LMDA New & Noteworthy, October 2019

Contents include: Welcome! Letter from LMDA President; The Case for Good Practices; Upcoming Regional Events; Mentor Match.https://soundideas.pugetsound.edu/lmdanewsletter/1039/thumbnail.jp

LMDA New & Noteworthy, May 2020

Contents include: #LMDA2020 // Conference Countdown; Managing Life and Work in the Time of COVID-19: Thoughts from the LMDA Executive Committee; The Kennedy Center Dramaturgy Intensive: Learn from the best. Work with the best; Regional Events; Your Dramaturgy Ad Here; Pandemic Response: Resources for Artists in the U.S. and Canada (link).https://soundideas.pugetsound.edu/lmdanewsletter/1033/thumbnail.jp

A surgical anatomy training session improves knowledge and confidence in identifying anatomical structures among medical students on the surgical clerkship

Purpose Recent trends in medical education have shifted towards earlier clinical experiences with reduced preclinical time, thereby decreasing didactic time for human anatomy prior to surgical rotations. Here we assess a dedicated program designed to teach relevant general surgery principles to students at the beginning of their surgical clerkship. Methods All medical students who rotated on the surgery clerkship from 2022 to 2023 at a single institution were included. Students voluntarily and anonymously completed identical assessments prior to, 24 h after, and 10 weeks after participating in a required 4-h in-person prosection-based anatomy session. The assessment was comprised of (1) written multiple-choice questions, (2) image-based multiple-choice questions using intraoperative photographs, and (3) confidence scoring utilizing a 5-point Likert scale. Results Pre-session and post-session and post-clerkship test survey completion rates were 52% ( n  = 104), 27.5% ( n  = 55), and 20% ( n  = 30), respectively. Post-session and post-clerkship test written, image-based, and confidence scores were significantly higher than pre-test scores. Post-session and post-clerkship test scores were not different with the exception of written-based questions. Conclusions A focused general surgery anatomy session improves both written-based and image-based test performance as well as overall confidence in medical students’ understanding of surgical anatomy while completing the surgery clerkship. As medical school curricula continue to evolve with earlier clinical exposure at the expense of dedicated anatomy didactics, new methods that teach surgically relevant anatomy should continue to be explored to optimize medical education

Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

ObjectiveTo evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants.Study designProspectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared.ResultsMPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality.ConclusionsLow and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists

Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants

ObjectivesTo describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants.Study designThis was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated.ResultsOf 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality.ConclusionsThe majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay