Still Scholarworks (A.T. Still University)
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On the spinal venous sinus of Alligator mississippiensis
No full textAbstract
The epidural space of the American alligator (Alligator mississippiensis) is largely filled by a continuous venous sinus. This venous sinus extends throughout the trunk and tail of the alligator, and is continuous with the dural sinuses surrounding the brain. Segmental spinal veins (sl) link the spinal venous sinus (vs) to the somatic and visceral venous drainage. Some of these sl, like the caudal head vein along the occipital plate of the skull, are enlarged, suggesting more functional linkage. No evidence of venous valves or external venous sphincters was found associated with the vs; the relative scarcity of smooth muscle in the venous wall of the sinus suggests limited physiological regulation. The proatlas (pr), which develops between the occipital plate and C1 in crocodylians, is shaped like a neural arch and is fused to the dorsal surface of the vs. The present study suggests that the pr may function to propel venous blood around the brain and spinal cord. The vs effectively encloses the spinal dura, creating a tube-within-a-tube system with the (smaller volume) spinal cerebrospinal fluid (CSF). Changes in venous blood pressure, as are likely during locomotion, would impact dural compliance and CSF pressure waves propagating along the spinal cord
The Fragility of Statistical Findings in Meniscus Repair Literature: A Systematic Review of Randomized Controlled Trials
No full textBackground: Within the realm of orthopedic literature, the determination of statistical significance for outcomes relies on probability analysis and the reporting of P-values. The aim of this study was to employ fragility analysis as a means of evaluating the resilience of randomized controlled trials (RCTs) that assess meniscus surgeries. It was hypothesized that dichotomous outcomes would be statistically fragile and comparable to other orthopedic specialties. Methods: Included in this study were RCTs reporting dichotomous measures pertaining to meniscus repair, sourced from 14 orthopedic journals indexed on PubMed between 2000 and 2022. The fragility index (FI) for each outcome was determined by iteratively reversing a single outcome event until the significance was reversed. To calculate the fragility quotient (FQ), the FI of each study was divided by its respective sample size. Additionally, the interquartile range (IQR) was calculated for both the FI and FQ. Results: Out of the 7,844 articles screened, a total of 17 RCTs with 112 dichotomous outcomes were included for analysis. The FI for all the outcomes was 7, with an IQR of 4 to 10. Similarly, the FQ was 0.067, with an IQR of 0.029 to 0.107. However, statistically significant outcomes had a FI and FQ of 4 (IQR 2 to 7) and .057 (IQR 0.03 to 0.108), respectively. The average number of patients lost to follow-up was 2 patients and 17.6% of studies reporting lost to follow up of 7 or greater. Conclusion: Recent findings suggest that the stability of the literature concerning meniscus repair may not be as robust as previously assumed. Consequently, we strongly advocate for the inclusion of the FI and FQ metrics, alongside the P-value, to enhance the interpretation of clinical findings presented in the meniscus repair literature. Level of Evidence: I
A “Fishy” Situation, Rare Pathogen and Presentation in Prosthetic Valve Infective Endocarditis
Get PDFLactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve. L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and poultry), but the route of human transmission remains unclear. It seems to have a predilection for individuals with prosthetic valves, immunocompromised states, prior gastrointestinal surgery, gastrointestinal disorders (colon polyps and diverticulosis), and the use of acid-reducing medications. Infective endocarditis is the most common systemic disease caused by L. garviae This report details the case of a 75-year-old male, with multiple comorbidities and risk factors for L. garviae infection who was admitted for “symptomatic anemia”. High clinical suspicion, coupled with an inadequate hemoglobin response to transfusion, a normal anemia workup, and blood cultures positive for L. garviae, promoted a transesophageal echocardiogram (TEE). However, the results were negative. Consequently, an 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan (18 FDG PET/CT) was performed. The scan revealed increased uptake in the aortic valve replacement consistent with prosthetic valve endocarditis in the setting of Lactococcus garviae bacteremia
“Letter to my future self” as a device for assessing health education effectiveness
No full textObjective: To examine whether a “letter to my future self” analyzed using structural topic modeling (STM) represents a useful technique in revealing how participants integrate educational content into planned future behaviors. Methods: 453 club-sports athletes in a concussion-education randomized control study wrote two-paragraph letters describing what they hoped to remember after viewing one of three randomly assigned educational interventions. Results: A six-topic solution revealed three topics related to the content of the education and three topics related to the participant behavioral takeaways. The content-related topics reflected the educational content viewed. The behavioral takeaway topics indicated that the Consequence-based education was more likely to generate the Concussion Seriousness[CS:23%] topic while Traditional(24%) and Consequence-based(20%) interventions were more likely to generate the Responsibility for Brain Health[BH] topic. Traditional(21%) and Revised-symptom(17%) interventions were more likely to generate the Awareness and Action topics. Conclusion: Unstructured user-generated data in the form of a “letter to my future self” analyzed using structural topic modeling provides a novel evaluation of the present and likely future impact of educational interventions. Practice implications: Patient educators can enhance the effectiveness of education through the application of these methods to the evaluation of and innovation in programs
Evolving impact of the COVID-19 pandemic on lung transplant recipients: A single-center experience
No full textBackground: Lung transplant recipients (LTRs) are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19); however, the disease course has changed as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants have mutated. We compared COVID-19-related clinical outcomes in LTRs at different stages of the pandemic. We also identified risk factors for developing severe COVID-19 independent of the dominant SARS-CoV-2 variant. Methods: This single-center, retrospective cohort study of LTRs with COVID-19 used Cox regression analyses and bootstrapping to identify factors affecting COVID-19 severity. Results: Between March 2020 and August 2022, 195 LTRs were diagnosed with COVID-19, almost half (89 [45.6%]) during the Omicron period. A total of 113 (58.5%) LTRs were hospitalized and 47 (24.1%) died. Age \u3e65 years increased the risk of hospitalization and death. Although infection with the Omicron variant was associated with a lower risk of hospitalization, the median length of hospital stay (10 days, [interquartile range, 5-19]) was similar between the variants. Intensive care unit (ICU) admission and death were more common with the Delta variant but comparable between the original, Alpha, and Omicron variants. Remdesivir and molnupiravir reduced the risk of hospitalization, and monoclonal antibody therapy reduced the risk of ICU admission, intubation, and death. Vaccination and pre-exposure prophylaxis (PrEP) with tixagevimab-cilgavimab did not significantly reduce COVID-19-related ICU admission, intubation, or mortality among LTRs. Conclusions: LTRs with COVID-19 continue to have high hospitalization rates and prolonged hospital stays, despite the reduced virulence of the Omicron variant. More effective PrEP and therapeutic interventions for COVID-19 among vulnerable patient groups are needed
Nourish to Flourish: An educational program for caregiver involvement with children who have developmental delay
Get PDFCaregivers of children with additional needs often experience high rates of burnout, stemming from limited time, lack of knowledge about child development and/or diagnoses, and elevated stress levels. This burnout can result in decreased caregiver follow-through on addressing a child’s needs or interventions in the home environment. This project aimed to bridge the gap between parents and increase their follow-through in the outpatient setting for children diagnosed with developmental delay and/or additional needs by providing a 10-week educational program. A mixed-methods approach was used with a pre-intervention and post-intervention using the Parenting Sense of Competence Scale (PSOC) to measure parental self-efficacy. An introductory needs assessment and survey were provided for insight including the demographics of the families. The project implementation included short questionnaires related to specific topics, individualized parent programs for carryover at home, and a tracking form for data collection and accountability. There were a total of three mothers who participated. This project was supported by literature findings, theory, and outcome measures prior to implementation. Key findings and approaches to this capstone project were embedded through the lens of occupational therapy. With a broad approach to improve parental perceptions, each participant demonstrated minimal increase in their own self-efficacy and parental competence through a mixed-methods approach
Proposed Nutrition Competencies for Medical Students and Physician TraineesA Consensus Statement
No full textAbstract
Importance: In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education.
Objective: To recommend nutrition competencies for inclusion in medical education to improve patient and population health.
Evidence review: The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies.
Findings: A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations.
Conclusions and relevance: These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations
Evaluating the impact of tubular retractors in glioma surgery: A systematic review and meta-analysis
No full textBackground: Achieving safe, maximal tumor resection in gliomas can be challenging due to the tumor\u27s intricate relationship with surrounding structures. Tubular retractors offer a minimally invasive approach, preserving functional pathways and reducing complications. To assess their efficacy and safety, we conducted a systematic review and meta-analysis. Methods: A search across databases identified 26 studies meeting inclusion criteria, encompassing 106 patients with various glioma types and tumor locations. Results: Among 26 eligible studies, 15 provided sufficient data on 106 patients (median age: 50.5 years). Glioblastoma multiforme constituted 52.4 % of tumors, followed by IDH-mutant astrocytomas at 31.0 %. Tumor locations varied, with intraventricular and thalamic involvement in 16.3 % (16/98) of cases, followed by temporal (12.2 %), frontal and occipital (each 8.16 %), basal ganglia (8.16 %), parietal (7.14 %), optic pathway (2.04 %), and caudate nucleus (1.02 %) involvement. VyCor and Brainpath retractors were most used (22.6 % and 21.7 %, respectively). Tubular retractors were often combined with the exoscope (35.9 %). Gross total resection (GTR) was achieved in 69.4 % of cases, near-total resection (NTR) in 5.1 %, and subtotal resection/partial resection (STR/PR) in 25.5 %. Mean extent of resection (EOR) significantly differed between GTR and STR/NTR/PR groups (p\u3c0.001). Postoperative complications included visual deficits (6.38 %), hemiparesis or weakness (2.13 %), multiple complications (1.06 %), and other unspecified complications (3.19 %). Conclusion: Tubular retractors are a valuable intraoperative adjunct and component of the surgical armamentarium for glioma surgery allowing bimanual operative techniques to manage hemostasis directly with excellent surgical outcomes and an acceptable complication profile
Is the facial bone wall critical to achieving esthetic outcomes in immediate implant placement with immediate restoration? A systematic review
Get PDFBackground. Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic. Objectives. This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient. Materials and methods. The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools. Results. Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus’s risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies. Conclusions. It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension