Spartan medical research journal最新文献

Context: To summarize available literature to date and discuss the importance of Disordered Eating (DE) in adolescent athletes, with special attention to the female athlete triad. In this paper, the authors will review the literature regarding adolescent athletes who intentionally engage in abnormal eating behaviors and focus on adolescent athletes of all training levels who may be affected by both DE and eating disorders (ED).

Methods: In 2019, the authors completed a systematic literature search on PubMed using the search term variations of "Feeding and Eating Disorders" and "athletes" with "high school."

Results: A total of 20 pertinent articles were identified concerning DE in adolescent athletes. ED have been shown to impose higher rates of comorbidity than other psychological disorders and only a small number of individuals with ED seek treatment. ED tend to be more prevalent in adolescent elite athletes than non-athletes of both genders in all sports and levels of competition.

Conclusions: More rigorous tools for family practice physicians, nurses, and coaches to use when working with at-risk adolescent athletes are needed to identify DE behaviors. Healthcare and school professionals need to be educated and trained to detect DE and the components of the female athlete triad. Additional research with adolescent males or those associating with alternative gender roles is also required to help them prevent physical and mental health consequences associated with DE.

Context: A novel multi-site 'train the trainer' point-of-care ultrasound (POCUS) training course was designed to better meet the graduate medical education learning needs of a geographically dispersed consortium of 16 community-based Michigan emergency medicine (EM) residency programs. The specific aim of this study was to explore the feasibility of using volunteer EM physicians who were novices with ultrasound techniques as instructors for a POCUS course. Additionally, the authors evaluated the effectiveness and consistency of a POCUS course delivered over multiple sites to enhance EM residents' ultrasound knowledge and skill acquisition.

Methods: For the initial session, the lead instructor conducted a focused two-hour course with the novice instructors. A subsequent four-hour session was then repeated for EM residents whereby the aforementioned novice instructors provided the hands-on instruction. The residents were given 10-item pre- and 20-item post-course knowledge tests to gauge the effectiveness of the instruction model. After the course, a satisfaction survey was administered to the resident participants and a qualitative open-ended survey to the volunteer EM physicians who served as instructors.

Results: Forty-two EM residents from 11 different residency programs attended at one of the three courses that were offered. After adjustments for size differences in the pre- and post-training tests, 35 (87.5%) of total sample resident learners' scores proportionately increased from pre- to post-test scores, with five (11.9%) other residents maintaining their pre-course score levels and only two (4.8%) residents experienced a post-score decline. In addition, resident participants responded favorably to a post-course summary evaluation with an average response of 4.8 (0-5 Likert scale) demonstrating overall satisfaction with the course. In the separate qualitative survey given to instructors, comments consistently conveyed a perceived benefit for the volunteer EM physicians.

Conclusions: The evaluation of this novel model supports the feasibility of the 'train the trainer' program. It provides a proof of principle that train the trainer model can be implemented for POCUS training courses. Despite the small sample size, our results show an increase in the pre- to post-test scores among most participating residents. This model provides an additional option for EM residency program educators to consider when developing their POCUS training courses across multiple GME settings.

Context: Orthopaedic Surgery has become one of the most competitive specialties. Each year the number of applicants is far greater than the number of available Orthopaedic residency training spots [1,2,3]. With medical schools expanding their class sizes and new medical schools opening out of proportion to the number of residency spots, the competition is becoming even more fierce [12]. There are several published articles on resident selection in allopathic orthopaedic programs [5-7]. However, there are currently no such published studies on osteopathic orthopaedic programs to our knowledge. With the AOA and ACGME merger, this topic is critical to both allopathic and osteopathic applicants alike. The goal of our study was to evaluate the resident selection criteria for osteopathic orthopaedic residency programs.

Methods: A twenty-five-question survey was sent to all of the osteopathic orthopaedic programs in December of 2017. The most important selection factors were then calculated as a mean of all the responses and were ranked accordingly.

Results: The survey was completed by 29 out of 41 program directors (71%). The most important factors in resident selection were performance during the student's rotation at the program, formality/politeness and performance in the interview, and medical school board exam scores.

Conclusions: This study is the most comprehensive study to date on the osteopathic orthopaedic resident selection process. The results from this study will help future applicants, both MD and DO, to focus on the factors in resident selection. The results may also help programs evaluate their own selection process and make improvements.

Context: Since the 1980s, the use of ultrasonography for suspected acute pediatric appendicitis has become increasingly common. Multiple studies have suggested that ultrasound of the appendix has consistently high sensitivity and specificity when the appendix can be clearly visualized. The authors' primary objective for this study was to retrospectively evaluate their community-based healthcare system's processes for detecting acute pediatric appendicitis using ultrasonography.

Methods: This was a retrospective medical chart review study of data over a five-year 2014-2018 period at Mercy Health Muskegon in Muskegon, Michigan. All patients aged 3-18 years who had received an appendix ultrasound during this period were identified using the McKesson Radiology (MS) PACS-Lite computer program. Pediatric appendix ultrasound cases were collected and analyzed for sensitivity, specificity, positive predictive value, negative predictive value with 95% confidence intervals. Acute appendicitis cases had been confirmed based on pathology reports. Secondary measures including white blood cell, body mass index, and body temperature were also included in analyses.

Results: In this sample, the overall sensitivity at detecting acute pediatric appendicitis using ultrasonography was relatively low at approximately 42% (95% CI: 21.1 - 66.0%). On the other hand, sample specificity was quite high at 97% (95% CI: 89.9 - 99.5%). The overall positive predictive value (PPV) was 80% (95% CI: 44.2-96.5%) and the negative predictive Value (NPV) was 86% (95% CI: 75.7-92.4%). The occurrence for false positives was 20% (95% CI: 3.5-55.8%). False negatives were 14% (95% CI: 7.6-24.3%).

Conclusions: The use of ultrasonography at the authors' institution less often accurately identified cases of later-confirmed pediatric appendicitis compared to some earlier published studies. The authors concluded that this could be due to seeing a lower number of more complex/ambiguous cases of pediatric appendicitis or lack of hospital personnel's pediatric-specific training and/or experience compared to specialty children's hospitals. It is possible that imaging improvements could be achieved by either or a combination of: offering training sessions for general ultrasound technicians, offering training session for radiologists, and visiting pediatric physicians and ultrasound technicians. A valuable follow-up study would be to track anticipated improvements and lead to formulation of an acute pediatric appendicitis care protocol within the authors' healthcare system.

Musculoskeletal symptoms are consistently one of the most commonly cited reasons for visits to ambulatory care centers every year, with knee pain accounting for approximately one-third of the reported complaints. Previous studies have demonstrated that many non-orthopedic physicians report a lack of confidence in performing clinical musculoskeletal knee examinations. "The Rules of Four" approach presented in this paper is designed to present a systematic and concise method to musculoskeletal examination of the knee within a memorable format. The approach allows for the timely diagnosis of common musculoskeletal injuries while aiding in directing further treatment and diagnostic testing. This method will ideally allow medical students and non-orthopedic physicians alike to confidently and effectively evaluate patients with complaints of knee pain in ambulatory care settings.

Context: The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital.

Methods: The authors performed a retrospective review of the specific types of consultations received during calendar year 2016.

Results: A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen ("earwax") removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available.

Conclusions: These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.