Derivation and validation of a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality in 20 countries.

INTRODUCTION: Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality across various settings. METHODS: We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool. RESULTS: A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84). CONCLUSIONS: The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality.

Attributes of successfully matched versus unmatched obstetrics and gynecology fellowship applicants.

OBJECTIVE: We sought to determine the attributes of successful and unsuccessful fellowship applicants of the American Board of Obstetrics and Gynecology Inc (ABOG)-approved fellowship programs and to identify salient differences between subspecialty applicants. STUDY DESIGN: Anonymous questionnaires were completed by obstetrics and gynecology fellowship applicants using a web-based survey after match day of 2012. Fellowship applicant practices were evaluated and included importance of prematch preparations, interview process, networking practices, and postmatch reflections. RESULTS: A total of 327 fellowship applicants applying to programs accredited by the ABOG were surveyed, and 200 completed the survey (61% response rate). A comparison between prematch educational preparations pursued by applicants showed that matched applicants were more likely to come from allopathic medical schools (94%), attain membership in Alpha Omega Alpha and/or Phi Beta Kappa (27%), and receive a letter of recommendation from a nationally known subspecialist (77%) than unmatched applicants (P = .03, .005, and .007, respectively). Applicants to reproductive endocrinology and infertility were more likely than female pelvic medicine and reconstructive surgery to be members of academic honor societies (P = .008). Research publication was common among matched subspecialist applicants, with over half publishing 1-3 peer-reviewed manuscripts prior to matching. Applicants to gynecologic oncology did more visiting electives than any other specialty applicants (P < .001). CONCLUSION: Successful obstetrics and gynecology fellowship applicants have superior prematch preparations, strong letters of recommendation from leaders in their field of interest, and multiple research publications. These data will guide applicants to a critical self-analysis before deciding to apply.

Assessment of four tissue models on knot tensile strength.

OBJECTIVE: To determine whether the tissue model onto which a knot is tied influences the knot's tensile strength. STUDY DESIGN: Zero-gauge, nonexpired, silk, polyglactin 910, polydioxanone, and polypropylene sutures were tied on 4 different mock tissue models. The tissue models were standard metal hex head screw, uncooked chicken breast, a tube of packaged "string" cheese, and a cylinder of bubble wrap. The knots were tied without a surgeon's knot and with 4 additional square knots (1 = 1 = 1 = 1 = 1). The knots were tied by a single obstetrician/gynecologist investigator (J.M.D.) over the period of 1 week to minimize fatigue. We compared the knots when subjected to a tensiometer until the suture broke or untied. A minimum of 20 knots per group were needed to detect a moderate effect size with a power of 85% and a type I error rate of 5%. RESULTS: A total of 407 knots were tied with 4 types of material (silk, polyglactin 910, polydioxanone, and polypropylene), using 4 different models (chicken, bubble wrap, cheese, and metal). Among the knot failures, 113 of 407 untied rather than broke (28%). No differences in the likelihood of knots coming untied between the different models (p = 0.34) or tension at failure (p = 0.81) were noted. A 4 × 4 factorial analysis of variance (ANOVA) was conducted to determine the effects of the suture material and model type on tension at failure and whether there was any interaction between the 2 factors. No significant difference was observed in the interaction between suture material and model type (p = 0.35), and no effect for model type was found (p = 0.22). CONCLUSIONS: Tissue models that use materials more similar to human tissue do not seem to influence knot strength when compared with standard metal models. We propose that it is possible to have an accurate understanding of how knots withstand force and to simulate an in vivo environment by using low-cost, easily accessible natural and synthetic materials for the mechanism onto which the knot is tied.