What Can You Learn About Psychiatry Programs from Their Website? A Content Evaluation for Potential Applicants.

OBJECTIVE: This project aimed to assess the information contained on general psychiatry program websites and identify common themes that may be useful and informative for residency applicants. METHODS: A survey study design was used to evaluate all US general psychiatry program websites as listed in the FREIDA database. The evaluation form included 44 binary (yes or no) items. Two reviewers rated each item on all program websites between September 2021 and January 2022. Item discrepancies were settled by a third reviewer. Fisher's exact tests evaluated differences between geographic regions and program types. Multidimensional scaling and Rasch modeling were conducted to examine clustering and the probability of items reported on program websites. RESULTS: A total of 285 websites were identified; 13 were excluded. Internal consistency was high among reviewers, Cronbach's Alpha = 0.927; κ = 0.863. Websites varied considerably in quality. Significant inconsistent reporting was observed by region for current residents' photos and alumni careers (fellowship/jobs); p<0.001. Program types varied regarding information about program faculty, which included significant differences for faculty photo, faculty research interest, and faculty research publications; p<0.001. CONCLUSIONS: While inter-rater reliability was high, considerable variation among websites was observed. Residency programs could be improved by consistently reporting resident and faculty information. Results show that applicants may encounter issues finding pertinent information, as programs' FREIDA link did not direct the user to the residency program website two-thirds of the time.

Improving Medical Student Mentorship in Orthopaedic Surgery.

Introduction: Owing to limited clinical clerkships and travel restrictions related to COVID-19, recent medical student mentorship in orthopaedic surgery has been impacted negatively. The purpose of this quality improvement (QI) project was to determine if medical student awareness of orthopaedics as a possible career field may be improved through a mentoring program designed and delivered by orthopaedic residents. Methods: A five-resident QI team developed four educational sessions aimed at a medical student audience. Forum topics included: (1) orthopaedics as a career, (2) fracture conference, (3) splinting workshop, and (4) residency application process. Pre- and post-forum surveys were administered to student participants to assess changes in their perceptions regarding orthopaedic surgery. Data derived from the questionnaires were analyzed with nonparametric statistical tests. Results: Of 18 forum participants, 14 were men and 4 were women. A total of 40 survey pairs were collected, averaging 10 per session. In the all-participant encounter analysis, there were statistically significant improvements in all outcome measures including interest in, exposure to, and knowledge of orthopaedics; exposure to our training program; and ability to interact with our residents. Those undecided regarding their specialty demonstrated larger increases in post-forum responses, suggesting that the learning experience was more impactful for that subgroup. Conclusions: This QI initiative was a successful demonstration of orthopaedic resident mentorship of medical students, wherein perceptions of orthopaedics were influenced favorably by the educational experience. For some students with limited access to orthopaedic clerkships or formal one-on-one mentoring, forums like these may be an acceptable alternative.

Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study.

BACKGROUND: On December 13, 2016, the US Congress enacted the 21st Century Cures Act (hereafter the Cures Act), which contained the Final Rule mandate that took effect on April 5, 2021. Since then, health systems have been required to provide patients digital access to their eHealth information "without delay" and without charge. OBJECTIVE: This study aimed to assess clinicians' initial experiences with, and attitudes toward, sharing visit notes with patients after being mandated to do so by the Cures Act and to determine clinician preferences regarding instant record release. METHODS: This cross-sectional survey study was conducted between June 10, 2021, and August 15, 2021, at the University of Kansas Health System, a large academic medical center in Kansas City, Kansas, United States. Participants included clinicians currently employed by the health system, including resident and attending physicians, physician assistants, nurse practitioners, and critical care and emergency medicine registered nurses. RESULTS: A total of 1574 attending physicians, physician assistants, and nurse practitioners, as well as 506 critical care and emergency medicine nurses, were sent invitations; 538 (34.18%) and 72 (14.2%), respectively, responded. Of 609 resident physicians, 4 (response rate not applicable because it was unknown how many residents viewed the website while the link was available) responded. The majority of respondents were attending physicians (402/614, 65.5%) and within the department of internal medicine (160/614, 26.1%). Most agreed that sharing visit notes was a good idea (355/613, 57.9%) and that it is important to speak with the patients before they accessed their records (431/613, 70.3%). Those who agreed that sharing visit notes is a good idea tended to view the practice as a useful tool for engaging patients ("Agree": 139/355, 39.2%; "Somewhat agree": 161/355, 45.4%; P<.001) and experience no change in the clinical value of their notes for other clinicians (326/355, 91.8%; P<.001). Those who disagreed (or were neutral) tended not to encourage patients to read their notes (235/258, 91.1%; P<.001) and were more likely to experience a change in their charting practice (168/257, 65.4%; P<.001) and increased time charting (99/258, 38.4%; P<.001). CONCLUSIONS: The findings of this study may be generalizable to institutions similar to the University of Kansas Health System, and the clinician testimonies gathered in this study may provide valuable insight into the initial opinions and experiences of clinicians at these institutions. In addition, these clinician experiences collected early in the transition period may be used to guide future health policy implementation and to understand how best to prepare clinicians for these changes in practice.

Quadriceps Strength and Knee Function After Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Bone Autograft: A Preliminary Report.

Introduction: The purpose of this study was to evaluate quadriceps strength and knee function after anterior cruciate ligament (ACL) reconstruction using a quadriceps tendon bone (QTB) autograft. Methods: Preliminary data were extracted from an ongoing prospective cohort study in which the operative extremity was compared to non-operative extremity. Patients from 14 to 40 years of age who had an ACL reconstruction with QTB autograft volunteered to have knee assessment including quadriceps isokinetic strength measures and functional knee testing at 6 and 12 months post-operatively. Paired t-tests were conducted to compare post-operative strength and function scores on participants who had minimum one-year post-surgical follow-up. Results: Patients had a significant recovery of quadriceps strength as determined by isokinetic testing and single leg hop test. For 31 participants, quadriceps strength of the operative leg measured at 60 deg/sec was 63% of the non-operative leg at six months, increasing to 79% at one year (p < 0.001); when measured at 180 deg/sec, these values were 68% at six months, increasing to 82% at one year (p < 0.001). For 30 participants, single leg hop functional scores of the operative leg were 80% of the non-operative leg at six months, increasing to 91% at one year (p < 0.001). Conclusions: After QTB autograft for ACL reconstruction, there were significant gains in quadriceps strength and knee function from six months to one year post-operative. These findings indicated the QTB is an acceptable ACL reconstruction option.

Lessons Learned from Implementing Unconscious Bias Training at an Academic Medical Center.

Introduction: In 2018, our Midwestern university medical center began offering unconscious bias training. Each session concluded with a standard evaluation. We analyzed two years of data that focused on three areas: 1) whether demographic differences or amount of prior knowledge on the topic influenced the training experience; 2) what participants liked best about the training; and 3) whether participants' stated intentions to apply their learning at the end of the training aligned with institutional goals of the training. Methods: Participants attended sessions open to the campus community pre-scheduled by the Office for Diversity, Equity, and Inclusion and posted on its website. Chi-square tests were utilized to test associations between outcomes and questionnaire responses. Outcome measures included race/ethnicity, prior knowledge level, and overall rating of the training. Thematic analysis was used to code comments and establish themes from two open-ended survey questions. Results: Significant differences were found by race and ethnicity for all questionnaire responses; each were p < 0.001. Those who reported they had advanced/expert knowledge on the topic were less likely to report the training increased their knowledge, and those who reported their race as White/Caucasian tended to give the training the highest overall rating, as did heterosexuals. Through thematic analysis, participants valued the interactive nature of the training sessions, the use of storytelling, and the safety of the learning environment. Participants' intention to apply their learning indicated they had gained general awareness of bias and settings where it might influence their work. Conclusions: In an effort to foster a better working and learning environment for those who are underrepresented in the health professions, training was provide that may not have met the expectations of all participants. At the same time, participants who identified as White clearly increased their awareness of bias. Therefore, it is recommended to move away from one-size-fits-all unconscious bias training and develop a robust training continuum to provide ongoing advancement for diverse audiences.

Improving Electronic Patient Handoff in an Orthopaedic Residency using the Listrunner© Application.

Introduction: Miscommunication during shift change and other handoff events is a common source of malpractice claims and patient-care errors. An efficient patient handoff system is imperative to prevent miscommunication. Owning to limitations with our current handoff system and to an ever-increasing reliance on electronic health information, our residency program sought to modernize our handoff method. Methods: To improve handoff communication, the HIPAA-compliant application Listrunner© was adopted. Members of the orthopaedic trauma team were oriented to the new application. Change-of-shift patient handoff was transitioned from the current email system to List-runner©. After three months of using the new application, a web-based questionnaire was administered to all members of the care team to assess their experiences, including perceived benefits and limitations of the Listrunner© application. Results: Seventeen orthopaedic resident physicians and three orthopaedic trauma attending physicians completed the survey. While almost half of the respondents were satisfied using email as a checkout tool, more than half of study participants indicated that it lacked security and several users believed there was a need for improvement. Most indicated that Listrunner© was easy to use, improved clinical efficiency, and improved patient care and safety. Seventeen of 20 respondents reported that they would like to continue using Listrunner© as a check-out tool. Conclusions: The Listrunner© application was adopted quickly by our orthopaedic trauma team, whose members opined that the application increased the efficiency and accuracy of handoff when compared to the previous secure email system.

Comparative Analysis of Topical Versus Intravenous Administration of Epsilon-Aminocaproic Acid on Blood Management in Total Knee Arthroplasty.

Introduction: Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. Methods: This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Results: Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). Conclusions: The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.

Second Survey of County Health Departments of Kansas and COVID-19: Time for Change in Model for Pandemic Response.

INTRODUCTION: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) causing COVID-19 (Coronavirus Disease 2019) continues to be widespread in Kansas. County health departments are trying to contain this pandemic. METHODS: This second survey of Kansas county health department directors occurred from August 7 to September 7, 2020. Since the first survey in April, there have been significant increases in the number of positive cases of COVID-19 and related deaths. Thus, the aim of the study was to re-evaluate county-level containment efforts and assess shortfalls that were identified in the April 2020 survey. RESULTS: In total, 41 out of 105 directors responded to the survey. Generally, respondents said there were increased supplies for testing, increased testing centers, shorter time to get test results, and in some cases, increased funding. However, the number of people involved in contact tracing had not increased substantially, which was one of the recommended changes for improving containment. Moreover, of those persons who were tested, only a few (18%) counties inquired if they wear masks in public. From comments reported, there was a sense of employees being overwhelmed, especially among the smaller county health departments. CONCLUSION: As the cases of and deaths from COVID-19 are increasing in the state, especially in high density areas, the respondents to our survey indicated there was continued need for additional funding with easy access, increased staffing, especially for contact tracing, and significant help for effective messaging to improve adherence to public health directives.

Effectiveness of a Pilot Breastfeeding Educational Intervention Targeting High BMI Pregnant Women.

INTRODUCTION: Overweight and obesity during pregnancy are associated with adverse health outcomes leading to increased maternal and neonatal morbidity and mortality. Women with a high body mass index (BMI) also experience low breastfeeding rates. There is limited evidence of effective educational programs that aim to improve length of breastfeeding among this population. The main objective of this pilot educational intervention was to determine knowledge and skills retention at six weeks after completion of a breastfeeding class. METHODS: A two-hour breastfeeding class was offered during the second and third trimester of pregnancy targeting high BMI women. A longitudinal, survey study design was conducted using two data collection points. No comparator group was employed. RESULTS: Baseline mean age of respondents was 26.6 years (SD = 5.7). Respondents who completed post-intervention surveys were largely white (69.2%) followed by Hispanic (15.4%) and non-Hispanic black (15.4%), some college (57.1%), earned less than $50,000/year (64.3%), had employer-provided insurance (53.8%), and did not receive WIC benefits (78.6%). Most respondents had a pre-pregnancy BMI category of overweight (28.6%) or obese (57.1%). The intervention appeared to have some impact on responses. The following were observed: an increased understanding that baby may be fussy in the evening hours and wants to nurse more often (p < 0.002), how to bring baby to the breast (p = 0.004), knowing what to do if breastfeeding hurts (p = 0.031), and knowing what to do when baby has trouble breastfeeding (p = 0.021). CONCLUSION: Consistent with previous findings, all participants in our study reported increased knowledge to breastfeed. Thus, women's confidence to breastfeed their infant is enhanced through knowledge obtained from breastfeeding education. Additional studies are underway to assess breastfeeding behaviors.

Resident Experience Associated with Lung Biopsy Outcomes: A Cross-Sectional Study of Diagnostic Radiology Residents. Does the Level of Training Matter?

INTRODUCTION: Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions. METHODS: A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 - 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated. RESULTS: Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 - 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 - 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases. CONCLUSION: Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.

The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study.

Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting. We recommend that a standard biopsy be performed alongside targeted biopsy.

Resident Training on Methylenetetrahydrofolate Reductase: a National Survey.

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR) is an enzyme important in folate metabolism. Genetic polymorphisms of MTHFR have potential clinical implications, particularly in treating mental disorders, where a biologically active form of metafolin is FDA approved in the treatment of major depressive disorder and schizophrenia. Therefore, residents in a variety of specialties must understand the link between genetic polymorphisms of MTHFR and clinical disorders. OBJECTIVE: To identify current gaps in residency curricula with regards to the MTHFR gene. METHODS: Using a snowball sampling method, a national online survey was sent to residency program directors in family medicine, internal medicine, and psychiatry to be forwarded to their corresponding residents. Data was collected between April 5, 2019, and May 14, 2019. Statistical tests included a Pearson chi-square test. Qualitative content analysis for open item responses was conducted in which recurring keywords and phrases were summarized. The primary outcome of interest was a dichotomous question: Does your curriculum teach about MTHFR? RESULTS: The results showed that many of residency programs surveyed do not include MTHFR in their courses (family medicine 153/166, 92%; internal medicine 135/151, 89%; psychiatry 70/90, 78%) and a majority of residents are unaware of the clinical associations of MTHFR genetic polymorphisms with cardiovascular diseases and psychiatric disorders. CONCLUSIONS: While many residents were aware of the MTHFR gene, knowledge about the gene was minimal and many curricula do not include MTHFR as part of their program. Therefore, we recommend residency training programs assess their level of training on MTHFR and its genetic polymorphisms.

The Effect of Different Combinations of Three Stacked Half-Hitches and Suture Materials on an Arthroscopic Knot in a Dry or Wet Environment.

Purpose: Evidence is lacking on the effect of different combinations of three stacked half-hitches and suture materials on the loop/ knot security of an arthroscopic knot under cyclic loading conditions. The specific aim of this study was to identify variables, such as stacked half-hitch configurations, suture materials, and testing environments, that affect knot strength and loop security under cyclic loading conditions. Methods: Two suture materials (Orthocord and ForceFiber) were used to tie five differently stacked reversing half-hitches on alternating posts (RHAP) in an arthroscopic knot condition. All knots were evaluated in both dry and wet cyclic loading tests. Results: Knots tied with three identical half-hitches stacked on the same post (Conf #1) resulted in 100% knot slippage regardless of suture material in dry environment. In the wet environment this knot configuration performed slightly better (ForceFiber: 20% survived; Orthocord: 40% survived). With knots tied with one of the half-hitches in the RHAPs reversed, a significant improvement occurred in knot holding compared to Conf #1 (p<0.05). Knots tied with the last half-hitches in the RHAPs reversed using ForceFiber were 100% secure in both test environments; whereas those tied with Orthocord had 70% and 80% security rates in the respective environments. Knots tied with two half-hitches of the RHAPs reversed demonstrated the best overall performance. Conclusion: Significant effects for both stacked half-hitch configurations and suture materials on the knot loop and knot security were observed. Caution should be used when tying the 3 RHAPs in a knot using standard arthroscopic techniques. This study may provide a solution that might improve the maximum failure loads observed between orthopaedic surgeons, and achieve better clinical outcomes. Clinical Relevance: The findings of this study indicate the importance of three reversing half-hitches on alternating posts in performing arthroscopic knot tying, and provide evidence regarding discrepancies of maximum clinical failure loads observed between orthopaedic surgeons leading to better surgical outcomes.

Pioneer baby: suggestions for pre- and postnatal health promotion programs from rural English and Spanish-speaking pregnant and postpartum women.

In the United States, more than 9 million rural women (15-44 years old) experience limited access and delivery of reproductive healthcare services. Rurality coupled with lower socio-economic status are associated with increased maternal and neonatal morbidity and mortality. The purpose of this qualitative study was to gain in-depth information from underserved English- and Spanish-speaking pregnant and postpartum rural women on what they would value in a health promotion program. Three focus group sessions were conducted exploring four domains: (1) physical activity, (2) dietary habits, (3) fetal movement/kick counts, and (4) breastfeeding and other support resources. Five overarching themes were observed across domains, with the following health promotion needs: (1) information on safe exercises, (2) advice on healthy food and drink, (3) breastfeeding support, (4) guidance on counting fetal movement, and (5) self- and peer-education. Study findings will inform intervention programming that aims to improve pregnancy and birth outcomes.

Malignant Self-Regard in clinical outpatient samples.

While the malignant self-regard construct and a corresponding questionnaire, the Malignant Self-Regard Questionnaire (MSRQ; Huprich, 2011) have been empirically evaluated in several non-clinical samples, it has yet to be evaluated in a clinical population. In this study, 139 outpatients in the Departments of Psychiatry and Behavioral Sciences (n = 83) and Internal Medicine (n = 57) were administered the MSRQ and a number other measures to assess its construct and incremental validity. The MSRQ was internally consistent in both samples, and was positively correlated with four dimensions of levels of personality functioning, DSM-5 personality trait domains, overdependence, detachment, insecure attachment, and general perceptions of physical and mental well-being. Furthermore, the MSRQ incrementally predicated variance in levels of personality functioning, interpersonal dependency, and general perceptions of physical and mental well-being above and beyond DSM-5 traits and (where appropriate) levels of personality functioning. These findings converge with studies of the MSRQ in nonclinical samples and support the clinical utility and validity of the MSRQ for further use.

Convergent and Discriminant Validity and Utility of the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ): Associations with Medical Health Care Provider Ratings and Measures of Physical Health.

The ability to evaluate patients' level of personality functioning in assessing personality disorders has become increasingly important since the DSM-5 Section III hybrid system of personality disorder assessment was released. One measure developed to assess this criterion is the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ; Huprich et al., 2017 ), which assesses individuals' self and other representations in four domains-self-direction, identity, empathy, and intimacy-across two contexts-work or school and relationships. A sample of 140 psychiatric and internal medicine outpatients were administered several questionnaires, including the DLOPFQ. Provider ratings also were obtained for level of functioning and DSM-5 pathological personality traits. Several of the DLOPFQ scales were significantly correlated with self-reported and provider-reported measures of DSM-5 trait domains and levels of functioning, along with self-reported measures of effortful control, overall physical and mental health, and well-being. Certain DLOPFQ scales and subscales were associated with provider ratings of likeability and patient contact with the providers. However, relatively modest validity coefficients, as well as poor discriminant validity of domain scales, indicate further research and measure refinement might be needed. It is concluded that, although further research is necessary, the DLOPFQ could be useful for understanding patients' personality pathology in clinical settings.

Women's Leadership in the ACR, 2001-2015.

PURPOSE: To assess the trends of women in voluntary leadership roles in the ACR from 2001 to 2015. METHODS: Retrospective leadership records from 2001 to 2015 were collected from the ACR Membership Database based on member demographics, gender, and participation in leadership roles at the national and state level. Data were sorted by gender and year to assess the proportion of women in each leadership position relative to total member/representation counts. RESULTS: Overall, there were increasing numbers of women represented in ACR leadership. From 2001 to 2015, there were increasing rates of women achieving fellowship in the College (7%-11%), now at parity with male member rates. Representation by women has risen from 7% to 21% for state chapter presidents and from 14% to 18% for state councilors. Comparing rolling 5-year averages from 2001-2005 and 2011-2015 showed statistically significant increases (P < .05) in these leadership roles. Women members of the council steering committee rose from 13% in 2001 to 19% in 2015, peaking at 24% in 2014. The Board of Chancellors (BOC) showed the largest increase in women, from 9% to 33%, with a peak at 37% in 2014. However, no BOC chairs were women, one council speaker was a woman, two women were ACR presidents, and two women were vice presidents. CONCLUSIONS: Women's participation in ACR leadership has increased significantly at the state level and in fellowship recognition. Although there are increasing numbers of women on the BOC, top positions remain male-dominated at the national level.