Social media (some) models in resident education.

Social media has changed the way in which we communicate, as it has grown tremendously in the past decade. Social media platforms have even penetrated the area of surgery and surgical education. The COVID-19 pandemic has even further pushed for more innovative communication and surgical education methods, such as case and video discussions, asking for advice, and having journal clubs. In this article, we review several social media platforms, such as Twitter, Facebook, and others, and the ways that they have been integrated into surgical education.

Evaluation of the educational quality of publicly available online videos on laparoscopic jejunostomy by utilizing the LAP-VEGaS guidelines.

BACKGROUND: Despite its common nature, there is no data on the educational quality of publicly available laparoscopic jejunostomy training videos. The LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool, released in 2020, has been developed to ensure that teaching videos are of appropriate quality. This study applies the LAP-VEGaS tool to currently available laparoscopic jejunostomy videos. METHODS: A retrospective review of YouTube® videos was conducted for "laparoscopic jejunostomy." Included videos were rated by three independent investigators using LAP-VEGaS video assessment tool (0-18). Wilcoxon rank-sum test was used to evaluate differences in LAP-VEGaS scores between video categories and date of publication relative to 2020. Spearman's correlation test was performed to measure association between scores and length, number of views and likes. RESULTS: 27 unique videos met selection criteria. Academic and physician video walkthroughs did not demonstrate a significant difference in median scores (9.33 IQR 6.33, 14.33 vs. 7.67 IQR 4, 12.67, p = 0.3951). Videos published after 2020 demonstrated higher median scores than those published before 2020 (13 IQR 7.5, 14.67 vs. 5 IQR 3, 9.67, p = 0.0081). A majority of videos failed to provide patient position (52%), intraoperative findings (56%), operative time (63%), graphic aids (74%), and audio/written commentary (52%). A positive association was demonstrated between scores and number of likes (rs = 0.59, p = 0.0011) and video length (rs = 0.39, p = 0.0421), but not number of views (rs = 0.17, p = 0.3991). CONCLUSION: The majority of available YouTube® videos on laparoscopic jejunostomy fail to meet the basic educational needs of surgical trainees, and there is no difference between those produced by academic centers or independent physicians. However, there has been improvement in video quality following the release of the scoring tool. Standardization of laparoscopic jejunostomy training videos with the LAP-VEGaS score can ensure that videos are of appropriate educational value with logical structure.

Pain Interference and Decreased Physical Function After Emergency General Surgery: Measuring Patient-Reported Outcomes.

INTRODUCTION: There is increasing emphasis on patient-reported outcomes (PROs) measures in healthcare, but this area remains largely unexplored in emergency general surgery (EGS) conditions. We hypothesized that postoperative patients in our EGS clinic would report detrimental changes in several domains of health-related quality of life (HRQoL). METHODS: We administered the PROMIS-29, a HRQoL measurement tool, to postoperative patients in our EGS clinic (11/2019-4/2020). Patients responded to measures of 7 domains. Domain scores were converted to t-scores, allowing comparison to average values within the general US population (set to 50 by definition). We report the mean scores within each domain. Higher scores in negatively worded domains (e.g., "Depression") are worse; vice versa for positively worded domains (e.g., "Physical Function"). Changes in scores at subsequent clinic visits were analyzed using the paired t-test. RESULTS: There were 97 patients who completed the PROMIS-29 at the first postoperative visit. Mean (SD) age was 54.1 (16.2) years; 51% were male. There was no difference in our patients from the average US population in the domains of Ability to Participate in Social Roles and Activities, Anxiety, Fatigue, and Sleep Disturbance. However, EGS patients experienced significantly greater Pain Interference (56.1 [54.1, 58.1]) and worse Physical Function (40.6 [38.4, 42.7]) than average. For patients seen in follow-up twice (13 patients, median interval between clinic visits 21 days), there were improvements in the domains of Physical Function (42.9 vs 37.3; p = 0.04) and Fatigue. CONCLUSION: We demonstrate room for improvement in the domains of pain interference and physical function. While positive changes over a relatively short period of time are encouraging, consideration should be given to patient perceptions of illness and lifestyle impact when managing EGS patients.

Pulmonary contusions in the elderly after blunt trauma: incidence and outcomes.

BACKGROUND: In the general population with blunt chest trauma, pulmonary contusions (PCs) are commonly identified. However, there is limited research in the elderly. We sought to evaluate the incidence and outcomes of PCs in elderly blunt trauma admissions. METHODS: We retrospectively reviewed the trauma registry at a level I trauma center for all blunt thoracic trauma patients aged ≥65 y, who were admitted between 2007 and 2015. The medical records of PC patients were reviewed. RESULTS: There were 956 admissions with blunt thoracic trauma; of which 778 had no pulmonary contusion (NO) and 178 had PC. The major mechanisms of injury were falls (58.7% NO, 39.3% PC, P <0.001) and motor vehicle crash/motor cycle crash (35.6% NO, 51.7% PC, P <0.001). Rib fractures were present in 79.8% of PC and 73.8% of NO patients, P = 0.1. PC patients more often had serious (AIS ≥3) head/neck (30.3% versus 20.6%, P <0.001), abdomen (12.4% versus 6.6%, P <0.001), and extremity injuries (20.8% versus 11.4%, P <0.001). Complication (46.1% PC versus 26.6% NO, P <0.001) and mortality (14.0% PC versus 6.2% NO, P = 0.0003) rates were higher in PC patients. On multivariate logistic regression analyses, PC presence was significantly associated with mechanical ventilation (odds ratio 2.5), intensive care unit admission (odds ratio 2.3), and mortality (odds ratio 1.9). CONCLUSIONS: Over 18.6% of elderly blunt thoracic trauma patients sustained PC, despite an often low energy mechanism of injury. The presence of a PC should prompt investigation for other serious intrathoracic and extrathoracic injuries. PC presence is associated with substantial morbidity and mortality.

The Use of Hypothermic Circulatory Arrest During Heart Transplantation Does Not Worsen Posttransplant Survival.

BACKGROUND: Hypothermic circulatory arrest (HCA) has been used as an adjunct to cardiopulmonary bypass for decades, both electively and emergently, to facilitate a bloodless operative field while maintaining cerebral protection. The aim of this study is to determine the impact of HCA during heart transplantation on posttransplant outcomes. METHODS: All adult patients undergoing orthotopic heart transplantation at our institution between 2000 and 2012 were retrospectively reviewed. Patients were stratified based on need for HCA during surgery; patients who required HCA (HCA group, n = 25), and patients who did not (no-HCA group, n = 903). The primary outcomes of interest were 30-day and 1-year mortality and postoperative complication rate. RESULTS: Indications for HCA included control of significant hemorrhage (n = 9), need for distal aortic procedures (n = 9), or as an aid in difficult mediastinal dissection (n = 7). Mean duration of HCA was 22 ± 18 minutes at a mean temperature of 24.5° ± 5.5°C. Significantly more patients in the HCA group underwent transplant for congenital heart disease (16.0% HCA versus 2.8% no-HCA, p = 0.006), and patients in the HCA group had undergone more prior sternotomies (HCA 1 [interquartile range: 1 to 2] versus no-HCA 1 [interquartile range: 0 to 1], p < 0.001]. There was no statistical difference in 30-day mortality (8.0% HCA versus 4.2% no-HCA, p = 0.29) or 1-year mortality (8.0% HCA versus 12.3% no-HCA, p = 0.76). The HCA group had higher rates of reoperation for mediastinal bleeding and postoperative respiratory failure. CONCLUSIONS: The need for HCA during heart transplantation is rare but, when required, it is frequently a life-saving adjunct to cardiopulmonary bypass. However, patients who require HCA have higher rates of postoperative complications. Risk factors for needing HCA during transplantation include congenital heart disease and more than one prior sternotomies.

Aortic Root Replacement in Octogenarians Offers Acceptable Perioperative and Late Outcomes.

BACKGROUND: As the proportion of the population more than 80 years of age increases, cardiac surgeons will increasingly be consulted to operate on this high-risk patient group. The aim of this study is to evaluate the perioperative and late outcomes of octogenarians undergoing aortic root replacement in comparison with younger patients. METHODS: All patients undergoing aortic root replacement at our institution between 2005 and 2012 (n = 592) were retrospectively reviewed. Patients were stratified according to their age at surgery: patients less than 80 years old (group LT80, n = 558) and octogenarians (group OG, n = 34). Primary outcomes of interest were inhospital mortality and perioperative complication rate. RESULTS: Patients in the OG group had significantly higher rates of preoperative stroke history, atrial fibrillation, and coronary artery disease. Indication for surgery was type A aortic dissection in 62 (10.5%), thoracic aortic aneurysm in 514 (86.8%), and endocarditis in 11 (1.9%), with no intergroup differences. Inhospital mortality was not significantly different between groups (5.9% OG versus 2.3% LT80, p = 0.21), and postoperative atrial fibrillation was more common in OG (60.6% OG versus 38.5% LT80, p = 0.01). Type A dissection, diabetes mellitus, and prior cardiac surgery were independent predictors of inhospital mortality or postoperative stroke. CONCLUSIONS: Octogenarians can safely undergo aortic root replacement with moderately worse but acceptable perioperative mortality and late survival. Further studies are necessary to determine which subset of octogenarians are at the highest operative risk and may benefit from a conservative approach.

Effect of cholecalciferol supplementation on inflammation and cellular alloimmunity in hemodialysis patients: data from a randomized controlled pilot trial.

BACKGROUND: Memory T-cells are mediators of transplant injury, and no therapy is known to prevent the development of cross-reactive memory alloimmunity. Activated vitamin D is immunomodulatory, and vitamin D deficiency, common in hemodialysis patients awaiting transplantation, is associated with a heightened alloimmune response. Thus, we tested the hypothesis that vitamin D3 supplementation would prevent alloreactive T-cell memory formation in vitamin D-deficient hemodialysis patients. METHODS AND FINDINGS: We performed a 12-month single-center pilot randomized, controlled trial of 50,000 IU/week of cholecalciferol (D3) versus no supplementation in 96 hemodialysis patients with serum 25(OH)D<25 ng/mL, measuring effects on serum 25(OH)D and phenotypic and functional properties of T-cells. Participants were randomized 2:1 to active treatment versus control. D3 supplementation increased serum 25(OH)D at 6 weeks (13.5 [11.2] ng/mL to 42.5 [18.5] ng/mL, p<0.001) and for the duration of the study. No episodes of sustained hypercalcemia occurred in either group. Results of IFNγ ELISPOT-based panel of reactive T-cell assays (PRT), quantifying alloreactive memory, demonstrated greater increases in the controls over 1 year compared to the treatment group (delta PRT in treatment 104.8+/-330.8 vs 252.9+/-431.3 in control), but these changes in PRT between groups did not reach statistical significance (p = 0.25). CONCLUSIONS: D3 supplements are safe, effective at treating vitamin D deficiency, and may prevent time-dependent increases in T-cell alloimmunity in hemodialysis patients, but their effects on alloimmunity need to be confirmed in larger studies. These findings support the routine supplementation of vitamin D-deficient transplant candidates on hemodialysis and highlight the need for large-scale prospective studies of vitamin D supplementation in transplant candidates and recipients. TRIAL REGISTRATION: Clinicaltrials.gov NCT01175798.

Low Dietary Intake of Vitamin D and Vitamin D Deficiency in Hemodialysis Patients.

BACKGROUND: The purpose of this study was to test the hypothesis that decreased dietary intake of Vitamin D contributes to Vitamin D deficiency in end-stage renal disease (ESRD) patients on hemodialysis (HD). METHODS: We performed a cross-sectional study of 58 hemodialysis outpatients from two Mount Sinai Medical Center (MSMC)-affiliated outpatient HD units in New York City and 648 outpatients at MSMC with CKD stages I-IV. Serum 25(OH)D concentrations were measured from August 2010 to July of 2011 in recruited hemodialysis patients (n=58) and linked with results of dietary and lifestyle surveys. The Mount Sinai Data Warehouse (electronic medical record) was used to capture 25(OH) Vitamin D levels for outpatients with CKD stages I-IV who had Vitamin D testing during the same time period. RESULTS: The prevalence of Vitamin D insufficiency/deficiency in the HD cohort was 96.6%. Mean (SD) and median (IQR) 25(OH)D concentrations were 15.65 (6.82) and 13.55 (10.15) ng/mL, respectively. Dietary surveys showed a median weekly Vitamin D intake of 1044 IU (IQR=808, vs. a recommended weekly allowance of 4200 IU) and specific avoidance of foods containing both Vitamin D and phosphorus. In contrast, mean and median 25(OH)D concentrations in patients with CKD stages I-IV were 25.66 (13.44) and 23.60 (15.48) ng/mL (p<0.001 vs. HD patients). CONCLUSIONS: Vitamin D deficiency is more prevalent in HD patients than in pre-dialysis patients with CKD and is associated with decreased dietary intake of Vitamin D. Dialysis restrictions imposed to reduce dietary phosphorus intake likely contributes to the development of hypovitaminosis D in ESRD patients.

Complementary and alternative therapies for children and adolescents with ADHD.

PURPOSE OF REVIEW: To provide a comprehensive review of complementary and alternative medicine (CAM) treatments for children and adolescents with attention deficit hyperactivity disorder (ADHD). RECENT FINDINGS: Many parents of children with ADHD are reluctant to pursue medication options and unable to access behavioral counseling. CAM therapies are often appealing to families and studies show that a large percentage of children with ADHD are treated with one or more CAM therapy. Most research studies evaluating CAM therapies are methodologically flawed, and often times there are inconsistencies across either study design or results. Although the American Academy of Pediatrics does not recommend any CAM therapies for ADHD, essential fatty acid supplementation is likely well tolerated and modestly effective. SUMMARY: Most complementary and alternative treatments do not have adequate research to recommend their use in children with ADHD. Physicians should be aware of the many CAM treatment options and the research surrounding them in order to provide their patients with the most current and accurate information available.

Precise color tuning via hybrid light-emitting electrochemical cells.

We report color-tunable light-emitting devices employing CdSe/ZnS quantum dots (QDs) blended into a polymer light-emitting electrochemical cell (LEC) architecture. This novel structure circumvents the charge-tunneling barrier of QDs to achieve bright, uniform, and highly voltage-independent electroluminescence, with nearly all emission generated by the QDs. By blending varying ratios of two QD materials that emit at different wavelengths, we demonstrate precise color control in a single layer device structure.