Baylor University Medical Center Proceedings最新文献

Background: We hypothesized that patients who received a lower dose of intrathecal morphine (ITM) would have higher postoperative opioid consumption following cesarean delivery.

Methods: Patients who had cesarean deliveries from February 15, 2022, through February 14, 2024 at Baylor Scott & White Medical Center - Temple with single injection spinal or combined spinal epidural anesthesia who did not have labor epidural anesthesia were included. Morphine milligram equivalent (MME) opioid consumption in the first 24 postoperative hours was recorded along with patient demographic, physical, and clinical characteristics.

Results: A total of 535 and 502 patients received 0.2 and 0.15 mg ITM, respectively. Patients who received 0.15 mg ITM had higher rates of depression, scheduled cesarean deliveries, and acetaminophen administration compared to patients who received 0.2 mg ITM. Patients who received 0.2 mg ITM and 0.15 mg ITM had median (interquartile range) 24-hour MME consumption of 10.0 mg (0-30.0 mg) and 10.0 mg (0-40.0 mg), respectively (P = 0.97).

Discussion: MME consumption for 24 hours following cesarean delivery was similar between patients who received 0.2 and 0.15 mg ITM.

Background: This study aimed to determine whether surgical multiple-choice questions generated by ChatGPT are comparable to those written by human experts (surgeons).

Methods: The study was conducted at a medical school and involved 112 fourth-year medical students. Based on five learning objectives in general surgery (colorectal, gastric, trauma, breast, thyroid), ChatGPT and surgeons generated five multiple-choice questions. No change was made to the ChatGPT-generated questions. The statistical properties of these questions, including correlations between two group of questions and correlations with total scores (item discrimination) in a general surgery clerkship exam, were reported.

Results: There was a significant positive correlation between the ChatGPT-generated and human-written questions for one learning objective (colorectal). More importantly, only one ChatGPT-generated question (colorectal) achieved an acceptable discrimination level, while other four failed to achieve it. In contrast, human-written questions showed acceptable discrimination levels.

Conclusion: While ChatGPT has the potential to generate multiple-choice questions comparable to human-written ones in specific contexts, the variability across surgical topics points to the need for human oversight and review before their use in exams. It is important to integrate artificial intelligence tools like ChatGPT with human expertise to enhance efficiency and quality.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Social determinants of health (SDH) significantly impact HCC outcomes, yet comprehensive insights into these effects are lacking. This scoping review aimed to examine the influence of SDH on HCC outcomes.

Methods: Following PRISMA-ScR guidelines, we searched 10 databases, including PubMed and Scopus, using terms related to HCC and SDH. We included studies published between 1994 and 2024, focusing on human participants and various study designs. A total of 20 studies were selected, including cross-sectional, cohort, and case-control studies.

Results: The review identified disparities in HCC outcomes linked to socioeconomic status, health care access, and racial and ethnic differences. Patients in disadvantaged socioeconomic conditions and marginalized racial groups faced delays in treatment and worse outcomes. United States-based studies highlighted pronounced disparities compared to studies in Argentina, France, and Australia. Various SDH metrics provided inconsistent results, illustrating a need for standardized measures.

Conclusions: SDH significantly shapes HCC outcomes, revealing gaps in current research. Future studies should integrate various SDH factors using consistent metrics to improve HCC care and reduce health disparities.

Background: Endoscopic bariatric interventions are viable alternatives to traditional weight loss surgeries for patients with a body mass index between 30 and 40 kg/m². While studies have explored the impact of intragastric balloons on obesity and weight reduction, comprehensive data on real-world device-related complications and failures are limited. This study aimed to investigate mechanical failures leading to patient adverse events reported to the US Food and Drug Administration.

Methods: A retrospective analysis using the Manufacturer and User Facility Device Experience (MAUDE) database examined device-related events and patient outcomes associated with various intragastric balloons from July 2017 to October 2023. Data analysis was performed using SPSS software to assess the reported events and their associations with specific types of intragastric balloons.

Results: Our review included 1393 cases, revealing 1758 device malfunctions and 1760 patient complications. Deflation problems (25.31%) and balloon leakage or rupture (21.90%) were the most common device-related complications. Patient complications were primarily linked to the Orbera balloon, with implant failure (24.30%), abdominal pain (21.92%), and vomiting (21.26%) as leading adverse events.

Conclusion: Our findings highlight the need for continuous surveillance, rigorous monitoring, and enhanced safety protocols for intragastric balloons.

Background: Patients with regional lymph node involvement from squamous cell carcinoma (SCC) of the vulva have a 48% 5-year relative survival. Recently, sentinel lymph node (SLN) biopsy has become a viable alternative to inguinofemoral lymphadenectomy. We sought to identify risk factors for predicting a positive SLN in patients with vulvar SCC.

Methods: A retrospective review of 29 patients with vulvar SCC was performed from 2016 to 2021 at a tertiary care center. Clinicopathologic data were collected in addition to SLN status, including number of lymph nodes removed.

Results: The average depth of invasion was 7.9 mm, average tumor size was 1.8 cm, 3 of 23 patients had perineural invasion, and 4 of 23 patients had lymphovascular invasion. One patient who did not map on lymphoscintigraphy and five patients with recurrent vulvar SCC were excluded from final analysis. The average number of SLNs removed was two. One patient had a positive SLN: the depth of invasion was 17 mm, tumor size was 5.1 cm, and lymphovascular invasion was present.

Conclusions: Most patients with early stage vulvar SCC had a negative SLN biopsy. Further study is needed to determine the patient subset that could avoid SLN biopsy altogether.

Background: Peer support has been shown to reduce the incidence and severity of mental health disorders among firefighters. This pilot project had two aims: (1) to assess training satisfaction and knowledge, self-efficacy, and skills development of Texas firefighters participating in the International Association of Fire Fighters (IAFF) Peer Support Training, and (2) to determine if newly trained peer support specialists would use monthly phone supervision.

Methods: The study included 14 Texas firefighters who enrolled in the IAFF Peer Support Training. Pre- and post-tests were administered to evaluate training satisfaction, skills development, self-efficacy, and behavioral health knowledge of participants. Use of phone supervision over 6 months following the training was also recorded.

Results: Overall, participants reported high satisfaction with the training provided. While self-efficacy regarding detection of mental health issues and therapeutic empathy skills significantly improved following the training, participants did not show a significant improvement in knowledge regarding mental health. Attendance of participants to supervision calls was less than expected, although 71% attended at least one supervision call.

Conclusions: This project was successful in increasing firefighters' self-efficacy and therapeutic empathy skills, and participants were highly satisfied with the training. However, further research on follow-up supervision of peer support trainees is needed.