Patient Satisfaction with Bedside Teaching Rounds Compared with Nonbedside Rounds.

OBJECTIVES: Many barriers have been cited in reference to why bedside teaching rounds have decreased in frequency during graduate medical education. One perceived barrier to the use of bedside teaching rounds is a fear of it causing patient discomfort or dissatisfaction. The objective of this study was to compare patient perception of bedside versus nonbedside teaching rounds. METHODS: Study participants were adults admitted to a family medicine inpatient team at a large university teaching hospital. Upon admission, participants were randomized to receive bedside or nonbedside teaching rounds conducted by a team consisting of medical students, family medicine residents, and one attending physician. Each participant completed a questionnaire administered on the day of discharge assessing patients' perception of their involvement in medical decision making, trust in the medical team, satisfaction with care, and provider compassion. Statistical analysis was performed to examine any differences between the two groups. RESULTS: The vast majority of the sample indicated that they knew what they were being treated for in the hospital (n = 105, 98%), reported the medical team spent an adequate amount of time with them (n = 100, 94%), and reported the medical team explained the diagnosis and care in easy-to-understand terms (n = 101, 94%). On 1- to 5-point scales, participants reported that the medical team involved them in making decisions (4.62, standard deviation [SD] 0.72), they trusted the medical team (4.91, SD 0.32), they were satisfied with their care (4.85, SD 0.38), and their medical team was compassionate toward them (4.84, SD 0.44). Overall levels of satisfaction were positive on all of the measures, with no statistical significance between the two groups regarding measures of involvement in medical decision making, trust in the medical team, and satisfaction with care. Interestingly, subjects perceived level of compassion of their medical team to be significantly higher with a bedside teaching approach compared with a nonbedside approach. CONCLUSIONS: Despite concerns that bedside teaching rounds may lead to patient discomfort, this study found no evidence supporting this perception. In fact, patients may perceive a medical team that engages in bedside teaching rounds as being more compassionate providers, supporting a patient-centered argument that teaching rounds should return to the bedside.

Suppression of tumor growth by designed dimeric epidithiodiketopiperazine targeting hypoxia-inducible transcription factor complex.

Hypoxia is a hallmark of solid tumors, is associated with local invasion, metastatic spread, resistance to chemo- and radiotherapy, and is an independent, negative prognostic factor for a diverse range of malignant neoplasms. The cellular response to hypoxia is primarily mediated by a family of transcription factors, among which hypoxia-inducible factor 1 (HIF1) plays a major role. Under normoxia, the oxygen-sensitive α subunit of HIF1 is rapidly and constitutively degraded but is stabilized and accumulates under hypoxia. Upon nuclear translocation, HIF1 controls the expression of over 100 genes involved in angiogenesis, altered energy metabolism, antiapoptotic, and pro-proliferative mechanisms that promote tumor growth. A designed transcriptional antagonist, dimeric epidithiodiketopiperazine (ETP 2), selectively disrupts the interaction of HIF1α with p300/CBP coactivators and downregulates the expression of hypoxia-inducible genes. ETP 2 was synthesized via a novel homo-oxidative coupling of the aliphatic primary carbons of the dithioacetal precursor. It effectively inhibits HIF1-induced activation of VEGFA, LOX, Glut1, and c-Met genes in a panel of cell lines representing breast and lung cancers. We observed an outstanding antitumor efficacy of both (±)-ETP 2 and meso-ETP 2 in a fully established breast carcinoma model by intravital microscopy. Treatment with either form of ETP 2 (1 mg/kg) resulted in a rapid regression of tumor growth that lasted for up to 14 days. These results suggest that inhibition of HIF1 transcriptional activity by designed dimeric ETPs could offer an innovative approach to cancer therapy with the potential to overcome hypoxia-induced tumor growth and resistance.

Histopathologic findings in patients who have undergone blue light cystoscopy and bladder biopsy or transurethral resection: A contemporary clinicopathologic analysis of 100 cases.

Blue light cystoscopy is utilized to assist Urologists highlight potentially malignant -bladder lesions that might otherwise be undetected by standard cystoscopic techniques. There is a paucity of published studies in the literature regarding the histopathologic findings in this setting, especially regarding false positive lesions. A search was performed for patients who underwent blue light cystoscopy at our institution from 2017 to 2021. Clinicopathologic data was obtained. One hundred cases were included in the study. The mean patient age was 69 years (range: 33-97 years), with a male predominance (3.5:1). Of these cases, 69 were malignant lesions. Twenty-nine cases were high grade urothelial carcinoma (UCa), including 17/29 (58.6%) that were non-invasive, 7/29 (24.1%) invasive into lamina propria, and 5/29 (17.2%) invasive into muscularis propria (Detrusor muscle). Twenty-seven cases were non-invasive low grade UCa, 12 cases were urothelial carcinoma in situ, and 1 case was prostatic adenocarcinoma. Thirty-one cases were benign lesions, including 11/31 (35%) inflammation, 4/31 (13%) nephrogenic adenoma, 3/31 (10%) each: therapy related changes; cystitis cystica et glandularis; reactive changes/atypia, 2/31 (7%) foreign body reaction, 1/31 (3%) each: urothelial papilloma, urethral polyp, squamous metaplasia, focal atypia, and biopsy site changes. Although most cases were malignant, a significant number of benign entities (false positives) were also identified. Correlation between the histopathologic and blue light cystoscopy findings could play a critical role in further stratification and management of patients undergoing this procedure, including surveillance protocols.

Aging and bilateral symmetry detection.

The salience of bilateral symmetry varies as a function of the orientation of the symmetry axis. Vertical symmetry is most salient, followed by horizontal and then oblique orientations. We tested symmetry detection in different age groups to determine whether performance of this intermediate-level visual task is affected by normal, nonpathological aging. We tested forty participants and analyzed the results with respect to age group and symmetry orientation (vertical, horizontal, and 45 degree oblique). There was a vertical symmetry detection advantage for all participants, where sensitivity was highest for vertical symmetry, followed by horizontal symmetry, and then the oblique symmetry. Sensitivity to symmetry did not differ for the two younger age groups (aged 19-39 and 40-60), but declined significantly for the group aged 61-70, and declined again for the oldest group aged 71-80. This age-related difference in sensitivity to symmetry was not reflected in a measure of bias, where there were no differences as a function of age.

Gold nanoparticle based X-ray contrast agent for tumor imaging in mice and dog: a potential nano-platform for computer tomography theranostics.

The goal of our study was to demonstrate the utility of nanocrystalline gold as an X-ray contrast agent for imaging tumor in living subjects. Even though significant progress has been achieved in this area by researchers, clinical translation remains challenging. Here, we investigated biocompatible gum Arabic stabilized gold nanocrystals (GA-AuNPs) as X-ray contrast agent in tumor bearing mice and dog. Single intratumoral injections of GA-AuNP resulted in X-ray contrast change of -26 HU in the tumor region after 1 hour post-injection period. Subsequently, five intratumoral injections were performed in the mice. The change in CT number in tumor region is not progressive; rather it reaches a saturation point after fourth injection. These data suggested that accumulation of GA-AuNP reaches a threshold limit within a short time period (5 h), and is retained in the tumor tissue for the rest of the period of investigation. A pilot study was conducted in a client-owned dog presented with collision tumor of thyroid carcinoma and osteosarcoma. In this study, GA-AuNP was injected intratumorally in dog and a contrast enhancement of 12 deltaHU was observed. The CT images of both mice and dog clearly demonstrated that GA-AuNP was effectively distributed and retained throughout the tumor site. The CT data obtained by the present study would provide the crucial dosimetry information for strategic therapy planning using this construct. Both mice and dog did not show any clinical changes, thereby confirming that GA-AuNP did not induce toxicity and can be explored for future clinical applications.