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This pioneering study introduces the use of transformer-based machine learning models and explainable AI approaches to explore the impact of nutrition on Alzheimer's disease (AD) mortality. Using data from the Third National Health and Nutrition Examination Survey (Nhanes iii 1988 to 1994) and the NHANES III Mortality-Linked File (2019) databases, we investigate the intricate relationship between various nutritional factors and AD mortality. Our approach features a novel application of transformer models, which are then benchmarked against established methods like random forests and support vector machines. This comparison not only underscores the strengths of transformer models in handling complex medical datasets but also highlights their potential for providing deeper insights into disease progression. Key findings, such as the significant roles of Platelet distribution width in AD mortality in transformer and Serum Vitamin B12 in random forest, are enhanced by the use of Explainable Artificial Intelligence (XAI), particularly the Shapley Additive Explanations (SHAP) and the integrated gradient methods. This study serves as a vital step forward in applying advanced AI techniques to medical research, offering new perspectives in understanding and combating Alzheimer's Disease.
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BACKGROUND: Colon cancer outcomes in the United States have improved over the last thirty years. However, there remain significant outcome disparities, especially in rural regions. It is unclear if distance to the treating facility has an independent effect on colon cancer mortality and outcomes. We sought to evaluate whether distance from a treating facility impacts stage at diagnosis and mortality. METHODS: The National Cancer Database (NCDB) was utilized to identify a cohort of adult patients with colon cancer between the years 2013 and 2017 in all regions of the United States. Outcomes measured included colon cancer TNM stage, time to surgery, time to chemotherapy, and overall survival. RESULTS: A total of n = 356,189 patients met inclusion criteria. When controlling for race, education status, insurance status, comorbidities, and income, distance from the treating facility was a significant predictor of stage at presentation with more advanced clinical TNM stage as distance increased (AORs 1.12-1.62, P < .001 for all groups). Longer distance significantly increased the time to surgery (between 5.06 and 14.46 days, P < .001) and overall mortality (HR 1.11-1.28, P < .001). Median survival was 82.4 months for the closest group, versus 75.1 months for the farthest group (P < .001). CONCLUSIONS: Increased distance from the treating facility resulted in a significantly higher stage at presentation, increased time to surgery, and increased mortality. These results suggest that there are significant disparities in access to cancer care for patients who live in rural areas. Targeted interventions by treating facilities are needed to improve screening and timely treatment for rural colon cancer patients.
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Extended focused assessment with sonography for trauma (eFAST) is a rapid triage tool aiding the detection of life-threatening injuries. In academic settings, residents perform most eFAST; however, the ACGME has no recommendations for eFAST training standards. We surveyed general surgery programs (GSPs) regarding eFAST training and established a baseline for sensitivity, specificity, and positive and negative predictive values for resident-performed eFAST. US GSP eFAST surveys were conducted by email and phone. We prospectively collected patient variables and evaluated resident performance from May to September 2022 and 2023 at an academic level I trauma center. A total of 60/339 general surgery residency programs (GSRPs) responded: Ten use Advanced Trauma Life Support (ATLS) only, n = 7 group training, n = 8 on-the-job only, and n = 33 several methods. Resident-performed eFAST had accuracy = 85.6%, sensitivity = 35.6%, specificity = 97.2%, PPV = 75%, and NPV = 87%. General surgery residency program training in eFAST is non-standardized. Sensitivity was considerably lower than the literature suggests. Positive resident-performed eFAST is generally accurate. We recommend a standardized approach to resident training in eFAST.
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Traumatismos Abdominais , Competência Clínica , Avaliação Sonográfica Focada no Trauma , Cirurgia Geral , Internato e Residência , Humanos , Cirurgia Geral/educação , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Sensibilidade e Especificidade , Estudos Prospectivos , Educação de Pós-Graduação em Medicina/métodos , Feminino , Masculino , Adulto , Inquéritos e Questionários , TriagemRESUMO
Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm 2 versus 15.3 cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.
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Retalhos de Tecido Biológico , Humanos , Antebraço/cirurgia , Fíbula , População Rural , Estudos Retrospectivos , Mandíbula/cirurgiaRESUMO
BACKGROUND: The burden from medication costs for treating heart failure can be financially toxic for uninsured/underinsured patients and their families. Prescription discount cards, which offer cash price reductions, may decrease out-of-pocket costs for patients without prescription benefits, but the degree to which they offer financial relief remains unclear. Our objective was to assess the financial burden for uninsured/underinsured patients prescribed a drug from each of the 4 standard classes of medications for heart failure with reduced ejection fraction. A second objective assessed whether discounts varied across economically and geographically diverse regions in Tennessee. METHODS: This was a cross-sectional pricing analysis of guideline-directed medical therapy heart failure with reduced ejection fraction regimens utilizing prescription discount cards. Between February 9 and March 31, 2022, we conducted searches on 3 discount card websites (GoodRx, NeedyMeds, and Blink Health) for the prices of 30- and 90-day supplies of select guideline-directed medical therapy heart failure regimens for 6 Tennessee ZIP codes. Prices were compared with Amazon and Redbook prices. RESULTS: Monthly costs among discount card services varied from $10.58 to $30.86 for a generic 3-drug regimen consisting of beta blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. With the addition of a sodium-glucose cotransporter-2 inhibitor, prices increased to $540.32 to $593.74. The ideal 4-drug regimen (beta blocker, angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter-2 inhibitor) ranged from $1188.31 to $1464.54. When compared with Amazon cash prices, the cards offered an average discount of 65% on a generic 3-drug regimen; when brand-name medications were added, discounts were modest (<12%). There were no significant variations in pricing based on ZIP codes in differing economic and geographic regions. CONCLUSIONS: Although prescription discount cards offered significant savings on generic medications, brand-name drug discounts were small and overall costs remained high. These findings highlight the potential for unequal access to life-saving therapies for heart failure with reduced ejection fraction.
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Insuficiência Cardíaca , Medicamentos sob Prescrição , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Gastos em Saúde , Estudos Transversais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico , Prescrições de Medicamentos , Medicamentos Genéricos , Antagonistas Adrenérgicos beta , Redução de Custos , Custos de Medicamentos , Glucose , Sódio , Antagonistas de Receptores de Angiotensina , Antagonistas de Receptores de MineralocorticoidesRESUMO
The risk of women developing breast cancer after augmentation mammaplasty may be lower than the general population, with minimal current literature on breast reconstruction in this population. We sought to evaluate the impact of previous augmentation on postmastectomy breast reconstruction. Methods: Retrospective review of patients who underwent mastectomies from 2017 to 2021 at our institution was performed. Analysis included frequencies and percentages, descriptive statistics, chi-square analysis, and Fisher exact test. Results: Four hundred seventy patients were included, with average body mass index of 29.1 kg/m2, 96% identifying as White, and an average age at diagnosis of 59.3 years. Twenty (4.2%) patients had a prior breast augmentation. Reconstruction was performed in 80% of the previously augmented patients compared to 49.9% of nonaugmented patients (P = 0.01). Reconstruction was alloplastic in 100% of augmented and 88.7% of nonaugmented patients (P = 0.15). All reconstructed augmented patients underwent immediate reconstruction compared with 90.5% of nonaugmented patients (P = 0.37), and two-stage reconstruction was most common (75.0% versus 63.5%; P = 0.42). Of the previously augmented patients, 87.5% increased implant volume, 75% underwent same implant plane reconstruction, and 68.75% underwent same implant-type reconstruction as their augmentation. Conclusions: Previously augmented patients were more likely to undergo reconstruction after mastectomy at our institution. All reconstructed augmented patients underwent alloplastic reconstruction, with most performed immediately in staged fashion. Most patients favored silicone implants and maintained the same implant type and plane of reconstruction, with increased implant volume. Larger studies are required to further investigate these trends.
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In individuals who have sustained maxillofacial trauma, inadequate nutrition is often a sequela and may lead to complications. The purpose of this study was to investigate the association between preoperative laboratory values and postoperative complications in patients with maxillofacial trauma requiring surgical intervention. A retrospective cohort study of patients with maxillofacial trauma requiring surgical repair from 2014 to 2020 was performed at a single academic Level I Trauma Center. The primary predictor variables were preoperative laboratory values including serum albumin, white blood cell count, absolute neutrophil count, and lymphocyte count. Complications related to surgical reconstruction of facial injuries represented the primary outcome variable. The patient cohort included 152 patients, of whom 50 (32.9%) were female. When controlling for all other variables, female gender (odds ratio=2.08, 95% confidence interval, 1.02-4.21; P =0.04) and number of procedures performed ( P =0.02) were the only statistically significant predictors of postoperative complications. There were no significant differences between the complication groups for age ( P =0.89), injury severity score ( P =0.59), hospital length of stay ( P =0.30), serum albumin ( P =0.86), hemoglobin ( P =0.06), white blood cell count ( P =0.20), absolute neutrophil count ( P =0.95), lymphocyte count ( P =0.23), or absolute neutrophil/lymphocyte count ratio ( P =0.09). In this study, it was found that only gender and the number of procedures performed significantly predicted postoperative complications, while preoperative nutritional laboratory values did not. Further study with a larger cohort of patients is likely required.
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Traumatismos Maxilofaciais , Complicações Pós-Operatórias , Humanos , Feminino , Masculino , Estudos Retrospectivos , Fatores de Risco , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Albumina Sérica , Traumatismos Maxilofaciais/complicações , Cicatrização , DemografiaRESUMO
Abstract Introduction Plasma transfusion is a common therapeutic strategy used to lower international normalized ratio (INR) values in the non-emergent setting. However, due to lack of evidence of its efficacy, standardized guidelines for this practice have not been well established. Methods This retrospective observational cohort study analyzed 276 inpatient encounters that involved plasma transfusions focusing on change in INR values from pre- to post-transfusion, with respect to the following predictor variables: vitamin K co-administration, number of plasma units transfused, order indication and body mass index (BMI). Results The overall average change in the INR was 1.35. Patients who received vitamin K showed an average change of 2.51, while patients that did not receive vitamin K demonstrated an average change of 0.70. Increased numbers of plasma units transfused showed benefit up to three-unit orders. Greater decreases in the INR were observed for patients requiring plasma for anticoagulation reversal or active bleeding. There was no significant difference in the change in INR based on the BMI. By multivariate and regression analyses, the stepwise addition of each successive predictor variable demonstrated an increase in the shared variance in the outcome of the post-transfusion INR: the pre-transfusion INR and vitamin K co-administration alone was not significant (p= 0.45); the additional number of plasma units transfused was significant (R² = 0.13, p < 0.001), and; the subsequent additional plasma order indications (R² = 0.19, p < 0.001) and BMI (R² = 0.18, p < 0.001) were increasingly significant. Conclusion Taking into consideration the combination of multiple predictive factors may aid in a more efficient use of plasma products.
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Humanos , Plasma , Vitamina K , Valor Preditivo dos Testes , Coeficiente Internacional NormatizadoRESUMO
Blunt trauma patients are often evaluated with extended focused assessment with sonography for trauma (eFAST). eFAST is a noninvasive, rapid, ultrasound-guided assessment for hemoperitoneum, pericardial effusion, and hemopneumothorax. Specificity and sensitivity are as high as 95% and 74%, respectively. Research suggests obesity confers increased morbidity and mortality and is an independent risk factor for trauma death. A previous study demonstrated that a BMI change from 36 to 40 changed the odds ratio for inaccurate eFAST from 1.85 to 3.12. Our current prospective data collection is 202 consecutive blunt trauma patients from 5/13/22 to 8/18/22 receiving an eFAST and a CT/OR for comparison. Odds ratio of inaccurate eFAST increased by 5.65% for each increase of 1 kg/m3 of BMI (95% Cl 0.1%-10.8%). This research also investigated surgical resident eFAST accuracy to improve patient outcomes through the implementation of individualized training in normal and obese models.
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Avaliação Sonográfica Focada no Trauma , Traumatismos Torácicos , Ferimentos não Penetrantes , Humanos , Índice de Massa Corporal , Sensibilidade e Especificidade , Ferimentos não Penetrantes/diagnóstico por imagem , Ultrassonografia , Serviço Hospitalar de Emergência , Obesidade/complicaçõesRESUMO
Factors that influence breast reconstruction after mastectomy have been previously examined in national databases. The purpose of this study was to determine the impact of patient travel distance and income on breast reconstruction after mastectomy in a rural population. Methods: Retrospective review of mastectomy patients from 2017 to 2021 was performed from our prospectively enrolled tumor registry. Analysis included frequencies and percentages, descriptive statistics, χ 2 analysis, independent sample t tests, and multivariable analysis. Results: In total, 462 patients were included. Median BMI was 27.6 kg/m2, 96.1% of patients were White, and median age at diagnosis was 60.0 years. Reconstruction rate was 52.6%, and median length of follow-up was 24.6 months. No significant difference was found in the distance traveled by patients who underwent reconstruction (16.6 versus 16.7 miles; P = 0.94). Rates of reconstruction in patients who traveled 0-10 miles, 11-30 miles, and over 30 miles did not differ significantly (P = 0.16). Median household income was significantly different in reconstructed and nonreconstructed patients ($55,316.00 versus $51,629.00; P = 0.047). Rates of reconstruction were significantly higher in patients with median household income greater than $65,000 (P = 0.024). This difference was not significant on multivariable analysis. Conclusions: Travel distance did not significantly impact reconstruction rates after mastectomy, while household income did on univariable analysis. Studies at an institutional or regional level remain valuable, especially in populations that may not be accurately represented in larger database studies. Our findings highlight the importance of patient education, resource allocation, and multidisciplinary approach to breast cancer care, especially in the rural setting.
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PURPOSE: Functional status is a major contributor to overall health and reflects both daily activity level (performance) and maximum attainable activity level (capacity). Existing assessment tools evaluate only 1 domain of function and do not provide insight into contributors to functional decline. We addressed these deficiencies by developing the Tennessee Functional Status Questionnaire (TFSQ), which reports activity levels in metabolic equivalents (METs) and evaluates 5 key areas: performance, capacity, activity, pain, and acute care. We validated the activity levels reported by the TFSQ against the Duke Activity Status Index (DASI). METHODS: In this prospective, observational study, 120 patients completed both the TFSQ and the DASI. TFSQ-reported functional performance and capacity was correlated with DASI-calculated METs. RESULTS: Pearson correlation between TFSQ-reported capacity and DASI-calculated METs was r = 0.69, P < .001. TFSQ capacity was significantly lower in patients who reported recently decreased activity, pain affecting function, or recent acute care exposure. CONCLUSIONS: The TFSQ is a brief and efficient assessment of patient function, standardized to METs and validated against the DASI. Our study suggests that many patients may have the functional reserve to increase daily physical activity and that factors such as changes in activity, pain, and recent acute care interaction may lower functional capacity.
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Exercício Físico , Estado Funcional , Humanos , Inquéritos e Questionários , Estudos Prospectivos , TennesseeRESUMO
BACKGROUND: The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0-4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of stay. Bleeding events, severe postoperative nausea, and dehydration typically occur in the first few days postoperatively. We designed a pathway focused on detecting and preventing these early post-op complications to allow safe outpatient bariatric surgery. METHODS: We used a preoperative evaluation tool to risk stratify bariatric patients. During a 16-month period, 89 patients were identified as low risk for outpatient surgery. We designed a postoperative protocol that included IV hydration and PO intake goals to meet a safe discharge. We sent patients home with a pulse oximeter and had them self-monitor their pulse and oxygen saturation. We called all patients at 10 pm for a postoperative assessment and report of their vitals. Patients returned to clinic the following day and were seen by a provider, received IV hydration, and labs were drawn. RESULTS: 80 of 89 patients (89.8%) were successfully discharged on POD 0. 3 patients were readmitted within 30 days. We had zero deaths in our study cohort and no morbidity that would have been prevented with postoperative admission. CONCLUSION: We demonstrate that by identifying low-risk patients for outpatient bariatric surgery and by implementing remote monitoring of vitals early outpatient follow-up, we were able to safely perform outpatient bariatric surgery.
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Cirurgia Bariátrica , COVID-19 , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/epidemiologia , Fístula Anastomótica/etiologia , Pandemias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Obesidade/complicações , Obesidade/cirurgia , Obesidade/epidemiologia , Cirurgia Bariátrica/métodos , Náusea e Vômito Pós-Operatórios/epidemiologiaRESUMO
INTRODUCTION: Plasma transfusion is a common therapeutic strategy used to lower international normalized ratio (INR) values in the non-emergent setting. However, due to lack of evidence of its efficacy, standardized guidelines for this practice have not been well established. METHODS: This retrospective observational cohort study analyzed 276 inpatient encounters that involved plasma transfusions focusing on change in INR values from pre- to post-transfusion, with respect to the following predictor variables: vitamin K co-administration, number of plasma units transfused, order indication and body mass index (BMI). RESULTS: The overall average change in the INR was 1.35. Patients who received vitamin K showed an average change of 2.51, while patients that did not receive vitamin K demonstrated an average change of 0.70. Increased numbers of plasma units transfused showed benefit up to three-unit orders. Greater decreases in the INR were observed for patients requiring plasma for anticoagulation reversal or active bleeding. There was no significant difference in the change in INR based on the BMI. By multivariate and regression analyses, the stepwise addition of each successive predictor variable demonstrated an increase in the shared variance in the outcome of the post-transfusion INR: the pre-transfusion INR and vitamin K co-administration alone was not significant (pâ¯=â¯0.45); the additional number of plasma units transfused was significant (R²â¯=â¯0.13, p < 0.001), and; the subsequent additional plasma order indications (R²â¯=â¯0.19, p < 0.001) and BMI (R²â¯=â¯0.18, p < 0.001) were increasingly significant. CONCLUSION: Taking into consideration the combination of multiple predictive factors may aid in a more efficient use of plasma products.
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Feline infectious peritonitis (FIP) remains a major diagnostic and treatment challenge in feline medicine. An ineffective immune response is an important component of FIP pathophysiology; hence treatment with an immune stimulant such as Polyprenyl Immunostimulant™ (PI), which enhances cell-mediated immunity by upregulating the innate immune response via Toll-like receptors, is a rational approach. Records of cats with FIP treated with PI orally for over 365 days were retrospectively studied. Of these cats (n = 174), records were obtained for n = 103 cats with appropriate clinical signs and clinical pathology. Of these, n = 29 had FIP confirmed by immunohistochemistry (IHC) or reverse transcription polymerase-chain-reaction (RT-PCR). Most of the cats (25/29; 86%) had non-effusive FIP, and only 4/29 cats (14%) had effusive FIP. The mean survival time (MST) was 2927 days (eight years); with 55% of the cats (16/29) still being alive at the time data collection, and 45% (13/29) having died. A persistently low hematocrit plus low albumin:globulin (A:G) ratio, despite treatment, was a negative prognostic indicator. It took a mean of ~182 days and ~375 days, respectively, for anemia and low A:G ratio to resolve in the cats that presented with these laboratory changes. This study shows that PI is beneficial in the treatment of FIP, and more studies are needed to establish the best protocols of use.
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BACKGROUND: Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency. MATERIALS AND METHODS: Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Exclusions: age<18 y/o, GCS < 14, hospital length of stay (LOS) <3 d, <3 RF, ventilator support, injury-related mortality, disclosed/discoverable, acute/chronic opiate Rx within 90 days preadmission, substance abuse, patient inaccessible via Controlled Substance Monitoring Database (CSMD), and/or not using opioids in-/post-hospitalization. CSMD queried regarding opioid prescriptions filled by cohort. Cohort variable analysis performed on SPSS Version 27sf (Armonk, NY: IBM Corp). RESULTS: 153 patients included - 113 (74%) stopped opiates by 30 days post-discharge (NORx30), 40 (26%) continued beyond 30 days (Rx+). No significant differences in age, gender, ISS, number of RF, bilaterality, flail chest, and discharge disposition. Significant differences included hospital LOS (7.62 NORx30 vs. 10.22 Rx+, p = .02), number of prescribers (1.73 NORx30 vs. 2.98 Rx+, p < .01), average MME/day during initial 30 days post-discharge (36.7 ± 17 NORx30 vs. 45.4 ± 30.2 Rx+, p = .03), and number of pills (49 ± 38 NORx30 vs. 120 ± 85 Rx+, p < .01). Patients who received lidocaine infusion (LIDO+) had lower MME/day prescribed (32.24 ± 19.9, p = .03), were younger (61.2 vs. 65.6, p < .01), had more RFs (7.1 vs. 6.05, p = .03), and shorter LOS (7.71 vs 10.2, p = .01). DISCUSSION: Prescriber attention to MME/day and number of pills dispensed affects opioid dependency. We recommend 35-40 MME/day with 50 pill/month limit prescribed by a single provider monitoring patient and CSMD. Early LI offers post-discharge opioid cessation advantage.
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Alcaloides Opiáceos , Fraturas das Costelas , Adolescente , Assistência ao Convalescente , Analgésicos Opioides/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Dor , Dor Pós-Operatória , Alta do Paciente , Padrões de Prática Médica , Estudos Retrospectivos , Fraturas das Costelas/complicaçõesRESUMO
BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) has implemented milestones for progression of residents. Career academic physicians would benefit from similar concrete guidance for scholarly activity and faculty development. After developing milestones across six recognized competencies among our family medicine academicians, we acknowledged the potential benefit of expanding the development of milestones throughout the academic medical center. METHODS: Milestones that we previously developed were modified by departmental leaders within our institution reflecting levels of career development based on benchmarks in each field. These objective measures for guiding maturation of clinical and academic skill sets were then circulated to clinicians in five residency programs throughout our academic medical center for self-evaluation. We analyzed the completed surveys to determine if an association exists between years in academics and rank across each area of competency. RESULTS: We received fifty-three responses from the 91 faculty invited. We noted a significant association in the competency of medical knowledge with progression from assistant to full professor, and we noted a trend toward significance in professionalism and progression from assistant to full professor. These objective measures of clinician development and competency suggest association with levels of academic career development by rank within the institution. CONCLUSIONS: This rubric can be helpful for directing faculty development and faculty mentorship. These milestones are general enough that other physician specialties may be able to adopt them for their own needs.
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Internato e Residência , Médicos , Acreditação , Competência Clínica , Educação de Pós-Graduação em Medicina , Docentes de Medicina , HumanosRESUMO
To construct and validate a scale of emotional intelligence (EI) for the medical field, n = 80 resident physicians responded to a 69-item self-report measure during the pilot phase of development of the Scale of Emotional Functioning: Medicine (SEF:MED). Based on multiple-phase item and structural analyses, a final 36-item version was created based on data from n = 321 respondent residents. Initially exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) supported the expected three-factor solution as did additional CFA from a second sample of n = 113 participants. Internal consistency reliabilities obtained from the original n = 321 residents for the three SEF:MED subscales of Interpersonal Skills (IS), Emotional Awareness (EA), and Emotional Management (EM) were 0.81, 0.82, and 0.84, respectively. Alphas for the second CFA data set were 0.89, 0.87, and 0.88 for IS, EM, and EA, respectively. In addition, the SEF:MED was validated by comparing it to related measures (i.e., the Profile of Emotional Competence (PEC) and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel [MBI-HSS (MP)]); Correlation coefficients between the Total EI composite on the SEF:MED and the PEC global scales ranged from r = 0.64 to 0.68. Finally, correlation coefficients from the Total EI composite on the SEF:MED significantly related to the MBI-HSS (MP) Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scales (r = -0.50, -0.44, and 0.52, respectively). The SEF:MED may provide useful data to physicians and other medical professionals as they consider their own well-being and how it may affect care of their patients.
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Esgotamento Profissional , Internato e Residência , Médicos , Esgotamento Profissional/psicologia , Inteligência Emocional , Humanos , Médicos/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Post-operative ileus and delayed return of gastrointestinal function are complications seen frequently in patients undergoing colorectal surgery. Many enhanced recovery after surgery protocols include alvimopan to inhibit the effects of opiates in the gastrointestinal tract and lidocaine to augment analgesics. Limited data exist regarding alvimopan's efficacy in opiate-sparing regimens. METHODS: This single-center, retrospective cohort analysis was conducted in a randomly selected population of adult patients undergoing colorectal resection between February 2018 and October 2019. Patients meeting inclusion criteria were divided into four groups dependent upon whether or not they received alvimopan (A or a) and/or lidocaine (L or l). The primary endpoint in this study was median time to first bowel movement or discharge, whichever came first. Our secondary endpoint was length of stay. RESULTS: Of the 430 patients evaluated, a total of 192 patients were included in the final evaluation in the following groups: AL (n = 93), Al (n = 34), aL (n = 44), and al (n = 21). A significant difference was found among the groups for the primary outcome of median time to bowel movement or discharge (p = 0.001). Three subsequent pair-wise comparisons resulted in a significant difference in the primary outcome: group AL 39.4 h vs. group aL 54.0 h (p = 0.003), group AL 39.4 h vs. group al 55.4 h (p = 0.001), and group Al 44.9 h vs. group al 55.4 h (p = 0.01). Length of stay was significantly reduced by 1.8 days in groups AL and Al compared to group aL (p < 0.001). CONCLUSION: Treatment with alvimopan resulted in a significant improvement in time to GI recovery and decreased length of stay in an established ERAS program. While lidocaine's reduction in opiates was minimal, the group receiving both alvimopan and lidocaine had the greatest reduction in time to GI recovery and length of stay.
Assuntos
Cirurgia Colorretal , Íleus , Alcaloides Opiáceos , Adulto , Fármacos Gastrointestinais/uso terapêutico , Humanos , Íleus/etiologia , Íleus/prevenção & controle , Tempo de Internação , Lidocaína/farmacologia , Lidocaína/uso terapêutico , Alcaloides Opiáceos/farmacologia , Piperidinas , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Estudos RetrospectivosRESUMO
OBJECTIVE: Emotional intelligence (EI) is associated with job success in multiple fields, in part, because EI may mitigate stress and burnout. Research suggests these relationships may include teaching. Our purpose is to further explore the relationships between EI, burnout, and teaching for faculty surgeons. DESIGN: With IRB approval, surgical faculty were offered the opportunity to complete personal demographics, the Maslach Burnout Inventory, the SETQ-SMART assessment of teaching ability, and the SEF:MED self-assessment of emotional intelligence. Surgical residents rated faculty teaching ability using the SETQ-SMART SETTING: A medium-sized academic medical center in the Southeast approved to graduate 6 residents per year. PARTICIPANTS: ACGME surgical faculty and general surgical residents PGY1 to PGY5 including preliminary residents, were given the opportunity to participate. RESULTS: Faculty self-assessed teaching scores were significantly different from resident scores for nine (60%) faculty; three (33%) overrated their and 6 (67%) under rated their overall teaching ability, relative to resident ratings. The 3 SEF:MED scales correlated low-moderate to strongly with the SETQ-OTS: IS (râ¯=â¯0.41, pâ¯=â¯0.13), EM (râ¯=â¯0.67, p < 0.01), and EA (râ¯=â¯0.43, pâ¯=â¯0.11). Overall, 8(53%) faculty scored moderate to high on at least 1 of the 3 MBI subscales. Overall self-rated faculty teaching scores correlated negatively with higher EE and DP and positively with PA (râ¯=â¯-0.08, -0.21, and 0.52, pâ¯=â¯0.047; respectively). EI negatively correlated with MBI-EE and DP and positively with PA (râ¯=â¯-0.31, -0.18, 0.45, respectively), though due to the small sample none reach statistical significance with alpha set to 0.05. CONCLUSIONS: In this pilot study, EI is positively correlated to surgical faculty members' teaching ability. Burnout was less strongly correlated with resident-assessed faculty teaching scores, but with similar trends. Finally, EI was correlated with MBI EE, DP, and PA as expected given the literature in other fields. Expanded study is warranted.