Attitudes of deaf individuals towards genetic testing of genes known to cause hearing loss

Congenital deafness is one of the most common birth defects reported. Approximately 70% of congenital deafness is non-syndromic, and approximately 80% of non-syndromic hearing loss results from a genetic cause. Middleton et al.’s1998 study highlighted the negative attitudes of culturally Deaf individuals towards genetic testing for genes known to cause hearing loss. While studies concerning genetic testing for deafness genes reference Middleton’s study, to our knowledge a re-evaluation of the attitudes of Deaf individuals towards genetic testing has not been conducted recently. The purpose of this study is to re-establish attitudes of Deaf individuals towards genetic testing of genes known to cause hearing loss. A computer-based questionnaire was distributed to members of the Deaf community. Responses of participants were recorded and analyzed. The primary investigator then attended Deaf community events and the 2015 Alabama Association of the Deaf Conference, and recruited individuals interested in participating in the study. The surveys were distributed to these individuals and their anonymous responses were analyzed. Our results show there are more positive attitudes within the Deaf community towards genetic counseling, genetic testing, and prenatal testing of genes known to cause hearing loss than were previously documented, although negative attitudes are still present. Additionally, our study shows there is a desire among members of the Deaf community to learn more about and potentially receive these services, despite the fact they are rarely offered by healthcare providers.

Effectiveness of Huffing Manoeuvre on Fentanyl Induced Cough

Aim: To determine the effect of huffing manoeuvre to preventing cough caused by intravenous administration of fentanyl during induction of anaesthesia. Study Design: Cross-sectional study Place and duration of study: General Anaesthesia Department, SICU and Pain Management, Civil Hospital Karachi from 1st June 2019 to 30th November 2019. Methodology: One hundred and sixty four patients meeting were enrolled. Every patient was taught to perform huffing manoeuvre by primary investigator visiting patient in ward at night before surgery. The act of huffing manoeuvre was lasts within 5 seconds. Any episode of cough within 60 seconds of fentanyl administration was classified as fentanyl induced cough. All patients were received Propofol (2mg/kg) for induction of anaesthesia. Results: The mean age was 46.42±8.92 years. Incidence of fentanyl induced cough was observed in 4.3% cases and huffing manoeuvre was effective in 95.7% cases. Conclusion: Huffing manoeuvre is an effecting method of reducing fentanyl induced cough in patients undergoing surgery, especially the manoeuvre prevents developing of severe fentanyl induced cough. Keywords: Fentanyl, Cough, Huffing manoeuvre, Analgesic opioids

The Trials and Tribulations of Assembling Large Medical Imaging Datasets for Machine Learning Applications

With vast interest in machine learning applications, more investigators are proposing to assemble large datasets for machine learning applications. We aim to delineate multiple possible roadblocks to exam retrieval that may present themselves and lead to significant time delays. This HIPAA-compliant, institutional review board–approved, retrospective clinical study required identification and retrieval of all outpatient and emergency patients undergoing abdominal and pelvic computed tomography (CT) at three affiliated hospitals in the year 2012. If a patient had multiple abdominal CT exams, the first exam was selected for retrieval (n=23,186). Our experience in attempting to retrieve 23,186 abdominal CT exams yielded 22,852 valid CT abdomen/pelvis exams and identified four major categories of challenges when retrieving large datasets: cohort selection and processing, retrieving DICOM exam files from PACS, data storage, and non-recoverable failures. The retrieval took 3 months of project time and at minimum 300 person-hours of time between the primary investigator (a radiologist), a data scientist, and a software engineer. Exam selection and retrieval may take significantly longer than planned. We share our experience so that other investigators can anticipate and plan for these challenges. We also hope to help institutions better understand the demands that may be placed on their infrastructure by large-scale medical imaging machine learning projects.

Adult patient perceptions on the effectiveness of scoliosis specific exercises

There is a paucity of research focusing on adults with scoliosis, yet many of these individuals suffer from pain and disability. Recent literature has demonstrated that for this patient population general physical therapy is no better than other non-operative treatment options.[1-3] This study assessed the perceptions of the effectiveness of Physiotherapeutic Scoliosis Specific Exercises (PSSE) on adult scoliosis. The purpose of this study is to present the results of a retrospective analysis of how adults with scoliosis perceive that physical therapy utilizing PSSE has impacted their quality of life (QoL), function, and pain. A 10 question survey was sent via a secure server (Qualtrics) to all PSSE participating patients ≥ 18 years old from one PSSE specialty clinic from the beginning of the PSSE program, 7 years. Survey responses were anonymous, collected by someone other than the primary investigator, and statistics were calculated with SPSS 24 (IBM Corp., Armonk, NY). Results: Fifty-seven adults (88.9% female) responded to the survey (55% response rate) with 67.2% being over the age of 55 years. The majority (61.9%) felt that PT had moderately or significantly positively impacted their QoL. The most common number of PT visits ranged from 5–10, after which 71.9% of participants were either somewhat or very confident in their ability to perform their PSSE program unsupervised at home. The most common frequency of home exercise program (HEP) performance was 1-2 times per week (46.0%) for a duration of 5–40 minutes. Quantitative analysis of exercise adherence using a Spearman’s rho (rs) revealed positive associations between confidence in correctly performing the HEP with the perceived positive impact of the exercises (rs = .45, p < .001), the greater frequency of performing the HEP (rs = .30, p = .024) and greater time performing the HEP (rs = .33, p = .004). This retrospective analysis showed that 61.9% of adults with scoliosis felt that PT utilizing PSSE had moderately or significantly positively impacted their QoL. Adherence to a HEP is critical to the success of the program. Greater confidence in correctly performing the HEP was positively correlated with perceived impact, frequency and time spent exercising. The sample was limited to adults from one clinic that specializes in scoliosis and may not be generalizable to other clinics.

Patient oriented research in mental health: matching laboratory to life and beyond in Canada

As patient-oriented research gains popularity in clinical research, the lack of patient input in foundational science grows more evident. Research has shown great utility in active partnerships between patient partners and scientists, yet many researchers are still hesitant about listening to the voices of those with lived experience guide and shape their experiments. Mental health has been a leading area for patient movements such as survivor-led research, however the stigma experienced by these patients creates difficulties not present in other health disciplines. The emergence of COVID-19 has also created unique circumstances that need to be addressed. Through this lens, we have taken experiences from our patient partners, students, and primary investigator to create recommendations for the better facilitation of patient-oriented research in foundational science in Canada. With these guidelines, from initial recruitment and leading to sustaining meaningful partnerships, we hope to encourage other researchers that patient-oriented research is necessary for the future of mental health research and foundational science.

Structured Long Interview and Clinical Examination (SLICE) as Formative Assessment Tool in Clinical Clerkship: Medical Students Perspective

Objective: This study aimed to assess the medical students’ opinions and views on undertaking SLICE as a formative assessment. Methods: This was a qualitative, exploratory study. Purposive sampling technique was used to select final year medical students who have undertaken a formative assessment through SLICE in their clerkship rotation. Total 32 students participated in this study .Four sets of focus group discussions (FGD) were conducted from medical students who had recently gone through their clinical clerkship modules for Pediatrics, General Medicine, General Surgery and Gynecology& Obstetrics. Each recorded FGD was transcribed verbatim. Thematic analysis was conducted manually. Themes were identified from the transcribed data, coded and analyzed. In order to achieve adequate coding and researcher reliability, investigator triangulation was performed. The initial thematic analysis was performed by the primary investigator. Thereafter, two more investigators independently analyzed the data. Before the data was finalized, all the three investigators reached a final consensus upon the themes that had emerged, ensuring triangulation of the analyzed data. Results: A four staged thematic analysis was conducted, in which five major themes and five sub-themes emerged. The main themes being: Purpose, Learning, Timing, Relevancy and Fairness of SLICE. Conclusion: The students generally thought that SLICE was effective in enhancing their clinical skills learning and should be conducted more frequently with minor adjustments. Continuous...

Industry-Sponsored Research Payments in Neurosurgery—Analysis of the Open Payments Database From 2014 to 2018

BACKGROUND The Open Payments Database (OPD) started in 2013 to combat financial conflicts of interest between physicians and medical industry. OBJECTIVE To evaluate the first 5 yr of the OPD regarding industry-sponsored research funding (ISRF) in neurosurgery. METHODS The Open Payments Research Payments dataset was examined from 2014 to 2018 for payments where the clinical primary investigator identified their specialty as neurosurgery. RESULTS Between 2014 and 2018, a $106.77 million in ISRF was made to 731 neurosurgeons. Fewer than 11% of neurosurgeons received ISRF yearly. The average received $140 000 in total but the median received $30,000. This was because the highest paid neurosurgeon received $3.56 million. A greater proportion ISRF was made to neurosurgeons affiliated with teaching institutions when compared to other specialties (26.74% vs 20.89%, P = .0021). The proportion of the total value of ISRF distributed to neurosurgery declined from 0.43% of payments to all specialties in 2014 to 0.37% in 2018 (P &lt; .001), but no steady decline was observed from year to year. CONCLUSION ISRF to neurosurgeons comprises a small percentage of research payments made to medical research by industry sponsors. Although a greater percentage of payments are made to neurosurgeons in teaching institutions compared to other specialties, the majority is given to neurosurgeons not affiliated with a teaching institution. A significant percentage of ISRF is given to a small percentage of neurosurgeons. There may be opportunities for more neurosurgeons to engage in industry-sponsored research to advance our field as long as full and complete disclosures can always be made.

Effect of Different Host-Related Factors on Postoperative Endodontic Pain in Necrotic Teeth Dressed with Interappointment Intracanal Medicaments: A Multicomparison Study

Objectives The current study aimed to assess the impact of factors such as age, gender, and the tooth type on postoperative endodontic pain in necrotic teeth with symptomatic periapical periodontitis and radiolucency dressed randomly with either calcium hydroxide or propolis paste. Materials and Methods The standard chemomechanical root canal preparation of 80 teeth was performed by the primary investigator. The intracanal medicaments were inserted by the secondary operator. Patients self-recorded their postoperative endodontic pain intensity with the help of visual analog scale at 4, 12, 24 (day 2), 48 (day 3), and 72 (day 4) hours. During analysis, patients (68/80) were grouped according to gender, age, and the tooth type. Statistical Analysis Mann–Whitney’s U test was applied for mean pain score comparison between genders and between tooth type. Kruskal–Wallis’ test was applied for mean pain score comparison between the age groups. Results No significant difference (p > 0.05) in pain scores was found between the age groups and between the tooth types. Males had significantly higher pain scores as compared with females at days 2 (p = 0.035), 3 (p = 0.023), and 4 (p = 0.020). Conclusion The results suggested that there was no impact of age and tooth types on postoperative endodontic pain.

Implications for Policy and Practice for Educational Leaders

This chapter provides insight into the complex nature of a study that serves as the foundation upon which this book is based. The chapter's conclusion articulates years of study yielding data, analyses, and conclusions reached by the primary investigator that offer the potential for bringing much needed changes to school policy, thereby confirming the critical nature of this work. The chapter emphasizes the need for the involvement of all stakeholders in becoming a part of the solution in bringing about such change and the role of the school's leadership in guiding the process of such collaboration, which requires the need for the school community to strengthen its cultural competency, including its motivation and willingness to embrace and respect the diversity among the populations it serves.