit in the date range of being published between 2010 and 2020, and included information on COVID-19. The research team conducted title/abstract screening based on the inclusion and exclusion criteria.
Results: A total of 8,083 articles were identified and included through searches, ending in a total of 1,203 articles after full-text screening. Most sources for this osteopathic medical education review were journal articles (n=505) and conference proceedings (n=482). A total of 23 trends were identified, with the top three being residency (n=318), curriculum (n=235), and pedagogy (n=178). None of the other 23 primary trends were above 6.9 %.
Conclusions: Osteopathic medical education trends from 2010 to 2020 were primarily focused on residency, curriculum, and pedagogy. This information was disseminated evenly between published journal articles and conference presentations, and osteopathic institutions that have existed longer and have established research track records were more likely to publish and share information in this area
Immersive Extended Reality (I-XR) in Medical and Nursing for Skill Competency and Knowledge Acquisition: A Systematic Review and Implications for Pedagogical Practices
Full text linkSimulation has evolved from basic practice to Immersive Extended Reality (I-XR). This systematic review examined 56 published studies on the impact of I-XR, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), on the education of medical and nursing students, specifically their skill competency, and knowledge acquisition. The results demonstrate the significant potential of I-XR in healthcare education, with 42.5% of VR studies, 42.9% of AR studies, and the single MR study also demonstrating greater improvements in clinical skills and knowledge acquisition compared to non-immersive (non-I-XR) training conditions. In contrast, only 2.5% of VR studies and 7.14% of AR studies favored non-I-XR methods. It is important, however, to acknowledge the 26.8% of studies that showed mixed results (some evidence for the I-XR methods on some outcomes, but also some evidence for the non-I-XR methods, on other outcomes). Notably, the review also identified a critical gap in the theoretical foundations of I-XR learning, highlighting the urgent need for research to inform the effective pedagogical implementation of these powerful tools. We offer a preliminary framework to address the lack of learning theory in healthcare I-XR training, with implications for pedagogical practices