Vestibular Schwannoma: Epidemiology, Risk Factors, and Quality of Life

INTRODUCTION: The goal of this study has been to describe the epidemiology of vestibular schwannoma and explore potential risk factors for this tumor. Other goals of this study have been to look at the function and quality of life of patients compared with the general US population as well as outcomes after radiosurgery treatment. METHODS: A 1:1 matched case-control study was designed. Odds ratios were established based on multivariate conditional logistic regression models. Quality of life was measured with the Short-Form 36 Item Health Survey v.2 and audiograms measuring the non-tumor ear were collected and analyzed for comparison with normative US population data. RESULTS: Average age at diagnosis was 53 (StDev±12). More than 90% of the participants were Caucasian. Patients were evenly distributed by gender. Family history of cancer, a history of hay fever, managerial and professional occupations, and frequent dental x-rays were found to have an increased association with acoustic neuroma in multivariate models. Tobacco use and diabetes were found to have a significantly decreased association with acoustic neuroma in multivariate models. Patients did not have significantly different quality of life scores or audiogram measurements of their non-tumor ear when compared to age-matched US population norms. CONCLUSIONS: Patients with (AN) have the profile of being Caucasian, either gender, in their 50-60’s, and working in managerial, professional jobs. Hay fever, family history of cancer, and frequent dental x-rays are strongly associated with an increase risk of acoustic neuromas. Tobacco use and diabetes demonstrate a protective effect, although the mechanism of this is poorly understood. Patients maintain a quality of life similar to the US population. Acoustic neuromas do not affect hearing in the non-tumor ear. PUBLIC HEALTH SIGNIFICANCE: The epidemiology and risk factors of vestibular schwannoma are poorly understood. Continued research in this area will help to develop an understanding of brain tumor etiology and the role of potential carcinogens in the environment. Functional research will help to look at the role of surgical treatments and the degree of morbidity in these patients

Clinical phenotypes of infantile onset CACNA1A-related disorder

BACKGROUND: CACNA1A-related disorders present with persistent progressive and non-progressive cerebellar ataxia and paroxysmal events: epileptic seizures and non-epileptic attacks. These phenotypes overlap and co-exist in the majority of patients. OBJECTIVE: To describe phenotypes in infantile onset CACNA1A-related disorder and to explore intra-familial variations and genotype-phenotype correlations. MATERIAL AND METHODS: This study was a multicenter international collaboration. A retrospective chart review of CACNA1A patients was performed. Clinical, radiological, and genetic data were collected and analyzed in 47 patients with infantile-onset disorder. RESULTS: Paroxysmal non-epileptic events (PNEE) were observed in 68% of infants, with paroxysmal tonic upward gaze (PTU) noticed in 47% of infants. Congenital cerebellar ataxia (CCA) was diagnosed in 51% of patients including four patients with developmental delay and only one neurological sign. PNEEs were found in 63% of patients at follow-up, with episodic ataxia (EA) in 40% of the sample. Cerebellar ataxia was found in 58% of the patients at follow-up. Four patients had epilepsy in infancy and nine in childhood. Seven infants had febrile convulsions, three of which developed epilepsy later; all three patients had CCA. Cognitive difficulties were demonstrated in 70% of the children. Cerebellar atrophy was found in only one infant but was depicted in 64% of MRIs after age two. CONCLUSIONS: Nearly all of the infants had CCA, PNEE or both. Cognitive difficulties were frequent and appeared to be associated with CCA. Epilepsy was more frequent after age two. Febrile convulsions in association with CCA may indicate risk of epilepsy in later childhood. Brain MRI was normal in infancy. There were no genotype-phenotype correlations found

Integration of the first physician assistants into Israeli emergency departments – the physician assistants’ perspective

Abstract Background A new role of Physician Assistant (PA) was introduced into Emergency Departments (ED) in Israel in 2016, as part of a larger effort to improve the quality of service in the EDs. When the new role was introduced, there was a fair amount of uncertainty about whether it would succeed, in light of ambivalence on the part of many ED nurses, and lack of clarity among ED directors about the necessity of a PA role, and about the extent to which PAs would be allowed to take on professionally meaningful tasks. The first class to train PAs was run by the Ministry Of Health between May 2016 and August 2017, with 34 PA trainees participating. 17 out of 24 EDs across Israel partook in the integration of the new PAs. This study assessed how this initial phase of integration is proceeding, from the perspective of the PA trainees themselves. Methods New PA trainees were surveyed at the beginning and end of their training. Likert scale responses were collected (using a scale of 1 to 6). Respondents were asked about difficulties in their previous profession, their motives for choosing the PA profession and their expectations for the new position. The follow-up survey included additional questions about their clinical activities. Descriptive and correlational statistics were performed. Results In the first survey, PA trainees reported that their main difficulties as paramedics were lack of options for professional advancement and burnout. New PA trainees had initially very high expectations for professional challenge, professional status upgrade, personal fulfillment, career prospects and an increase in wages (average mean score 5.7). In the follow-up survey there was a large drop in all of their ratings (average mean score 3.8). In the second survey, PA trainees reported spending the majority of their time evaluating, diagnosing and managing patients as opposed to preforming clinical procedures, such as inserting an IV, administrating medicine or applying casts. Despite their decreased expectations, they still felt that they were intellectually stimulated (5.3 average), given high levels of responsibility (4.8 average), and making significant contributions to the healthcare team and patients (average score of 5.5). All of the above were correlated with overall satisfaction. The main difficulties they reported were related to limited authority and further career advancement. Conclusions The new Israeli PA role has officially been launched in emergency medicine. The first group of PA trainees report a positive, productive integration, and overall satisfaction levels with their new career are high. However, the PA trainees reported having experienced some difficulties along the way, and there was a large decrease in their overall expectations from the new position during their first year on the job. Since the subject of limited authority was found to be a substantial difficulty for the new PA trainees, the Ministry of Health should explore this issue and create a uniform policy on it

Un historien parle aux historiens : politique et écriture de l’histoire dans le Traité de l’historien parfait du Chinois Liu Zhiji

International audienc

A National Survey of Quality Improvement Education in Physician Assistant Programs

PurposeQuality improvement (QI) is emerging as a leadership and career track for physician assistants (PAs). Information on how PA programs teach QI is sparse. This study aimed to define how PA programs are providing education in QI through a national program survey.MethodsCurriculum survey questions were deployed as a part of the 2014-2015 Physician Assistant Education Association program survey. Questions were grouped into 4 categories: QI champion, pedagogy, integration strategy, and curriculum content. Differences between groups were analyzed, and logistic regression models were built to explore associations.ResultsAll 194 (100%) PA programs responded to the survey. There were 137 (70.6%) programs that were teaching QI. The median number of total instructional hours was 12 (interquartile range = 16, overall range = 109). There were 37 (27%) programs that were categorized as having a mature curriculum. Mature curricula were significantly associated with a QI champion who is an expert from an outside department/institution (odds ratio [OR], 5.05; 95% confidence interval [CI], 1.14-22.33) and with programs that have a QI capstone or thesis project (OR, 3.66; 95% CI, 1.14-11.72) whose educational hours correlated more with experiential learning (r = 0.51, P \u3c.01), small group sessions (r = 0.42, P =.01), and web-based modules (r = 0.36, P =.03).ConclusionQuality improvement is an important skill set for PAs, but nearly one-third of PA programs do not have a QI curriculum. Mature curricula were associated with more experiential learning and project-based learning (including capstone/thesis). This study captured many elements of QI education for PAs, which can be used by programs to develop and improve their curricula

Demographic profile for graduate students enrolled in FiBS curriculum.

<p>Demographic profile for graduate students enrolled in FiBS curriculum.</p

Ordinal logistic regression models for improved performance in FiBS curriculum: Crude and adjusted values.

<p>Dependent variable ranked as: Fail/Pass/High performer, as previously defined. All variables included in adjusted model. Test of Parallel Lines = 0.57 for model. Significant correlations are indicated in bold.</p