A Novel Risk Score to Predict Thirty-Day Readmissions after Acute Type A Aortic Dissections.

BACKGROUND: Readmissions following acute type A aortic dissections (ATAAD) are associated with potentially worse clinical outcomes and increased hospital costs. Predicting which patients are at risk for readmission may guide patient management prior to discharge. METHODS: The National Readmissions Database was utilized to identify patients treated for ATAAD between 2010 and 2018. Univariate mixed effects logistic regression was used to assess each variable. Variables were assigned risk points based off the bootstrapped (bias-corrected) odds ratio of the final variable model according to the Johnson's scoring system. A mixed effect logistic regression was run on the risk score (sum of risk points) and 30-day readmission. Calibration plots and predicted readmission curves were generated for model assessment. RESULTS: A total of 30,727 type A aortic dissections were identified. The majority of ATAAD (66%) were in men with a median age of 61 years and 30-day readmission rate of 19.4%. The risk scores ranging from -1 to 14 mapped to readmission probabilities between 3.5% and 29% for ATAAD. The predictive model showed good calibration and receiver operator characteristics with an area under the curve (AUC) of 0.81. Being a resident of the hospital state (OR: 2.01 [1.64, 2.47], p < 0.001) was the highest contributor to readmissions followed by chronic kidney disease (1.35 [1.16, 1.56], p = 0), discharge to a short-term facility (1.31 [1.09, 1.57], p = 0.003), and developing a myocardial infarction (1.20 [1.00, 1.45], p = 0.048). CONCLUSIONS: The readmission model had good predictive capability given by the large AUC. Being a resident in the State of the index admission was the most significant contributor to readmission.

Primary achalasia diagnosed during pregnancy: rare cause of nausea and vomiting.

Nausea and vomiting during pregnancy are very common; however, when persistent symptoms lead to severe malnutrition, other conditions should be considered. We present a patient with severe postprandial nausea and vomiting resulting in 120 lb weight loss. She was treated for presumed hyperemesis gravidarum but diagnosed with achalasia type 1 upon further work-up. The pregnancy was further complicated by fetal growth restriction, shortened cervix and preterm premature rupture of membranes, and resulted in delivery at 26 weeks of gestation. Postpartum, she underwent a peroral endoscopic myotomy procedure and has returned to normal body mass index.The differential for nausea/vomiting is broad, and major medical conditions can manifest for the first time during pregnancy. Severe malnutrition adversely affects maternal and fetal health. Further work-up should be pursued when symptoms cannot otherwise be explained.

Dissuasion in women surgical trainees pursuing cardiothoracic surgery.

BACKGROUND: The reasons for persistent gender disparity in cardiothoracic surgery (CTS) are multifaceted. The objective of this paper is to understand if and why women surgical trainees are dissuaded from pursuing CTS. METHODS: A survey was sent to self-identified women participating in Women in Thoracic Surgery speed mentoring. Statistical analysis was performed to determine dissuasion rates. Open-ended responses describing examples of dissuasion were characterized and categorized. RESULTS: Of all participants, 76 â€‹% (163/215) reported dissuasion from a CTS career. Third- and fourth-year medical students experienced the highest rate by training (81 â€‹%, 48/59) and those interested in Congenital CTS experienced the highest rate based on subspecialty interest (94 â€‹%, 17/18). The most cited dissuasion examples included work/life balance, lifestyle with children, and gender. CONCLUSIONS: Most women surveyed had been dissuaded from pursuing a career in CTS. Examples of dissuasion provided are heavily associated with traditional gender roles, supporting the presence of continued gender bias in CTS.

Prophylactic Unfractionated Heparin in Antepartum Hospitalizations: A Randomized Controlled Trial.

OBJECTIVE: To assess the effect of gestational age-based dosing of unfractionated heparin (UFH) compared with standard dosing of UFH for thromboprophylaxis on an elevated serum activated partial thromboplastin time (aPTT) during prolonged antepartum hospitalizations. METHODS: This was a randomized trial of pregnant persons who were admitted in the antepartum period for at least 72 hours. Participants were randomly allocated to the standard dose of UFH (5,000 units subcutaneously every 12 hours) or the gestational age-based dose of UFH (first trimester [less than 14 weeks]: 5,000 units subcutaneously every 12 hours; second trimester [14-27 6/7 weeks]: 7,500 units subcutaneously every 12 hours; third trimester (28 weeks or more): 10,000 units subcutaneously every 12 hours). The primary outcome was the proportion of antepartum patients who had an elevated serum aPTT value above the normal range (more than 36.2 seconds) 6 hours after an UFH dose. Secondary outcomes included the development of venous thromboembolism (VTE) and reported side effects of heparin administration. RESULTS: Between December 15, 2020, and April 1, 2022, 97 patients with antepartum hospitalizations were screened and 46 were randomized: 22 allocated to standard dosing and 24 allocated to gestational age-based dosing of UFH. A significantly greater proportion of antepartum patients who received gestational age-based dosing had an abnormal elevation in aPTT compared with those who received standard dosing (33.3% vs 4.8%, P =.02). Gestational age-based dosing resulted in higher maximum [interquartile range] aPTT (30.4 [27.4, 37.5] vs 26.6 [23.0, 29.6], P =.01) and anti-Xa levels (0.09 [0.09, 0.11] vs 0.09 [0.09, 0.09], P =.04). There was no significant difference in VTE between groups ( P =.47). CONCLUSION: Gestational age-based dosing of UFH for thromboprophylaxis of antepartum hospitalizations was associated with significantly increased rates of elevated coagulation parameters compared with standard fixed dosing. This study suggests a need for close monitoring if higher doses of UFH during pregnancy are used later in gestation. The efficacy of gestational age-based dosing compared with standard dosing for UFH to prevent thromboembolic events remains an area for future investigation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04635839.

Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study.

Respiratory distress (RD) has been reported in SARS-CoV-2 exposed uninfected (SEU) term neonates. Prior studies suggest that prenatal exposure to Coronavirus Disease 19 (COVID-19) may activate an inflammatory cascade in the newborn airway. In this study, we examine the relationship between maternal COVID-19 vaccination and neonatal RD using a longitudinal cohort of mother-infant pairs in Los Angeles, CA. Two-hundred and twenty-one mothers with laboratory confirmed SARS-CoV-2 during pregnancy and 227 exposed fetuses are enrolled in our study. Maternal disease severity and neonatal RD variables were defined based on current accepted clinical criteria. To explore the multifactorial associations between maternal COVID-19 parameters and infant RD, we utilize a multivariable logistic regression model and a proteomic sub-analysis to propose a pathway for the development of RD following in utero exposure to SARS-CoV-2. Unusually high rates of RD are observed in SEU infants (17%). The odds ratio of RD is 3.06 (95% CI:1.08-10.21) in term neonates born to unvaccinated individuals versus those born to individuals vaccinated prior to maternal infection. Proteomic analysis reveals a robust inflammatory response associated with ciliary dysregulation and enhanced IgE production among SEU neonates with RD. Maternal vaccination against COVID-19 reduces the frequency of neonatal RD.

Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero.

It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.

Crossword puzzles versus Student-Led Objective Tutorials (SLOT) as innovative pedagogies in undergraduate medical education / Palavras cruzadas versus Tutoriais Objetivos Liderados pelo Estudante (SLOT) como pedagogias inovadoras na graduação em medicina: nossa experiência

AIMS: Small group teaching in Pharmacology offers an effective platform to encourage interaction amongst peers and self-directed learning. The present study is an attempt to assess and compare the effectiveness and perception of students on two different pedagogical methods: Crossword puzzles and Student Led Objective Tutorials (SLOT). METHODS: Second year undergraduate students who gave their informed consent were divided randomly into two groups: one which received crossword puzzle as a teaching learning method and the other had SLOT during which the students conducted an interactive quiz with multiple choice questions prepared by themselves. The students' perceptions were recorded using a self-administered questionnaire. One week later, a unit test was conducted for both the groups and the performance of the students was compared. Statistical analysis was done using independent Student's T test with SPSS version 15.0. RESULTS: Analyses revealed a statistical significant difference (P<0.001) between the mean marks obtained in the SLOT group (n= 74; 6.5±3.8) and the marks obtained in the crossword group (n= 87; 4.2±2.9), with the students in the tutorial group performing better. The students opined that SLOT sessions helped them to understand Pharmacology better whereas crossword sessions enabled them to memorize the names of the drugs. CONCLUSION: The present study revealed that SLOT sessions fared better compared to the crossword puzzles in terms of improving the students' test scores. It fostered teamwork, self-directed learning skills and critical thinking. Crossword puzzles make the session more student friendly as it is fun and engaging but a careful design is inevitable as it may fail to test in-depth learning in students.

OBJETIVOS: O ensino de farmacologia em pequenos grupos oferece uma plataforma eficaz para estimular a interação entre pares e a aprendizagem autodirigida. O presente estudo procurou avaliar e comparar a eficácia e percepção dos alunos em dois métodos pedagógicos diferentes: palavras cruzadas e tutoriais objetivos conduzido pelo aluno (SLOT). MÉTODOS: Alunos do segundo ano de graduação, que deram seu consentimento informado, foram divididos aleatoriamente em dois grupos: um que recebeu palavras cruzadas como método de ensino-aprendizagem e o outro teve SLOT onde os alunos realizaram um questionário interativo com questões de múltipla escolha elaborado por si mesmos. As percepções dos alunos foram registradas por meio de um questionário autoaplicável. Uma semana depois, um teste foi realizado para ambos os grupos e o desempenho dos alunos foi comparado. A análise estatística foi feita usando o teste T de student de amostras independentes. RESULTADOS: As análises revelaram uma diferença estatisticamente significativa (P <0,001) entre as notas médias obtidas no grupo SLOT (n = 74; 6,5±3,8) e as notas obtidas no grupo de palavras cruzadas (n = 87; 4,2±2,9), com os alunos do grupo tutorial tendo melhor desempenho. Os alunos opinaram que as sessões de tutoria objetiva conduzida pelos alunos os ajudaram a entender melhor a Farmacologia, ao passo que as sessões de palavras cruzadas lhes permitiram memorizar os nomes dos medicamentos. CONCLUSÃO: O presente estudo revelou que as sessões do SLOT se saíram melhor comparativamente àquelas com as palavras cruzadas em termos de melhorar as pontuações dos alunos nos testes, assim como promoveu o trabalho em equipe, habilidades de aprendizagem autodirigida e pensamento crítico. As palavras cruzadas tornam a sessão mais amigável ao aluno, pois é divertida e envolvente, mas um design cuidadoso é inevitável, pois pode falhar em testar o aprendizado em profundidade nos alunos.

Approaches to learning and academic performance in pharmacology among second-year undergraduate medical students / Abordagens de aprendizagem e desempenho acadêmico em farmacologia entre estudantes de medicina do segundo ano

AIMS: To determine the learning approach of second-year undergraduate medical students and whether a surface or deep approach to learning had any correlation with the pharmacology sessional and university examination marks obtained. METHODS: A cross-sectional study was conducted among second-year medical students in their fifth semester. To determine the students' learning approach, whether superficial or deep, we used the Revised Two Factor Study Process Questionnaire (R-SPQ-2F), which contains 20 items in the form of a five-point Likert scale and is suitable for use in higher education settings. Cronbach's alpha was calculated using the scores obtained from a sample of 20 students to determine the internal consistency. To determine the relationship between the learning approach and examination scores, the average of the individual sessional examination marks and the university examination scores obtained by the students were calculated. RESULTS: Of the 170 students who participated in the study, 87 (51.2%) were females. The Cronbach's alpha value was considered acceptable for both surface and deep approach. While the academic performance was significantly better in females (U=2571.5; p=0.001), no difference was seen in the learning approach based on gender. Fifty (29.4%) students had a higher score for the surface approach. This group had lower examination scores compared with those with equal scores for surface and deep approach or higher scores for the deep approach. A weak negative correlation was seen between the examination marks and surface approach (τb=-0.167; p=0.002). When analyzed based on gender, the correlation was statistically significant only in females (τb=-0.173; p=0.02). CONCLUSIONS: A weak negative correlation was seen between the examination marks and surface approach to learning. Although statistically significant, the actual difference between the groups was of a small magnitude. Hence, whether promoting deep learning approach improves academic performance in terms of marks obtained in the examination needs to be confirmed by further studies.

OBJETIVOS: Investigar a abordagem de aprendizagem de estudantes de medicina do segundo ano de graduação e se uma abordagem superficial ou profunda teve alguma correlação com as notas obtidas na disciplina de farmacologia e nos exames universitários. MÉTODOS: Um estudo transversal foi conduzido entre estudantes do segundo ano de medicina em seu quinto semestre. Para determinar a abordagem de aprendizagem dos alunos, como superficial ou profunda, usamos o questionário Revised Two Factor Study Process Questionnaire (R-SPQ-2F), que contém 20 itens em forma de uma escala Likert de cinco pontos, sendo o seu uso adequado para ambientes de ensino superior. O alfa de Cronbach foi calculado usando as pontuações obtidas de uma amostra de 20 alunos para determinar a consistência interna. Para determinar a relação entre a abordagem de aprendizagem e as pontuações do exame, calculou-se a média das notas dos exames individuais e as pontuações dos exames universitários obtidas pelos alunos. RESULTADOS: Dos 170 alunos que participaram do estudo, 87 (51,2%) eram do gênero feminino. O alpha de Cronbach foi considerado bom tanto para a abordagem superficial quanto profunda. Enquanto o desempenho acadêmico foi significativamente melhor em mulheres (U=2571,5; p=0,001), nenhuma diferença baseada no gênero foi observada na abordagem de aprendizagem. Cinquenta (29,4%) estudantes tiveram uma pontuação mais alta para a abordagem superficial. Esse grupo teve escores de exame mais baixos em comparação com aqueles com escores iguais para abordagem superficial e profunda ou escores mais altos para a abordagem profunda. Uma fraca correlação negativa foi observada entre as notas do exame e a abordagem superficial (τb=-0,167; p=0,002). Quando analisada com base no gênero, encontrou-se uma correlação de magnitude fraca e negativa apenas no gênero feminino (τb=-0,173; p=0,02). CONCLUSÕES: Uma fraca correlação negativa foi observada entre as notas do exame e a abordagem superficial para a aprendizagem. Embora estatisticamente significativa, a diferença real entre os grupos foi de pequena magnitude. Portanto, se a promoção de uma abordagem de aprendizagem profunda melhora o desempenho acadêmico em termos de notas obtidas no exame, isso precisa ser confirmado por outros estudos.