Racial and ethnic disparities in cardiovascular health care are well documented. Promising approaches to disparity reduction are increasingly described in literature published since 1995, but reports ...are fragmented by risk, condition, population, and setting. The authors conducted a systematic review of clinically oriented studies in communities of color that addressed hypertension, hyperlipidemia, physical inactivity, tobacco, and two major cardiovascular conditions, coronary artery disease and heart failure. Virtually no literature specifically addressed disparity reduction. The greatest focus has been African American populations, with relatively little work in Hispanic, Asian, and Native American populations. The authors found 62 interventions, 27 addressing hypertension, 9 lipids, 18 tobacco use, 8 physical inactivity, and 7 heart failure. Only 1 study specifically addressed postmyocardial infarction care. Data supporting the value of registries, multidisciplinary teams, and community outreach were found across several conditions. Interventions addressing care transitions, using telephonic outreach, and promoting medication access and adherence merit further exploration.
The flipped classroom (FC) is an integrated learning paradigm that equips students with self-directed study materials before scheduled meeting times allowing for the deeper application of acquired ...knowledge with an instructor. There is limited data on the application of FC to clinical undergraduate medical education and particularly as it applies to a surgical clerkship.
This study is a four-year retrospective study that includes two cohorts of students who matriculated through two training paradigms, traditional classroom (TC) and FC. Information regarding the FC cohort was collected from June 2018 to July 2020 (N=166). A two-year matched historical cohort of students enrolled in the clerkship and taught with the TC paradigm from June 2016 to July 2018 was used for comparison (N=157). The primary aim of this study is to assess the National Board of Medical Examiners (NBME) surgery shelf performance when the FC model is utilized compared to the TC model. This study will validate a prior similar study that had a smaller cohort with different secondary endpoints. Therefore, the secondary aim of this study assesses how teaching style can affect other performance metrics of a rotation (such as clinical performance, quizzes, Objective Structured Clinical Examinations (OSCE), and practicums) and how time was utilized by faculty, staff, and students.
There was no difference in overall NBME surgery shelf performance when comparing the FC to the traditional classroom teaching (68.94 vs 70.34, P= 0.1667). Likewise, there was no difference in quiz performance. The FC did allow instructors to spend more time in other clinical components of the curriculum leading to a significant difference in student practicum (84.2 vs 88.26, P = 0.0186) and OSCE grades (87.54 vs 90.58, P <0.0001).
The surgery NBME shelf performance is not compromised by FC and therefore can be used as an alternative to traditional classroom setting for teaching medical knowledge to surgery clerkship students. In addition, the FC can improve time management for instructors allowing for improved teaching and development in other components of the surgery curriculum.
Because of lack of insurance, he was not a candidate for biofeedback. ...the decision was made to implant a SNS to treat the refractory nocturnal fecal incontinence. ...he was taken back to the ...operating room to undergo definitive placement of the SNS. The treatment for fecal incontinence is evolving. ...the treatment for nocturnal fecal incontinence refractory to medical management is not well defined.
First defined in 1860 by Gascoyen, blue rubber bleb nevus syndrome (BRBNS) is a rare congenital anomaly characterized by blood loss.1 This disorder became more well known in 1958 when William Bennett ...Bean named the disease bean syndrome.1 BRBNS is defined as a vascular disorder in which dilated venous tissue develops within a thin layer of endothelial cells.1 This rare condition consists of blue nevi that range in size from a few millimeters to several centimeters in diameter. During colonoscopy, she was found to have cecal and right colon raised nodules that were bluish in hue and blanched on compression using forceps. Because of the vascular nature of the nodule, biopsy or snare was not performed. Endoscopic sclerotherapy and band ligation are also used for cases of significant bleeding.1 Resection serves as the best treatment method when numerous lesions accompany a local disease.1 A noninvasive treatment approach should be the first-line option for addressing BRBNS.1 if there is no bleeding from the lesions, BRBNS can be closely observed. Because our patient was asymptomatic with few lesions, we opted to closely observe with routine endoscopy.
Historically, they were thought to arise from the stomach (51%), small intestine (36%), rectum (7%), colon (5%), or the esophagus (1%), with little recognition of these tumors outside of the ...alimentary tract.1 EGISTs were likely to be misclassified as liposarcomas or myosarcomas because of the rarity of these tumors outside of the GI tract and lack of awareness of practitioners.3 With the usage of specific tumor markers to increase the accuracy of classification, the incidence of EGISTs is increasing, with newer reports identifying as high as 5 per cent of GISTs being extra alimentary.4 Rectovaginal stromal tumors can pose a surgical dilemma. ...an accurate diagnosis is important. Chemother-apeutic agents have shown little to no use in the management course of GIST and EGIST. ...the definitive therapy for GIST and EGIST is surgical resection.4 Tyrosine kinase inhibitors imatinib or sunitinib used in an adjuvant or neoadjuvant fashion has been shown to increase survival rates in patients with metastatic and recurrent disease.4 Tyrosine kinase inhibitors can also reduce the size of the tumor to improve resectability and to render the patient a candidate for a less invasive surgical approach.
Stercoral Colitis: A Surgical Dilemma Ayeni, A. Juliana; Turner, Jacquelyn; Clark, Clarence E. ...
The American surgeon,
09/2019, Volume:
85, Issue:
9
Journal Article
Peer reviewed
The second case is of an 84-year-old woman residing in a nursing home with a past medical history of bilateral below-knee amputations, Alzheimer's disease, type 2 diabetes mellitus, hypertension, ...stage III chronic kidney disease, and chronic constipation who presented with stool per vagina. Because she was a very poor historian, the duration of her abdominal pain was unclear. ...she underwent an intraoperative colonoscopy which confirmed the stercoral ulcer and rectovaginal fistula. Because of her multiple comorbidities, this patient underwent a diverting colostomy as a treatment for her rectovaginal fistula and pelvic sepsis. When diagnosed early, stercoral colitis can have minimal complications and be treated nonoperatively. ...we advocate for health-care providers to have a high index of suspicion of stercoral colitis in patients with chronic constipation and new onset of abdominal pain for early diagnosis and management to reduce the morbidity and mortality of this disease.
...due to the significant amount of prolapsed tissue, the use of Doppler to confirm the loss of the arterial signal was difficult. ...fluorescence angiography was used to assess hemorrhoid cushion ...perfusion and confirm dearterialization at the points of hemorrhoid artery ligation. In a meta-analysis study comparing the effectiveness of these varied modalities, Doppler-guided hemorrhoid ligation is shown to result in significantly fewer reoperations than other excisional techniques, quicker recovery, and significantly less postoperative complications, specifically pain and bleeding.2 Also on review of the literature, hemorrhoid artery ligation and mucopexy is shown to provide lasting results in patients after long-term follow-up, even among patients with grade IV hemorrhoids.3 However, Simillis et al. report a higher probability of recurrence when using Doppler-guided transanal hemorrhoid dearterialization compared with stapled hemorrhoidectomy and traditional hemorrhoidectomy.2 Confirmation after hemorrhoid artery ligation may be necessary in large, prolapsed hemorrhoids in an effort to reduce disease recurrence. ...fluorescence angiography is a considerable alternative form of confirmation of dearterialized hemorrhoidal tissue after ligation.
Cardiovascular Health Disparities Davis, Andrew M.; Vinci, Lisa M.; Okwuosa, Tochi M. ...
Medical care research and review,
10/2007, Volume:
64, Issue:
5_suppl
Journal Article
Peer reviewed
Open access
Racial and ethnic disparities in cardiovascular health care are well documented. Promising approaches to disparity reduction are increasingly described in literature published since 1995, but reports ...are fragmented by risk, condition, population, and setting. The authors conducted a systematic review of clinically oriented studies in communities of color that addressed hypertension, hyperlipidemia, physical inactivity, tobacco, and two major cardiovascular conditions, coronary artery disease and heart failure. Virtually no literature specifically addressed disparity reduction. The greatest focus has been African American populations, with relatively little work in Hispanic, Asian, and Native American populations. The authors found 62 interventions, 27 addressing hypertension, 9 lipids, 18 tobacco use, 8 physical inactivity, and 7 heart failure. Only 1 study specifically addressed postmyocardial infarction care. Data supporting the value of registries, multidisciplinary teams, and community outreach were found across several conditions. Interventions addressing care transitions, using telephonic outreach, and promoting medication access and adherence merit further exploration.
Presently, endoscopic procedures are a requirement for training competency for completion of a general surgery residency. There are no studies to date that have assessed whether having a resident ...perform a colonoscopy impacts quality indicators such as adenoma detection rate (ADR). To retrospectively review ADR in adult patients, who undergo screening colonoscopy at a single institution with (ColFacR) and without (ColFac) the participation of a general surgery resident. A total of 792 patients were identified in the database screening colonoscopies between the ages of 45 and 80 from July 2013 to June 2015. Of those, 501 were reviewed after exclusion criteria. When comparing the ColFac group (n = 316) to the ColFacR group (n = 185), there were no differences between age, gender, body mass index, American Society of Anesthesiologists score, or quality of bowel preparation. The mean number of total polyps, hyperplastic polyps, and adenomatous polyps retrieved were similar between the two groups. There was no difference in the ADR for the ColFac cases and ColFacR cases (25.95% vs 27.03%, respectively, P = 0.834). ADR is similar in elective colonoscopies that were performed with or without a general surgery resident. The participation of a general surgery resident in routine colonoscopies should not impact reported quality indicators.
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