Barriers to research among residents in oral and maxillofacial surgery.

PURPOSE/OBJECTIVES: Research is an integral part of oral and maxillofacial surgery (OMS) residency training. This study aimed to identify the current barriers perceived by OMS residents toward conducting research during training. METHODS: A cross-sectional, questionnaire-based study was conducted. The survey was distributed to 670 OMS residents across the United States in 2021 and consisted of questions regarding demographics, residency program requirements and resources, and perceived barriers to research. Data were analyzed using descriptive statistics, Fisher's exact tests, Kruskal-Wallis tests, and post hoc Dunn's test with a statistical significance of P < 0.05. RESULTS: The response rate was 24.2%. Most participants' programs had a minimum research requirement to complete a residency (80%). The top three reported barriers to completing research were lack of time (84%), limited access to research mentors or supervisors (37%), and lack of access to biostatistical support (31%). Factors associated with these barriers included the lack of a research director, supervisor, mentor, assistant, or statistician. There was no significant difference between residents in programs with protected research time versus those without. CONCLUSIONS: OMS residents generally viewed research experience during residency as beneficial but reported important barriers, most notably: insufficient time. Although most OMS training programs in the US require research for completion, many do not provide adequate time to facilitate this process. Compared with literature from over a decade ago, it appears little progress has been made to remedy similar barriers to research. Addressing this deficiency may increase the quantity and quality of research, furthering the profession.

Vascular Regenerative Capacity and the Obesity Paradox in Coronary Artery Disease.

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Droxidopa as an effective treatment for refractory neurogenic orthostatic hypotension and reflex bradycardia in amyloid light-chain amyloidosis: a case report.

BACKGROUND: Droxidopa is an oral treatment for the stepwise treatment of neurogenic orthostatic hypotension from autonomic dysfunction. It has been shown to be useful predominantly with neurogenic orthostatic hypotension secondary to Parkinson's disease, but only a few cases have documented its usefulness in patients with neurogenic orthostatic hypotension due to amyloidosis, which is often severe and refractory. In addition, only one source in the literature reports the concomitant use of midodrine and droxidopa for such patients. Finally, we argue that droxidopa seems to have a protective effect against episodes of reflex bradycardia, which is not previously reported. CASE PRESENTATION: A 64-year-old white man was admitted for 1 year of worsening syncopal episodes, diarrhea, failure to thrive, heart failure, and neuropathy. Medical emergencies were called five times on the overhead hospital intercom over a 4-day period in the beginning of his admission due to severe hypotension and bradycardia. He was eventually diagnosed as having amyloid light-chain amyloidosis and myeloma. After starting droxidopa, both his systolic blood pressure and reflex bradycardia improved, and no more medical emergency events were called during the remaining 30 days of admission. He felt much better subjectively and was able to sit upright and engage in physical therapy. CONCLUSIONS: We show that droxidopa is effective when used with midodrine to treat refractory neurogenic orthostatic hypotension in patients with amyloidosis. There are very few cases reporting the use of droxidopa in amyloidosis, with only one study that uses droxidopa and midodrine concomitantly. In addition, our patient's reflex bradycardia improved drastically after starting droxidopa, which we believe is mediated by increased systemic norepinephrine. There were no side effects to droxidopa, and the benefits lasted well beyond the reported duration of 1-2 weeks that was noted to be a limitation in some studies.