General Surgery Resident Participation in a Mandatory Wellness Program: Six Years Later.

INTRODUCTION: Following the approval of a resident-created physician wellness program in 2016, an initial survey demonstrated majority support for the implementation of a mandatory curriculum. The purpose of this study is to survey surgical residents about the wellness curriculum six years after implementation and re-evaluate preference for mandatory participation. METHODS: In 2016, the CORE7 Wellness Program didactic sessions were integrated into the general surgery resident education curriculum. A comparison between 2016 and 2022 resident survey results was done to examine overall approval and resident experience. RESULTS: A total of 25 general surgery residents responded to the 2022 survey which equaled to a response rate of 67.5% compared to a response rate of 87.1% in 2016. Similar to the results in 2016, there was unanimous support (100%, n = 25) in favor of the ongoing development of a general surgery wellness program. The majority of residents (88% versus 85.2% in 2016) preferred quarterly "wellness half-days" remain a mandatory component of the program. In 2016, most of the residents (50%) stated that the reason for mandatory preference for wellness half-days was ease of explanation to faculty. In 2022, the reason changed to a combination of reasons with most residents (59%) selecting ease of explanation to attendings, feeling too guilty otherwise to leave the shift, and forcing the resident to think about self-care. Complaints about taking a wellness half-day from other team members increased from 29% in 2016 to 48% in 2022. CONCLUSIONS: Six years after implementation, there is unanimous support for the mandatory components of a general surgery residency wellness curriculum. Increased perceived complaints from faculty and staff about resident wellness present an opportunity for improvement.

Technology Use, Barriers, and Future Needs Among Community-Dwelling Older Adults.

PURPOSE: Social isolation and loneliness are social determinants of health (SDOH) that can negatively affect the well-being of older adults. Using technology has the potential to reduce social isolation; thus, increasing safe use of technology among older adults can positively impact their health and promote aging in place. METHOD: Older adults (N = 730) were surveyed regarding their use of, access and barriers to, satisfaction with, and anticipated future needs related to technology. RESULTS: Survey respondents found technology was a significant resource for staying connected; however, low levels of satisfaction with devices and fear of scams indicate the need for additional training on the best and safest use of technology. CONCLUSION/IMPLICATIONS: By screening older adults for SDOH, identifying their current and anticipated needs, and advocating for changes in health care and communities to meet these needs, nurses can help facilitate safe and healthy aging in place for their patients. [Journal of Gerontological Nursing, 50(2), 26-31.].

Incidental Intraoperatively Detected Choledocholithiasis: A General Surgeon's Approach to Management.

Background Up to 15% of patients with cholelithiasis have choledocholithiasis, with almost 10% not detected pre-operatively. Our study aims to quantify the prevalence of incidental choledocholithiasis during routine intra-operative cholangiogram (IOC), identify the best management pathway, and identify reliable pre-operative factors to predict choledocholithiasis. Methods We conducted a single-centre, retrospective cohort study at St John of God Midland Hospital in Western Australia, Perth, on 880 consecutive patients who underwent cholecystectomies performed by 15 surgeons between January 2, 2020, and December 30, 2021.  Results The overall choledocholithiasis rates were 10.6% (93), with 4.0% (35) diagnosed pre-operatively and 6.6% (58) diagnosed during IOC. In all, 50% of incidental choledocholithiasis during IOC were managed with hyoscine butylbromide, with a 55.2% success rate; 22.4% of patients received octreotide, with a 61.5% success rate; and 8.6% of patients underwent trans-cystic bile duct exploration (TCBE) and 8.6% underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP), both with 100% success rates. Choledocholithiasis most commonly presents with gallstone pancreatitis, with a median aspartate aminotransferase (AST) level 7.2 times and alanine transaminase (ALT) level 7.8 times higher than those of patients without choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) was the most sensitive in identifying choledocholithiasis with a 66.7% pickup rate. The median common bile duct (CBD) diameter on ultrasound was 8 mm, computerised tomography scans were 11 mm, and MRCP was 9 mm. Conclusion One in 10 cholecystectomies will be complicated with choledocholithiasis, and over half will be incidentally diagnosed during routine IOC. We propose IOC in all cases and hyoscine butylbromide, octreotide, and saline flushes as first-line treatment; if unsuccessful, TCBE is performed. Gallstone pancreatitis, markedly elevated AST/ALT, and imaging showing CBD ≥8 mm may serve as early predictors of choledocholithiasis.

Everything is Infinite: Children's Beliefs About Endless Space, Time, and Number.

How do children form beliefs about the infinity of space, time, and number? We asked whether children held similar beliefs about infinity across domains, and whether beliefs in infinity for domains like space and time might be scaffolded upon numerical knowledge (e.g., knowledge successors within the count list). To test these questions, 112 U.S. children (aged 4;0-7;11) completed an interview regarding their beliefs about infinite space, time, and number. We also measured their knowledge of counting, and other factors that might impact performance on linguistic assessments of infinity belief (e.g., working memory, ability to respond to hypothetical questions). We found that beliefs about infinity were very high across all three domains, suggesting that infinity beliefs may arise early in development for space, time, and number. Second, we found that-across all three domains-children were more likely to believe that it is always possible to add a unit than to believe that the domain is endless. Finally, we found that understanding the rules underlying counting predicted children's belief that it is always possible to add 1 to any number, but did not predict any of the other elements of infinity belief.

Stay away, Santa: Children's beliefs about the impact of COVID-19 on real and fictional beings.

The COVID-19 pandemic has forced children to reckon with the causal relations underlying disease transmission. What are children's theories of how COVID-19 is transmitted? And how do they understand the relation between COVID-19 susceptibility and the need for disease-mitigating behavior? We asked these questions in the context of children's beliefs about supernatural beings, like Santa and the Tooth Fairy. Because these beings cannot be observed, children's beliefs about the impact of COVID-19 on them must be based on their underlying theories of disease transmission and prevention rather than on experience. In the summer of 2020, N = 218 U.S. children between the ages of 3 and 10 years (M = 81.2 months) were asked to rate supernatural beings' susceptibility to COVID-19, and the extent to which these beings should engage in disease-mitigating behaviors, such as social distancing and mask wearing. Many children believed supernatural beings were susceptible to COVID-19. However, children rated the need for supernatural beings to engage in disease-mitigating behaviors as higher than the beings' disease susceptibility, indicating a disconnect between their conceptions of the causal relations between disease-mitigating behavior and disease prevention. Children's belief that a particular supernatural being could be impacted by COVID-19 was best predicted by the number of human-like properties they attributed to it, regardless of the child's age. Together, these findings suggest that although young children fail to appreciate specific pathways of disease transmission, they nonetheless understand disease as a bodily affliction, even for beings whose bodies have never been observed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improving Adolescent Depression in Primary Care: A Quality Improvement Initiative.

The coronavirus disease 2019 pandemic has exacerbated and increased the prevalence of depression in adolescents. There is significant evidence supporting best practices for treating adolescent depression; yet, many adolescents remain unidentified or untreated by their primary care provider. For this quality improvement initiative, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were implemented in a primary care setting. After GLAD-PC implementation, 90% of participants identified as having depression received an intervention compared with 60% of patients in the baseline group. The results showed that implementing GLAD-PC led to a significant increase in the treatment of adolescent depression in primary care.

Valproic acid as a radio-sensitizer in glioma: A systematic review and meta-analysis.

Background: Histone deacetylase inhibitors (HDACi) including valproic acid (VPA) have the potential to improve radiotherapy (RT) efficacy and reduce treatment adverse events (AE) via epigenetic modification and radio-sensitization of neoplastic cells. This systematic review and meta-analysis aimed to assess the efficacy and AE associated with HDACi used as radio-sensitizers in adult solid organ malignancy patients. Methods: A systematic review utilized electronic searches of MEDLINE(Ovid), Embase(Ovid), The Cochrane Library, and the International Clinical Trials Registry Platform to identify studies examining the efficacy and AEs associated with HDACi treatment in solid organ malignancy patients undergoing RT. Meta-analysis was performed with overall survival (OS) reported as hazard ratios (HR) as the primary outcome measure. OS reported as median survival difference, and AEs were secondary outcome measures. Results: Ten studies reporting on the efficacy and/or AEs of HDACi in RT-treated solid organ malignancy patients met inclusion criteria. All included studies focused on HDACi valproic acid (VPA) in high-grade glioma patients, of which 9 studies (n = 6138) evaluated OS and 5 studies (n = 1055) examined AEs. The addition of VPA to RT treatment protocols resulted in improved OS (HR = 0.80, 95% CI 0.67-0.96). No studies focusing on non-glioma solid organ malignancy patients, or non-VPA HDACi met the inclusion criteria for this review. Conclusions: This review suggests that glioma patients undergoing RT may experience prolonged survival due to HDACi VPA administration. Further randomized controlled trials are required to validate these findings. Additionally, more research into the use of HDACi radio-adjuvant treatment in non-glioma solid organ malignancies is warranted.

Pharmacist-Initiated De-Prescribing Efforts Reduce Inappropriate Continuation of Acid-Suppression Therapy Initiated in the ICU.

OBJECTIVES: Stress ulcer prophylaxis initiated for intensive care unit (ICU)-specific indications is often continued upon transfer or discharge despite lack of indication. This quality improvement initiative aimed to achieve a 25% reduction from baseline in ICU-initiated acid suppression therapy prescriptions by May 2021. METHODS: This initiative was conducted in adult ICU patients at Boston Medical Center from July 2020 through May 2021. A multidisciplinary approach to de-prescribing was utilized, including the implementation of formalized stress ulcer prophylaxis criteria and an electronic handoff tool used to identify patients appropriate for assessment of acid suppression therapy continuation post-ICU stay. The primary outcome measure was the number of discharge prescriptions for ICU-initiated acid suppression therapy. Secondary endpoints included incidence of de-prescribing workflow failures, percentage of acid suppression therapy discharge prescriptions with inappropriate indications, and incidence of stress ulcer-related gastrointestinal bleeding. RESULTS: A 55% decrease in ICU-initiated acid suppression therapy discharge prescriptions occurred after implementing the multidisciplinary workflow. The decrease was sustained for 28 weeks through the completion of the study. CONCLUSIONS: Implementation of a pharmacist-initiated electronic handoff tool along with provider education and creation of formalized stress ulcer prophylaxis criteria may reduce the number of ICU-initiated acid suppression therapy prescriptions inadvertently or inappropriately continued at discharge.

Histone deacetylase inhibitor use as a radiosensitizer in solid organ malignancies: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the efficacy and adverse effects of histone deacetylase inhibitors (HDACi) in combination with radiotherapy for the treatment of solid organ malignancies. INTRODUCTION: Histone deacetylase inhibitors are a diverse class of drugs that have shown promise as novel anti-cancer therapeutics via epigenetic modification and radiosensitization of neoplastic cells. The aim of HDACi in combination with radiotherapy is to reduce radiation dosage requirements, improve radiotherapy efficacy, and reduce treatment side effects. INCLUSION CRITERIA: This review will consider studies utilizing HDACi in conjunction with radiotherapy in adult patients with solid organ malignancy. Sources to be included in this review include experimental and quasi-experimental study designs, analytical studies, and descriptive observational studies. METHODS: A systematic review of effectiveness will be conducted in accordance with JBI methodology. A detailed search will be conducted via MEDLINE (Ovid), Embase (Ovid), and Scopus. A search of the Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform, and ClinicalTrials.gov will also be performed for relevant trials. Inclusion and exclusion criteria will be utilized to select studies, and papers selected for retrieval will be assessed for methodological validity using the JBI critical appraisal instruments. Evidence will be extracted from eligible studies and summarized using quantitative methods, where possible, including meta-analysis and assessment of heterogeneity. Where statistical pooling is not possible, the findings will be presented in diagrammatic or tabular form accompanied by a narrative summary. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021293005.

Establishing the content of gender stereotypes across development.

Gender stereotypes shape individuals' behaviors, expectations, and perceptions of others. However, little is known about the content of gender stereotypes about people of different ages (e.g., do gender stereotypes about 1-year-olds differ from those about older individuals?). In our pre-registered study, 4,598 adults rated either the typicality of characteristics (to assess descriptive stereotypes), or the desirability of characteristics (to assess prescriptive and proscriptive stereotypes) for targets who differed in gender and age. Between-subjects, we manipulated target gender (boy/man vs. girl/woman) and target age (1, 4, 7, 10, 13, 16, or 35). From this, we generated a normed list of descriptive, prescriptive, and proscriptive gender-stereotyped characteristics about people across the early developmental timespan. We make this archive, as well as our raw data, available to other researchers. We also present preliminary findings, demonstrating that some characteristics are consistently ungendered (e.g., challenges authority), others are gender-stereotypic across the early developmental timespan (e.g., males from age 1 to 35 tend to be dirty), and still others change over development (e.g., girls should be submissive, but only around age 10). Implications for gender stereotyping theory-as well as targets of gender stereotyping, across the lifespan-are discussed.

How age and race affect the frequency, timing, and content of conversations about race with children.

Anti-racist efforts require talking with children about race. The present work tested the predictors of U.S. adults' (N = 441; 52% female; 32% BIPOC participants; Mage  = 35 years) conversations about race with children across two timepoints in 2019. Approximately 60% of adult participants talked to their children (3-12 years) about race during the preceding week; only 29% talked to other adults about race during the same period. This paper describes the content and predictors of conversations about race, revealing how conversations differ depending on the participant's race, a child's age, and whether the conversation occurs with children or another adult. These data have important implications for theorizing about when, why, and how adults actually talk about race with children and adults.

Improving the generalizability of infant psychological research: The ManyBabies model.

Yarkoni's analysis clearly articulates a number of concerns limiting the generalizability and explanatory power of psychological findings, many of which are compounded in infancy research. ManyBabies addresses these concerns via a radically collaborative, large-scale and open approach to research that is grounded in theory-building, committed to diversification, and focused on understanding sources of variation.

Flipping the classroom: An innovative approach to graduate nursing education.

Nurse educators must be prepared to adopt innovative, evidence-based teaching approaches that, like the flipped learning method, improve student learning outcomes and better prepare the nursing workforce of the future. The purpose of this paper is to provide a comprehensive plan and resources for faculty to transition a graduate nursing course from traditional lecture-based teaching to flipped learning. The flipped learning approach was fully implemented with 24 graduate nursing students in a primary care family nurse practitioner course. The process of transitioning from traditional lecture-based teaching to flipped learning is presented, including a detailed explanation of how flipped learning class sessions were facilitated. Nurse practitioner students who participated in the flipped learning course found that this method fostered engagement with the course content and improved students' confidence in their ability to apply knowledge and skills in clinical practice. The flipped learning method has the potential to increase active learning and student engagement, integration of classroom and clinical knowledge, and application of knowledge from the classroom to nursing practice.

Preschoolers' relevance inferences in linguistic and non-linguistic contexts.

Understanding symbols requires going beyond what they literally are, and figuring out what they're intended to communicate. For example, a drawing of a bird (or the word bird) could refer to a particular bird, a species, etc… The interpreter must decide between these intended meanings. We ask how children go beyond the literal meanings of communicative acts (i.e., compute pragmatic inferences), and whether these inferences are domain-general. We tested 443 US 2- to 6-year-olds' inferences about the referential interpretation of ambiguous symbols. We manipulated the domain (e.g., word or a drawing) and task (interpret vs. create the communicative act). Children robustly identified the referents of ambiguous symbols and chose from among alternatives during linguistic and non-linguistic communication tasks. There were no effects of age or domain on performance. These data provide some of the earliest evidence of children's computations of pragmatic inferences, and provide exciting evidence that pragmatic inferences may extend beyond the domain of language.

SAYCam: A Large, Longitudinal Audiovisual Dataset Recorded From the Infant's Perspective.

We introduce a new resource: the SAYCam corpus. Infants aged 6-32 months wore a head-mounted camera for approximately 2 hr per week, over the course of approximately two-and-a-half years. The result is a large, naturalistic, longitudinal dataset of infant- and child-perspective videos. Over 200,000 words of naturalistic speech have already been transcribed. Similarly, the dataset is searchable using a number of criteria (e.g., age of participant, location, setting, objects present). The resulting dataset will be of broad use to psychologists, linguists, and computer scientists.

Assessment of a vessel and tissue-sealing device for ovariectomy in chickens to evaluate the potential application of the procedure to other avian species.

OBJECTIVE: To assess the feasibility of a novel technique involving a vessel and tissue-sealing device (VTSD) for ovariectomy in chickens to evaluate the potential application of the procedure to other avian species. ANIMALS: 20 domestic laying hens (Gallus domesticus), of which 10 were immature (< 4 months old) and 10 were adults (> 18 months old). PROCEDURES: Ovariectomy was performed with a VTSD through a left lateral celiotomy. Birds were allowed to recover for 14 days after the procedure and then were euthanized for necropsy. A board-certified veterinary pathologist performed complete necropsies, with particular attention to identifying any remaining ovarian tissue. RESULTS: All birds survived the procedure. For the mature and juvenile birds, the mean ± SD durations of anesthesia (interval from intubation to extubation) were 67.2 ± 7.6 minutes and 50.5 ± 5.1 minutes, respectively, and mean durations of surgery were 45.3 ± 8.5 minutes and 31.6 ± 5.1 minutes, respectively. Three birds had severe hemorrhage during ovariectomy. At necropsy, ovarian tissue was present grossly in 2 mature birds and histologically in 6 additional birds (2 mature and 4 juvenile birds), indicating incomplete excision in 8 (40%) birds. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the evaluated VTSD can be used to successfully perform ovariectomies in both juvenile and mature chickens, although the procedure was associated with major hemorrhage and incomplete excision of ovarian tissue in some cases. Use of this VTSD for ovariectomy in birds of other species, particularly birds with reproductive tract disease, should be investigated.

What Counts? Sources of Knowledge in Children's Acquisition of the Successor Function.

Although many U.S. children can count sets by 4 years, it is not until 5½-6 years that they understand how counting relates to number-that is, that adding 1 to a set necessitates counting up one number. This study examined two knowledge sources that 3½- to 6-year-olds (N = 136) may leverage to acquire this "successor function": (a) mastery of productive rules governing count list generation; and (b) training with "+1" math facts. Both productive counting and "+1" math facts were related to understanding that adding 1 to sets entails counting up one number in the count list; however, even children with robust successor knowledge struggled with its arithmetic expression, suggesting they do not generalize the successor function from "+1" math facts.

Management of Minor Traumatic Brain Injury in an ED Observation Unit.

INTRODUCTION: Traumatic intracranial hemorrhages (TIH) have traditionally been managed in the intensive care unit (ICU) setting with neurosurgery consultation and repeat head CT (HCT) for each patient. Recent publications indicate patients with small TIH and normal neurological examinations who are not on anticoagulation do not require ICU-level care, repeat HCT, or neurosurgical consultation. It has been suggested that these patients can be safely discharged home after a short period of observation in emergency department observation units (EDOU) provided their symptoms do not progress. METHODS: This study is a retrospective cross-sectional evaluation of an EDOU protocol for minor traumatic brain injury (mTBI). It was conducted at a Level I trauma center. The protocol was developed by emergency medicine, neurosurgery and trauma surgery and modeled after the Brain Injury Guidelines (BIG). All patients were managed by attendings in the ED with discretionary neurosurgery and trauma surgery consultations. Patients were eligible for the mTBI protocol if they met BIG 1 or BIG 2 criteria (no intoxication, no anticoagulation, normal neurological examination, no or non-displaced skull fracture, subdural or intraparenchymal hematoma up to 7 millimeters, trace to localized subarachnoid hemorrhage), and had no other injuries or medical co-morbidities requiring admission. Protocol in the EDOU included routine neurological checks, symptom management, and repeat HCT for progression of symptoms. The EDOU group was compared with historical controls admitted with primary diagnosis of TIH over the 12 months prior to the initiation of the mTBI protocols. Primary outcome was reduction in EDOU length of stay (LOS) as compared to inpatient LOS. Secondary outcomes included rates of neurosurgical consultation, repeat HCT, conversion to inpatient admission, and need for emergent neurosurgical intervention. RESULTS: There were 169 patients placed on the mTBI protocol between September 1, 2016 and August 31, 2019. The control group consisted of 53 inpatients. Median LOS (interquartile range [IQR]) for EDOU patients was 24.8 (IQR: 18.8 - 29.9) hours compared with a median LOS for the comparison group of 60.2 (IQR: 45.1 - 85.0) hours (P < .001). In the EDOU group 47 (27.8%) patients got a repeat HCT compared with 40 (75.5%) inpatients, and 106 (62.7%) had a neurosurgical consultation compared with 53 (100%) inpatients. Subdural hematoma was the most common type of hemorrhage. It was found in 60 (35.5%) patients, and subarachnoid hemorrhage was found in 56 cases (33.1%). Eleven patients had multicompartment hemorrhage of various classifications. Twelve (7.1%) patients required hospital admission from the EDOU. None of the EDOU patients required emergent neurosurgical intervention. CONCLUSION: Patients with minor TIH can be managed in an EDOU using an mTBI protocol and discretionary neurosurgical consults and repeat HCT. This is associated with a significant reduction in length of stay.

Poetry for Veterans: Using Poetry to Help Care for Patients in Palliative Care-A Case Series.

Background: Although there is growing evidence that close reading of literature and reflective writing can improve providers' appreciation of the patient experience, foster physician development, and combat burnout, there has been less work on the experience of reading literature with patients, and even less literature about its effect on those facing serious or life-threatening illness. In addition, longer form reading may be unsuitable for some patient populations, given high burden of fatigue and possible contribution of delirium. Time pressure may also preclude discussion by a practitioner working in a busy clinical context. Hypothesis: We feel the condensed medium of poetry presents a natural opportunity to engage patients with the medical humanities, helping them to articulate difficult or joyful experiences, and/or serving as necessary diversion when facing serious illness. Project Description: Poetry for patients-a project developed through collaboration between Northwestern Memorial Hospital, The Jesse Brown VA, and the Poetry Foundation in Chicago, an independent literary organization committed to a vigorous presence for poetry in our culture-has developed three short collections of poems, and an accompanying discussion guides for use specifically with patients and families. Hereunder, we present three case examples of a short (10-30 minutes) reading session with patients demonstrating that it is feasible to incorporate reading poetry with patients facing serious illness. Potential therapeutic value includes helping patients to articulate pain and joy, giving patients a vehicle to recapture their creative voice, and altering the power dynamics inherit to the provider-patient relationship. We have also noted enhanced life review, often on themes otherwise difficult to access. In turn, these readings have deepened our ability to see out patients as creative, intellectual, and larger than their medical illness.