Impact of Medical Student Participation in Student-Run Clinics on Education, Residency Selection, and Patient Care: A Review of Selected Articles.

Student-run clinics (SRCs) are becoming increasingly popular at medical schools in the United States. These clinics have provided a variety of benefits, including serving disadvantaged populations and providing early clinical exposure for students. There has been no consensus on the impact of SRCs on medical education, specialty selection, and patient care. This review provides a thorough overview of student and patient outcomes as a function of medical students volunteering at SRCs. We queried PubMed for original literature published in English between the years 2000 and 2020. Inclusion criteria included primary research articles evaluating the impact of medical student participation in SRCs on education, specialty selection, and patient care. All articles included in the final review were agreed upon by three reviewers, and the pertinent data were extracted. Of 10,200 initial search results, seven papers were included in this review. These included two studies evaluating medical education, five studies evaluating residency selection, and three studies analyzing patient care. Three studies were included in multiple evaluations. The relationship between volunteering at SRCs and academic performance is unclear. Clinic volunteers had increased retention of empathy compared to non-volunteers. Additionally, clinic volunteers provided satisfactory care as determined by patient-reported outcomes, and were not more likely to pursue primary care specialties. As SRCs are increasing in number, research into the impact on medical students and patients is necessary to understand how these clinics may affect the field of health care. It is important to further evaluate how medical student involvement in SRCs can further improve patient care and outcomes.

Reinforced circular stapler in bariatric surgery.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is the most common procedure for weight loss surgery but has multiple complications. This study evaluates the use of reinforced circular staplers (RCS) and their effects on reducing gastrojejunal anastomotic complications. METHODS: We conducted a retrospective chart review from January 2007 to November 2008. Laparoscopic RYGBP were performed in 287 patients. A comparison was made of the complications with and without the use of reinforced circular staplers. The comparison was between a nonreinforced circular stapler (NRCS) group comprising 182 patients and an RCS group comprising 105 patients. RESULTS: Complications at gastrojejunal anastomosis were experienced by 15.3% of the patients; 9.5% were in the RCS group and 18.7% were in the NRCS group (P=0.026). Neither group had anastomotic leaks. Bleeding rate was 4.8% in the RCS group vs. 6.6% in the NRCS group. Ulcers occurred in 2.9% of the RCS group vs. 6.0% of the NRCS group. Stricture rate was 1.9% in the RCS group vs. 6.6% in the NRCS group. CONCLUSION: The application of RCS reduced the incidence of gastrojejunal anastomotic complications. Patients are twice as likely to develop complications when no RCS device is used (95% CI 1.03, 4.623). Therefore, it is beneficial to utilize RCS for the gastrojejunal anastomosis in RYGBP procedures.

Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic (Sleep COVID-19): structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The primary aim of the present study is to examine the efficacy of an online intervention for poor sleep in the context of an ongoing stressful major life event, by assessing if this intervention can reduce insomnia severity at short-term (one week post-intervention) and long-term (one and three months post-intervention) follow-up time points. It is hypothesised that the intervention will: 1) reduce insomnia severity in poor sleepers, compared to wait-list control poor sleepers, and good sleepers; 2) reduce subjective symptoms of anxiety and depression in all groups, and 3) prevent the transition to acute insomnia in good sleepers. TRIAL DESIGN: This study is a cluster randomised controlled trial. PARTICIPANTS: Both healthy good sleepers, who do not report having any current sleep problems, and individuals who report having sleep problems, will be recruited for the present study. This is a single-site study (Northumbria University). This study will be delivered using the internet and there are no geographic restrictions. Individuals who self-report as poor sleepers will meet DSM-5 criteria for acute insomnia, which is where individuals: 1) have difficulties in falling asleep, staying asleep, or awakening too early for at least three nights per week, for a time period of between two weeks and three months; and 2) report experiencing distress or impairment caused by sleep loss. Both 1) and 2) must have occurred despite the individual having had an adequate opportunity for sleep during this time period. Good sleepers will be individuals who do not have current sleep problems. All participants must have a sufficient level of English comprehension to understand and complete study measures. Individuals cannot participate if they report having chronic sleep problems (where they have existed for more than three months immediately prior to providing consent), nor will individuals who are actively seeking treatment for their sleep problems irrespective of how long they have had the sleep problem. Individuals also cannot participate if they have a self-reported history of head injuries, or if they have a self-reported diagnosis of schizophrenia, epilepsy or personality disorder, as the distraction techniques involved in the insomnia intervention may increase rumination in individuals with these conditions, and influence the effectiveness of the intervention. INTERVENTION AND COMPARATOR: Participants who receive the intervention will be provided with an online version of a self-help leaflet. A printed version of this leaflet has been successfully used in previous treatment studies, which have been conducted by our research group. Participants will be encouraged to download, save or print out this leaflet, which will be provided in PDF format. There will be no restrictions on use and participants will be encouraged to refer to this leaflet as often as they wish to. Briefly, this self-help leaflet aims to improve sleep by identifying and addressing sleep-related dysfunctional thinking by providing education about sleep, providing techniques to distract from intrusive worrisome thoughts at night, and providing guidelines for sleep-related stimulus control. The comparator is a wait-list control (i.e. where they will receive the intervention after a one month delay) group. MAIN OUTCOMES: The primary outcome measure will be insomnia severity, as measured using the Insomnia Severity Index (Bastien, Vallières, & Morin, 2001), assessed immediately prior to the intervention and at one week, one month and three months post-intervention, compared to baseline. Secondary outcome measures will include subjective mood, measured using the 7-item Generalised Anxiety Disorder Questionnaire (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 2006)) and 9-item Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & Williams, 2001), assessed immediately prior to the intervention, and one week, one month and three months post-intervention, compared to baseline. Additionally, subjective sleep continuity, derived from sleep diaries (Carney et al., 2012), will be compared pre and post-intervention. RANDOMISATION: This study will operate as a cluster randomised controlled trial. Good sleepers will be randomised into an intervention or a no-intervention group, with a 1:1 allocation. Poor sleepers will be randomised into an intervention or wait-list control group, with a 1:1 allocation. Randomisation will be conducted automatically using Qualtrics study software, where block sizes will be equal and randomisation will be computer-generated. BLINDING (MASKING): Participants will not be blinded to group assignment. The outcomes will be assessed by a blinded investigator. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The minimum sample size is 60. A total of 30 poor sleepers will be randomised to the intervention or wait-list control group. A total of 30 good sleepers will be randomised to the intervention or no intervention group. TRIAL STATUS: Recruitment for this study has yet to start. It is anticipated that recruitment will begin in August 2020 and end in April 2022. The current study protocol is version 1.0 (20 July 2020) TRIAL REGISTRATION: This study was prospectively registered in the ISRCTN registry (registration number ISRCTN43900695 , date of registration: 8 April 2020). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

Study aims to improve colorectal cancer screening participation.

Colorectal cancer is the second leading cause of cancer-related deaths (behind lung cancer) in the United States, yet it is one of the most preventable cancers, since screenings can detect pre-cancerous polyps. The removal of polyps inhibits and often eliminates their progression to cancer.

General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).

This report is a revision of General Recommendations on Immunization and updates the 2002 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This report is intended to serve as a general reference on vaccines and immunization. The principal changes include 1) expansion of the discussion of vaccination spacing and timing; 2) an increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table defining the appropriate storage temperature range for inactivated and live vaccines; 4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at CDC's National Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National Immunization Program) website at http//:www.cdc.gov/nip.

Analytic solution for source distributions in brachytherapy to obtain uniform dose rates in spherical tumor models.

Interstitial brachytherapy involves implanting many small radioactive sources into a tumor, with the goal of delivering a uniform radiation dose to the target volume. As a guide for the optimal placement of these sources, we assumed a spherical tumor irradiated by a continuously distributed radiation source. The solution of the ensuing integral equation shows that the source density is very low near the center of the sphere, increases rapidly toward the surface and becomes infinite at the surface. Integration of the source density over a given spherical sub-volume shows that only about 6% of the total activity is contained in the central core up to 50% of the tumor radius, while about one-half of the activity has to be placed in the outer spherical shell having a thickness of one-tenth of the tumor radius. Since attenuation is not taken into account, the results are applicable to highly penetrating radiation of isotopes such as 192Ir and 137Cs and tumor radii of a few cm. This situation is approximated in the high dose rate (HDR) treatment of the prostate using 192Ir. The results are in good agreement with the recommendations given in the traditional Paterson-Parker tables for radium and cesium treatments and a numerical solution to the problem.

Mercury in ground water, septage, leach-field effluent, and soils in residential areas, New Jersey coastal plain.

Water samples were collected from domestic wells at an unsewered residential area in Gloucester County, New Jersey where mercury (Hg) concentrations in well water were known to exceed the USEPA maximum contaminant level (MCL) of 2,000 ng/L. This residential area (the CSL site) is representative of more than 70 such areas in southern New Jersey where about 600 domestic wells, sampled previously by State and county agencies, yielded water containing Hg at concentrations that exceed the MCL. Recent studies indicate that background concentrations of Hg in water from this unconfined sand and gravel aquifer system are <10 ng/L. Additional sampling was conducted at the CSL site in order to better understand sources of Hg and potential Hg transport mechanisms in the areas with Hg-contaminated ground water. At the CSL site, concentrations of Hg were substantially lower (although still exceeding the MCL in some cases) in filtered water samples than in the unfiltered water samples collected previously from the same wells. Surfactants and elevated concentrations of sodium, chloride, nitrate, ammonium, and phosphate in water from domestic and observation wells indicated septic-system effects on water quality; detections of sulfide indicated localized reducing conditions. Hg concentrations in septage and leach-field effluent sampled at several other households in the region were low relative to the contaminant-level Hg concentrations in water from domestic wells. Relations of Hg concentrations in leach-field effluent to iron concentrations indicate that reductive dissolution of iron hydroxides in soils may release Hg to the percolating effluent.

The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center.

Although physician turnover in a healthcare organization can incur substantial costs, little formal attention has been given to estimating or modeling the financial impact on revenues. To address this gap in available information, the current study proposes a model by which to estimate the impact on revenue of physician turnover. We designed a financial model that accounts for the physician's departure, the search period for a successor physician, the time and rate at which the incoming physician increases initial productivity to reach the practice norm, and the ability of the remaining physicians in the practice to recover revenue during the search period. This model and the potential revenue impact underscore the importance of minimizing physician turnover and offer specific opportunities to minimize the potential revenue impact.

Efficacy of passive sand filtration in reducing exposure of salmonids to the actinospore of Myxobolus cerebralis.

The aquatic oligochaete Tubifex tubifex parasitized by Myxobolus cerebralis releases triactinomyxon (TAM) actinospores that can infect some species of salmonids and cause salmonid whirling disease. Silica sand was tested as a filtration medium for removal of TAMs from water containing the parasite. Laboratory tests indicated sand filtration removed > 99.99% of TAMs. In 2 different field tests, groups of 1 mo old rainbow trout Oncorhynchus mykiss were exposed for 2 wk to filtered and unfiltered water from a spring-fed pond enzootic for M. cerebralis. In November 2000, the exposure dose was estimated as between 3 and 5 TAMs fish(-1). During a March 2001 exposure, the estimated dose was between 286 and 404 TAMs fish(-1). Fish were held for 6 mo post exposure (p.e.) in laboratory aquaria for observation and evidence of clinical signs of whirling disease. We used 4 diagnostic techniques to assess the prevalence and severity of infection by M. cerebralis among fish exposed to filtered and unfiltered water. These included polymerase chain reaction (PCR) for genomic DNA of the parasite, histological evaluation for tissue damage, tissue digestion for quantification of cranial myxospores of the parasite, and total non-sampling mortality that occurred over 6 mo p.e. All diagnostic tests verified that the prevalence and severity of infection was significantly reduced among fish in treatment groups exposed to filtered water compared to those exposed to unfiltered water in both the low-dose and high-dose exposures.