Baylor University Medical Center Proceedings最新文献

Emotional intelligence (EI) is an asset in health professionals supporting resilience, job satisfaction, interprofessional collaboration, and improved health outcomes for patients. Emerging research in health professions education shows that self-reflection and peer feedback, simulation, and experiential learning may contribute to the development of EI. The evidence indicates that training should be incorporated longitudinally throughout the educational process with increasing complexity and challenge. Several contextual factors may support success, such as framing the learning activities as opportunities for growth, adequate faculty and instructor training, and establishment of trusting relationships.

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.

A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles. Subsequent surgical biopsy and resection revealed tumoral calcinosis, with an ultimate diagnosis of autosomal recessive familial tumoral calcinosis. This case report highlights the radiographic appearance and progression of a rare disease in this unusual location and the differential diagnosis.

In this narrative account, we describe our experiences as medical students coordinating a health fair in collaboration with a student-led free clinic. We gain insights into the challenges of delivering healthcare beyond the walls of a clinic or hospital. This article explores the importance of integrating community-based initiatives into medical student education.

Introduction: Strongyloides stercoralis is a soil-transmitted helminth that can lead to life-threatening hyperinfection in transplant recipients. Targeted screening based on social history alone may preclude a large proportion of seropositive patients. Our institution implemented universal screening for kidney transplant candidates. This study aimed to identify the prevalence and identify risk factors of transplant candidates.

Methods: This was a retrospective chart review of kidney transplant candidates who were Strongyloides seropositive using the Strongyloides IgG enzyme-linked immunosorbent assay (ELISA) test. An equivocal Strongyloides serology was defined as 1.0 to 1.1 IV, a positive test as >1.1 IV, and a negative test as <1.0 IV.

Results: A total of 1653 patients underwent screening for Strongyloides, and 121 (7.3%) tested positive. Forty-seven patients (38.8%) who tested positive had no reported travel history to endemic areas, and 86% of patients originated from the United States. Forty-six patients (97.9%) who received a kidney transplant received treatment with ivermectin, and none developed disseminated disease or hyperinfection.

Conclusions: Among kidney transplant candidates screened for Strongyloides, 7.3% were seropositive and many reported no travel history to endemic areas, which highlights the significant prevalence of this parasite in Central Texas. Universal screening at our institution identified a substantial number of seropositive patients who might have otherwise been missed.

Physicians, and specifically surgeons, have unique expectations and responsibilities regarding professionalism. Further, surgeons interact with multiple different groups of people including surgical peers, trainees, other physicians, ancillary care partners, and patients. Communication between all of these groups must be respectful, appropriate, and effective, even in the high-stress environment of surgery. Norms of professional behavior are evolving to reflect the practices of the current era as well as the increasingly diverse surgical workforce. Thus, multiple surgical societies as well as the Accreditation Council for Graduate Medical Education have incorporated professionalism as a core pillar of surgeon evaluation. While professionalism has typically been modeled, the trait is now being more formally taught in medical education pathways. Future directions for professionalism in surgery include validated modules, more formalized surgeon review, linkage to credentialing, and reimbursement.