Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates.

BACKGROUND: An endoscopist's adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. AIMS: We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). METHODS: We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). RESULTS: There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR. CONCLUSIONS: Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.

Identifying barriers to upper extremity reconstruction in tetraplegia: a systematic scoping review.

STUDY DESIGN: Systematic scoping review OBJECTIVES: The purpose of this study was to understand the barriers to accessing upper extremity (UE) reconstructive surgery among those living with tetraplegia, and to identify gaps in knowledge. METHODS: Using standardized scoping review methods, a literature search was conducted using four databases and 1069 articles were procured. Two independent reviewers systematically screened the articles in two phases. Retrieved articles underwent thematic analysis using a constructivist grounded theory methodology. RESULTS: The reviewed articles (n = 25) were published between 2002 and 2019, and study designs included: cross-sectional (64%), retrospective (16%), and review articles (8%). Common barriers to UE reconstruction were categorized into factors related to patients, providers, and systems. These general domains included lack of awareness of UE reconstruction and its benefits among people with tetraplegia and providers, poor interdisciplinary working relationships, and a lack of specialized centers that provide these reconstructive surgeries. Specific patient-related barriers related to intrinsic (coping skills, trust, fear) and extrinsic (support network, finances, postoperative course) factors that influenced decision-making. CONCLUSIONS: There are many barriers that prevent individuals with tetraplegia from accessing surgery at different levels of the healthcare system. Establishing specialized centers with strong interdisciplinary working relationships and raising awareness about the advantages and disadvantages of UE reconstruction through peer networks may help to improve accessibility. Using a value-based, patient-centered approach by exploring how individuals with SCI weigh each decision factor when considering surgery may help providers develop treatment options that better align with their goals.

Return rates and pregnancy outcomes after oocyte preservation for planned fertility delay: a systematic review and meta-analysis.

OBJECTIVE: To characterize the literature on social oocyte preservation, specifically the return rates, thaw rates, clinical pregnancy rates, and live birth rates. IMPORTANCE: Oocyte preservation for planned fertility delay, also referred to as social oocyte preservation or colloquially as "egg freezing" has become increasingly popular in the last few decades. Previous literature has suggested that there are gaps in counseling and expectations regarding the expected thaw rates and outcomes of preserved oocytes. DATA SOURCES: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of seven databases (MEDLINE, EMBASE, Emcare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus) until January 1st, 2024. The Risk Of Bias In Non-randomized Studies of Interventions tool was used for critical appraisal. Study selection and synthesis: All original human research that reported data for individuals who underwent autologous oocyte preservation for planned fertility delay (i.e., not for medical indications such as chemotherapy) were included for analysis. Meta-analysis was done using descriptive statistics and pooled prevalence rates. Title, and abstract screening and data extraction was conducted in duplicate by two independent reviewers for all studies until full agreement on eligibility was achieved through consensus-based discussion. RESULTS: After screening 1540 references, a total of 27 studies encompassing 13,724 patients were included. Follow-up ranged from 4 to 19 years, with a median follow-up time of 7 years. A total of 16,153 oocyte retrieval cycles for planned fertility delay were reported, with most individuals undergoing a single cryopreservation cycle. Overall, 10.8% of individuals returned to thaw their eggs with an aggregate oocyte survival rate of 79.52%. Implantation rate was 39.25%, clinical pregnancy rate was 32.5%, and ongoing pregnancy rate was 24.4% across the studies that reported these outcomes. A live birth was reported for 23.2% of individuals across all age groups who returned to thaw eggs. CONCLUSIONS AND RELEVANCE: Individuals should be counseled regarding the low return rates following oocyte preservation for planned fertility delay.

A Qualitative Study on the Effects of the COVID-19 Pandemic on Solid Organ Transplantation.

Introduction: Solid organ transplantation is a lifesaving intervention requiring extensive coordination and communication for timely and safe care. The COVID-19 pandemic posed unique challenges to the safety and management of solid organ transplantation. This descriptive qualitative study aimed to understand how hospital stakeholders were affected by and responded to the COVID-19 pandemic to contribute toward improved healthcare delivery responses and strategies during times of systemic strain on the healthcare system. Methods: One-hour-long semistructured interviews were performed in 3 cohorts: healthcare professionals (N = 6), administrative staff (N = 6), and recipients (N = 4). Interviews were analyzed using conventional thematic content analysis. Thematic saturation was reached within each cohort. Findings: Twelve codes and 6 major themes were identified including the Impact on Clinical Practice, Virtual Healthcare Delivery, Communication, Research, Education and Training, Mental Health and Future Pandemic Planning. Reflecting on these codes and major themes, 4 recommendations were developed (Anticipation and Preparation, Maximizing Existing Resources and Networks, Standardization and the Virtual Environment and Caring for the Staff) to guide transplant programs to optimize healthcare pathways while enhancing the best practices during future pandemics. Conclusion: Transplant programs will benefit from anticipation and preparation procedures using ramping-down strategies, resource planning, and interprofessional collaboration while maximizing existing resources and networks. In parallel, transplant programs should standardize virtual practices and platforms for clinical and educational purposes while maintaining an open culture of mental health discussion and integrating strategies to support staff's mental health.