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The Intersection of Race, Ethnicity, and Urbanicity on Treatment Paradigms and Clinical Outcomes for Non-Malignant Primary Tumors of the Spine
No full textBackground: Non-malignant primary tumors of the spine (NMPTS) patients in rural areas face unique barriers that may limit their capacity to receive optimal care. With a lower geographical distribution of neurosurgical specialists and limited healthcare infrastructure, rural NMPTS patients may receive certain treatments at a lower frequency than metropolitan patients. NMPTS We sought to examine the association between residential urbanicity, race-ethnicity, treatment patterns, and survival outcomes for cases diagnosed with NMPTS.
Methods: Cases of NMPTS diagnosed between 2004 and 2019 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a combined dataset of CDC\u27s National Program of Cancer Registries (NPCR) and NCI\u27s Surveillance, Epidemiology and End Results (SEER) data. Using multivariable logistic regression, we evaluated the association between urbanicity and treatment (including surgery and radiation), adjusted for age at diagnosis, sex, and race-ethnicity. Patient-level all-cause survival data were obtained from the NPCR Survival Analytical Database (2004-2018).
Results: A total of 38,414 cases were identified, 33,097 of whom lived in metropolitan and 5317 of whom lived in non-metropolitan regions. Nerve sheath tumors and meningiomas were the most common tumor histopathologies across both regions, with no clinically significant difference in other histopathologies (p
Conclusion: Our data demonstrates significant differences in the incidence of NMPTS across both race-ethnicity and urbanicity. However, a wider analysis of all-cause mortality reveals disparities in health outcomes across both race-ethnicity and urbanicity for Black and Hispanic populations. To address the disparity in health outcomes, policymakers and health providers need to work with local communities in rural areas to improve access to equitable and quality healthcare
Development of a Cadaveric Breast Ultrasound Module and Analysis of Its Effectiveness Among Medical Students
No full textInformation characterizing a standardized breast ultrasound curriculum in medical education is lacking, and due to the sensitive nature of this imaging, medical schools encounter difficulties in obtaining standardized patients for practicing these skills. Therefore, a supplemental, cadaver-based, point-of-care ultrasound (POCUS) module was created to introduce preclinical medical students to breast anatomy and pathology (IRB #1950978). Participants (n = 104) completed a 16-item, pre-instruction assessment followed by an online breast ultrasound module. After, participants completed a 60-min, in-person training session using donor models to examine (1) normal breast tissue, (2) fluid-filled cysts, (3) benign and malignant solid lesions, and (4) breast implants; a 19-item, post-instruction assessment was completed. Comparison of mean scores from the multiple choice, knowledge-based items in the pre- and post-assessments demonstrated improvement in knowledge gained (pre, 5.08; post, 7.78) (p = 0.001); Cronbach’s alpha, pre, 0.199 vs. post, 0.596. Participant perceptions were evaluated using a Likert survey; participants noted strong agreement (77%) or agreement (17%) with the benefit of and strong agreement (32%) or agreement (55%) regarding confidence in performing breast ultrasound (Cronbach’s alpha: pre, 0.705; post = 0.755). Analysis of open responses revealed five themes: positive feedback (74.5%), appreciation/thanks (35.3%), emphasis of hands-on learning (21.6%), desire for additional sessions (19.6%), and suggestions for improvement (17.6%). Positive results from the introduction of a cadaver-based breast ultrasound module early in medical students’ careers show promise and should be a consideration when discussing its integration into preclinical curriculum
Intravenous Tranexamic Acid Reduces Complications Following Surgical Treatment of Pathologic Fractures of the Lower Extremity
No full textBackground and objectives: This study aimed to evaluate the postoperative complications associated with administering intravenous (IV) tranexamic acid (TXA) in patients undergoing surgical fixation for neoplastic pathologic fractures of the lower extremities.
Methods: Patients ≥18 years old who underwent surgical intervention for neoplastic pathologic lower extremity fractures from 2015 to 2021 were identified using the Premier Healthcare Database. This cohort was divided by TXA receipt on the index surgery day. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the cohorts.
Results: From 2015 to 2021, 4497 patients met inclusion criteria (769 TXA[+] and 3728 TXA[-]). Following propensity score matching, patients who received TXA had a significantly shorter length of stay than those who did not (7.6 ± 7.3 days vs. 9.0 ± 15.2, p = 0.036). Between the two cohorts, there were no significant differences in comorbidities. Regarding differences in postoperative complications, TXA(+) patients had significantly decreased odds of deep vein thrombosis (DVT) (1.87% vs. 5.46%; odds ratio [OR]:0.33; 95% confidence interval: 0.17-0.62; p = 0.001).
Conclusion: Administration of IV TXA may be associated with a decreased risk of postoperative DVT without an increased risk of other complications. Orthopedic surgeons should consider the utilization of IV TXA in patients treated surgically for neoplastic pathologic fractures of the lower extremity
Evaluating the Diagnostic Accuracy of Reduced Lead Paediatric Electrocardiograms
No full textIntroduction: Alternate electrocardiogram acquisition with fewer leads lacks systematic evaluation in children. This study aims to determine if electrocardiograms with fewer leads maintain diagnostic accuracy in paediatrics.
Methods: This is a single-centre review of 200 randomly selected standard 12-lead electrocardiograms from our hospital database (2017-2020) for patients aged 2 weeks to 21 years. An overlay technique generated 8-lead (limb + V1/V6) and 6-lead (limb only) variations of the 12-lead tracings, resulting in a total of 600 electrocardiograms, which were then interpreted by two independent paediatric electrophysiologists.
Results: In total, 18% (35/200) of the baseline electrocardiograms were abnormal. Intervals were measured in lead II for all electrocardiograms. Comparing 12-lead to 6- and 8-lead electrocardiograms, there was almost perfect agreement for specific rhythm identification (97.5-100%, κ 0.85-1). The 8-lead showed substantial agreement with 12-lead electrocardiograms when identifying specific electrocardiogram patterns (97.5-100%, κ 0.66-1). A similar degree of agreement was not demonstrated with the 6-lead variant. Utilising the 12-lead electrocardiogram as the gold standard, sensitivity and specificity of the 8- and 6-lead electrocardiogram were \u3e 89% for specific rhythm identification. Specificity for specific pattern recognition was \u3e 99% while sensitivity was \u3c 90% for certain variables for both 6- and 8-lead electrocardiogram, likely due to smaller sample size and fewer abnormal electrocardiograms. There was high percent reader agreement (92.5-100%).
Conclusions: 8-lead electrocardiograms provide comparable diagnostic accuracy to 12-lead electrocardiograms for children. This information holds potential for future technological advancements in electrocardiogram acquisition tailored specifically for paediatrics. Additional studies are required to further refine conventional electrocardiogram acquisition
Illuminating the Use of Photodynamic Therapy in Urologic Oncology
No full textIntroduction: We report the first scoping review of the clinical urologic literature for photodynamic therapy (PDT) among multiple urologic malignancies.
Materials and methods: A scoping review using Medline and Embase was performed for treatment of urologic malignancies with PDT.
Results: There were 84 papers included with the majority involving bladder and prostate cancer. Upper tract urothelial cancer (UTUC) only comprised three publications and there was no clinical data for renal or testicular cancer. Utilizing PDT in prostate cancer led to a negative biopsy rate of 30%-100%. Bladder cancer treatment with PDT had a 3-month complete response rate of 31.5%-100%. UTUC management with PDT reported at least 50% complete response rate.
Conclusions: Ultimately, PDT has been established as a safe and effective treatment for urologic malignancies and we provide the first comprehensive review of the literature regarding the utility of this treatment modality
Herniation of the Right Colon, From the Cecum to the Hepatic Flexure, Through the Foramen of Winslow: A Case Report
Get PDFHerniation of bowel contents between the peritoneal cavity proper and the omental bursa, through the foramen of Winslow, can present diagnostic challenges that can potentially delay necessary surgical intervention. This case describes a 49-year-old female with a past medical history of hiatal hernia and biliary dyskinesia who presented to the emergency department with severe epigastric and right lower quadrant abdominal pain one day after a reported gastrointestinal illness of unknown etiology. Initial emergency department workup demonstrated an elevated white blood cell count without lactic acidosis. Computed tomography imaging was interpreted as gastric distension with volvulus around the mesentery and second portion of the duodenum. Intraoperatively, the entirety of the right colon was noted to have passed through the foramen of Winslow into the lesser sac. This led to twisting of the mesocolon causing compression of the duodenum and a gastric outlet obstruction. After surgical reduction of the herniation, the patient noted great improvement in pain and other symptoms
A Case Report of Grisel’s Syndrome Complicating the Postoperative Course of Craniotomy for a Massive Cystic Brain Lesion
Get PDFThis report presents the case of a seven-year-old child diagnosed with Grisel’s syndrome following a craniotomy for a cystic brain lesion. The patient initially presented with persistent, progressively worsening headaches that coincided with neurological symptoms. Imaging revealed a massive cystic lesion causing a significant compression and midline shift. Following craniotomy and insertion of a left frontal Ommaya reservoir, the patient developed Grisel’s syndrome, characterized by painful neck muscle spasms and rotation to the right. Management included the application of halo traction to ensure rigid cervical spine immobilization, closed reduction, and subsequent transition to a halo vest to maintain alignment and facilitate gradual recovery
Disability Socialization at Work
No full textThis chapter elaborates the social identity approach (SIA) in the context of disability at work. SIA evolved from its original focus on organizational structure toward the many modern social and psychological phenomena affected by social identity. The SIA to Disability (SIAD) provides a disability-centered analysis of the social and psychological precursors, contexts, and consequences of disability social identity. Prior to the SIAD, the SIA was historically disconnected from areas of psychology related to disability or impairment. This chapter offers an up-to-date overview of disability-centric approaches to workplace socialization
Mohs Micrographic Surgery Interpretation of Positive Versus Negative Specimens
No full textThe accurate interpretation of positive and negative margins in Mohs micrographic surgery depends on specialized training in histological evaluation. This process involves the histological interpretation of tangentially processed frozen sections—a method that differs from the traditional vertical sectioning used in general pathology. When interpreting a slide, the initial step of a Mohs surgeon is to identify the tumor. This initial information is usually obtained from a biopsy performed before the surgical procedure. However, the biopsy results may not always be accurate or complete. For instance, a superficial basal cell carcinoma could have an undetected nodular component not identified during the initial histological evaluation.
Certain skin cancers are easier to identify due to their prevalence and recognizable features in patients. In contrast, rare tumors can be more challenging to diagnose and may require special histological stains for accurate margin assessment. Many recurrences of skin cancer are attributed to errors in slide preparation or interpretation
Recurrent Adult Urinary Tract Infection Secondary to Unrecognized Ureterocele Urolithiasis
No full textBackground: A ureterocele is a cystic dilation of the distal ureter, most commonly presenting as a congenital abnormality that may be associated with other renal anomalies. Ureteroceles present in a variety of manifestations in both children and adults, from asymptomatic to significant flank pain with urolithiasis or recurrent urinary tract infections (UTIs) that often mimic other more common renal pathologies, owing to its challenging clinical diagnosis.
Case Presentation: We report the case of a 78‐year‐old female patient who presented with recurrent UTIs and failure to thrive, complicated by a large stone that first presented in the bladder on computed tomography scan and was later found in the distal right ureter.
Conclusion: This case underscores the varied and often deceptive clinical presentation of ureterocele, stressing the importance of timely diagnosis to prevent secondary complications