Spartan medical research journal最新文献

Background: University undergraduate students often seek opportunities to gain exposure to clinical research. Physician residency training programs must engage in scholarly activities and publish their findings. "Research associate programs" (RAPs) can aid with Graduate Medical Education (GME) research. This is the first collective description of these US programs, using data from the Registry of American Research Associates Programs.

Methods: The American Research Associates Program Registry (ARAPR) was started in 2014 and developed through Medline, direct familiarity, comprehensive online search, and chain-referral sampling. Data fields were selected based on a literature review and an expert panel, and included leadership, funding, research types, training, associates' activities, university affiliation, and the selection process. Results were analyzed using descriptive statistics.

Results: Responses were from 40 of 50 RAPs (80.0%) with a mean of 24 undergraduate associates (SD = 16, range 5-70) in each program. Associates worked on investigator-initiated projects (34/40, 85.0%), prospective research (35/40, 87.5%), retrospective reviews (25/40, 62.5%), and informed consent (38/40, 95.0%). Some also involved associates with data abstraction, protocol development, abstract writing, manuscript preparation, and quality improvement. Most required college course enrollment (25/40, 62.5%). Training included patient confidentiality (HIPAA) and research ethics (39/40, 97.5%).

Conclusions: This survey provides the first collective descriptive insight into the structures, training, and activities of RAPs. These findings serve as a foundation for institutions considering establishing such programs and highlight the need for future research on measurable outcomes such as student trajectories, publication rates, and program impact.

Introduction: Renal stones develop when urinary solutes crystallize into solid deposits within the urinary tract. The 2019 National Institute for Health and Care Excellence (NICE) and British Association of Urological Surgeons (BAUS) guidelines recommend serum calcium and urate testing for all patients with renal or ureteric stones. This single-center audit aimed to assess compliance with these guidelines in a local urology department and implement quality improvement interventions to enhance adherence.

Methods: We conducted a retrospective two-cycle audit on patients admitted with renal stones by the urology team at Chesterfield Royal Hospital, United Kingdom. Patient information and admission investigations were reviewed using the hospital's electronic medical records. Data were obtained from electronic medical records and assessed for compliance with calcium and urate testing guidelines. Interventions included educational sessions for clinicians, reminder posters, and updates to admission documentation. Pre- and post-intervention results were compared using statistical analysis.

Results: A total of 70 patients were included (36 in the first cycle; 34 in the second). In the first cycle, urate testing was performed in 2 patients (5.6%), while calcium testing was performed in 31 (86.1%). Following the intervention, urate testing increased to 13 patients (38.2%; p = 0.00087) and calcium testing reached 100% compliance (p=0.0241).

Conclusion: This audit identified poor adherence to urate and calcium testing guidelines for patients with renal stones. Educational and process interventions significantly improved compliance, achieving 100% for calcium testing and a more than sixfold increase in urate testing. Sustained improvement will require continued quality improvement measures.

Introduction: There is a high rate of surgical complications and removal of symptomatic hardware for patients who have undergone open reduction internal fixation (ORIF) for transverse patella fractures. In recent years there has been increased interest in more low profile ORIF techniques to combat these issues. The aim of this study was to evaluate if a reduced hardware burden would correlate with fewer complications and equal rates of fracture union when compared to traditional techniques for treating transverse patella fractures.

Methods: Nine patient charts were retrospectively reviewed dating between June 2015 and March 2023. All patients sustained a transverse patella fracture and underwent ORIF with a suture button and suture tension band construct by a single surgeon. The primary outcome measure was rate of radiographic fracture union at final follow up. Secondary outcome measures included any need for removal of hardware or other revision procedure, surgical and medical complications, postoperative pain score and the ability to perform a straight leg raise.

Results: Eight of nine patients demonstrated radiographic evidence of fracture consolidation with an average follow-up time of 17.9 months (range 12-26 months). One patient required an additional operation for revision ORIF before going on to successful union. No patients underwent a procedure for removal of hardware before final follow up. All patients were able to hold a straight leg raise at final follow up.

Conclusions: Suture button with suture tension band construct is a reasonable treatment option for treating transverse patella fractures. Surgeons may employ this technique for older patients or those with some fracture comminution, although there should be some caution and close follow up for displacement.

Objective: To examine the relationship between COVID-19 diagnosis timing during pregnancy and adverse maternal and fetal outcomes.

Methods: Pregnant women diagnosed with COVID-19 by a nasopharyngeal swab SARS-CoV-2 PCR between January 1, 2021, and December 31, 2021, irrespective of the pregnancy outcome, were included in the study. Patients not diagnosed with COVID-19 were included as a comparison group. The timing of COVID diagnosis was categorized by trimester (first trimester, <13 weeks; second trimester, 13 to <27 weeks; third trimester, >27 weeks). Maternal outcomes included placental abnormalities, HELLP syndrome, deep vein thrombosis, pulmonary embolism, and maternal death. Fetal outcomes included pregnancy loss, intrauterine growth restriction, preterm birth, stillbirth, and admission to the NICU. Quantitative data were analyzed using a one-way ANOVA and are presented as mean ± standard deviation (SD). Nominal data were compared using chi-square or Fisher's exact tests and are reported as frequency (percent). Statistical significance was set at p < 0.05.

Results: A total of 289 COVID-affected pregnancies and 1706 non-COVID-19 pregnancies were included. Most patients, 189 (65.4%), were diagnosed with COVID-19 in the third trimester, 66 (22.8%) in the second trimester, and 34 (11.8%) in the first trimester. There was a statistically significant higher proportion of patients experiencing placental abnormalities in patients diagnosed with COVID-19 in the 3rd trimester with lowest occurrence in non-COVID-19 pregnancies, followed by patients diagnosed in the 1st and 2nd trimesters (p<0.001). Further, preterm delivery followed a similar frequency pattern, occurring most often in patients diagnosed with COVID-19 in the 3rd trimester (p<0.001).

Conclusion: Patients with COVID-19 infection in the third trimester of pregnancy face a heightened risk of adverse maternal-fetal outcomes. Further investigation into this relationship is warranted.

Introduction: Upper gastrointestinal bleeding (UGIB) is the most common emergency in gastroenterology. The Glasgow Blatchford Score (GBS) is a validated tool used for risk stratification. The cutoff values for GBS to predict the need for clinical intervention, endoscopic treatment, and mortality, are not consistent. To determine the relationship between mean GBS score and the need for hemostatic intervention, and blood transfusion, and to evaluate quality of care and proper allocation of resources at our midwestern community hospital.

Methods: In this cross-sectional study, we retrospectively extracted records for patients ≥18 years who were admitted for UGIB and underwent esophagogastroduodenoscopy between July 2018 and July 2020. GBS was calculated for each observation. Multivariate analysis and a logistic regression model were performed to predict the GBS score, and the odds ratio, associated with the need for hemostatic intervention and blood transfusion while controlling for confounding factors.

Results: The GBS sample mean score was 11.17. Those who required hemostatic intervention and blood transfusion scored significantly higher GBS (13.18 versus 10.79) and (13.57 versus 9.21), respectively. A GBS of >10 was associated with higher odds at 21.84 (CI: 10.324,46.185, P<0.001) and 5.085 (CI: 1.864, 13.872, P=0.001) for receiving blood transfusion and hemostatic intervention, respectively. A cutoff of 10 was 22.41% sensitive and 95.41% specific for requiring hemostatic interventions and 66.67% sensitive and 89.91% specific for receiving blood transfusion.

Conclusion: There is a clinical role to using the GBS even at a score higher than 2 to further stratify the severity of UGIB and determine the need for intervention. The sensitivity of a score of 10 on the GBS in this dataset was low. A cutoff with higher sensitivity is needed to stratify a life-threatening condition such as UGIB.

Introduction: Funduscopic examination is a critical skill for diagnosing eye-related pathologies but has witnessed a decline in proficiency over recent decades. Simulation-based training is proposed as a solution to enhance emergency medicine residents' funduscopic examination skills. We hypothesized that a combination of lecture and simulation would improve residents' diagnostic abilities, with senior residents potentially outperforming junior counterparts.

Methods: This study aimed to assess the effectiveness of simulation-based training in improving the funduscopic examination skills of emergency medicine residents and whether factors such as seniority or prior ophthalmology rotation influenced the results. Residents participated in a 10-question image-based exam, with alternating pairs viewing images and answering questions. Simulation equipment, including digital eye examination retinopathy trainers, was utilized for the study. A lecture covering possible answers was provided, followed by a second round of testing.

Results: A total of 20 participants in this pilot study took both the pre- and post-lecture tests. Test scores significantly improved after supplemental education, indicating the effectiveness of simulation-based training in enhancing funduscopic diagnostic skills. Interestingly, resident year and prior completion of an ophthalmology rotation did not significantly impact test scores, underscoring the importance of supplemental education. Notably, participants demonstrated high accuracy in identifying Normal Fundus and several specific pathologies post-training.

Conclusion: Simulation-based training, supplemented by lectures, offers a promising avenue for improving funduscopic examination proficiency among emergency medicine residents. This study's findings highlight the potential for standardized training methods to benefit residents across different levels of experience. Future research could explore the long-term retention of these skills and their translation into clinical practice. In an era where technological advancements are reshaping medical education, simulation-based training offers a promising avenue for ensuring that essential clinical skills are not lost but rather strengthened among medical professionals.