General surgeon performed emergency craniotomies in regional Queensland hospitals: a 20-year state-wide study on patient outcomes.

BACKGROUND: Traumatic brain injuries account for up to 50% of trauma related deaths and if surgical intervention is indicated, consensus suggests a maximum of 4 hours to surgical decompression. The occurrence and outcomes of craniotomies performed by non-neurosurgeons in regional Queensland hospitals have never been reported previously in the literature. METHODS: A retrospective review was performed at all regional Queensland hospitals without an on-site neurosurgical service from January 2001 to December 2022 to identify patients undergoing emergency craniotomy. Data recorded included basic demographics, history of anti-coagulant use, mechanism of injury, type of haemorrhage, Glasgow Coma Score and Glasgow Outcome Scale (GOS) on discharge. Radiological parameters measured included midline shift and maximal coronal depth of haematoma. The primary aim of this study was to assess the clinical and radiological outcomes of patients who underwent a craniotomy performed by general surgeons. RESULTS: Over the past 20 years there have been 23 emergency decompressive procedures (one excluded) performed in regional Queensland. Preoperative imaging demonstrated 9 extradural haematomas and 13 subdural haematomas. Six of 17 transferred cases required reoperation after transfer to a neurosurgical centre. Survival was observed in 9 of 22 cases, with 'good' functional outcome (GOS ≥3) observed in 7 cases. In no cases were rurally performed burr holes effective. DISCUSSION: Qualitatively, a larger craniotomy may be associated with better clinical and radiological outcomes. Although rare occurrences, our results demonstrate that general surgeon performed craniotomies are frequently efficacious in producing radiological and/or clinical improvement and should be considered as a potentially lifesaving procedure.

Systematic review of existing literature regarding the prevalence of pediatric atopic dermatitis in Honduras.

Background: Atopic dermatitis (AD) is an inflammatory skin condition, often multifactorial in origin, and most commonly manifests during childhood. Although there remains a deficit in literature, current data suggest Honduras may have the highest prevalence and severity of AD among all Latin American countries. Objective: To assess the current prevalence of pediatric AD in Honduras and evaluate existing gaps in available literature to monitor disease burden. Methods: A comprehensive literature search was performed in March 2023. Articles were removed if they were published before 2007, were of the incorrect study design, or were focused on countries outside of Honduras. The articles were independently reviewed by 2 authors. Results: The initial literature search yielded 174 studies, of which 7 met inclusion criteria. AD prevalence rates in children in Honduras ranged from 0.7% to 40.0%. Limitations: Limitations include elements of study design, analytic methods, study populations, and limited articles. Conclusion: There appears to be a disproportionately higher prevalence and disease burden of pediatric AD in Honduras. Future research should acquire accurate data to further understand the prevalence, incidence, and severity of AD in Honduras.

Enhancing Patient Care With the "David and Wendy" Approach: The Effectiveness of Ward Round Documentation Proformas.

Background Surgical ward round documentation, essential for high-quality patient care, is often completed poorly. The advent of electronic medical records offers an opportunity to introduce proformas, aiding junior staff in completing notes both timely and accurately. We aimed to assess whether the introduction of a proforma would improve the quality and speed of ward round documentation. Methods We completed a prospective cohort analysis of ward round documentation at a single institution. Analysis was conducted on the documentation of a single surgical team over a 10-week period, comprising five weeks of baseline data collection followed by five weeks with implementation of a proforma. This proforma was based on the "David & Wendy" acronym, encompassing diet, activity, vital signs, investigations/IV therapy, drains/lines, wound assessment, examination findings, nursing concerns, drugs/deep vein thrombosis (DVT) prophylaxis, and barriers to discharge. Results A total of 711 ward round notes were analyzed, 349 with proforma and 362 without. Statistically significant improvements were observed in the documentation of diet, activity, investigations/IV therapy, drains/lines, wound assessment, nursing concerns, drugs/DVT prophylaxis, and barriers to discharge (p < 0.05) with proforma use. No significant difference was noted in the documentation of vital signs or examination findings. The time taken to finalize ward round notes was significantly reduced with the proforma (M = 31.28 vs. 60.05 minutes, p < 0.001). Conclusion The introduction of the David & Wendy proforma significantly improved the speed and quality of documentation for key surgical ward round information during our study.

Examining Barriers and Strengthening Community Collaboration as a Means to Increase Exclusive Breastfeeding Rates in Sarasota County, Florida.

Background Maternal and infant benefits of breastfeeding have been established and widely recommended by the American Academy of Pediatrics. However, there is a discrepancy between the number of mothers initiating breastfeeding and those continuing to breastfeed for six months and beyond. In this project, we investigated current breastfeeding practices and barriers to feeding for mothers in Sarasota County, Florida to develop an intervention aimed at increasing the rate of exclusive breastfeeding at six months and beyond. Methodology The PDSA framework was used to develop interventions aimed at increasing breastfeeding rates in Sarasota County. Initially, breastfeeding mothers were administered a survey to understand breastfeeding practices and barriers. Community agencies that supported breastfeeding practices were identified. Based on survey data and feedback, a community breastfeeding conference was organized to improve collaboration and increase breastfeeding rates. Attendees' knowledge and confidence were assessed through a conference pre-test and post-test. Additionally, attendees developed Smart, Measurable, Achievable, Relevant, and Timely goals that were recorded for data collection. Results Of the 28 completed community breastfeeding surveys, the respondents were of Caucasian or Hispanic ethnicity with an average age of 31. The majority of respondents had a goal of breastfeeding for 12 months, but only two participants reported that they continued to exclusively breastfeed to the 12-month mark. A total of 38 individuals from different agencies pre-registered for the conference; of these pre-registrants, 19 individuals checked in for conference attendance, 17 completed the conference pre-test, and 15 completed the conference post-test. Each domain surveyed demonstrated an increase in the values. Conclusions Following our intervention, there is an evident need for improvement in the pipeline of expanding collaboration among breastfeeding community agencies in Sarasota County. Upon completing our community breastfeeding conference, it was shown that this intervention provided both an educational improvement (demonstrated by increased mean domain scores) and a novel platform for providers to network. Our project highlights that strengthening the existing breastfeeding service infrastructure may directly increase exclusive breastfeeding rates at six months and beyond. Future interventions will aim to solidify recurrent infrastructural processes and policies.

Examining the Growing Demand for Surgical Care in Rural Communities and Novel Approaches to Achieving a Sustainable Surgical Workforce: A Narrative Review.

Surgery continues to be an increasingly vital component of public health and aspect of patient care in rural communities. An anticipated shortage of surgeons within the next decade in the United States prompts a growing concern for increasing the delivery of essential surgical care to these populations. When considering the existing barriers to surgical healthcare in rural communities, there is a sense of urgency to identify innovative approaches that will promote a sustainable surgeon workforce. A narrative review was conducted to investigate the current state of access to essential surgical care in rural communities. Qualitative and quantitative data were collected to better understand the key issues in rural healthcare and to provide statistical data related to the status of the surgical workforce. With the anticipated shortage of surgeons in both rural and urban areas, this review highlights the importance of enacting immediate measures to address the concern. This review has accomplished the initial objectives of gaining a better understanding of the current state of access to surgical care in rural communities and utilizing this knowledge to provide recommendations to readily attain a sustainable number of rural surgeons. With each approach addressing ways to address the contributory issues to the surgeon shortage, this review reveals a new avenue of integrating valuable aspects from each approach, rather than relying on a single approach. In particular, enhancing the overall pipeline of medical training to attending status may prove to be more beneficial for achieving this goal. Ultimately, this may be accomplished by introducing additional rural surgical mentorship opportunities for medical students, developing a rural surgery fellowship, and incorporating a market-based response that will correspond to attractive incentives that help to retain a sustainable number of surgeons working in rural areas.

Evaluation and description of a healthcare academia elective for student pharmacists.

BACKGROUND AND PURPOSE: Pharmacists, regardless of practice setting, will be called to provide education to patients, healthcare professionals, students, and the community. In an effort to increase students' exposure to the knowledge, skills, and responsibilities of a pharmacist in academia, an introductory healthcare academia elective was created. The purpose of this article is to describe the implementation and assessment of this elective course. EDUCATIONAL ACTIVITY AND SETTING: The course was offered to students in spring 2021 and focused on exposing students to academia aspects, including curriculum design, pillars of academia, and roles of assessment and feedback. The largest project was a student created and delivered Accreditation Council for Pharmacy Education-accredited continuing education presentation. FINDINGS: The twelve students completed pre- and post-surveys regarding their perceived knowledge and personal abilities in select areas. Overall, students' perceived knowledge and abilities increased in each area at the end of the course. Additionally, a total of four continuing education presentations were delivered to students, faculty, and practicing pharmacists. SUMMARY: One semester of a unique healthcare academia elective increased students' perceived confidence in their knowledge and application of academia-related tasks.

The Impact of COVID-19 on Acute Surgical Admissions at the Sunshine Coast University Hospital.

Purpose It has been noted in international literature that acute surgical admissions and number of operations reduced as a result of coronavirus disease2019 (COVID-19). This study assesses the impact of the COVID-19 pandemic on the number of acute surgical admissions, operations, and length of stay (LoS) at the Sunshine Coast University Hospital (SCUH), Queensland, Australia. Methodology A retrospective study was conducted on patients admitted to the Acute Surgical Unit (ASU) during March and April for the years 2018, 2019, and 2020. Admission data for ASU patients in 2018 and 2019 were combined (pre-COVID) and compared with 2020 (COVID) to determine impact of the pandemic on presentations and procedures. Results ASU admissions reduced in 2020 (461 patients) compared with pre-COVID years (mean: 545 patients per year). There was an increase in the number (%) of operations performed in 2020, 175 patients (38%) compared with pre-COVID years, mean 158 patients (29%), p = 0.001. There was a significant decrease in the number (%) of functional presentations in 2020, 29 patients (6.3%) compared with pre-COVID years, mean 105 patients (9.6%), p = 0.04. LoS was not significantly different (52 hours vs. 54 hours, p = 0.11). Conclusion COVID-19 has reduced the absolute number of acute surgical admissions at SCUH. This effectively reduced triage workload. Contrary to the literature, this study did not demonstrate a reduction in the number of operations or change in LoS. These data could be used by health administrators to help with resource allocation during future pandemics.

Identifying Low Pharmaceutical Calculation Performers Using an Algebra-Based Pretest.

Objective. To determine whether a pretest assessing algebra-based problem-solving skills could aid in identifying those who may underperform in calculations course assessments and whether this provides additional value beyond preadmission and demographic characteristics.Methods. Student pharmacists were screened for algebraic problem-solving skills using an 18-item pretest taken the semester prior to a course containing pharmaceutical calculations content. These scores were compared to students' later performance on pharmaceutical calculations assessments. Linear regression models were computed to determine the relationship between pretest scores and pharmaceutical calculations performance after controlling for preadmission factors and demographic characteristics.Results. The median pretest score was 15 out of 18 possible points, with scores ranging from 5 to 18 points. After controlling for age, gender, American College Testing (ACT) scores, and high school grade point average (GPA), scores on the algebra-based, word-problem pretest were associated with performance on pharmaceutical calculation assessments.Conclusion. This research demonstrates the ability of a pretest aimed at identifying deficiencies in algebraic problem-solving skills to identify those at risk of failing to obtain mastery of pharmaceutical calculations, even after controlling for demographics, prior grades, and prior standardized test scores. Identifying these students is a first step towards implementing tailored interventions to improve students' algebra-based word problem skills to prevent deficiencies in pharmaceutical calculations mastery before class even begins.

Participants' perceptions of a residency teaching certificate program: the quality, impact and benefits.

BACKGROUND: Currently, there are no accreditation requirements for pharmacy resident teaching certificate programs (RTCPs) but rather suggested guidelines and documents for individual programs to follow. RTCP curriculums are often "handed-down" from past personnel and vary based on individual interpretation. Quality improvement may be overlooked when programs do not report to governing bodies. OBJECTIVE: The primary objective of this quality improvement project was threefold: 1) to identify past RTCP participants' perceptions regarding program seminars, activities, and requirements; 2) to determine the short-term and long-term impact on participant careers and interaction with learners; and 3) to improve the program to meet participants' needs. METHODS: A 25 item Qualtrics survey was sent to 93 past pharmacy residents who completed the RTCP. Delivery of the survey was confirmed to 89 previous residents. Participants provided consent and were given 12 days to complete the survey. Data was collected and coded by the research team independently. RESULTS: The participants hold positions in a variety of roles, with 68.3% of participants currently holding a non-academia position. The top five most beneficial activities during the RTCP were: giving a large room lecture, facilitating small group learning, developing test questions, delivering professional CE, and meeting with their teaching mentor. Most seminar topics were beneficial to residents during the RTCP, with over two-thirds of the topics (n=23) found beneficial by at least 90% of the participants. A total of 92.9% of respondents said that the most beneficial aspect of having an assigned mentor was the teaching advice and feedback provided. CONCLUSIONS: The perceptions and beliefs of past RTCP participants were obtained regarding how beneficial the programming, activities, and mentorship offered were during and after RTCP completion. Quality improvement ideas from this work include redistribution of time in seminars compared to hands-on activities, the adoption of tracks or concentrations within the RTCP, and the creation of mentor training and development.

Training upcoming academicians through interviews of pharmacy resident teaching certificate leaders.

BACKGROUND: Discovering methods of Residency Teaching Certificate Programs (RTCPs) will allow for collaboration in developing best practices to ensure both high quality of programming and outcomes for participants. OBJECTIVE: The primary objective of this project is to describe and compare how RTCPs are conducted in the state of Ohio. Secondarily, to identify current practices in assessing RTCPs in both programmatic effectiveness and individual resident teaching outcomes. METHODS: The seven coordinators of the seven Ohio RTCPs (n=7) were contacted via email and asked to participate in an IRB-approved interview, either in-person or telephonically. Standardized questions were developed to inquire about six categories of interest: demographics/background, administration/logistics, content, assessment of the resident, program financing, and program continuous quality improvement (CQI). All seven programs participated in interviews. Data was coded by multiple members of the research team for presentation in aggregate form. RESULTS: RTCPs include seminar days at the respective pharmacy colleges; however, the number, length, and content of seminars vary. The majority of programs (n=5) stated using inherited curriculum and materials passed down from previous coordinators. While each RTCP requires participants to submit a teaching portfolio, only three of seven programs assess the summative portfolios. All programs (n=7) award participants a certificate based on completion of requirements without a defined minimum performance standard. Two programs are collecting participant feedback after every session for CQI however no programs are completing an annual programmatic assessment of resident outcomes. The majority of coordinators (n=7) are interested in collaborating and sharing "best practices" between RTCPs in the state. CONCLUSIONS: Although published and available resources exist surrounding the development and delivery of RTCPs, in Ohio, their use varies greatly. The most striking outcomes highlighted the lack of resident and program assessment of outcomes in RTCPs. The research has brought forth ideas of ways to improve these programs through resident assessment, program assessment and also leads to reflection and innovation around the best way to deliver these programs.

Identifying and evaluating gaps in knowledge, skills, and qualities necessary for a career in academia.

INTRODUCTION: Due to demands for qualified faculty and educators, more pharmacy residency programs have adopted resident teaching certificate programs (RTCP). There is a lack of standardization and published research on what should be included in these programs. The primary objective of this study was to utilize an online survey to identify and evaluate perceived gaps in skills, qualities, and knowledge needed for a successful career in academia. METHODS: An IRB-approved Qualtrics® survey was developed and emailed to faculty at Ohio colleges of pharmacy in January 2018. RESULTS: Eighty of 299 total surveys (26.8%) were completed by faculty with representation from all seven colleges in Ohio. When asked to select from a provided list, the top five self-identified gaps in knowledge at the beginning of their career were: accreditation (80.56%), institutional finance (79.17%), programmatic assessment (79.17%), admissions/marketing (77.78%), and experiential site recruitment/retention (77.78%). However, when asked to list five gaps as a free response, the most common themes were tenure, teaching, research, curriculum, and work life balance/time management. Additional questions assessed skills, qualities, resources, and faculty development techniques. CONCLUSIONS: There are many identifiable gaps that participants recalled experiencing in their early years as a faculty member. The number of RTCPs is growing and RTCPs are often the only training residents receive in direct relation to academia and pedagogy. It is critical that RTCPs cover consistent content to expose residents to a career in academia and teach skills that residents need to successfully educate others.