“Live Sun Smart!” Testing the effectiveness of a sun safety program for middle schoolers

Background: Skin cancer is a well-recognized public health issue, and primary prevention is the most effective strategy for reducing skin cancer risk. The current recommendations are that behavioral counseling for sun safety measures is most beneficial and effective for children and adolescents and that targeting this population at primary and middle schools is the ideal intervention strategy to increase sun-protective behaviors and reduce UV exposure, sunburn incidence, and formation of new moles. Numerous studies on the effectiveness of school-based sun safety interventions among elementary and middle school students have shown an increase in sun safety knowledge, attitudes, and behaviors following the intervention. Objective: To conduct a pilot feasibility study of “Live Sun Smart!,” (LSS) a school-based, multicomponent, interactive sun safety presentation, at changing sun safety knowledge, attitudes, and behaviors among middle school students. Methods: A non-randomized, single-group pretest-posttest interventional pilot study of the LSS program among children enrolled in grade 6. Results: After exposure to LSS, participants were more likely to give correct answers to knowledge-based sun safety questions and to report negative attitudes toward tanning. Minimal and not significant changes were found in self-reported sun safety behaviors, though students did report an intention to change behaviors following the intervention. Participants were satisfied with the program and believed it increased their sun safety knowledge. Conclusion: Live Sun Smart! appears to be an effective school-based, multicomponent sun safety program for improving sun safety knowledge and attitudes toward tanning among middle school students in this initial test of it. The strengths and weaknesses of this pilot study have implications for future research

Determination of the minimal clinically important difference of the UNC Dry Eye Management Scale

Purpose: To establish an initial estimation of the MCID of the University of North Carolina Dry Eye Management Scale (UNC DEMS) and assess its association with patient perceptions of symptom change. Methods: Thirty-three patients (33.3% men, 67.7% women, mean age 60.5 yrs) with previous DEMS scores were recruited from a UNC ophthalmology clinic in spring 2014. We used anchor-based methods, categorizing important symptom change, to compare the change in the DEMS scores across visits to patient assessments of change; linear regression coefficients estimated the MCID. We correlated clinical assessments, patient perceptions, and DEMS scores. Results: DEMS score changes correlated with global anchors [20.4229 (P = 0.014)]. Unadjusted linear regression yielded a beta coefficient of 20.54 (confidence interval, 20.97 to 20.12, R2 = 0.18, P = 0.014), which estimated the DEMS MCID. Adjusting the regression model for days since the last visit and DEMS score improved the association (beta = 20.56; confidence interval, 20.99 to 20.13; R2 = 0.43; P = 0.013). Descriptive statistics produced an MCID of 1 point. Patients said that 2 points would represent a significant change. The DEMS modestly correlated with the Schirmer test (20.4045, P = 0.0266), Oxford Grading Scheme (+0.3713, P = 0.0364), and tear breakup time (20.3559, P = 0.0456). Conclusions: The UNC DEMS is a valid, responsive patient-reported outcome measure instrument, which is easy to use in the clinic and capable of showing an MCID of 1 point

Status of Simulation-Based Training in Departments of Surgery in the United States

Background: Surgical simulation is particularly attractive because it allows training in a safe, controlled, and standardized environment. However, the status of surgical simulation among Departments of Surgery (DoS) in the United States is unknown. The objective of this study was to characterize the status of simulation-based training in DoS in the United States. Materials and methods: A Qualtrics online survey was sent to 177 chairs of DoS in the United States in March 2018 regarding the utilization of surgical simulation in their department. Questions in the survey were focused on simulation capacities and activities as well as chairs' perception of the value and purpose of simulation. Results: A total of 87 of 177 chairs responded to the survey (49% response rate). Most programs had either 20-50 trainees (42 of 87; 48%) or more than 50 trainees (37 of 87; 43%). Most chairs reported having a simulation center in their institution (85 of 87; 98%) or department (60 of 86; 70%) with a formal simulation curriculum for their trainees (83 of 87; 95%). Ninety percent (78 of 87) of DoS had protected time for simulation education for their residents, with most residents engaging in activities weekly or monthly (65 of 85; 76%). Although most chairs felt simulation improves patient safety (72 of 84; 86%) and is useful for practicing surgeons (68 of 84; 81%), only 40% reported that faculty use simulation to maintain technical skills and only 17% reported that faculty use simulation to address high complication rates. Conclusions: The vast majority of the DoS in the United States have established simulation activities for their trainees. However, engagement of faculty in simulation to maintain or improve their skills remains low

Practice variation in late-preterm deliveries: a physician survey

Objective: Late preterm (LPT) neonates account for over 70% of all preterm births in the US. Approximately 60% of LPT births are the result of non-spontaneous deliveries.The optimal timing of delivery for many obstetric conditions at LPT gestations is unclear, likely resulting in obstetric practice variation. The purpose of this study is to identify variation in the obstetrical management of LPT pregnancies. Study design: We surveyed obstetrical providers in NC identified from NC Medical Board and NC Obstetrical and Gynecological Society membership lists. Participants answered demographic questions and 6 multiple-choice vignettes on management of LPT pregnancies. Result: We obtained 215/859 (29%) completed surveys; 167 (78%) from Obstetrics/Gynecology, 27 (13%) from Maternal-Fetal Medicine, and 21 (10%) from Family Medicine physicians. Overall, we found more agreement on respondents’ management of chorioamnionitis (97% would proceed with delivery), mild preeclampsia (84% would delay delivery/expectantly manage), and fetal growth restriction (80% would delay delivery/expectantly manage). We found less agreement on the management of severe preeclampsia (71% would proceed with delivery), premature preterm rupture of membranes (69% would proceed with delivery), and placenta previa (67% would delay delivery/expectantly manage). Management of LPT pregnancies complicated by PPROM, FGR, and placenta previa vary by specialty. Conclusion: Obstetrical providers report practice variation in the management of LPT pregnancies. Variation might be influenced by provider specialty. The absence of widespread agreement on best practice might be a source of modifiable LPT birth

Teaching procedural skills to medical students: a pilot procedural skills lab

Background: Medical students have limited confidence in performing procedural skills. A pilot study was conducted to evaluate the effect of a multifaceted Procedural Skills Lab (PSL) on the confidence of medical students to perform procedural skills. Methods: Twelve 2ndyear medical students were randomly selected to participate in a pilot PSL. The PSL students met with an instructor for 2 h once a week for 4 weeks. Students participated in a flipped classroom and spaced education program before laboratory sessions that included a cadaver laboratory. Procedural skills included a focused assessment with sonography in trauma (FAST) scan, cardiac echocardiogram, lumbar puncture, arthrocentesis, and insertion of intraosseous and intravenous catheters. Students in the PSL were asked to rank their confidence in performing procedural skills before and after completion of the laboratory sessions (Wilcoxon ranked-sum test). A web-based questionnaire was also emailed to all 2ndyear medical students to establish a baseline frequency for observing, performing, and confidence performing procedural skills (Mann–Whitney U-test). Results: Fifty-nine percent (n = 106) of 180 2ndyear medical students (n = 12 PSL students [treatment group], n = 94 [control group]) completed the survey. Frequency of observation, performance, and confidence in performing procedural skills was similar between the control and treatment groups at baseline. There was an increased confidence level (p < 0.001) for performing all procedural skills for the treatment group after completion of the PSL. Discussion: An innovative PSL may increase students' confidence to perform procedural skills. Future studies will examine competency after a PSL

The future of pediatric pulmonology: A survey of division directors, assessment of current research funding, and discussion of workforce trends

Adequacy of the US workforce in pediatric pulmonology has been a source of serious concern within the field for some time, as it has been for several pediatric subspecialties. Contributing factors have been thought to include low fill rates of fellowship training programs, aging, and retirement rates of the subspecialist population, and the perception of insufficient numbers of specialists in some regions to meet clinical care needs. Several approaches to assessing workforce needs have already been described, and stakeholder groups are currently working on additional analyses. Although the recent report by Harris et al. captured a broad snapshot of workforce perceptions of 485 pediatric pulmonologists, this study (reporting data collected in 2014) did not address the future scope of practice

Association between furosemide in premature infants and sensorineural hearing loss and nephrocalcinosis: a systematic review

Abstract Furosemide is a potent loop diuretic commonly and variably used by neonatologists to improve oxygenation and lung compliance in premature infants. There are several safety concerns with use of furosemide in premature infants, specifically the risk of sensorineural hearing loss (SNHL), and nephrocalcinosis/nephrolithiasis (NC/NL). We conducted a systematic review of all trials and observational studies examining the association between these outcomes with exposure to furosemide in premature infants. We searched MEDLINE, EMBASE, CINAHL, and clinicaltrials.gov . We included studies reporting either SNHL or NC/NL in premature infants (< 37 weeks completed gestational age) who received at least one dose of enteral or intravenous furosemide. Thirty-two studies met full inclusion criteria for the review, including 12 studies examining SNHL and 20 studies examining NC/NL. Only one randomized controlled trial was identified in this review. We found no evidence that furosemide exposure increases the risk of SNHL or NC/NL in premature infants, with varying quality of studies and found the strength of evidence for both outcomes to be low. The most common limitation in these studies was the lack of control for confounding factors. The evidence for the risk of SNHL and NC/NL in premature infants exposed to furosemide is low. Further randomized controlled trials of furosemide in premature infants are urgently needed to adequately assess the risk of SNHL and NC/NL, provide evidence for improved FDA labeling, and promote safer prescribing practices.https://deepblue.lib.umich.edu/bitstream/2027.42/146523/1/40748_2018_Article_92.pd

Application of assessment metrics for an academic department faculty development program

Faculty development is increasingly seen as a cornerstone of career sustainability in academic medicine, pediatrics, and other disciplines. Many current senior academic medical faculty developed their careers in systems that are distinctly different from current paradigms. Multiple internal and external variables have caused the academic environment to transform. These variables include rapidly changing technology, the opening of the academy to public scrutiny, external rankings, changes in the opportunities for academic advancement (including the increasing predominance of non–tenure track faculty), sharp reductions in protected time for teaching, increased pressure to meet measurable benchmarks for academic and financial productivity, and an increased emphasis on multidisciplinary team science to more rapidly advance biomedical research. Faculty must also become adept at assessing learning outcomes, and engaging in collaborative projects that couple scholarly expertise with the local, national, or international communities. The increasing incidence of burnout and other sequelae of chronic stress among medical faculty is well documented and has led to recommendations for more formalized institutional attention to these threats to the academic medical enterprise

A Review of Quality of Life Measures in Dry Eye Questionnaires

Dry eye disease (DED) is an ocular disease that affects 5% to 17% of the US population. Because of the negative effects of DED on patients’ quality of life (QOL), disease-specific questionnaires that assess QOL in patients with dry eyes are essential in the monitoring and management of this chronic ocular condition. This review provides clinicians and researchers with a summary of the current questionnaires available for assessing QOL in patients with dry eyes

Development of a proxy-reported pulmonary outcome scale for preterm infants with bronchopulmonary dysplasia

<p>Abstract</p> <p>Background</p> <p>To develop an accurate, proxy-reported bedside measurement tool for assessment of the severity of bronchopulmonary dysplasia (also called chronic lung disease) in preterm infants to supplement providers' current biometric measurements of the disease.</p> <p>Methods</p> <p>We adapted Patient-Reported Outcomes Measurement Information System (PROMIS) methodology to develop the Proxy-Reported Pulmonary Outcomes Scale (PRPOS). A multidisciplinary group of registered nurses, nurse practitioners, neonatologists, developmental specialists, and feeding specialists at five academic medical centers participated in the PRPOS development, which included five phases: (1) identification of domains, items, and responses; (2) item classification and selection using a modified Delphi process; (3) focus group exploration of items and response options; (4) cognitive interviews on a preliminary scale; and (5) final revision before field testing.</p> <p>Results</p> <p>Each phase of the process helped us to identify, classify, review, and revise possible domains, questions, and response options. The final items for field testing include 26 questions or observations that a nurse assesses before, during, and after routine care time and feeding.</p> <p>Conclusions</p> <p>We successfully created a prototype scale using modified PROMIS methodology. This process can serve as a model for the development of proxy-reported outcomes scales in other pediatric populations.</p