National Analysis of Clinical Outcomes Associated With Cirrhotic Blunt Trauma Patients Undergoing Emergency Laparotomy Versus Non-operative Management: A Propensity Case-Matched Analysis.

INTRODUCTION: This study aims to evaluate clinical outcomes among severely injured trauma patients presenting with isolated blunt abdominal solid organ injuries with a pre-diagnosis of liver cirrhosis (LC) undergoing emergency laparotomy vs nonoperative management (NOM). METHODS: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) dataset from 2017 to 2021. Adults (≥18 years) with a pre-existing diagnosis of LC who presented with severe blunt (ISS ≥ 16) isolated solid organ abdominal injuries and underwent laparotomy or NOM were included. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and in-hospital complications such as acute renal failure and deep vein thrombosis. RESULTS: 929 patients were included in this analysis, with 355 undergoing laparotomy and 574 managed nonoperatively. Laparotomy patients suffered greater in-hospital mortality (n = 186, 52.3% vs n = 115, 20.0%; P < .01), required significantly more blood within 4 hours (8.9 units vs 4.3 units, P < .01), and had a significantly longer ICU-LOS (10.2 days vs 6.7 days, P < .01). In the 1:1 propensity score matched analysis of 556 matched patients, in-hospital mortality was greater for laparotomy patients (52.3% vs 20.0%, P < .01). CONCLUSION: Laparotomy was associated with significantly higher in-hospital mortality in propensity-matched trauma patients, longer ICU-LOS, and more blood products given at 4 hours compared to NOM. These findings illustrate that NOM may be a safe approach in managing severely injured trauma patients with isolated blunt abdominal solid organ injuries and a pre-diagnosis of LC.

Rural Vascular Trauma: Time to Care.

Previous rural vascular trauma research has focused on case series dating back two decades. The current research aims to measure clinical decline in comparison to time to care in rural vascular trauma. This single-center retrospective cohort study included adult trauma patients with vascular injury who were admitted to a level II trauma center. Multivariable logistic regression assessed the effect of clinical decline based on arrival within the golden hour. 149 patients were included. For every 1 unit increase in the shock index ratio, there was 99.9% reduction in odds that the patient would arrive to the trauma center within the golden hour. This study is the first of its kind within the last two decades to comprehensively review rural vascular trauma. Our research showed clinical decline in SIR associated with prolonged time to care and will allow us to optimize pre-hospital care and transport in regions with prolonged arrival times.

Tumour tissue-derived small extracellular vesicles reflect molecular subtypes of bladder cancer.

mRNA-based molecular subtypes have implications for bladder cancer prognosis and clinical benefit from certain therapies. Whether small extracellular vesicles (sEVs) can reflect bladder cancer molecular subtypes is unknown. We performed whole transcriptome RNA sequencing for formalin fixed paraffin embedded (FFPE) tumour tissues and sEVs separated from matched tissue explants, urine and plasma in patients with bladder cancer. sEVs were separated using size-exclusion chromatography, and characterized by transmission electron microscopy, nano flow cytometry and western blots, respectively. High yield of sEVs were obtained using approximately 1 g of tissue, incubated with media for 30 min. FFPE tumour tissue and tumour tissue-derived sEVs demonstrated good concordance in molecular subtype classification. All urinary sEVs were classified as luminal subtype, while all plasma sEVs were classified as Ba/Sq subtype, regardless of the molecular subtypes indicated by their matched FFPE tumour tissue. The comparison within urine sEVs, which may exclude the sample type specific background, could pick up the different biology between NMIBC and MIBC, as well as the signature genes related to molecular subtypes. Four candidate sEV-related bladder cancer-specific mRNA biomarkers, FAM71E2, OR4K5, FAM138F and KRTAP26-1, were identified by analysing matched urine sEVs, tumour tissue derived sEVs, and adjacent normal tissue derived sEVs. Compared to sEVs separated from biofluids, tissue-derived sEVs may reflect more tissue- or disease-specific biological features. Urine sEVs are promising biomarkers to be used for liquid biopsy-based molecular subtype classification, but the current algorithm needs to be modified/adjusted. Future work is needed to validate the four new bladder cancer-specific biomarkers in large cohorts.

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis.

INTRODUCTION: Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. METHODS: A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24 hours, late >24 hours). RESULTS: Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. CONCLUSION: Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Evaluating the quality of multiple-choice questions in a NAPLEX preparation book.

INTRODUCTION: There is a plethora of preparatory books and guides available to help study for the North American Pharmacist Licensure Examination (NAPLEX). However, the quality of questions included has not been scrutinized. Our objective was to evaluate the quality of multiple-choice questions (MCQs) construction in a commonly used NAPLEX preparatory book. METHODS: Five students and two faculty members reviewed MCQs from the RxPrep 2018 edition course book. Item structure and utilization of case-based questions were evaluated using best practices for item construction. Frequency of item writing flaws (IWF) and utilization of cases for case-based questions was identified. RESULTS: A total of 298 questions were reviewed. Twenty-seven (9.1%) questions met all best practices for item construction. Flawed questions contained an average of 2.53 IWF per MCQ. The most commonly identified best practice violations were answer choices containing differing length and verb tense (21%) and question stems containing too little or too much information necessary to eliminate distractors (16.6%). Of the case-based questions, the majority (61.9%) did not require utilization of the provided case. CONCLUSIONS: This pilot analysis identified that a majority of MCQs in one NAPLEX preparatory source contained IWF. These results align with previous evaluations of test-banks in published books outside of pharmacy. Further evaluation of other preparatory materials, to expand on the findings from this pilot analysis, are needed to evaluate the pervasiveness of IWF in preparatory materials and the effect of flawed questions on utility of study materials.

Enhanced assessment of chest pain and related symptoms in the primary care setting through the use of a novel personalized medicine genomic test: results from a prospective registry study.

Novel approaches for assessing patients with chest pain and related symptoms may improve outpatient care. The REGISTRY I study measured the impact of a personalized gene expression score (GES) on subsequent cardiac referral decisions by primary care providers. Of the 342 stable, nonacute patients evaluated, the mean age was 55 years, 53% were female, and mean (SD) GES was 16 (±10) (range = 1-40). Low GES (≤15), indicating a low current likelihood of obstructive coronary artery disease (CAD), was observed in 49% of patients. After clinical covariate adjustment, each 10-point GES decrease was associated with a 14-fold decreased odds of cardiac referral (P < .0001). Low GES patients had 94% reduced odds of referral relative to elevated GES patients (P < .0001), with follow-up supporting a favorable safety profile. This genomic-based test demonstrated clinical utility by guiding decision making during assessment of symptomatic patients with suspected obstructive CAD.

Tests of the theory of work adjustment with economically distressed African Americans.

The present study tested 2 competing, extended models of the theory of work adjustment (TWA) with a sample of 100 economically distressed working African Americans receiving services at a nonprofit community center. Model 1 depicted a mediated model consistent with postulations of the TWA's original theorists. Model 2 depicted a moderated mediation model consistent with cultural critiques of the TWA. Bivariate correlations indicated that perceptions of person-organization (P-O) fit were positively related to job satisfaction and negatively related to turnover intentions, and job satisfaction was negatively related to turnover intentions. Furthermore, perceptions of racial climate were positively related to perceptions of P-O fit and job satisfaction and negatively related to turnover intentions. Moreover, results of the path analyses indicated stronger support for Model 2, the moderated mediation model, in which the indirect link of P-O fit with turnover intentions through job satisfaction was conditional on levels of racial climate. Specifically, when racial climate was perceived as less supportive, the indirect link of P-O fit with turnover intentions was nonsignificant, but when employees reported moderate and more supportive levels of racial climates, this indirect relation was significant. Research and career counseling implications of the present study's findings for financially distressed African American employees are discussed.

The expert patient as teacher: an interprofessional Health Mentors programme.

BACKGROUND: To meet future health care needs, medical education must increase the emphasis on chronic illness care, interprofessional teamwork, and working in partnership with patients and families. One way to address these needs is to involve patients as teachers in longitudinal interprofessional educational programmes grounded in principles of patient-professional partnerships and shared decision-making. CONTEXT: The University of British Columbia has a history of initiatives designed to bring patient and community voices into health professional education. Increasing opportunities for interprofessional education has become important because of accreditation requirements. INNOVATION: We describe preliminary findings from a 3-year pilot of an interprofessional Health Mentors programme, an elective patient-as-teacher initiative in which groups of four students from different disciplines learn together, with and from a mentor with a chronic condition (an 'expert by experience') over three semesters. The goals, achieved through six themed meetings and a symposium, are to learn about living with a chronic condition from the patient's perspective and to develop interprofessional competencies. Groups are given suggested topics for each meeting, but function as self-managed learning communities, and are encouraged to explore their own questions. Faculty members support direct learning between students and mentors through setting broad objectives and responding to the student reflections written after each group meeting. Students and mentors rate the programme highly, and a wide range of important learning outcomes have been documented. Medical education must increase the emphasis on chronic illness care, working in partnership with patients IMPLICATIONS: Key characteristics, generalisable to other educational programmes, include the role of faculty staff in supporting learning between students and patients, a minimalist structure to promote ownership and creativity, and flexible delivery.

Patterns of career and identity interference for lesbian, gay, and bisexual young adults.

Researchers have hypothesized about the potentially competing demands of sexual identity development and career development (e.g., Chen, Stracuzzi, & Ruckdeschel, 2004; Fassinger, 1996; Morrow, 1997; Schmidt, 2004). In the present study, we explored these hypotheses focusing specifically on career decision making. Using cluster analysis, we identified three groups of lesbian, gay, and bisexual young adults who differed in terms of the conflict experienced between sexual identity and career development: career conflict group (n = 11), sexual identity conflict group (n = 45), and those who experienced low levels of conflict between the two domains (n = 71). Differences were found between the clusters in levels of career decision making supports, career decision making barriers, and career decision making self-efficacy. Results tentatively suggest the importance of considering within-group differences when using Social Cognitive Career Theory to understand the career decision making of this population.

Methylenetetrahydrofolate reductase polymorphisms and risk of squamous cell carcinoma of the head and neck: a case-control analysis.

Folate deficiency is implicated in cancer risk that may be modulated by a genetic variation in the methylenetetrahydrofolate reductase (MTHFR) gene in folate metabolism. We hypothesized that genetic variants in MTHFR are associated with risk of squamous cell carcinoma of the head and neck (SCCHN). We genotyped 3 MTHFR polymorphisms (C677T, A1298C and G1793A) and estimated their haplotypes in a hospital-based case-control study of 537 SCCHN cases and 545 cancer-free controls. The controls were frequency-matched to the cases by age (+/- 5 years), sex, ethnicity and smoking status. We found that the MTHFR 1298AC/CC genotypes were associated with an approximately 35% reduction in risk of SCCHN (adjusted odds ratio = 0.65; 95% CI = 0.51-0.82) compared to the AA genotype. The MTHFR 677CT and 1793GA/AA genotypes were associated with nonsignificant increased risk of SCCHN compared to the 677CC and 1793GG genotypes, respectively. We estimated that there were 8 haplotypes and 16 haplotype genotypes based on these 3 variants. When we used the haplotypes and assumed that the 677T, 1298A and 1793A alleles were risk alleles, the adjusted odds ratios increased as the number of risk alleles increased: 1.00 for 0-1 variant, 1.85 (1.3-2.5) for any 2 risk alleles and 1.93 (1.4-2.7) for any 3 risk alleles. These results suggest that all 3 MTHFR polymorphisms may play a role in the susceptibility to SCCHN among non-Hispanic whites. Future studies should incorporate detailed data on alcohol consumption, dietary folate intake and related serologic measurements.

Magnetic resonance imaging and surgical repair of cleft palate in a four-week-old canine (Canis familiaris): an animal model for cleft palate repair.

Successful cleft palate repair (palatoplasty) was accomplished in a male canine pup from a kindred with autosomal recessive transmission for a complete cleft palate phenotype. This case represents the potential application of a new animal model for cleft palate repair. This reproducible congenital defect provides a clinically relevant model to improve research into the human anomaly, as compared with previous iatrogenic or teratogenically induced animal models. This case report presents the basis for new repair techniques and for studying the genetic basis of the cleft palate defect.