Triple hormone receptor agonist retatrutide for metabolic dysfunction-associated steatotic liver disease: a randomized phase 2a trial.

Retatrutide is a novel triple agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1 and glucagon receptors. A 48-week phase 2 obesity study demonstrated weight reductions of 22.8% and 24.2% with retatrutide 8 and 12 mg, respectively. The primary objective of this substudy was to assess mean relative change from baseline in liver fat (LF) at 24 weeks in participants from that study with metabolic dysfunction-associated steatotic liver disease and ≥10% of LF. Here, in this randomized, double-blind, placebo-controlled trial, participants (n = 98) were randomly assigned to 48 weeks of once-weekly subcutaneous retatrutide (1, 4, 8 or 12 mg dose) or placebo. The mean relative change from baseline in LF at 24 weeks was -42.9% (1 mg), -57.0% (4 mg), -81.4% (8 mg), -82.4% (12 mg) and +0.3% (placebo) (all P < 0.001 versus placebo). At 24 weeks, normal LF (<5%) was achieved by 27% (1 mg), 52% (4 mg), 79% (8 mg), 86% (12 mg) and 0% (placebo) of participants. LF reductions were significantly related to changes in body weight, abdominal fat and metabolic measures associated with improved insulin sensitivity and lipid metabolism. The ClinicalTrials.gov registration is NCT04881760 .

Ultrasound evaluation of gastric emptying of high-energy semifluid solid beverage in parturients during labor at term: a randomized controlled trial.

PURPOSE: What to intake during labor is controversial. The purpose of this study was to compare the gastric emptying of high-energy semifluid solid beverage (HESSB) versus that of carbohydrate (CHO) solution of equal calories and volume by evaluating the gastric antral cross-sectional area (CSA) using ultrasonography in parturients during labor at term. METHODS: The study was conducted at a maternity and infant hospital between June and October 2020. Forty parturients scheduled for epidural labor analgesia during labor at term were randomly assigned to receive HESSB (300 mL, n = 20) or CHO (300 mL, n = 20). Gastric antral CSA was measured at baseline and 5, 30, 60, 90, and 120 min after consumption of the drink. The primary outcome was gastric antral CSA at 120 min in the HESSB group and CHO group. RESULTS: The gastric antral CSA between the HESSB group and CHO group at 120 min was not statistically significant (2.73 cm2 ± 0.55 vs. 2.55 cm2 ± 0.72, P = 0.061). All patients returned to baseline at 120 min after intake of 300 mL isocaloric HESSB and CHO, confirmed by evaluation of gastric antral CSA. The visual analog scale score for satiety was higher in the HESSB group (P < 0.001), with better taste satisfaction (7[5-8] vs. 5[4-6], P < 0.001). CONCLUSION: The change of gastric antral cross-sectional area after HESSB is similar to the corresponding calories and volume of CHO and the gastric emptying of HESSB can be emptied within 2 h with better taste satisfaction and satiety in pregnant women under labor analgesia.

Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial.

BACKGROUND: Retatrutide (LY3437943) is an agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors. Its dose-response relationships with respect to side effects, safety, and efficacy for the treatment of obesity are not known. METHODS: We conducted a phase 2, double-blind, randomized, placebo-controlled trial involving adults who had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 30 or higher or who had a BMI of 27 to less than 30 plus at least one weight-related condition. Participants were randomly assigned in a 2:1:1:1:1:2:2 ratio to receive subcutaneous retatrutide (1 mg, 4 mg [initial dose, 2 mg], 4 mg [initial dose, 4 mg], 8 mg [initial dose, 2 mg], 8 mg [initial dose, 4 mg], or 12 mg [initial dose, 2 mg]) or placebo once weekly for 48 weeks. The primary end point was the percentage change in body weight from baseline to 24 weeks. Secondary end points included the percentage change in body weight from baseline to 48 weeks and a weight reduction of 5% or more, 10% or more, or 15% or more. Safety was also assessed. RESULTS: We enrolled 338 adults, 51.8% of whom were men. The least-squares mean percentage change in body weight at 24 weeks in the retatrutide groups was -7.2% in the 1-mg group, -12.9% in the combined 4-mg group, -17.3% in the combined 8-mg group, and -17.5% in the 12-mg group, as compared with -1.6% in the placebo group. At 48 weeks, the least-squares mean percentage change in the retatrutide groups was -8.7% in the 1-mg group, -17.1% in the combined 4-mg group, -22.8% in the combined 8-mg group, and -24.2% in the 12-mg group, as compared with -2.1% in the placebo group. At 48 weeks, a weight reduction of 5% or more, 10% or more, and 15% or more had occurred in 92%, 75%, and 60%, respectively, of the participants who received 4 mg of retatrutide; 100%, 91%, and 75% of those who received 8 mg; 100%, 93%, and 83% of those who received 12 mg; and 27%, 9%, and 2% of those who received placebo. The most common adverse events in the retatrutide groups were gastrointestinal; these events were dose-related, were mostly mild to moderate in severity, and were partially mitigated with a lower starting dose (2 mg vs. 4 mg). Dose-dependent increases in heart rate peaked at 24 weeks and declined thereafter. CONCLUSIONS: In adults with obesity, retatrutide treatment for 48 weeks resulted in substantial reductions in body weight. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT04881760.).

The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design.

Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service. OBJECTIVES: To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. DESIGN: This study was designed using a mixed-methods design. SETTING: Two campuses of a university school of nursing in China. PARTICIPANTS: First grade Bachelor of Nursing Science students (n = 191). METHODS: Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. RESULTS: The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. CONCLUSION: Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.

Mindfulness-Based Stress Reduction for Quality of Life, Psychological Distress, and Cognitive Emotion Regulation Strategies in Patients With Breast Cancer Under Early Chemotherapy-a Randomized Controlled Trial.

Mindfulness-based interventions (MBIs) have been receiving growing attention in cancer care. This study evaluated the impact of the mindfulness-based stress reduction (MBSR) on quality of life, psychological distress (anxiety and depression), and cognitive emotion regulation strategies in patients with breast cancer under early chemotherapy. A total of 101 patients with breast cancer under early chemotherapy were randomly assigned to either an 8-week MBSR group (n = 50) or a control group (n = 51). The primary outcome was quality of life, measured on Functional Assessment of Cancer Therapy-Breast Cancer. The secondary outcomes were anxiety (Self-rating Anxiety Scale), depression (Self-rating Depression Scale), and cognitive emotion regulation strategies (The Chinese version of Cognitive Emotion Regulation Questionnaire). The participants were assessed at baseline (T0) and week 8 (T1). The data were statistically analyzed by SPSS 21.0. The participants in the MBSR group experienced significantly better outcomes in their quality of life, psychological distress, and cognitive emotion regulation strategies than the control group. The MBSR intervention was demonstrated to improve the positive cognitive emotion regulation strategies and quality of life in patients with breast cancer under early chemotherapy and significantly reduce the patient's anxiety, depression, and negative cognitive emotion regulation strategies, and help the patients to adjust their mental state and promote positive psychology to improve their quality of life.

Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review.

Demoralization has been extensively studied in oncology and palliative care settings, and is characterized by a loss of meaning and purpose in life, a sense of powerlessness over life events, and a sense of helplessness. The objective of this systematic review is to synthesize the prevalence, associated factors, and adverse outcomes of demoralization in cancer patients by reviewing the literature of the last decade. Seven databases (PubMed, PsycINFO, Embase, Web of Science, Medline, CINAHL and Cochrane Library databases) were systematically searched from January 2012 to June 2022. Roughly speaking, the prevalence of demoralization in cancer patients ranges from 13.50% to 49.4%. A total of 45 factors are associated with demoralization, of which psychological factors have been studied more frequently in the last decade. There are nine outcomes related to demoralization, with the strongest evidence for the correlation between demoralization and suicidal ideation. The study emphasizes the complexity of factors associated with demoralization in cancer patients. There appears to be a intersection between the constructs of demoralization and depression, anxiety, and suicidal ideation, which may explain the correlation between them.

Barriers and Facilitators to the Choice of Active Surveillance for Low-Risk Papillary Thyroid Cancer in China: A Qualitative Study Examining Patient Perspectives.

Background: Internationally, several clinical practice guidelines recommend active surveillance as a nonsurgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance among patients with low-risk papillary thyroid carcinoma in China. Methods: Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July and November 2021 for semistructured interviews; 24 of whom rejected and 15 patients chose "active surveillance" as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks, and thematic discussions were used to assert rigor. Results: Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes, and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased, and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol, and physicians' recommendations. Conclusions: Patient's acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choose active surveillance and patients require more attention and supportive intervention.

Porphyrin Centered Paclitaxel Tetrameric Prodrug Nanoassemblies as Tumor-Selective Theranostics for Synergized Breast Cancer Therapy.

Although having undergone decades of development, nanoparticulate drug delivery vehicles for efficient cancer therapy remain a challenge, confined by low drug loading, instability, and poor cancer tissue selectivity. A self-assembled prodrug, the combination of prodrug strategy and the self-assembly merits, represents a special chemical entity which spontaneously organizes into supramolecular composites with defined architecture, therefore also providing a strategy to develop new medications. Paclitaxel (PTX) is still among the most generally prescribed chemotherapeutics in oncology but is restricted by poor solubility. Although photodynamic therapy, with its noninvasive features and barely developed drug resistance, signifies an alternative tool to suppress life-threatening cancer, sole use hardly fulfills its potential. To this end, a reduction-activatable heterotetrameric prodrug with the photosensitizer is synthesized, then formulated into self-assembled nanoparticles (NPs) for tumor imaging and combined chemo- and photodynamic therapy. Coating the NPs with amphiphilic polymer distearylphosphatidylethanolamine-polyethylene glycol-arginine-glycine-aspartate (DSPE-PEG-RGD) offers high stability and enables cancer tissue targeting. The as-prepared NPs enlighten disease cells and reveal more potent cytotoxicity comparing to PTX and the photosensitizer alone. Furthermore, the NPs selectively accumulates into tumors and synergistically inhibits tumor proliferation with reduced side effects in mice.

Co-Delivery of Paclitaxel Prodrug, Gemcitabine and Porphine by Micelles for Pancreatic Cancer Treatment via Chemo-Photodynamic Combination Therapy.

Pancreatic carcinoma is an aggressive subtype of cancer with poor prognosis, known for its refractory nature. To address this challenge, we have established a stable nanoplatform that combines chemotherapy with photodynamic therapy (PDT) to achieve better curative efficacy. First, we designed and synthesized a disulfide-bonded paclitaxel (PTX)-based prodrug, which was further mixed with gemcitabine (GEM) and photosensitizer THPP in an optimized ratio. Subsequently, the mixture was added dropwise into amphiphilic polymer DSPE-PEG water solution to form micelles composed of DSPE-PEG nanoparticles (TPG NPs). The TPG NPs were around 135 nm, and showed great ability of DTT stimulated release of PTX and GEM. Moreover, the TPG NPs can be efficiently uptaken by pancreatic cancer PANC-1 cells and effectively kill them, especially when combined with 650 nm laser irradiation. Finally, the TPG NPs have shown enhanced long-term circulation ability and also exhibited efficient anti-tumor activity in combination with 650 nm laser irradiation in a pancreatic cancer mouse model. In summary, the designed TPG NPs possesses great potential for co-delivery of paclitaxel prodrug, GEM and THPP, which enables combined chemo-photodynamic therapy for cancer treatment. In addition, the stimulated release of PTX prodrug and GEM also allows for better targeting of tumor cells and the increased therapeutic effect against cancer cells. Overall, the TPG NPs can serve as a good candidate for pancreatic cancer treatment.

"I'm walking on eggshells": challenges faced by mothers with breast cancer in interacting with adolescent daughters.

BACKGROUND: With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters' mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother's health, including such a key symbol of her womanhood-the breast-which may adversely affect the development of an adolescent daughter's own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers' perspective. METHODS: We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data. RESULTS: Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter's curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters' risk of cancer, influencing daughters' development, and imposing burdens on daughters). CONCLUSIONS: Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions.

Effects of Mindfulness-Based Stress Reduction Therapy on Posttraumatic Growth and Quality of Life in Patients With Breast Cancer Under Early Chemotherapy: A Randomized Controlled Trial.

Posttraumatic growth (PTG) in patients with breast cancer has been reported. Mindfulness-based stress reduction (MBSR) has been found to be effective in improving the psychological well-being during cancer care. This study aimed to evaluate the impact of MBSR on the levels of PTG, perceived social support, and quality of life. A sample of 101 participants who experienced early chemotherapy enrolled in an MBSR group (n = 50) and a routine care group (n = 51) for 8 weeks. Their postintervention data were combined with preintervention data through a bundle of questionnaires reporting levels of PTG, perceived social support, and quality of life. MBSR showed the prominent validity in raising the levels of PTG and increasing in perceived social support and quality of life from pre- to posttreatment. MBSR improved the levels of PTG, perceived social support, and quality of life in patients with breast cancer in early chemotherapy. In conclusion, MBSR may help to optimize the positive psychological processes that will be targeted to maximize the efficacy of treatment for future cancer survivors.

Activated Stellate Cell Paracrine HGF Exacerbated Pancreatic Cancer Cell Ferroptosis Resistance.

As a refractory tumor, pancreatic carcinoma is more vulnerable to ferroptosis, a novel regulated cell death mode. However, the exact role of pancreatic stellate cells (PSCs) in pancreatic cancer ferroptosis is still unclear. Using the coculture system, we revealed that activated PSCs promote pancreatic cancer cell ferroptosis resistance. Mechanistically, activated PSCs secreted HGF, which further activated the HGF receptor, c-MET, in pancreatic cancer cells, prevented lipid peroxidation, and ultimately triggered pancreatic cancer cell ferroptosis resistance in vitro and in vivo. TCGA and GEPIA databases also revealed a strong correlation between c-MET and antiferroptosis indicators. Our study supplied the evidence for the cross-talk between activated PSCs and pancreatic cancer cells in ferroptosis, which suggested a strategy to inhibit PSC paracrine signaling for preventing pancreatic carcinoma ferroptosis resistance.

The Entanglement between Mitochondrial DNA and Tumor Metastasis.

Mitochondrial DNA, the genetic material in mitochondria, encodes essential oxidative phosphorylation proteins and plays an important role in mitochondrial respiration and energy transfer. With the development of genome sequencing and the emergence of novel in vivo modeling techniques, the role of mtDNA in cancer biology is gaining more attention. Abnormalities of mtDNA result in not only mitochondrial dysfunction of the the cancer cells and malignant behaviors, but regulation of the tumor microenvironment, which becomes more aggressive. Here, we review the recent progress in the regulation of cancer metastasis using mtDNA and the underlying mechanisms, which may identify opportunities for finding novel cancer prediction and therapeutic targets.

Managing uncertainty and responding to difficult emotions: Cancer patients' perspectives on clinician response during the COVID-19 pandemic.

OBJECTIVE: Patients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians' responsiveness to patients' uncertainty and difficult emotions were associated with better health and well-being. METHODS: Patients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress. RESULTS: 317 respondents participated in the study. Patients' perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health. CONCLUSION: Even when controlling for patients' personal and health-related characteristics, clinicians' communication addressing patients' uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status. PRACTICE IMPLICATIONS: Clinicians' communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China.

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Factors affecting cancer patients' electronic communication with providers: Implications for COVID-19 induced transitions to telehealth.

OBJECTIVE: Because of the pandemic, electronic communication between patients and clinicians has taken on increasing significance in the delivery of cancer care. The study explored personal, clinical, and technology factors predicting cancer survivors' electronic communication with clinicians. METHODS: Data for this investigation came from the Health Information National Trends Survey (HINTS5, Cycle 2) that included 593 respondents who previously or currently had cancer. Multivariate regression analyses were used to predict electronic communication with clinicians. Predictors included demographic variables and health status, technology use (online health information-seeking behavior, tracking of health-related data such as using a Fitbit), and quality of past communication experiences with clinicians. RESULTS: In this pre COVID-19 sample, 42 % respondents (N = 252) did not engage in any type of electronic communication (e.g., emailing, texting, data sharing) with providers. In multivariate analyses, predictors of more electronic communication with clinicians included frequency of seeking health-related information online (ß = .267, p < .001) and better communication experiences with clinicians (ß = .028, p = .034), while no demographic variable showed significance. The technology use variables (online health information seeking, health tracking) were significantly higher predictors of electronic communication with clinicians (ΔR2 = .142, p < .001) than was past experiences with clinicians (ΔR2 = .029, p = .016). CONCLUSIONS: Access and past experience with interactive media technologies are strong predictors of cancer patients' electronic communication than with clinicians. Adoption of telehealth technology likely depends as much on patients' relationships with technology as it does their relationships with clinicians. PRACTICE IMPLICATIONS: Since Covid-19, cancer care providers have turned to telehealth provide patients with needed cancer care services. Enhancing patients' digital competence and experience with electronic communication will help them more easily navigate telehealth care. Providers can leverage their relationship with patients to facilitate more effective use of telehealth services.

Mineralization of pH-Sensitive Doxorubicin Prodrug in ZIF-8 to Enable Targeted Delivery to Solid Tumors.

The zeolitic imidazolate framework (ZIF-8), composed of zinc ion and dimethylimidazole, is widely used in drug delivery because of the easy fabrication process and the good biosafety. However, ZIF-8 suffers from low affinity to nonelectric-rich drugs and does not have surface functional groups. Here, to deliver doxorubicin (DOX) with ZIF-8 to specific target sites, DOX was first modified with a pH-sensitive linker containing two carboxyl groups to form the inactive prodrug CAD and subsequently seeded inside ZIF-8 by a 5 min mineralization process. CAD has high affinity to ZIF-8 because of the carboxyl groups and can anchor to the ZIF-8 surface to enable the surface modification with folic acid for tumor targeting. Moreover, the DOX release is precisely controlled by three steps of acidic pH response, with the dissociation of the FA layer, the breakdown of the ZIF-8 structure, and the cleavage of the pH-sensitive linker in prodrug. This novel "prodrug-ZIF-8" strategy has opened a new horizon in drug delivery.

Examining Potential Usability and Health Beliefs Among Young Adults Using a Conversational Agent for HPV Vaccine Counseling.

The human papillomavirus (HPV) vaccine is the most effective way to prevent HPV-related cancers. Integrating provider vaccine counseling is crucial to improving HPV vaccine completion rates. Automating the counseling experience through a conversational agent could help improve HPV vaccine coverage and reduce the burden of vaccine counseling for providers. In a previous study, we tested a simulated conversational agent that provided HPV vaccine counseling for parents using the Wizard of OZ protocol. In the current study, we assessed the conversational agent among young college adults (n=24), a population that may have missed the HPV vaccine during their adolescence when vaccination is recommended. We also administered surveys for system and voice usability, and for health beliefs concerning the HPV vaccine. Participants perceived the agent to have high usability that is slightly better or equivalent to other voice interactive interfaces, and there is some evidence that the agent impacted their beliefs concerning the harms, uncertainty, and risk denials for the HPV vaccine. Overall, this study demonstrates the potential for conversational agents to be an impactful tool for health promotion endeavors.

The state of diversity based on race, ethnicity, and sex in otolaryngology in 2016.

OBJECTIVE: To compare the representation of women and racial minorities among otolaryngology residents and faculty to other surgical specialties. METHODS: Information from 2016 regarding female and minority representation among medical school graduates, otolaryngology applicants, otolaryngology residents, otolaryngology faculty and residents, and faculty in other surgical specialties was obtained from the publicly available registries from the American Medical Association and the American Association of Medical Colleges. The data obtained was used to explore the differences between the various stages of training in otolaryngology and to compare the female and minority diversity of otolaryngology residents with residents in other surgical specialties. RESULTS: Women and African Americans were underrepresented at the resident level compared with their level of representation as medical school graduates. Women were underrepresented in otolaryngology resident applicants (P < .001), but equally represented between otolaryngology residency applicants and residents (P = .582). African Americans were equally represented between medical school graduates and otolaryngology resident applicants (P = .871), but underrepresented in otolaryngology residents (P < .001). Asian Americans and Hispanics were underrepresented among otolaryngology faculty compared with their representation in otolaryngology residency programs (P < .001, P < .001, respectively). Otolaryngology has the lowest percentage of African-American residents and faculty compared to other surgical specialties. The representation of women in otolaryngology residencies is higher than most surgical specialties but worse than general surgery, integrated plastics, and medical school graduates. CONCLUSION: Otolaryngology lags behind other surgical specialties in representation of minorities and women. Continued efforts should be made to increase diversity in the field of otolaryngology, especially in regard to underrepresented minorities. LEVEL OF EVIDENCE: 3 Laryngoscope, 2019.

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.