Gender and Race/Ethnicity dynamics in anesthesiology mentorship: results of a European survey.

BACKGROUND: Mentorship is crucial to career advancement, medical education, and psychosocial support, especially for women and minorities. Although anesthesia mentoring programs have shown promise, there are no survey data regarding mentor-mentee relationship dynamics. This study aimed to explore the dynamics of the anesthesia mentor/mentee relationship. METHODS: A open cross-sectional web-based survey was distributed by the European Society of Anesthesiology and Intensive Care and European Society of Regional Anesthesia to European anesthesiologists. Participation was anonymous and consent was obtained. The study evaluated responses relating to preferences, facilitators, and barriers to mentorship relationships along with sociodemographic information. RESULTS: In total, 543 anesthesiologists responded to the survey, and 406 (111 mentees, 49 mentors, 193 both, 53 neither) responded to questions regarding mentorship. 184 anesthesiologists identified as woman and 22 as other genders (non-binary, transgender, gender-fluid, and self-described gender). Moreover, 250 anesthesiologists identified as white. Both mentors and mentees indicated that personal compatibility was the most important factor for successful mentorship. Barriers to mentorship included time consumption and perceived lack of interest from the mentor and mentee. Both mentors and mentees benefited from this relationship. The former reported feeling helpful, and the latter supported the development of clinical skills. The mentors indicated that their participation was important for protecting against burnout/exhaustion and impostor syndrome. Participants reported a preference for mentorship programs organized at the departmental level, offered at the start of the anesthesiology education curricula. Women were more likely to feel a 'lack of interest' in mentoring them as a barrier (OR = 2.49, P = 0.033). Gender was a barrier for mentors of other genders (OR = 23.9, P = 0.0027) and ethnicity (OR = 48.0, P = 0.0023). White mentees found gender (OR = 0.14, P = 0.021) and ethnicity (OR = 0.11, P = 0.048) to be less important barriers to successful mentorship relationship. CONCLUSION: When possible, programs should prioritize matching mentors and mentees based on personal compatibility and experience in the mentee's area of interest. Addressing the perceived lack of interest in mentoring is essential for promoting diversity, equality, and inclusion within anesthesiology, as well as and uplifting women and minorities. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05968339, First posted (01/08/2023).

Use of hospital big data to optimize and personalize laboratory test interpretation with an application.

BACKGROUND AND AIMS: In laboratory medicine, test results are generally interpreted with 95% reference intervals but correlations between laboratory tests are usually ignored. We aimed to use hospital big data to optimize and personalize laboratory data interpretation, focusing on platelet count. MATERIAL AND METHODS: Laboratory tests were extracted from the hospital database and exploited by an algorithmic stepwise procedure. For any given laboratory test Y, an "optimized and personalized reference population" was defined by keeping only patients whose laboratory values for all Y-correlated tests fell within their own usual reference intervals, and by partitioning groups by individual-specific variables like sex and age category. The method was applied to platelet count. RESULTS: Laboratory data were recorded for 28,082 individuals. At the end of the algorithmic process, seven correlated laboratory tests were chosen, resulting in a reference sample of 159 platelet counts. A new 95 % reference interval was constructed [152-334 × 109/L], notably reduced (27.2 %) compared to conventional reference values [150-400 × 109/L]. The reference interval was validated on a sample of 2,129 patients from another downtown laboratory, emphasizing the potential transference of the hospital-derived reference limits. CONCLUSION: This method offers new perspectives in laboratory data interpretation, especially in patient screening and longitudinal follow-up.

Endovascular Treatment of Abdominal Aortic Aneurysm: Impact of Diabetes on Endoleaks and Reintervention.

Background: Diabetes has a protective effect on abdominal aortic aneurysms (AAAs); however, there are contrasting reports on the impact of diabetes on endovascular aortic repair (EVAR) outcomes, endoleaks (ELs) being the major negative outcome. The present study characterizes ELs and their outcomes in AAA patients, diabetic or not. Methods: This single-center, retrospective, comparative study was carried out on 324 AAA patients who underwent elective EVARs between 2007 and 2016 at the University Hospital of Liège (Belgium). The primary endpoint was the incidence and effect of ELs on the evolution of the aneurysmal sac; the secondary endpoints were surgical reintervention and mortality rate. Diabetic and non-diabetic patients were compared with respect to various risk factors by logistic regression, while a Cox regression was used to analyze survival. Results: In AAA patients meeting the inclusion criteria (n = 248), 23% were diabetic. EL incidence was comparable (p = 0.74) in diabetic (38.7%) vs. non-diabetic (43.9%) patients. EL risk factors were age (HR = 1.04, p = 0.014) and fibrate intake (HR = 3.12, p = 0.043). A significant association was observed between ELs and aneurysm sac enlargement (p < 0.001), regardless of group (p = 0.46). Aneurysm sac regression per month for non-diabetic patients was -0.24 ± 0.013, while for diabetics it was -0.18 ± 0.027 (p = 0.059). Dyslipidemia (HR = 3.01, p = 0.0060) and sulfonylureas (HR = 8.43, p = 0.043) were associated with shorter EL duration, while diabetes (HR = 0.080, p = 0.038) and beta blockers (HR = 0.46, p = 0.036) were associated with longer EL duration. The likelihood of reoperation decreased with more recent surgery (OR = 0.90, p = 0.040), regardless of diabetic status. All-cause mortality was higher for the non-diabetic group (45.5% vs. 26.3%, p = 0.0096). Conclusions: Endoleak occurrence is a known risk factor for sac expansion. In diabetic patients, endoleaks lasted longer, and regression of the aneurysm sac tended to be slower. The number and type of reintervention was not related to the diabetic status of AAA patients, but overall survival was higher in patients with diabetes.

Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models.

Objectives: Calcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models. Methods: The PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes. Results: A total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength. Conclusion: The systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.

Comparison of HTK-Custodiol and St-Thomas solution as cardiac preservation solutions on early and midterm outcomes following heart transplantation.

OBJECTIVES: The choice of the cardiac preservation solution for myocardial protection at time of heart procurement remains controversial and uncertainties persist regarding its effect on the early and midterm heart transplantation (HTx) outcomes. We retrospectively compared our adult HTx performed with 2 different solutions, in terms of hospital mortality, mid-term survival, inotropic score, primary graft dysfunction and rejection score. METHODS: From January 2009 to December 2020, 154 consecutive HTx of adult patients, followed up in pre- and post-transplantation by 2 different tertiary centres, were performed at the University Hospital of Lausanne, Switzerland. From 2009 to 2015, the cardiac preservation solution used was exclusively St-Thomas, whereafter an institutional decision was made to use HTK-Custodiol only. Patients were classified in 2 groups accordingly. RESULTS: There were 75 patients in the St-Thomas group and 79 patients in the HTK-Custodiol group. The 2 groups were comparable in terms of preoperative and intraoperative characteristics. Postoperatively, compared to the St-Thomas group, the Custodiol group patients showed significantly lower inotropic scores [median (interquartile range): 35.7 (17.5-60.2) vs 71.8 (31.8-127), P < 0.001], rejection scores [0.08 (0.0-0.25) vs 0.14 (0.05-0.5), P = 0.036] and 30-day mortality rate (2.5% vs 14.7%, P = 0.007) even after adjusting for potential confounders. Microscopic analysis of the endomyocardial biopsies also showed less specific histological features of subendothelial ischaemia (3.8% vs 17.3%, P = 0.006). There was no difference in primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation. The use of HTK-Custodiol solution significantly improved midterm survival (Custodiol versus St-Thomas: hazard ratio = 0.20, 95% confidence interval: 0.069-0.60, P = 0.004). CONCLUSIONS: This retrospective study comparing St-Thomas solution and HTK-Custodiol as myocardial protection during heart procurement showed that Custodiol improves outcomes after HTx, including postoperative inotropic score, rejection score, 30-day mortality and midterm survival.

Development of a cancer risk model and mobile health application to inform the public about cancer risks and risk factors.

OBJECTIVE: To develop and evaluate a mobile health application, the Cancer Risk Calculator (CRC), aimed at improving public health literacy by providing personalized information on cancer risks and preventive measures. MATERIALS AND METHODS: The CRC was developed through a comprehensive process involving the identification of necessary content, integration of average cancer risks using data from reliable sources, creation of a novel risk model emphasizing modifiable factors, and the application's development for easy access. The application covers 38 cancer types, 18 subtypes, and approximately 790 risk factors, utilizing data from the Surveillance, Epidemiology, and End Results Program and scientific literature. RESULTS: CRC offers users personalized risk assessments across a broad range of cancers, emphasizing modifiable risk factors to encourage preventive behaviors. It distinguishes itself by covering more cancer types and risk factors than existing tools, with preliminary user feedback indicating its utility in promoting health literacy and lifestyle changes. DISCUSSION: The CRC application stands out as an innovative tool in health informatics, significantly enhancing public understanding of cancer risks. Its development underscores the potential of digital health technologies to bolster preventive healthcare strategies through improved health literacy. CONCLUSION: The Cancer Risk Calculator is a pivotal development in mobile health technology, offering comprehensive and personalized insights into cancer risks and prevention. It serves as a valuable resource for public health education, facilitating informed decisions and lifestyle modifications for cancer prevention.

The Possible Synergistic Pharmacological Effect of an Oral Berberine (BBR) and Curcumin (CUR) Complementary Therapy Alleviates Symptoms of Irritable Bowel Syndrome (IBS): Results from a Real-Life, Routine Clinical Practice Settings-Based Study.

Irritable bowel syndrome (IBS) is a prevalent chronic functional gastrointestinal disorder, characterised by recurrent abdominal discomfort and altered bowel movements. IBS cause a significantly negative impact on quality of life (QoL). Growing pharmacological evidence suggests that berberine (BBR) and curcumin (CUR) may mitigate IBS symptoms through multiple complementary synergistic mechanisms, resulting in the attenuation of intestinal inflammation and regulation of bowel motility and gut functions. In the present observational study conducted under real-life routine clinical practice settings, 146 patients diagnosed with IBS were enrolled by general practitioner clinics and pharmacies in Belgium. For the first time, this study assessed the potential synergistic pharmacological effect of a combined oral BBR/CUR supplement (Enterofytol® PLUS, containing 200 mg BBR and 49 mg CUR) (two tablets daily for 2 months), serving as complementary therapy in the management of IBS. Following the 2-month supplementation, significant improvements were observed in the patients' IBS severity index (IBSSI) (47.5%) and all the primary IBS symptoms, such as abdominal discomfort (47.2%), distension (48.0%), intestinal transit (46.8%), and QoL (48.1%) (all p < 0.0001). The improvement in the patients' IBSSI was independent of age, sex, and IBS sub-types. The patients' weekly maximum stool passage frequency decreased significantly (p < 0.0001), and the stool status normalized (p < 0.0001). The patients' need for concomitant conventional IBS treatment decreased notably: antispasmodics by 64.0% and antidiarrhoeals by 64.6%. Minor adverse effects were reported by a small proportion (7.1%) of patients, mostly gastrointestinal. The majority (93.1%) experienced symptom improvement or resolution, with a high satisfaction rate (82.6%) and willingness to continue the supplementation (79.0%). These findings support the potential synergistic pharmacological role of BBR and CUR in IBS, and their co-supplementation may alleviate IBS symptoms and improve QoL.

Influence of the scanning path on the accuracy of intraoral scanners in the implanted edentulous patient: an in vitro study.

AIM: The aim of this in vitro study was to investigate the influence of scan paths on the accuracy (trueness and precision) of intra-oral scanning of an implant impression on an edentulous patient. MATERIAL AND METHODS: An epoxy resin maxillary model was made with 6 bone level implants (NobelParallel Conical Connection RP, NobelBiocare®). The implants were placed at the spot of the first incisor, the canine and the first molar. The trans gingival component (Multi-unit, NobelBiocare®) was screwed onto the implants. The scanbodies (IO 2C-A, Elos Accurate®) were then screwed onto the multi-units. The model was run through a coordinate measurement machine to obtain a control cast. Then, five different scanning paths, respectively the zigzag technique (ZZT), the zigzag technique with palatal (ZZTP), the wrap technique (WT), the wrap technique with palatal (WTP), and the big zigzag technique (BZZT), were applied by a single operator. Finally, each scan was compared to the control model. Results were assessed by one-way ANOVA and linear mixed effects models at P<0.05. RESULTS: The study showed that scan paths ZZT and ZZTP had significantly lower absolute positioning errors and residual mean square errors than the others (P<0.0001). For distances between consecutive implant axes and for absolute vertical errors, their superiority was borderline (P<0.10). Overall, techniques ZZT and ZZTP were equally performant and proved to be the most accurate. CONCLUSIONS: This in vitro experimental study demonstrates that the scan path can have an influence on the accuracy of the optical impression for full arch rehabilitation on implants.

Association between PET/CT Scan Findings, Treatment, and Cancer Incidence in a Cohort of AAA Patients.

Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on serial FDG-PET/CT scan examinations to identify, among AAA patients, those at risk of cancer. Methods: Between 2006 and 2011 we recruited 149 AAA patients, free of cancer at baseline, and followed them until the end of 2021. All patients underwent an FDG-PET/CT scan at inclusion and possibly more scans during follow-up. At each medical imaging examination, the aneurysmal FDG uptake was recorded. Patients were stratified based on their aortic wall PET status (negative/positive). Any occurrence of cancer was reported. A Cox regression analysis and competing-risk modeling were applied to the data. Results: The proportion of AAA patients who developed cancer was 31.5% (mean time to diagnosis was 5.7 ± 3.4 years) and the death rate was 59%. A difference in cancer incidence between PET+ and PET- patients was detected (46.8% vs. 27.3%; HR = 1.96, 95%CI: 1.07-3.57, p = 0.028). Moreover, AAA patients undergoing surgical treatment had a lower risk of cancer than unoperated patients (28% vs. 50%; HR = 0.41, 95%CI: 0.21-0.80, p = 0.009). Conclusions: In AAA patients, diagnostic imaging with an FDG-PET/CT scan can help identify those patients at a higher risk of developing cancer. Moreover, the higher cancer risk in non-surgically treated patients calls for further analysis of associations between aneurysm growth and malignant disease.