Minimally Invasive Spine Surgery: Analyzing Internet-based Education Material.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVE: The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS). SUMMARY OF BACKGROUND DATA: Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability. MATERIALS AND METHODS: The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified. RESULTS: Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company. CONCLUSIONS: Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.

The Impact of a Radiation Oncologist led Oncology Curriculum on Medical Student Knowledge.

Medical students at our institution all take a pre-clinical oncology course as well as a clinical radiation oncology didactic session during their clinical curriculum. The objective of this analysis is to demonstrate the impact of the radiation oncology didactic on medical student knowledge of core oncology concepts. All students received a standardized didactic lecture introducing students to core concepts of general oncology and radiation. We administered an 18-question pretest and a posttest examining student knowledge between 2012 and 2015. Changes in student responses between pre-test and post-tests were analyzed to evaluate the effectiveness of the didactic session. Over the course of three years, 319 (64.4%) of 495 students who completed the Radiology block completed both the pre-test and post-test. The average student test grade improved from 62.0% on the pretest to 69.6% on the posttest (p < 0.001). By category, students increased their score from 81.4% to 89.8% (p < 0.001) in general oncology, from 59.9% to 69.9% (p < 0.001) in breast oncology, from 43.0% to 51.0% (p < 0.001) in prostate oncology, and from 71.3% to 75.7% (p = 0.003) in radiation oncology. Students showed increases in knowledge across general oncology, prostate oncology, breast oncology, and radiation oncology.

A Quality Improvement Initiative to Reduce Catheter Exchange Rates for Fluoroscopically Guided Gastrostomy Tubes.

PURPOSE: To evaluate the effectiveness of a data-driven quality improvement initiative to reduce catheter exchange rates. MATERIALS AND METHODS: A single-institution retrospective analysis of all percutaneous radiologic gastrostomy (PRG) placement and replacement procedures between January 2010 and July 2015 was conducted. A statistical model predicting the risk for catheter exchange for any reason and exchanges specifically for tube malfunction was created; a quality improvement plan to reduce catheter exchanges was designed and implemented in June 2014. The outcomes for subsequent PRG procedures from July 2014 through March 2015 were followed until July 2015. RESULTS: Between 2010 and June 2014, 1,144 primary PRG procedures and 442 replacement procedures were performed in 1,112 patients. Of the 442 exchange procedures, 289 were "rescue" procedures secondary to catheter malfunction. A quality improvement plan was implemented in June 2014 that encouraged primary gastrojejunostomy catheter and balloon-retained PRG catheter placement and placement of skin sutures in patients considered high risk for catheter dislodgment. From July 2014 through March 2015, 229 PRG catheters were placed, and 71 exchange procedures were performed through July 2015. There was a statistically significant decrease in the number of rescue exchanges performed secondary to catheter malfunction (P = .036). CONCLUSIONS: Procedural and patient-specific risk factors for PRG complications were identified, and a statistical model to predict rates of minor complications was created. These findings were used to implement a quality improvement program that resulted in a decrease in PRG exchanges secondary to catheter malfunction.

Role of Locoregional Therapy and Predictors for Dropout in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation.

PURPOSE: To identify factors associated with removal from the liver transplantation waitlist because of death, deterioration of condition, or exceeding Milan criteria in patients with hepatocellular carcinoma (HCC), with emphasis on the role of locoregional therapy (LRT), defined as percutaneous thermal ablation and drug-eluting embolic chemoembolization, as bridge therapy. MATERIALS AND METHODS: All patients listed for liver transplant at a single institution with exception points for HCC during 2004-2012 were evaluated. The most common cause of cirrhosis was hepatitis C (68%; 121/177). Seventy-one percent (125/177) of patients underwent liver transplantation, and 83% (147/177) underwent at least 1 LRT procedure. Of the 52 patients who did not undergo liver transplantation, 31 (60%) of livers were removed because of progression of HCC. RESULTS: The likelihood of transplant was higher for patients who received LRT (odds ratio [OR], 2.9; confidence interval [CI], 2.2-7.2) and lower for patients with multifocal tumors (OR, 0.25; CI, 0.12-0.52) and with larger tumors (OR, 0.94; CI, 0.90-0.98). Time on the waitlist (OR, 0.99; CI, 0.99-1.0) was not found to correlate with removal. LRT increased the likelihood of liver transplantation, specifically for patients with prolonged wait times. Patients who demonstrated complete response (CR) to LRT on the first follow-up imaging study were more likely to undergo liver transplantation. CONCLUSIONS: LRT increased the likelihood of a patient with HCC achieving liver transplant, particularly in patients facing prolonged waiting times. CR after LRT significantly increased the likelihood of liver transplantation.

Medical Student--Reported Outcomes of a Radiation Oncologist--Led Preclinical Course in Oncology: A Five-Year Analysis.

PURPOSE: There is a recognized need for more robust training in oncology for medical students. At our institution, we have offered a core dedicated oncology block, led by a radiation oncologist course director, during the second year of the medical school curriculum since the 2008-2009 academic year. Herein, we report the outcomes of the oncology block over the past 5 years through an analysis of student perceptions of the course, both immediately after completion of the block and in the third year. METHODS AND MATERIALS: We analyzed 2 separate surveys. The first assessed student impressions of how well the course met each of the course's learning objectives through a survey that was administered to students immediately after the oncology block in 2012. The second was administered after students completed the oncology block during the required radiology clerkship in the third year. All questions used a 5-level Likert scale and were analyzed by use of a Wilcoxon signed-rank test. RESULTS: Of the 169 students who took the oncology course in 2012, 127 (75.1%) completed the course feedback survey. Over 73% of students agreed or strongly agreed that the course met its 3 learning objectives. Of the 699 medical students who took the required radiology clerkship between 2010 and 2013, 538 participated in the second survey, for a total response rate of 77%. Of these students, 368 (68.4%) agreed or strongly agreed that the course was effective in contributing to their overall medical education. CONCLUSION: Student perceptions of the oncology block are favorable and have improved across multiple categories since the inception of the course. Students self-reported that a dedicated preclinical oncology block was effective in helping identify the basics of cancer therapy and laying the foundation for clinical electives in oncology, including radiation oncology.