Nevin Manimala

Dis Colon Rectum. 2024 Aug 1;67(8):1040-1047. doi: 10.1097/DCR.0000000000003254. Epub 2024 May 3.

ABSTRACT

BACKGROUND: There has been concern among colon and rectal surgery residency programs in the United States that IPAA procedures have been decreasing, but evidence is limited.

OBJECTIVE: The study aimed to evaluate the number of IPAAs performed by colon and rectal surgery residents in the United States and analyze the distribution of these cases on a national level.

DESIGN: Retrospective.

SETTINGS: The Accreditation Council for Graduate Medical Education Case Log National Data Reports were used to evaluate the number of IPAAs performed by residents from 2005 to 2021. The Nationwide Inpatient Sample database was used to identify all patients undergoing these procedures from 2005 to 2019.

PATIENTS: All IPAA procedures regardless of indication.

MAIN OUTCOME MEASURES: The primary outcome was the number of IPAAs performed by residents yearly. The secondary outcome was the national distribution of these procedures.

RESULTS: Among colon and rectal surgery residents, case log data revealed an increase in mean and total number of IPAAs from 2005 to 2013, followed by a decline in both metrics after 2013. Despite the decrease, the mean number of cases per resident remained fewer than 6 between 2011 and 2021. A weighted national estimate of 48,532 IPAA patients were identified in the Nationwide Inpatient Sample database. A significant decrease was noted in the number of IPAAs after 2015 that persisted through 2019. There was a significant decrease in rural and urban nonteaching hospitals (from 2.1% to 1.6% and 25.6% to 4.3%, respectively; p < 0.001) and an increase in urbanteaching hospitals (from 72.4% to 94.1%; p < 0.001).

LIMITATIONS: Nonrandomized retrospective study design.

CONCLUSIONS: Despite the recent increase in the percentage of IPAAs performed at urban academic centers, there has been a decrease in cases performed by colon and rectal surgery residents. This can have significant implications for residents who graduate without adequate experience in performing this complex procedure independently, as well as training programs that may face challenges with maintaining accreditation. See Video Abstract.

TENDENCIAS Y DISTRIBUCIN DE LA ANASTOMOSIS ANAL CON BOLSA ILEAL EN LOS ESTADOS UNIDOS SE EST VOLVIENDO MS DIFCIL DE ENCONTRAR EN LA CAPACITACIN DE RESIDENCIA EN CIRUGA DE COLON Y RECTO: ANTECEDENTES:Ha habido preocupación entre los programas de capacitación de residencia en cirugía de colon y recto en los Estados Unidos porque los procedimientos de anastomosis anal con bolsa ileal han estado disminuyendo; sin embargo, la evidencia es limitada.OBJETIVO:Evaluar el número de anastomosis anales con bolsa ileal realizadas por residentes de cirugía de colon y recto en los Estados Unidos y examinar la distribución de estos casos a nivel nacional.DISEÑO:Retrospectivo.AJUSTES:Se utilizaron los informes de datos nacionales del registro de casos de educación médica de posgrado del Consejo de Acreditación para examinar el número de anastomosis anales con bolsa ileal realizadas por residentes de 2005 a 2021. Se utilizó la base de datos de muestra nacional de pacientes hospitalizados para identificar a todos los pacientes sometidos a estos procedimientos de 2005 a 2019.PACIENTES:Todos los procedimientos de anastomosis anal con bolsa ileal independientemente de la indicación.MEDIDA DE RESULTADO PRINCIPAL:El resultado primario es el número de anastomosis anales con bolsa ileal realizadas por los residentes anualmente. El resultado secundario es la distribución nacional de estos procedimientos.RESULTADOS:Entre los residentes de cirugía de colon y recto, los datos de los registros de casos revelaron un aumento en el número medio y total de anastomosis anal con bolsa ileal de 2005 a 2013, seguido de una disminución en ambas métricas después de 2013. A pesar de la disminución, el número medio de casos por El residente permaneció >6 entre 2011 y 2021. Se identificó una estimación nacional ponderada de 48 532 pacientes con anastomosis anal con bolsa ileal en la base de datos de la Muestra Nacional de Pacientes Hospitalizados. Se observó una disminución significativa en el número de anastomosis anales con bolsa ileal después de 2015 que persistió hasta 2019. Hubo una disminución significativa en los hospitales no docentes rurales y urbanos (del 2,1% al 1,6% y del 25,6% al 4,3% respectivamente, p < 0,001) y un aumento en los hospitales universitarios urbanos (del 72,4% al 94,1%, p < 0,001).LIMITACIONES:Estudio retrospectivo no aleatorizado.CONCLUSIÓN:A pesar del reciente aumento en el porcentaje de anastomosis anal con bolsa ileal realizadas en centros académicos urbanos, ha habido una disminución en los casos realizados por residentes de cirugía de colon y recto. Esto puede tener implicaciones significativas para los residentes que se gradúan sin la experiencia adecuada en la realización de este complejo procedimiento de forma independiente, así como para los programas de capacitación que pueden enfrentar desafíos para mantener la acreditación. (Traduccion-AI-generated).

PMID:39019562 | DOI:10.1097/DCR.0000000000003254

BMJ. 2024 Jul 17;386:q1508. doi: 10.1136/bmj.q1508.

NO ABSTRACT

PMID:39019558 | DOI:10.1136/bmj.q1508

BMJ. 2024 Jul 17;386:e079364. doi: 10.1136/bmj-2024-079364.

ABSTRACT

OBJECTIVES: To evaluate the risk of major congenital anomalies according to infection with or vaccination against covid-19 during the first trimester of pregnancy.

DESIGN: Prospective Nordic registry based study.

SETTING: Sweden, Denmark, and Norway.

PARTICIPANTS: 343 066 liveborn singleton infants in Sweden, Denmark, and Norway, with an estimated start of pregnancy between 1 March 2020 and 14 February 2022, identified using national health registries.

MAIN OUTCOME MEASURE: Major congenital anomalies were categorised using EUROCAT (European Surveillance of Congenital Anomalies) definitions. The risk after covid-19 infection or vaccination during the first trimester was assessed by logistic regression, adjusting for maternal age, parity, education, income, country of origin, smoking, body mass index, chronic conditions, and estimated date of start of pregnancy.

RESULTS: 17 704 (5.2%) infants had a major congenital anomaly. When evaluating risk associated with covid-19 infection during the first trimester, the adjusted odds ratio ranged from 0.84 (95% confidence interval 0.51 to 1.40) for eye anomalies to 1.12 (0.68 to 1.84) for oro-facial clefts. Similarly, the risk associated with covid-19 vaccination during the first trimester ranged from 0.84 (0.31 to 2.31) for nervous system anomalies to 1.69 (0.76 to 3.78) for abdominal wall defects. Estimates for 10 of 11 subgroups of anomalies were less than 1.04, indicating no notable increased risk.

CONCLUSIONS: Covid-19 infection and vaccination during the first trimester of pregnancy were not associated with risk of congenital anomalies.

PMID:39019547 | DOI:10.1136/bmj-2024-079364

BMJ. 2024 Jul 17;386:e079016. doi: 10.1136/bmj-2023-079016.

ABSTRACT

OBJECTIVE: To examine trends in long term (>6 months) vaping among adults in England.

DESIGN: Population based study.

SETTING: England.

PARTICIPANTS: 179 725 adults (≥18 years) surveyed between October 2013 and October 2023.

MAIN OUTCOME MEASURES: Time trends in prevalence of long term vaping using logistic regression, overall and by vaping frequency (daily or non-daily), and main type of device used (disposable, refillable, or pod).

RESULTS: The proportion of adults reporting long term vaping increased non-linearly, from 1.3% (95% confidence interval 1.1% to 1.5%) in October 2013 to 10.0% (9.2% to 10.9%) in October 2023, with a particularly pronounced rise from 2021. This rise included an increase in long term daily vaping, from 0.6% (0.5% to 0.8%) to 6.7% (6.0% to 7.4%). Absolute increases in long term vaping were larger among people with a history of regular smoking (current smokers: 4.8% (4.0% to 5.8%) to 23.1% (20.4% to 25.9%); recent former smokers: 5.7% (3.4% to 9.2%) to 36.1% (27.6% to 45.4%); long term former smokers: 1.4% (1.0% to 1.9%) to 16.2% (14.2% to 18.4%)), but an increase also occurred among people who had never regularly smoked (0.1% (0.0% to 0.2%) to 3.0% (2.3% to 3.8%)). Growth was also more pronounced in young adults (eg, reaching 22.7% (19.2% to 26.5%) of 18 year olds v 4.3% (3.6% to 5.2%) of 65 year olds), including among those who had never regularly smoked (reaching 16.1% (11.1% to 22.7%) of 18 year olds v 0.3% (0.1% to 0.6%) of 65 year olds). Between October 2013 and March 2021, most long term vapers mainly or exclusively used refillable electronic cigarettes (2.5% to 3.3% of adults) and few (0.1% of adults) used disposable devices. However, prevalence of long term vaping using disposable devices subsequently rose rapidly, and by October 2023 similar proportions of adults mainly or exclusively used disposable and refillable devices (4.9% (4.2% to 5.7%) and 4.6% (4.0% to 5.3%), respectively).

CONCLUSIONS: The prevalence of long term vaping increased substantially among adults in England during 2013-23. Much of this increase occurred from 2021, coinciding with the rise in popularity of disposable e-cigarettes. Half of long term vapers now mainly or exclusively use disposable devices. The growth was concentrated among people with a history of regular smoking, but an increase also occurred among people who never regularly smoked, especially young adults.

PMID:39019543 | DOI:10.1136/bmj-2023-079016

Soins. 2024 Jul-Aug;69(887):15-19. doi: 10.1016/j.soin.2024.05.007. Epub 2024 Jun 26.

ABSTRACT

This article examines the evolution of domestic violence (DV) among Quebec women during the Covid-19 pandemic and the factors associated with this phenomenon. Based on the literature, we observed that DV increased significantly in Quebec during the health crisis. Furthermore, it appears that job loss, which affected more women than men, increased social isolation, deterioration of the mental health of spouses, increased alcohol and cannabis consumption, and difficulties in reconciling work and family life are the factors that contribute most to the increase in DV in Quebec during this period.

PMID:39019510 | DOI:10.1016/j.soin.2024.05.007

Reg Anesth Pain Med. 2024 Jul 16:rapm-2024-105747. doi: 10.1136/rapm-2024-105747. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Motor-sparing peripheral nerve blocks enhance multimodal opioid-sparing strategies after total knee arthroplasty. We hypothesized that adding a popliteal plexus block to a femoral triangle block could reduce 24-hour opioid consumption after total knee arthroplasty, compared with standalone femoral triangle block or adductor canal block.

METHODS: This patient- and assessor-blinded, randomized controlled trial allocated 165 patients into three equally sized parallel groups, receiving either 1) popliteal plexus block+femoral triangle block, 2) femoral triangle block, or 3) adductor canal block. Intravenous oxycodone was administered via patient-controlled analgesia pumps. The primary outcome was 24-hour postoperative opioid consumption. Secondary outcomes were preoperative maximum voluntary isometric contraction and manual muscle tests of knee and ankle movement assessed before and after the nerve block procedure together with postoperative pain scores, mobilization, and 12-hour opioid consumption.

RESULTS: 24-hour postoperative intravenous oxycodone consumption varied significantly between groups (p<0.01), with medians (IQR) of 6 mg (2-12) in the popliteal plexus block+femoral triangle block group, 10 mg (8-16) in the femoral triangle block group, and 12 mg (6-18) in the adductor canal block group. Median consumption in the popliteal plexus block+femoral triangle block group was reduced by -4 mg (95% CI -7.4 to -1.0, p<0.01) and -6 mg (95% CI -8.3 to -1.3, p=0.01) compared with groups of femoral triangle block and adductor canal block, respectively. No differences were found in pain scores, mobilization, or changes in preoperative muscle strength. Post hoc analysis revealed successful 24-hour opioid-free postoperative care among 12 patients with popliteal plexus block+femoral triangle block, as compared with two with femoral triangle block and six with adductor canal block.

CONCLUSION: Adding a popliteal plexus block to a femoral triangle block resulted in a statistically significant reduction of 24-hour postoperative opioid consumption after total knee arthroplasty. However, no differences were found in pain scores. Popliteal plexus block did not impair the lower leg muscles.

PMID:39019501 | DOI:10.1136/rapm-2024-105747

Int J Gynecol Cancer. 2024 Jul 16:ijgc-2024-005489. doi: 10.1136/ijgc-2024-005489. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of our study was to evaluate the feasibility of the modified International Germ Cell Cancer Collaborative Group risk classification system in Chinese female patients with malignant ovarian germ cell tumors and to identify predictive factors to enhance the risk classification system.

METHODS: In this retrospective cohort analysis, patients with malignant ovarian germ cell tumors who received surgery with/without chemotherapy were included. These patients had been followed-up by Peking Union Medical College Hospital between 2011 to 2020. Patients without complete medical records or no follow-up information were excluded.

RESULTS: The study enrolled a total of 271 patients. The risk model classified 106 (39.1%) patients as good-, 84 (31%) as intermediate-, and 81 (29.9%) as poor-risk. With a median follow-up time of 34 months (range 2-147), 48 (17.7%) recurrence and 16 (5.9%) deaths were observed. The risk classification significantly correlated with 3 year disease-free survival and overall survival (log rank p<0.001 and p=0.003, respectively). The survival outcomes of disease-free survival and overall survival were not statistically different among risk groups in patients who received neoadjuvant chemotherapy (log rank p=0.77 and 0.41, respectively). Univariate and multivariable analysis showed that tumor stage (p=0.033, hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.06 to 3.96) was significantly associated with relapse or progression of disease. Patients over age 40 years exhibited a poor prognosis.

CONCLUSION: The modified International Germ Cell Cancer Collaborative Group risk classification system was efficacious in patients with malignant ovarian germ cell tumors and was significantly associated with disease-free survival and overall survival. Risk assessment after neoadjuvant chemotherapy may be more predictive than stratification at initial diagnosis. Age and tumor stage were definitive prognostic factors for germ cell tumors, which may need to be incorporated in the stratification system.

PMID:39019492 | DOI:10.1136/ijgc-2024-005489

Klin Padiatr. 2024 Jul 17. doi: 10.1055/a-2367-9190. Online ahead of print.

ABSTRACT

English Abstract: Abstract Purpose: The most important cause of mortality and morbidity in acute rheumatic fever (ARF) is carditis and rheumatic heart disease (RHD). The aim of this study was to identify markers that may be indicators of chronic inflammation in whole blood analyses in pediatric patients with RHD who regularly received secondary deposilin prophylaxis.

METHODS: In our study, 100 children with ARF aged between 4 and 18 years were followed up in the pediatric cardiology outpatient clinic of the patient group. The control group consisted of 100 healthy children of the same sex and age as the patient group. All children in the patient group regularly received deposilin prophylaxis every 21 days. Our study included many whole blood parameters that are reported in the literature to represent changes in chronic inflammatory diseases. These parameters were CRP, RDW, PDW, MPV and leukocyte subtypes, neutrophil, lymphocyte, monocyte counts and their ratios (neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte).

RESULTS: Leukocyte count, lymphocyte count, basophil count, MLR and basophil count were significantly lower in the patient group than in the control group (p: 0.047, p: 0.023, p: 0.006). In addition, eosinophil count and RDW value were significantly higher in the patient group than in the control group (p: 0.043; p: 0.001).

CONCLUSION: In our study, low leukocyte, lymphocyte, basophil, MLR and higher eosinophil counts indicated that RDW could be effectively used as a marker for regular depositilin prophylaxis in pediatric patients with RHD. German Abstract: Zusammenfassung Zweck: Die wichtigste Ursache für Mortalität und Morbidität bei akutem rheumatischem Fieber (ARF) sind Karditis und rheumatische Herzkrankheit (RHD). Ziel dieser Studie war es, Marker zu identifizieren, die bei Vollblutanalysen bei pädiatrischen Patienten mit RHD, die regelmäßig eine sekundäre Deposilin-Prophylaxe erhielten, Indikatoren für chronische Entzündungen sein können.

METHODEN: In unserer Studie wurden 100 Kinder mit ARF im Alter zwischen 4 und 18 Jahren in der pädiatrischen kardiologischen Ambulanz der Patientengruppe nachbeobachtet. Die Kontrollgruppe bestand aus 100 gesunden Kindern desselben Geschlechts und Alters wie die Patientengruppe. Alle Kinder in der Patientengruppe erhielten regelmäßig alle 21 Tage eine Deposilin-Prophylaxe. Unsere Studie umfasste viele Vollblutparameter, von denen in der Literatur berichtet wird, dass sie Veränderungen bei chronischen Entzündungskrankheiten darstellen. Diese Parameter waren CRP, RDW, PDW, MPV und Leukozytensubtypen, Neutrophilen-, Lymphozyten-, Monozytenzahlen und ihre Verhältnisse zueinander (Neutrophilen/Lymphozyten, Thrombozyten/Lymphozyten und Monozyten/Lymphozyten). Ergebnisse: Leukozytenzahl, Lymphozytenzahl, Basophilenzahl, MLR und Basophilenzahl waren in der Patientengruppe signifikant niedriger als in der Kontrollgruppe (p: 0,047, p: 0,023, p: 0,006). Darüber hinaus waren Eosinophilenzahl und RDW-Wert in der Patientengruppe signifikant höher als in der Kontrollgruppe (p: 0,043; p: 0,001). Schlussfolgerung: In unserer Studie wiesen niedrige Leukozyten-, Lymphozyten-, Basophilen-, MLR- und höhere Eosinophilenzahlen darauf hin, dass RDW als Marker für eine regelmäßige Depositilinprophylaxe bei pädiatrischen Patienten mit RHD wirksam eingesetzt werden könnte.

PMID:39019479 | DOI:10.1055/a-2367-9190

Bone Jt Open. 2024 Jul 18;5(7):592-600. doi: 10.1302/2633-1462.57.BJO-2024-0033.R1.

ABSTRACT

AIMS: Patient dissatisfaction is not uncommon following primary total knee arthroplasty. One proposed method to alleviate this is by improving knee kinematics. Therefore, we aimed to answer the following research question: are there significant differences in knee kinematics based on the design of the tibial insert (cruciate-retaining (CR), ultra-congruent (UC), or medial congruent (MC))?

METHODS: Overall, 15 cadaveric knee joints were examined with a CR implant with three different tibial inserts (CR, UC, and MC) using an established knee joint simulator. The effects on coronal alignment, medial and lateral femoral roll back, femorotibial rotation, bony rotations (femur, tibia, and patella), and patellofemoral length ratios were determined.

RESULTS: No statistically significant differences were found regarding coronal alignment (p = 0.087 to p = 0.832). The medial congruent insert demonstrated restricted femoral roll back (mean medial 37.57 mm; lateral 36.34 mm), while the CR insert demonstrated the greatest roll back (medial 42.21 mm; lateral 37.88 mm; p < 0.001, respectively). Femorotibial rotation was greatest with the CR insert with 2.45° (SD 4.75°), then the UC insert with 1.31° (SD 4.15°; p < 0.001), and lowest with the medial congruent insert with 0.8° (SD 4.24°; p < 0.001). The most pronounced patella shift, but lowest patellar rotation, was noted with the CR insert.

CONCLUSION: The MC insert demonstrated the highest level of constraint of these inserts. Femoral roll back, femorotibial rotation, and single bony rotations were lowest with the MC insert. The patella showed less shifting with the MC insert, but there was significantly increased rotation. While the medial congruent insert was found to have highest constraint, it remains uncertain if this implant recreates native knee kinematics or if this will result in improved patient satisfaction.

PMID:39019478 | DOI:10.1302/2633-1462.57.BJO-2024-0033.R1

Appl Clin Inform. 2024 Jul 17. doi: 10.1055/a-2368-3514. Online ahead of print.

ABSTRACT

BACKGROUND: Health informatics (HI) is a growing field of study, yet sparse data is available on the characteristics of undergraduate health informatics programs in the United States (U.S.). The lack of a central location for U.S. HI undergraduate program data has led to a gap in information to support current efforts to promote academic standards in the field and attract potential students.

OBJECTIVES: The objective of this study was to perform an environment scan of colleges and universities within the U.S. and Puerto Rico to identify undergraduate programs in HI including majors, minors, and undergraduate level certificates.

METHODS: Potential institutions offering HI programs were identified from the National Center for Education Statistics (NCES), Commission for Accreditation of Health Informatics and Health Information Management Education (CAHIIM), the Association of University Programs in Health Administration (AUPHA), the Healthcare Information and Management Systems Society (HIMSS), and the American Health Information Management Association (AHIMA). Publicly available materials for these institutions were reviewed, and data were captured for identified HI programs including geographic location; college or school in which the program was offered; type of degree (if applicable); program title; total credits to complete the program; delivery format; and source of data.

RESULTS: 83 HI programs were identified from 60 institutions and 26 states. The primary finding of this environment scan was that inconsistencies exist among U.S. HI undergraduate programs including variations in offering college/school, title of program, number of credits required, delivery formats, CIP codes, and the type of information published on university/college websites.

CONCLUSION: This environment scan was a first step in exploring the characteristics of undergraduate HI programs within the U.S. Further research is needed on the curricular similarities and differences among the programs, the administrative methods of these interdisciplinary programs, and the information most needed by current and potential undergraduate students.

PMID:39019476 | DOI:10.1055/a-2368-3514