Quality analysis of publicly available information about hypoplastic left heart syndrome.

PURPOSE: Publicly available health information is increasingly important for patients and their families. While the average US citizen reads at an 8th-grade level, electronic educational materials for patients and families are often advanced. We assessed the quality and readability of publicly available resources regarding hypoplastic left heart syndrome (HLHS). METHODS: We queried four search engines for "hypoplastic left heart syndrome", "HLHS", and "hypoplastic left ventricle". The top 30 websites from searches on Google, Yahoo!, Bing, and Dogpile were combined into a single list. Duplicates, commercial websites, physician-oriented resources, disability websites, and broken links were removed. Websites were graded for accountability, content, interactivity, and structure using a two-reviewer system. Nonparametric analysis of variance was performed. RESULTS: Fifty-two websites were analysed. Inter-rater agreement was high (Kappa = 0.874). Website types included 35 hospital/healthcare organisation (67.3%), 12 open access (23.1%), 4 governmental agency (7.7%), and 1 professional medical society (1.9%). Median total score was 19 of 39 (interquartile range = 15.8-25.3): accountability 5.5 of 17 (interquartile range = 2.0-9.3), content 8 of 12 (interquartile range = 6.4-10.0), interactivity 2 of 6 (interquartile range = 2.0-3.0), and structure 3 of 4 (interquartile range = 2.8-4.0). Accountability was low with 32.7% (n = 17) of sites disclosing authorship and 26.9% (n = 14) citing sources. Forty-two percent (n = 22) of websites were available in Spanish. Total score varied by website type (p = 0.03), with open access sites scoring highest (median = 26.5; interquartile range = 20.5-28.6) and hospital/healthcare organisation websites scoring lowest (median = 17.5; interquartile range = 13.5-21.5). Score differences were driven by differences in accountability (p = 0.001) - content scores were similar between groups (p = 0.25). Overall readability was low, with median Flesch-Kincaid Grade Level of 11th grade (interquartile range = 10th-12th grade). CONCLUSIONS: Our evaluation of popular websites about HLHS identifies multiple opportunities for improvement, including increasing accountability by disclosing authorship and citing sources, enhancing readability by providing material that is understandable to readers with the full spectrum of educational background, and providing information in languages besides English, all of which would enhance health equity.

Never too early: the impact of a shadowing programme in paediatric and congenital cardiac surgery for undergraduate college students.

PURPOSE: Diversification of the medical and cardiothoracic surgical workforce represents an ongoing need. A congenital cardiac surgery shadowing programme for undergraduate students was implemented at the University of Florida Congenital Heart Center. METHODS: Students shadowing in the Congenital Heart Center from 17 December 2020 through 20 July 2021 were sent a survey through Qualtrics to evaluate the impact of their shadowing experience. The main objectives of the survey were to determine the personal relationship(s) of the students to physicians prior to shadowing, how the presence or absence of physicians in the family of a given student related to the exposure of the student to a medical setting prior to shadowing, and the interest of the students in medicine and cardiothoracic surgery prior to and after the shadowing experience. Survey responses included "Yes/No" questions, scaled responses using a Likert scale, selection lists, and free text responses. When applicable, t-tests were utilised to assess differences between student groups. RESULTS: Of the 37 students who shadowed during the study period, 26 (70%) responded. Most students were female (58%, n = 15), and the mean age was 20.9 ± 2.4 years. Students spent a mean duration of 95 ± 138 hours shadowing providers as part of the shadowing programme. Likert scale ratings of interest in the professions of medicine, surgery, and cardiothoracic surgery all increased after the shadowing experience (p < 0.01). Students with a family member in medicine had more clinical exposure prior to the shadowing programme (p < 0.01). CONCLUSION: A surgical shadowing programme at a Congenital Heart Center may have an important formative impact on the views of undergraduate students regarding potential careers in surgery and medicine. Additionally, students without family members in medicine tend to have less prior exposure to medicine and could likely benefit more from this type of shadowing programme.

Delayed aorto-atrial fistula-a rare complication of tricuspid valve endocarditis.

A patient with a history of endocarditis developed a fistula between the aorta and right atrium requiring surgical repair. The patient underwent surgical intervention with closure of the fistula using an autologous pericardial patch and primary repair. This report is significant because a rare surgical pathology is visualized clearly and provides an educational value to aid other clinicians in the recognition and management of this unusual diagnosis.

An assessment of surgery core rotation quality at osteopathic medical schools.

CONTEXT: Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards. OBJECTIVES: The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery. METHODS: After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software. RESULTS: A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested. CONCLUSIONS: Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.

The Effects of Single Accreditation and Pass/Fail Licensing Exams on Osteopathic Medical Students Applying to Surgical Residency Programs.

OBJECTIVE: To examine the effects of single accreditation and pass/fail licensing exams on osteopathic (DO) medical students applying for surgical residency. DESIGN: Electronic surveys were distributed to 1509 program directors (PD) in 10 surgical specialties. PDs were separated into 2categories based on their program's accreditation status prior to single accreditation: formerly accredited by the American Osteopathic Association (AOA) or not accredited by the AOA. Separate chi-squared and binomial tests were used to determine statistical differences between PDs in each category and within each surgical specialty. SETTING: Voluntary, anonymous, electronic survey. PARTICIPANTS: Three hundred survey responses were received (response rate 19.8%) and 234 responses were included in statistical analyses. Sixty-six responses were excluded because the survey was incomplete, the survey was not completed by a PD, or the PD indicated disqualification of DO applicants from matching at that program. RESULTS: The majority of PDs in both categories recommend or require that DO students take both United States Medical Licensing Examination (USMLE) Step1 [Χ2 (2, N = 234) = 8.939, p = 0.011] and USMLE Step 2 CK [Χ2 (2, N = 234) = 4.161, p = 0.125] despite pass/fail outcomes only on Step 1 and Level 1. When deciding whom to interview, PDs in both categories highly ranked USMLE Step 2 CK scores and letters of recommendation (LOR). Formerly-AOA-accredited programs highly ranked COMLEX-USA Level 2 scores (p = < 0.001) and completion of an audition rotation (p = 0.001). Non-AOA-accredited programs highly ranked the Medical Student Performance Evaluation (MSPE) (p = < 0.001) and clerkship grades/evaluations (p = 0.001). CONCLUSIONS: Significant differences exist in programs despite single accreditation. DO applicants should take both USMLE Step 1 and Step 2 CK to be considered competitive for any surgical specialty. Additionally, DO students should prioritize formerly-AOA-accredited programs for audition rotations.

Pediatric Heart Transplantation Over 36 Years and Contemporary Volume-Outcome Analysis of UNOS.

BACKGROUND: This study examines 36 years of national pediatric heart transplantation data to 1) identify trends in transplant volume, centers, and one-year graft survival, and 2) assess how center transplant volume impacts outcomes over a contemporary 11-year period. METHODS: We performed a retrospective review of pediatric patients (<18 years) undergoing heart transplantation from 1/1/1987 to 12/31/2022 using the United Network for Organ Sharing Database. Trend analyses included the whole cohort, while volume-outcome analyses included a contemporary cohort to account for the temporal changes observed in transplant survival. Highest volume centers were defined by the number of heart transplants performed per center per year. RESULTS: Over 36 years, 11,828 pediatric heart transplants were performed. Transplant volume steadily rose, the number of centers remained stable, and one-year graft survival has improved significantly. In the contemporary era (2012-2022), 89 centers conducted 4,959 pediatric heart transplants. The top 15% high-volume centers (13 centers) accounted for 48.3% (2,393) of transplants, with an average of 16.7±3.8 transplants per center annually, compared to 3.9±3.1 for lower volume centers. Despite transplanting higher risk patients, high-volume centers had similar postoperative outcomes and improved long-term survival. CONCLUSIONS: While the number of US pediatric heart transplant centers has remained stable, pediatric heart transplant volume is steadily increasing, as is one-year graft survival. In a contemporary cohort, the top 15th percentile highest volume centers accounted for 48.3% of US pediatric heart transplants and transplanted higher risk patients with similar postoperative outcomes and improved longitudinal survival.

Time From First Contact With Heart Team to Transcatheter Aortic Valve Replacement in the COVID-19 Era.

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has become the dominant form of aortic valve replacement in the United States. During the Coronavirus disease 2019 (COVID-19) pandemic, access to elective surgical care was decreased, particularly for TAVR patients. In this study, we examine the impact of each COVID-19 "wave," on our patient's access to TAVR procedures and their associated outcomes.  Methods: After institutional review board approval, we conducted a retrospective review of a prospectively maintained database and a review of our own center's database to assess time to TAVR pre-COVID-19 and during internally defined COVID-19 "waves." Statistical analysis was conducted via a t-test. RESULTS: We measured the time from first contact to TAVR and compared each COVID-19 wave to our institution's pre-COVID-19 data. During Wave 1 and 2 of COVID-19, our mean time to TAVR increased significantly to 68.44 ± 48.66 days (p = 0.05) and 68.94 ± 53.16 days (p = 0.02), respectively. All three COVID-19 waves demonstrated a statistically significant increase in all-cause mortality post-operatively (PO) with mean PO mortality of 2.5 (p = 0.0035), 1.33 (p = 0.0009), and 0.67 (p = 0.006), respectively, compared to pre-COVID-19 data.  Conclusions: Multiple studies have shown that increased time from first contact to TAVR results in increased morbidity and mortality. COVID-19 increased our institution's time to TAVR significantly across two waves with an increase in all-cause mortality in each wave. This study highlights the importance that institutions should develop mechanisms to ensure access to care during crises so that patients do not face potentially avoidable harm.

An Analysis of 183 Heart Transplants for Pediatric or Congenital Heart Disease-Impact of High Panel Reactive Antibody.

BACKGROUND: We reviewed our management strategy and outcome data for all 179 patients with pediatric and/or congenital heart disease who underwent 183 heart transplants from January 1, 2011, to December 31, 2021, and evaluated the impact of elevated panel reactive antibody (PRA). METHODS: High PRA was defined as PRA >10%. Univariate associations with long-term survival were assessed with Cox proportional hazards models. Impact of high PRA on survival was estimated with multivariable models. RESULTS: PRA >10% was present in 60 of 183 transplants (32.8%), who were more likely to have prior cardiac surgery, higher number of prior cardiac operations, prior sternotomy, prior heart transplant, and positive crossmatch (24 of 60 [40.0%] vs 11 of 123 [8.9%], P < .0001). Univariate associations with long-term survival include acquired heart disease vs congenital or retransplant (hazard ratio [HR], 0.18; 95% CI, 0.053-0.593; P = .005), prior cardiac surgery (HR, 5.6; 95% CI, 1.32-23.75; P = .020), number of prior cardiac operations (HR, 1.3 for each additional surgery; 95% CI, 1.12-1.50; P = .0004), single ventricle (HR, 2.4; 95% CI, 1.05-5.48; P = .038), and preoperative renal dysfunction (HR, 3.4; 95% CI, 1.43-7.49; P = .002). In multivariate analysis, high PRA does not impact survival when controlling for each of the factors shown in univariable analysis to be associated with long-term survival. The Kaplan-Meier method provided the following survival estimates at 1 year (95% CI) and 5 years (95% CI) after cardiac transplantation: All patients, 93.6% (89.9%-97.3%) and 85.8% (80.0%-92.1%); PRA <10%, 96.6% (93.4%-99.9%) and 86.7% (79.6%-94.3%); and PRA >10%, 86.7% (78.0%-96.4%) and 83.8% (74.0%-95.0%). Despite high PRA being associated with higher mortality at 1 year (14.9% vs 3.8%, P = .035), no significant difference exists in Kaplan-Meier overall survival at 5 years posttransplant in patients with and without high PRA (log-rank P = .4). CONCLUSIONS: In our cohort, 5-year survival in patients with high PRA (PRA >10%) is similar to that in patients without high PRA (PRA <10%), despite the presence of more risk factors in those with high PRA. Individualized immunomodulatory strategies can potentially mitigate the risk of high PRA.

Primary Appendiceal Adenocarcinoma Masquerading as Acute Appendicitis: A Case Report.

Primary adenocarcinoma of the appendix is a rare neoplasm, and a large number are found incidentally during abdominal imaging and operations with other indications. This report examines a case of primary appendiceal adenocarcinoma discovered incidentally following a seemingly routine laparoscopic appendectomy in a 69-year-old male. The patient presented with atypical signs of acute appendicitis, including a history of waxing and waning right lower quadrant pain without anorexia, fever, or chills over five days. After undergoing laparoscopic appendectomy, histopathologic analysis of the appendix specimen revealed invasive adenocarcinoma. This case emphasizes the importance of maintaining a high index of suspicion for appendicitis versus appendiceal neoplasm in older adults presenting with atypical signs and symptoms.

A Tooth Decaying in the Appendix: An Unusual Cause of Appendicitis.

Appendicitis is a very common indication for surgery, although in recent years uncomplicated cases have often been managed with antibiotics. In this case, we discuss a patient who presented to the emergency department with a case of seemingly uncomplicated acute appendicitis. Physical exam, history, and imaging indicated that this was due to an ingested foreign body, specifically a dental crown, that had impacted the appendix. In cases of ingested foreign bodies, antibiotics are not an appropriate treatment for appendicitis and all cases should be treated surgically if the patient will tolerate surgery. A thorough history and physical exam, as well as imaging when indicated, can assist in the assessment of such patients.

Stabbing on Six Mile: A Case Report of Tension Pneumopericardium Following Penetrating Trauma.

This report details a rare case of cardiac tamponade due to traumatic pneumopericardium in a 27-year-old male. The patient presented to the emergency department in May 2021 as a Level 1 trauma activation due to multiple stab wounds, including one in the epigastric region, with tachycardia and hypotension. He was found to have significant pneumopericardium, resulting in tamponade physiology. The patient was emergently transferred to the operating room for a left anterolateral thoracotomy with pericardiotomy. He recovered well postoperatively without complications and was discharged home on postoperative day four.

Beans in the wrong stalk: A case of urethral foreign bodies.

Placement of foreign bodies within the urethra has intrigued urologists for years. We present the case of a 30-year-old man who had self-inserted 6 kidney beans into his urethra for sexual pleasure. Conservative attempts at removal with bedside interventions were unsuccessful. The patient required operative intervention with cystoscopy and urethral foreign body retrieval. No additional trauma was appreciated and all beans were extracted. Management of patients with a urethral foreign body can be attempted with bedside extraction, however proximal or challenging objects may require surgical extraction via either endoscopic or open approaches.

Radiological Findings of COVID-19 Patients in Italy.

CONTEXT: The emergence of COVID-19/SARS-CoV2 (COVID-19) was an outbreak that began in December 2019 and rose to pandemic levels in 2020. One of the largest problems with COVID-19 is the typical delay in testing and diagnosis that can lead to additional transmission of the disease. Under consultation with a board-certified radiologist, the study team evaluated the common radiological findings of COVID-19 on computed tomography (CT) and compared the efficacy of chest radiographs (i.e., x-rays) to CT in diagnosing COVID-19. METHODS: In 2020, the authors completed a retrospective review of radiologic imaging data (i.e., the original imaging report notes) from Italy performed on 47 patients who had tested positive for COVID-19 in Italy during the national outbreak from February to March 2020. Radiologic images were obtained from Società Italiana di Radiologia Medica e Interventistica radiological database of COVID-19 patients. Each case was analyzed for whether they had positive findings on either chest radiograph or CT or both among patients who had positive COVID-19 test results. RESULTS: The authors found significant radiological finding similarities among the 47 COVID-19 positive case studies from Italy during the February to March 2020 time period. Ground glass opacities and crazy paving were the most significant findings, resembling the findings in China and other Coronavirus strains. The authors' statistical analyses indicated that CT scans were more reliable by 30.7% than chest radiographs in identifying signs of COVID-19. In cases where either an initial negative swab for COVID-19 or providers lacked patient social histories, chest radiographs were used to show clinical findings consistent with COVID-19. CONCLUSIONS: Based on these results, chest radiographs appear to be a consistent method to assist in the diagnosis of most COVID-19 cases. The authors discuss several scenarios in community-based and non-hospital US settings for COVID-19 diagnostic processes.