scholarly journals A Comparison of National Pediatric Procedures Training Guidelines With Actual Clinical Practice in Ohio

2019 ◽  
Vol 11 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Maya S. Iyer ◽  
David P. Way ◽  
Jennifer Kline ◽  
Rebecca Wallihan ◽  
Rachel M. Stanley
Keyword(s):  
Regional Differences ◽  
Response Rate ◽  
Review Committee ◽  
Rural Regions ◽  
Actual Clinical Practice ◽  
Customized Training ◽  
Clinical Procedures ◽  
Cerumen Removal ◽  
Post Hoc ◽  
Future Practice

ABSTRACT Background  The Accreditation Council for Graduate Medical Education (ACGME) and Pediatrics Review Committee (RC) recommends the clinical procedures residents should master during their training. These guidelines may be partially based on consensus opinion or tradition rather than actual need. The literature defining which procedures general pediatricians actually perform in practice is limited. Objective  Our objective was to determine how often general pediatricians perform procedures recommended by accreditation bodies, how well prepared they feel to perform them, and how important the procedures are to their practice. Methods  We categorized recommended procedures as emergent, urgent, or office-based, then developed and administered a survey in 2017 based on these classes. We randomly sampled and polled 439 general pediatricians from urban, suburban, or rural regions across central Ohio. Responses were compared using the Welch ANOVA, Mann Whitney U, and post-hoc tests. Results  The response rate was 60% (265 of 439). Pediatricians almost never performed 11 of 13 recommended procedures, yet felt well prepared to perform them all and believed that all were important. Rural pediatricians performed significantly more emergent and office-based procedures and rated them as more important. Commonly performed non-ACGME/RC procedures were circumcision, wart removal, cerumen removal, umbilical cauterization, and suture removal. Conclusions  Findings suggest that pediatricians rarely perform most of the recommended procedures, but think they are important. There are several office-based non-ACGME recommended procedures that pediatricians commonly perform. Regional differences suggest the need for customized training based on future practice plans.

scholarly journals ACTR-20. EFFICACY OF INITIAL TEMOZOLOMIDE FOR HIGH-RISK LOW GRADE GLIOMAS IN A PHASE II AINO (ITALIAN ASSOCIATION FOR NEURO-ONCOLOGY) STUDY: A POST-HOC ANALYSIS WITHIN MOLECULAR SUBGROUPS OF WHO 2016

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi16-vi17
Author(s):  
Roberta Rudà ◽  
Alessia Pellerino ◽  
Andrea Pace ◽  
Carmine Maria Carapella ◽  
Cristina Dealis ◽  
...  
Keyword(s):  
High Risk ◽  
Phase Ii ◽  
Response Rate ◽  
Long Term Results ◽  
Molecular Subgroups ◽  
Who Grade ◽  
Post Hoc Analysis ◽  
Grade Ii ◽  
Post Hoc ◽  
Who Grade Ii Gliomas

Abstract BACKGROUND The optimal management of high risk WHO grade II gliomas after surgery is still debated. The efficacy of initial temozolomide to delay radiotherapy and risk of cognitive defects could vary across the molecular subgroups of WHO 2016, but information on this issue are lacking. PATIENTS AND METHODS A post-hoc analysis has been performed on a cohort of high risk WHO grade II gliomas, who received initial temozolomide alone in phase II multicenter study, with the objective of re-evaluating the long-term results across the different molecular subgroups of the WHO 2016 classification. The primary endpoint of the study, carried out between 2007 and 2010, was response rate according to RANO, being seizure response, PFS and OS secondary endpoints. RESULTS Response rate (partial and minor responses) among oligodendrogliomas IDH-mutant and 1p/19q codeleted (76%) was significantly higher than that among diffuse astrocytomas either mutant (55%) or wild-type (36%). A reduction of seizure frequency >50% was observed in 87% patients and a seizure freedom in 72%. The probability of seizure reduction >50% was significantly associated with the presence of an IDH mutation. Median PFS, PFS at 5 and 10 years, median OS and OS at 5 and 10 years were all significantly longer in oligodendrogliomas IDH-mutant and 1p/19q codeleted. Of patients who did not recur or delay radiotherapy at recurrence for a median follow-up of 8.2 years, 67% and 59%, respectively, were oligodendrogliomas IDH-mutant and 1p/19q codeleted. CONCLUSIONS The post-hoc analysis of this phase II trial suggests that the beneficial effects of initial temozolomide prevail in oligodendrogliomas IDH-mutant and 1p/19q codeleted: thus, these tumors, when incompletely resected or progressive after surgery, especially when suffering from pharmacoresistant seizures, could receive temozolomide as initial treatment with radiotherapy and chemotherapy at recurrence. The trial was registered with EU Clinical Trials Register, EudraCT n. 2007/000386-38.

scholarly journals Effect of storage time and composite thickness on Degree of Conversion of Bulk-fill and universal composites using FTIR method

2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Farnaz Farahat ◽  
Abdolrahim Davari ◽  
Marzieh Fadakarfard
Keyword(s):  
Storage Time ◽  
T Test ◽  
Degree Of Conversion ◽  
Dental Composite ◽  
P Value ◽  
Clinical Procedures ◽  
Post Hoc ◽  
Storage Times ◽  
And Storage

Objective: Degree of Conversion (DC) of Resin-Based composites (RBCs) is a concern and is affected by different factors. This study was conducted to evaluate the effect of different thicknesses and storage times on DC of bulk-fill and universal RBCs using the FTIR method. Material and methods: For each of dental composite (Tetric N- Ceram Bulk Fill and Tetric N Ceram), 28 samples were prepared (14 samples with 2 mm height and 14 samples with 4 mm height). One and seven days (1d and 7d) after storage in an incubator at 37 ˚C, DC was measured and recorded using a FTIR device. Data were analyzed using t-test and Three-Way ANOVA and Tukey Post-Hoc Test. P < 0.05 was considered statistically significant. Results: DC of Bulk-fill composite is greater than universal composite. DC at 2 mm thickness is more than 4 mm. Unlike universal composite, 7d DC of Bulk-fill composite is greater than 1d. Of course, none of these differences are statistically significant (P-value > 0.05). Conclusions: Considering the limitation of this study, since no difference was found between DC of 1d and 7d, 1d DC is sufficient for clinical procedures, such as polishing, and the laboratory tests.KEYWORDSBulk-fill composites; Degree of Conversion; FTIR.

scholarly journals Alcohol Use in China: Unrecorded and Recorded Bai Jiu in Three Rural Regions

2021 ◽  
Vol 19 (1) ◽  
pp. 405
Author(s):  
Lanyan Ding ◽  
Baoping Song ◽  
Chengli Wu ◽  
Ian M. Newman ◽  
Lok-Wa Yuen ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Ethnic Differences ◽  
Rural Areas ◽  
Regional Differences ◽  
Small Neighborhood ◽  
Drinking Patterns ◽  
Rural Regions ◽  
Aggregated Data ◽  
Regulatory Systems ◽  
Stable Preference

In China, approximately 70% of beverage alcohol is consumed in the form of spirits. An estimated 25% of all alcohol consumed is unrecorded, mostly spirits (bai jiu), produced outside regulatory systems in small neighborhood distilleries, mostly in rural areas. Unrecorded bai jiu drinkers are generally older, male, prefer higher-strength bai jiu, and drink daily and mostly at home. To explore possible regional differences, researchers used interview data from 2919 bai jiu drinkers in rural areas in Hebei, Anhui, and Hubei provinces in China. Results confirmed that patterns varied by province. The sample in Hubei preferred unrecorded bai jiu with a more stable preference to alcohol type, tended to drink less frequently, and reported experiencing less drinking pressure, suggesting lower-risk drinking patterns in this region. The Hebei and Anhui sample reported higher frequency and greater amount of alcohol consumption, were more likely to experience drinking pressure, indicating higher-risk patterns in alcohol use in these two regions. The results provide needed details about regional differences in unrecorded bai jiu drinking patterns that are not evident in aggregated data and suggest variations in drinking patterns that may reflect local geography, local values, traditions, and ethnic differences.

scholarly journals An Examination of Burnout Predictors: Understanding the Influence of Job Attitudes and Environment

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 502
Author(s):  
Katelyn J. Cavanaugh ◽  
Hwa Young Lee ◽  
Diane Daum ◽  
Shine Chang ◽  
Julie G. Izzo ◽  
...  
Keyword(s):  
Response Rate ◽  
Job Attitudes ◽  
Group Level ◽  
Negative Consequences ◽  
Employee Survey ◽  
Single Item ◽  
Vacancy Rates ◽  
Post Hoc ◽  
Clinical Departments ◽  
Healthcare Employees

Burnout amongst healthcare employees is considered an epidemic; prior research indicates a host of associated negative consequences, though more research is needed to understand the predictors of burnout across healthcare employees. All employees in a cancer-focused academic healthcare institution were invited to participate in a bi-annual online confidential employee survey. A 72% response rate yielded 9979 complete responses. Participants completed demographic items, a validated single-item measure of burnout, and items measuring eight employee job attitudes toward their jobs and organization (agility, development, alignment, leadership, trust, resources, safety, and teamwork). Department-level characteristics, turnover, and vacancy were calculated for group level analyses. A univariate F test revealed differences in burnout level by department type (F (3, 9827) = 54.35, p < 0.05) and post hoc Scheffe’s tests showed employees in clinical departments reported more burnout than other departments. Hierarchical multiple regression revealed that employee demographic and job-related variables (including department type) explained 8% of the variance of burnout (F (19, 7880) = 37.95, p < 0.001), and employee job attitudes explained an additional 27% of the variance of burnout (F (8, 7872) = 393.18, p < 0.001). Relative weights analysis at the group level showed that, of the constructs measured, alignment is the strongest predictor of burnout, followed by trust and leadership. The relationships are inverse in nature, such that more alignment is related to less burnout. Turnover and vacancy rates did not predict group level burnout. The results reported here provide evidence supporting a shift in the focus of research and practice from detection to prevention of employee burnout and from individual-focused interventions to organization-wide interventions to prevent burnout.

Evaluation of daily patch application duration for epicutaneous immunotherapy for peanut allergy

2020 ◽  
Vol 41 (4) ◽  
pp. 278-284
Author(s):  
David M. Fleischer ◽  
Jonathan M. Spergel ◽  
Edwin H. Kim ◽  
Dianne E. Campbell ◽  
Todd D. Green ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Peanut Allergy ◽  
Response Rate ◽  
Peanut Protein ◽  
Phase Iii ◽  
Application Time ◽  
Phase Iii Clinical Trial ◽  
Patch Application ◽  
Epicutaneous Immunotherapy ◽  
Post Hoc

Background: Epicutaneous immunotherapy is a potential novel immunotherapy that utilizes unique cutaneous immunologic properties. In a phase III, randomized, double-blind, placebo controlled clinical trial, an epicutaneous patch (DBV712) with 250 µg of peanut protein applied once daily for 12-months was statistically superior to placebo in desensitizing children with peanut allergy (ages 4‐11 years) (N = 356). Objective: To assess the relationship between the hours of daily application time and the efficacy of DBV712 250 µg. Methods: DBV712 250 µg was applied to 30 nonallergic volunteers for various durations from 2 to 24 hours and then assayed for residual peanut protein. Patch application data from the phase III clinical trial were analyzed post hoc according to prespecified responder rates and changes in the eliciting dose (ED), as measured by the geometric mean (GM) ED ratio (12 months/baseline). Results: Following application, there was a marked decrease in peanut protein on the patches from 2 to 12 hours. After 12 hours, the median peanut protein recovered was below quantification limits. The median daily patch application duration in subjects from the phase III clinical trial was 21.1 hours (DBV712 250 µg) and 22.4 hours (placebo). Ninety-five percent of the treated population achieved >10 hours per day mean application. Response rates and GM ED ratios were similar among subjects across a range of application durations; e.g., in those with a mean duration of >10 hours, the response rate was 36.6% and the GM ED ratio was 3.8, comparable with 42.6% and 4.0, respectively, in those with a mean duration of >20 hours. In DBV712 250 µg subjects with >16 hours mean application duration (84.5% of the treated population), the response rate was 38.8% versus 13.4% for placebo (difference, 24.4% [95% confidence interval, 15.5‐34.0%]; p < 0.001). Conclusion: An evaluation of residual peanut protein on patches following application and post hoc analysis of phase III data strongly suggest that allergen delivery is attained with 12‐16 hours of daily patch application time, sufficient to drive clinically meaningful desensitization to peanut after 12 months.

Facial Blood Flow Responses to Dynamic Exercise

2020 ◽  
Author(s):  
Naoyuki Hayashi ◽  
Hideaki Kashima ◽  
Tsukasa Ikemura
Keyword(s):  
Blood Flow ◽  
Exercise Intensity ◽  
Regional Differences ◽  
Regional Blood Flow ◽  
Dynamic Exercise ◽  
Laser Speckle ◽  
Laser Speckle Flowgraphy ◽  
Handgrip Exercise ◽  
Post Hoc ◽  
One Way Anova

AbstractWe reported previously that a static handgrip exercise evoked regional differences in the facial blood flow. The present study examined whether regional differences in facial blood flow are also evoked during dynamic exercise. Facial blood flow was measured by laser speckle flowgraphy during 15 min of cycling exercise at heart rates of 120 bpm, 140 bpm and 160 bpm in 12 subjects. The facial vascular conductance index was calculated from the blood flow and mean arterial pressure. The regional blood flow and conductance index values were determined in the forehead, eyelid, nose, cheek, ear and lip. One-way ANOVA and Tukey’s post-hoc test were used to examine effects of exercise intensity and target regions. The blood flow and conductance index in skin areas increased significantly with the exercise intensity. The blood flow and conductance index in the lip increased significantly at 120 bpm and 140 bpm compared to the control, while the values in the lip at 160 bpm did not change from the control values. These results suggest that the blood flow in facial skin areas, not in the lip, responds similarly to dynamic exercise, in contrast to the responses to static exercise.

scholarly journals How Much Education and Training do Residents Across Specialties Receive in Neuropsychology?

2021 ◽  
Vol 14 ◽  
pp. 197-200
Author(s):  
Seher Chowhan ◽  
Phillip K. Martin ◽  
Matthew Macaluso ◽  
Christina Bowman ◽  
Ryan W. Schroeder
Keyword(s):  
Internal Medicine ◽  
Family Medicine ◽  
The United States ◽  
Education And Training ◽  
Multidisciplinary Teams ◽  
Chi Square ◽  
Strongly Agree ◽  
Post Hoc ◽  
Future Practice ◽  
And Training

Introduction. Neuropsychologists play an important role on multidisciplinary teams with physicians from multiple specialties. The extent of residency training on the use of neuropsychological services is unclear. We surveyed medical residents across multiple specialties throughout the United States to assess resident education, training, and understanding of neuropsychological services, along with their likelihood to consult neuropsychologists in the future. Methods. A survey was sent to residents in accredited psychiatry, neurology, family medicine, and internal medicine programs. After data were collected, chi-square group level analyses with post-hoc pairwise comparisons were used to analyze the data. Results. 434 residents took the survey. The proportion of residents exposed to neuropsychology during residency varied significantly according to specialty χ2 (3, N=419) = 51.4, p < .001, with more psychiatry and neurology residents reporting exposure than residents in family medicine or internal medicine. Similarly, the proportion of psychiatry and neurology residents who ‘agree’ or ‘strongly agree’ that they understand the nature of neuropsychological services differed significantly from family medicine and internal medicine residents χ2 (3, N=415) = 40.4, p < .001. The majority of residents across all specialties (85.7%) reported they are likely to consult/order neuropsychological services in future practice. Conclusions. The majority of residents in all specialties reported exposure to neuropsychological services in some manner, but forms of exposure varied. Results indicate a need for increased education and training in neuropsychological services, especially within family medicine and internal medicine programs. The majority of residents agreed that they would utilize neuropsychology services in future practice.

scholarly journals Manifestations of intraocular inflammation over time in patients on brolucizumab for neovascular AMD

2021 ◽  
Author(s):  
Ramin Khoramnia ◽  
Marta S. Figueroa ◽  
Lars-Olof Hattenbach ◽  
Carlos E. Pavesio ◽  
Majid Anderesi ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Time Course ◽  
Retinal Vasculitis ◽  
Intraocular Inflammation ◽  
Neovascular Amd ◽  
Review Committee ◽  
Safety Review ◽  
Retinal Vascular Occlusion ◽  
Post Hoc

Abstract Purpose To describe the adverse events associated with brolucizumab, in particular the sequence of intraocular inflammation (IOI), retinal vasculitis (RV), and/or retinal vascular occlusion (RO). Methods This was an unmasked post hoc analysis of the randomized HAWK/HARRIER clinical trials. Patients with neovascular AMD in the brolucizumab arms of the trials were included. IOI-related adverse events reported by study investigators were analyzed to determine early signs and the time course of IOI-related adverse events, using a subgroup of patients with definite/probable IOI cases identified in an independent unmasked post hoc review by an external safety review committee. A limited literature review on IOI following anti-VEGF therapy was also conducted. Results Among 50 patients with definite/probable IOI cases identified by the safety review committee, 12 had RV or RO adverse events reported by the investigators. For 6 of 12, IOI (other than RV) was reported before RV or RO. The duration from the first IOI adverse event to the first RV or RO adverse event ranged from 16 to 171 days for 5 patients and was 553 days for 1 patient. Four of the 6 patients received ≥ 1 brolucizumab injection on or after the date of the first IOI adverse event and before the first RV or RO adverse event. Conclusions IOI may precede RV or RO in some patients treated with brolucizumab.

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