Editor's Choice - Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial☆.

OBJECTIVE: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). METHODS: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. RESULTS: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 1.0 for below the knee). CONCLUSION: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.

Do foetuses communicate? Foetal responses to interactive versus non-interactive maternal voice and touch: An exploratory analysis.

The main aim of this study was to uncover any evidence for communicative engagement in foetuses. Taking into consideration the continuity of development pre- and postnatally, the social responsiveness of the newborn baby and the development of sensorimotor competence in the foetus, it is plausible to assume that communicative readiness develops before birth. During the interactive and noninteractive applications of three conditions: the mother's voice, the touch of her abdomen and a control condition, foetuses' (N = 12, 2-33 gestational weeks) behaviours were recorded through 4D scanning using Voluson S10 ultrasound and coded frame-by-frame. Foetuses displayed differential right-hand self-touch behaviours in response to the mother's touch. There was a reduction of this movement when the mother was touching her abdomen, compared to when the mother was talking or during the baseline conditions. There was also a reduction in right-hand touch responses during the interactive touch condition but not during interactive talk condition. A similar result was found with regards to right-hand face touch responses. Foetuses displayed a longer duration of mouth opening in the interactive talk condition compared to the noninteractive talk condition. During the first 60 s, foetuses showed a significant increase in sucking behaviours during the interactive touch condition, compared to all other conditions. This is the first study to compare interactive versus noninteractive engagement of the foetus. The findings of this study suggest that foetuses in the third trimester discriminate between interactive and non-interactive external stimuli and respond to contingent interactions.

Using a Modified Delphi Method to Reach Consensus on Best Practices for Medical Education Abstract Submissions to Multiple Conferences.

PURPOSE: Medical education researchers are often uncertain whether they should submit abstracts to certain conferences. Therefore, we aimed to elicit consensus among medical education conference organizers to answer the question: what are best practices for research abstract submissions to multiple conferences? METHODS: Using a 44-question online survey, we conducted a modified Delphi process to identify best practices for abstract submissions to medical education conferences. Consistent with the Delphi process, we identified conference representatives from non-specialty medical education conferences and across four conference types (institutional, regional, national, and international) to serve as panelists. RESULTS: Eleven expert panelists, representing all four conference types-two institutional conferences, five regional conferences, two national conferences, and two international conferences-completed three rounds of the survey. After three rounds, panelists reached consensus on 39/44 survey items-26 items in round 1, 10 items in round 2, and three items in round 3. Panelists' consensus and rationale indicated that it is most appropriate to resubmit abstracts to conferences with a larger or different audience, but not to more homogeneous audiences. Among the four conference types, abstract resubmission from institutional conferences to other conference types was the most widely accepted. Panelists agreed that abstracts using data and results submitted or accepted for publication could be submitted to any conference type. CONCLUSION: The results of this study provide best practices for presenting scholarship to medical education conferences. We recommend that guidelines for medical education conference abstract submissions provide consistent, clear instructions regarding the appropriate life cycle of an abstract.

Mutual Rewards: Engaging the Field and Creating a Path Toward Academic Journal Editorship.

In this commentary, the inaugural cohort of Academic Medicine assistant editors shares their experiences in this role and the value of creating a path toward academic journal editorship for early- and mid-career scholars. They are a group with diverse backgrounds and a common commitment to advance scholarship in medical education. They collectively describe how they have contributed to the journal in multiple ways, reflect on how they navigated onboarding challenges in the midst of a pandemic, and, most important, share why this role matters for the medical education scholarship community. They express how the assistant editor role has been mutually rewarding, allowing the assistant editors to gain entry to academic journal editorship while also serving the journal and its community.

Increasing skin infections and Staphylococcus aureus complications in children, England, 1997-2006.

During 1997-2006, general practitioner consultations for skin conditions for children <18 years of age in England increased 19%, from 128.5 to 152.9/1,000 child-years, and antistaphylococcal drug prescription rates increased 64%, from 17.8 to 29.1/1,000 child-years. During the same time period, hospital admissions for Staphylococcus aureus infections rose 49% from 53.4 to 79.3/100,000 child-years.

Evaluation of exposure to pioglitazone and risk of prostate cancer: a nested case-control study.

OBJECTIVES: Investigate potential association between pioglitazone exposure and risk of prostate cancer. RESEARCH DESIGN AND METHODS: Nested, matched case-control study. UK primary care data (Clinical Practice Research Datalink (CPRD) GOLD) linked to inpatient (Hospital Episode Statistics (HES)) and cancer registry (National Cancer Information Network (NCIN)) data. English men aged ≥40 years diagnosed with type 2 diabetes mellitus, January 1, 2001 to January 5, 2015. Cases, with prostate cancer diagnosis, matched with up to 4 controls by age, cohort entry date and region. ORs for association of exposure to pioglitazone to incident prostate cancer, adjusted for potential confounders. RESULTS: From a cohort of 47 772 men with 243 923 person-years follow-up, 756 definite cases of prostate cancer were identified. Incidence was 309.9/100 000 person-years (95% CI 288.6 to 332.8). Pioglitazone use was not associated with prostate cancer risk; adjusted OR 0.759, 95% CI 0.502 to 1.148. Analyses showed no difference when possible cases, prostate cancer in CPRD GOLD only, included (adjusted OR 0.726, 95% CI 0.510 to 1.034). No association when adjusted for channeling bias (OR 0.778, 95% CI 0.511 to 1.184) or limited to an index date prior to July 1, 2011 (adjusted OR 0.508, 95% CI 0.294 to 0.879), despite prostate-specific antigen screening occurring more frequently among cases than controls (81.6% of 756 definite cases cf. 24.2% of 2942 controls (p<0.01)). No association with duration of pioglitazone use, increasing pioglitazone dose or increasing time since initiation. CONCLUSIONS: In this real-world, nested matched case-control study, exposure to pioglitazone was not associated with increased risk of prostate cancer.

Epidemiological and economic burden of Alzheimer's disease: a systematic literature review of data across Europe and the United States of America.

BACKGROUND: Alzheimer's disease (AD) weighs heavily on health expenditure and is strongly associated with increasing age. Due to population aging, increasing global prevalence of AD will pose huge challenges to public health and elderly care systems in all countries across the world. OBJECTIVES: This study aimed to better understand the burden of AD from a healthcare perspective. METHODS: A systematic literature review of journal articles published between January 2002 and December 2012 was performed for studies conducted in France, Germany, Italy, The Netherlands, Spain, the United Kingdom (UK), and the United States of America (USA), using Medline, Embase, and the NHS Economic Evaluation Database. RESULTS: 3,288 references were initially retrieved, and 39 epidemiological and 66 economic publications were selected for data extraction. AD incidence rates greatly varied between countries; however, prevalence was more consistent across all included countries, ranging between 3-7%. Overall, medical costs were lower in France compared to other included countries and increased with AD severity, e.g., direct medical costs per year for mild AD ranged from 5,476 int$ in France to 27,380 int$ in Spain. Limitations, such as heterogeneous methodology and missing data, prevented the comparison of results across studies between countries or the conclusion of any trend over time. CONCLUSION: This review corroborates previous understanding that AD burden is high for both society and healthcare providers. Limitations regarding study heterogeneity restricted conclusions; further research is required. Stakeholders could benefit from new healthcare strategies addressing both epidemiological and economic aspects of AD.

A multidisciplinary model of health promotion incorporating spirituality into a successful aging intervention with African American and white elderly groups.

PURPOSE: A community and faith-based intervention with elderly persons and their adult children involving religious, medical, and academic communities is described. DESIGN AND METHODS: Lifestyle changes and individual and corporate forms of spirituality were affirmed using an expanded Rowe and Kahn model of successful aging. Faculty from academic, medical, state, and religious institutions presented a variety of workshops at a multichurch-sponsored conference that hosted over 500 seniors. RESULTS: Postconference surveys suggested extremely favorable satisfaction rates across all groups represented. The African American religious community provided critical leadership in achieving an excellent African American participation rate. IMPLICATIONS: The model described has the capacity to generate collaborations across denominational, racial, and class barriers, and has the potential of helping to unify the religious community around the important task of promoting successful aging.

Effect of antibiotics for otitis media on mastoiditis in children: a retrospective cohort study using the United kingdom general practice research database.

BACKGROUND: Information is needed on whether mastoiditis has increased in association with the decline in antibiotics prescribed to children by primary care physicians in the United Kingdom. OBJECTIVE: To determine time trends in mastoiditis incidence, the frequency of antecedent otitis media, and the effect of antibiotics for otitis media on the risk of mastoiditis in children. PATIENTS AND METHODS: We conducted a retrospective cohort study by using the UK General Practice Research Database. Children aged 3 months to 15 years between 1990 and 2006 were included. Risk of mastoiditis within 3 months after otitis media diagnosis and the protective effect of antibiotics were determined. RESULTS: There were 2 622 348 children within the General Practice Research Database; 854 had mastoiditis, only one third of whom (35.7%) had antecedent otitis media. Mastoiditis incidence remained stable between 1990 and 2006 ( approximately 1.2 per 10 000 child-years). Risk of mastoiditis, after otitis media, was 1.8 per 10 000 episodes (139 of 792 623) after antibiotics compared with 3.8 per 10 000 (149 of 389 649) without antibiotics, and increased with age. Antibiotics halved the risk of mastoiditis. General practitioners would need to treat 4831 otitis media episodes with antibiotics to prevent 1 child from developing mastoiditis. If antibiotics were no longer prescribed for otitis media, an extra 255 cases of childhood mastoiditis would occur, but there would be 738 775 fewer antibiotic prescriptions per year in the United Kingdom. CONCLUSIONS: Most children with mastoiditis have not seen their general practitioner for otitis media. Antibiotics halve the risk of mastoiditis, but the high number of episodes needing treatment to prevent 1 case precludes the treatment of otitis media as a strategy for preventing mastoiditis. Although mastoiditis is a serious disease, most children make an uncomplicated recovery after mastoidectomy or intravenous antibiotics. Treating these additional otitis media episodes could pose a larger public health problem in terms of antibiotic resistance.

Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium.

OBJECTIVES: To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. METHODS: Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. RESULTS: Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. CONCLUSIONS: The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.