Lip Biopsy Trends in the United States: A 7-Year Review of Medicare Provider Utilization and Payment Database

Biopsy of the lip is a procedure most used by dermatologists in order to obtain histopathological evaluation of a lesion. It has remained the definitive method of diagnosis for many pathologies, including malignancy. However, although the incidence of lip malignancy has been relatively unchanged since 2012, the number of lip biopsies performed has not followed the same trend, but rather steeply declined since. In this study, the national trends in lip biopsies are evaluated. The Medicare Provider Utilization and Payment (MPUP) database was used to evaluate these practice trends in Medicare providers

Flexural behaviour of reinforced concrete beams strengthened by NSM technique using ECC

Bendable concrete is also defined as engineered cementitious composites because of its great ductility and tight fracture width limitation. ECC mixtures by adding additional Portland cement, silica sand and fly ash, fiber types (polypropylene (PP), and polyvinyl alcohol (PVA)). The objective main aim of the research is to investigate the flexural performance of a series of RC beams that were externally bonded (EB) with steel bars using the engineered cementitious composite (ECC) matrix near-surface mounted technique. A total of 5 RC beams by 1500 mm as a length, 150 mm as width, and 200 mm as height, including one control and four strengthened, were prepared and tested. The test parameters are strengthening configurations and glue matrix (ECC and Epoxy). The test results revealed that ECC is an ideal cement matrix for reinforcement applications where ECC and Epoxy mortar bonded with steel bars are used as exterior reinforcement. As a result of what ECC has a number of attractive properties. The most unique aspect is the high tensile ductility, which is hundreds of times that of concrete while maintaining compressive strengths similar to concrete or high strength

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Impact of past environmental changes on the genetic diversity of the remnant natural populations of Cilician fir in Lebanon

International audienceAbies cilicica (Antoine & Kotschy) Carrière is a conifer species belonging to the high mountain ecosystems of Southern Turkey, Northwestern Syria and Northern Lebanon. In Lebanon, the Cilician fir forests reach their southernmost distribution and are being degraded by a variety of threats from grazing to intensive logging. The aim of this study is to highlight the genetic diversity status of these forests for future conservation strategies. Hence, we have extensively sampled 15 populations and performed genetic analyses using 10 nuclear microsatellite markers. Concomitantly, we are currently analyzing the pollen content of two new fossil records collected in the vicinity of fir populations. The founder effect that promoted the existence of these forests partly dictated the genetic diversity of their populations. A low level of genetic differentiation and no isolation by distance were found between populations suggesting the existence of a significant historical gene flow between populations, therefore, a rather recent fragmentation of these populations is mostly probable. A pollen record spanning the last 30 kyr BP is under study. This will allow us to confirm whether or not Abies cilicica was continuously present in the area

Impact of past environmental changes on the genetic diversity of the remnant natural populations of Cilician fir in Lebanon

International audienceAbies cilicica (Antoine & Kotschy) Carrière is a conifer species belonging to the high mountain ecosystems of Southern Turkey, Northwestern Syria and Northern Lebanon. In Lebanon, the Cilician fir forests reach their southernmost distribution and are being degraded by a variety of threats from grazing to intensive logging. The aim of this study is to highlight the genetic diversity status of these forests for future conservation strategies. Hence, we have extensively sampled 15 populations and performed genetic analyses using 10 nuclear microsatellite markers. Concomitantly, we are currently analyzing the pollen content of two new fossil records collected in the vicinity of fir populations. The founder effect that promoted the existence of these forests partly dictated the genetic diversity of their populations. A low level of genetic differentiation and no isolation by distance were found between populations suggesting the existence of a significant historical gene flow between populations, therefore, a rather recent fragmentation of these populations is mostly probable. A pollen record spanning the last 30 kyr BP is under study. This will allow us to confirm whether or not Abies cilicica was continuously present in the area

Genotype dataset for 10 microsatellite markers for 5 Abies species

This dataset describes the genotypes detected for 10 nuclear microsatellite markers in 5 Abies species in the Mediterranean basin. Species and populations codes are those of the corresponding article