A system-wide health sciences faculty mentor training program is associated with improved effective mentoring and institutional climate.

Introduction: Mentorship is critical for faculty success, satisfaction, and engagement. However, many faculty, particularly underrepresented racial/ethnic (UR) faculty, lack access to high-quality mentoring. In an effort to improve mentoring for all faculty, we developed and implemented a formally structured faculty mentor training program (FMTP) across UC San Diego Health Sciences, which included institutional support, mentorship training, and department/division mentorship programs. Methods: FMTP impact was evaluated using three primary outcome variables: mentoring quality, mentoring behaviors, and institutional climate. Participants' self-assessed mentoring competencies were measured using validated instruments. Results: A total of 391 (23%) of Health Sciences faculty participated in FMTP. Participation rate was higher for women than men (30% versus 17%) and highest for UR faculty (39%). FMTP was implemented in 16 of 19 departments. Self-reported mentoring improved for FMTP participants with mentoring quality (p = 0.009) and meeting mentees' expectations (p = 0.01) continuing to improve for up to 2 years after training. However, participants were unsure if they were meeting UR mentees' expectations. FMTP participants were significantly more satisfied with mentoring quality (p < 0.001) compared to non-participants, with the greatest increase in satisfaction reported by UR faculty (38-61%). UR faculty reported improved overall morale (51-61%) and a perception that the environment was supportive for UR faculty (48-70%). Conclusion: The implementation of a system-wide formal structured FMTP was associated with improved faculty satisfaction, quality of mentoring, and institutional climate, especially for UR faculty.

Comparison of Radiographic, Ultrasound, and Magnetic Resonance Imaging for the Detection of Retained Stingray Barb: A Cadaveric Study.

INTRODUCTION: Stingray envenomations are a common marine animal injury for which it is important to identify and remove retained barbs to prevent secondary infection. The optimal imaging modality in stingray foreign body detection is not well characterized in the existing literature. In this study, we compared the accuracy of plain radiography, ultrasound, and magnetic resonance imaging (MRI) in detecting stingray barbs in the human foot and ankle. METHODS: This cadaveric study included a 1:1 randomization to the presence or absence of barbs in 24 sample injuries of human cadaveric foot and ankle specimens. Physicians trained in emergency medicine and radiology performed ultrasound examinations on each specimen and interpreted the presence or absence of a barb. Participants also interpreted x-ray images in the same manner. MRI scans were separately interpreted by a musculoskeletal radiology attending. Data were analyzed using McNemar's test. RESULTS: The 19 participants included 14 (74%) trained in emergency medicine and 5 (26%) trained in radiology. Forty-seven percent were residents, 42% faculty, and 11% fellows. X-ray was associated with the highest sensitivity of 94% for the identification of a retained barb, followed by MRI (83%) and ultrasound (70%). MRI was associated with the highest specificity of 100%, followed by x-ray (98%) and ultrasound (73%). CONCLUSIONS: Retained stingray barbs can lead to secondary infection after envenomation. In human cadaveric specimens, x-ray demonstrated the highest sensitivity, MRI demonstrated the highest specificity, and ultrasound demonstrated lower sensitivity and specificity.

Diving after SARS-CoV-2 (COVID-19) infection: Fitness to dive assessment and medical guidance.

Scuba diving is a critical activity for commercial industry, military activities, research, and public safety, as well as a passion for many recreational divers. Physicians are expected to provide return-to-diving recommendations after SARS-CoV-2 (COVID-19) infection based upon the best available evidence, often drawn from experience with other, similar diseases. Scuba diving presents unique physiologic challenges to the body secondary to immersion, increased pressure and increased work of breathing. The long-term sequelae of COVID-19 are still unknown, but if they are proven to be similar to other coronaviruses (such as Middle East respiratory syndrome or SARS-CoV-1) they may result in long-term pulmonary and cardiac sequelae that impact divers' ability to safely return to scuba diving. This review considers available literature and the pathophysiology of COVID-19 as it relates to diving fitness, including current recommendations for similar illnesses, and proposes guidelines for evaluation of divers after COVID-19. The guidelines are based upon best available evidence about COVID-19, as well as past experience with determination of diving fitness. It is likely that all divers who have contracted COVID-19 will require a medical evaluation prior to return to diving with emphasis upon pulmonary and cardiac function as well as exercise capacity.

Dermatological Progression of a Probable Box Jellyfish Sting.

This case report describes the typical features of the dermatological progression of a patient stung by a (probable) box jellyfish. The purpose is to guide clinicians and patients to an understanding of what to expect after such a sting using the clinical narrative and unique sequential photographs of the injury. With knowledgeable consultation from experienced physicians and meticulous care, this envenomation healed without the need for skin grafting.

Management of central retinal artery occlusion following successful hyperbaric oxygen therapy: case report.

OBJECTIVE: This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO2) but subsequently suffered a recurrence of his visual loss. METHODS: CRAO may be treated successfully with HBO2 if treatment is undertaken promptly after the onset of vision loss. The goal of HBO2 therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. RESULTS: A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO2 was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO2. His vision loss recurred, however, 15 minutes after the HBO2 session. There was a delay to follow-up HBO2 treatments, and the improvement of vision that resulted from these subsequent HBO2 sessions was much less than that experienced during his initial HBO2 treatment. CONCLUSION: Recovery of vision during initial HBO2 treatment indicated that this patient's retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO2 treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, aggressive use of intermittent 100% normobaric and hyperbaric oxygen is indicated to preserve retinal function until central retinal artery recanalization occurs. An evidence-based management plan for such patients is presented.

A "Shark Encounter": Delayed Primary Closure and Prophylactic Antibiotic Treatment of a Great White Shark Bite.

BACKGROUND: Shark bites are rare but sensational injuries that are covered in the lay press but are not well described in the medical literature. CASE REPORT: We present the case of a 50-year-old man who sustained two deep puncture wounds to his thigh from a great white shark in the waters surrounding Isla de Guadalupe off the coast of Baja California, Mexico, during a caged SCUBA dive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We discuss our strategy of closing the wounds in a delayed primary fashion 24 hours after injury, our antibiotic choices, and the patient's course and review marine pathogens and appropriate antibiotic coverage.

Diplopia due to mask barotrauma.

BACKGROUND: Scuba diving is a very popular and safe sport. Occasionally divers will suffer an injury from barotrauma, decompression sickness or an arterial gas embolism. The history and physical examination are important when determining the etiology of the injury and its subsequent treatment. OBJECTIVES: This article will help readers identify key components of the history and physical examination in a patient to help differentiate between and injury caused by barotrauma or arterial gas embolism. CASE REPORT: This is a case of a diver that was initially felt to have an arterial gas embolism after scuba diving. After obtaining further history and performing a detailed physical exam it was determined that his diplopia was due to barotrauma from his mask. This was confirmed by an orbital computed tomography (CT) scan. SUMMARY: Scuba diving is a very safe sport. When injuries occur it is important to obtain a careful history and physical examination to determine the exact cause of the injury because treatments vary according to the type of injury. In this case, the history and physical examination showed that the only neurologic sign the patient had was diplopia, which is not consistent with a diagnosis of arterial gas embolism. The CT scan helped with the diagnosis because it proved the patient had an orbital hematoma causing his proptosis and double vision.

Hyperbaric oxygen therapy for hepatic artery thrombosis following liver transplantation: current concepts.

This article presents the case of an infant who underwent an orthotopic liver transplant and then developed hepatic artery thrombosis that was detected on routine post-operative right upper quadrant ultrasound. Alteplase (TPA) failed to open the artery, so the child received systemic heparin and hyperbaric oxygen (HBO) therapy. After six HBO treatments, the hepatic artery had recanalized and his liver function tests had returned to normal or near normal. There were no complications to the HBO therapy, and 1 yr after the transplant, the child's liver is functioning well. The present study discusses the beneficial effects of HBO therapy and the proposed mechanisms for its favorable results. In our patient, systemic heparin and HBO therapy prevented liver failure and need for retransplantation.

Refractive change in response to acute hyperbaric stress in refractive surgery patients.

PURPOSE: To determine whether acute hyperbaric stress affects visual acuity or refractive power after keratorefractive surgery. SETTING: Clinical multiplace hyperbaric chamber and ophthalmology clinic, University of California, San Diego, California, USA. METHODS: This prospective convenience sample study included 3 groups: 3 patients who had had bilateral myopic radial keratotomy (RK); 2 who had had bilateral myopic laser in situ keratomileusis (LASIK); and 4 control subjects who had no previous corneal refractive surgery or ocular pathology but had a myopic refractive error (-1.25 to -8.38 diopters [D]) similar to that in the treated patients before refractive surgery. One additional patient had had unilateral LASIK only and was included in the LASIK and control groups. Best spectacle-corrected visual acuity (BSCVA), manifest spherocylindrical refractive error, and intraocular pressure were measured at baseline, at 4 atmospheres absolute (atm abs), and on return to ambient pressure. Corneal pachymetry and keratometry were measured at baseline and on return to ambient pressure. RESULTS: The mean BSCVA changed from 0.06 logMAR (20/25 Snellen equivalent) at baseline to 0.10 logMAR (20/25) at 4 atm abs in the RK group and from 0.00 logMAR (20/20) to -0.06 logMAR (20/15) in the LASIK group; it did not change in the control group. The mean refractive error changed from 0.25 D at baseline to 0.50 D at 4 atm abs in the RK group, from -0.90 to -1.02 D in the LASIK group, and from -4.58 to -4.53 D in the control group. CONCLUSIONS: Acute hyperbaric stress did not appear to alter refractive power after corneal surgery.