Abdominal aortic aneurysm.

Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate.

National attitudes of medical students towards mandating the COVID-19 vaccine and its association with knowledge of the vaccine.

BACKGROUND: With the introduction of the novel COVID-19 vaccine, public hesitancy is being experienced with many turning to healthcare professionals for advice. As future physicians, medical students play a critical role in the public's view of the vaccine. OBJECTIVES: To determine the attitude of U.S. medical students toward mandating the COVID-19 vaccine to healthcare workers and patients, as well as whether their knowledge of the vaccine plays a role in their view. METHODS: The authors emailed a survey link to all U.S. medical schools with request to distribute it to their medical students. The survey remained open from 02/09/2021 to 03/15/2021 and included questions to determine the attitude of the medical students toward recommending the COVID-19 vaccine, and general knowledge questions about the vaccine. Chi square, Fisher's exact test, and linear regression were conducted to determine associations between willingness to recommend the COVID-19 vaccine and general knowledge of the vaccine. RESULTS: Among the 1,899 responses from medical students representing 151 U.S. medical schools, 57.82% approved of making the COVID-19 vaccine mandatory to healthcare workers, and 16.27% approved of making it mandatory to patients. Additionally, those who tested most knowledgeable of the vaccine were less likely to approve of making the vaccine mandatory for patients (66.67% vs. 72.70). Those that tested most knowledgeable were also more likely to personally receive the vaccine (72.35% vs 62.99%) as opposed to those that tested the least knowledgeable who were less willing to personally receive the vaccine (4.12% vs 14.17%). CONCLUSIONS: The data revealed that a slight majority of medical students support a vaccine mandate toward healthcare workers while a minority of medical students support a vaccine mandate toward healthcare workers. Additionally, medical students that had relatively high knowledge of the vaccine correlated with not approving of making the vaccine mandatory for patients. However increased knowledge of the vaccine correlated with increased willingness to personally receive the vaccine.

Caffeine as an ergogenic aid.

Caffeine is a naturally occurring substance that is widely consumed in a variety of forms. It produces multiple physiologic effects throughout the body. It is thought that this is mediated mainly through action at centrally located adenosine receptors. Caffeine has been studied for its potential use as an ergogenic aid. Several studies have demonstrated an improvement in exercise performance in submaximal endurance activities. Its potential ergogenic effect in acute, high-intensity exercise is less clear. Because of its potential use as an ergogenic aid, it use in sports is regulated by most sanctioning bodies.

Ergogenic aids: an update on ephedra.

Ephedra has been used medicinally for thousands of years dating back to ancient Chinese medicine. Since its introduction to Western medicine in the 20th century, ephedra has been used for various ailments. The amphetamine-like activity of ephedra made it a popular supplement for promotion of weight loss and enhancement of athletic performance, despite limited supporting data. With the implementation of the Dietary Supplement Health and Education Act of 1994, the US Food and Drug Administration's (FDA) regulation of ephedra-containing supplements diminished. As these products became increasingly available, adverse effects associated with their use also increased. These adverse effects are mainly a result of ephedra's sympathomimetic activity and have been manifested by premature cardiovascular and central nervous system disease. With mounting evidence concerning the unsafe nature of these products, the FDA was able to ban the sale of ephedra-containing dietary supplements in April of 2004.

The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience.

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment. Lessons learned in implementing and expanding an integrated ultrasound curriculum are also presented as are thoughts on future directions of undergraduate ultrasound education. Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. It is also well-suited for a competency-based model of medical education. Students learn ultrasound well and have embraced it as an important component of their education and future practice of medicine. An international consensus conference on ultrasound education is recommended to help define the essential elements of ultrasound education globally to ensure ultrasound is taught and ultimately practiced to its full potential. Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe.

Medical student identification of knee effusion by ultrasound.

Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.

An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience.

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.