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Research has established that “cognitive rehearsal,” (CR) or the visualization of application of a behavioral response to a situation, can increase self-efficacy through vicarious experience, but is challenging to induce online. Online higher education curricula can include collaborative game-based learning (GBL) in the form or roleplaying, which can facilitate CR. The purpose of this study was to develop an online GBL module to facilitate CR in online business graduate students learning management theory case studies, and to evaluate its ability to induce CR. A convenience sample of students voluntarily participated in a proof-of-conduct study using a mixed-methods design to gauge whether use of the module facilitated CR, a descriptive and thematic analysis was conducted. Data were collected from 106 students within two course sections in an online Master of Business Administration (MBA) program. The module was used as an optional supplement to a management case study assignment and approximately 50% of students used it. Scores on the assignment were compared between students who used the module and students who did not, and those who did scored statistically significantly higher (p = 0.0003). Students reported in a survey that the module induced CR about applying management theory. Students also expressed satisfaction with the module and provided feedback for its improvement in the areas of format and content. Our findings suggest that collaborative roleplaying GBL and other methods to induce CR in online higher education should be explored and formally studied.

Objective:The objective of this narrative review is to summarize the current knowledge on the prevalence of periodontitis in the Kingdom of Saudi Arabia (KSA) and to make recommendations for monitoring and improving oral health in the KSA population.Background:Periodontitis is a significant health issue in the general population, so conducting routine public health surveillance for this condition is important in every country. KSA is currently implementing a strategic plan called Vision 2030 which aims to improve many of the country’s infrastructures, including healthcare.Methods:To conduct this narrative review, Google Scholar (GS) was used to search for peer-reviewed articles on the prevalence of periodontitis in KSA. No limits were placed on the year of publication, but only articles translated into English were considered. Search terms used included “Saudi Arabia”, “periodontitis”, “surveillance”, “prevalence”, “rates”, “oral health” and “dental”.Results:The earliest estimate identified was from 1992, in which the rate of lack of periodontal health was estimated to be 90% in KSA residents aged 25 and over. A more recent estimate reported rates around 50%, but used a different case definition. Studies on tobacco use, periodontal health and KSA established that how tobacco is used strongly influences periodontal status. Other dental studies in KSA focus on other topics. The Saudi Health Information Survey (SHIS) conducted in 2013 asked oral health questions, but did not seek to estimate the rates of periodontitis in KSA.Conclusion:The World Health Organization’s (WHO) recommendations suggest that KSA should conduct research to develop surveillance case definitions of periodontitis that will have specific utility in KSA, and can be standardized to compare KSA rates with the rates worldwide. The existing surveillance definitions and efforts in other countries have been considered less than optimal, so research is needed to inform KSA’s effort. Recommendations are made for a national oral health research agenda in KSA under Vision 2030.

Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.

This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in nursing is reviewed, along with two models – the diversity model and the cultural competence model – that were applied unsuccessfully to counteract racism in nursing. Second, a description of how racism is entrenched in nursing leadership globally is presented. Third, the recalcitrant structures that serve to maintain institutionalized racism (IR) in the international nursing education system are carefully examined. Specifically, the components and constructs involved in IR in nursing education are delineated, and the way in which these negatively impact both ethnic minority (EM) students and faculty are explained. Based on this, a global agenda to eliminate racism in nursing education internationally is proposed. Eliminating racism in higher education in nursing is a mandatory social responsibility if global healthcare is ever to be equitable. Five actionable recommendations are made to eliminate racism in higher education are summarized as follows: (1) components of nursing programs which are designed to eliminate racism in nursing education should be governed at the country level, (2) to design and implement a system of surveillance of the global nursing community to enable standardized measurement to ensure nursing education programs in all countries are meeting anti-racism benchmark targets, (3) nursing education programs should be established worldwide to provide individual pipeline and mentorship programs to ensure the career success of EM nursing students and faculty, (4) nursing education programs should be conducted to reduce barriers to EM participation in these individual support programs, and (5) nursing education programs are required to teach their nursing faculty skills in developing anti-racist curricula that seeks to eliminate implicit bias.

Background: Couples who are at risk for having an infant with a serious genetic disorder can benefit from pre-implantation genetic diagnosis (PGD), but many couples still opt for the riskier pre-natal diagnosis (PND). Although couples make this decision together, the male and the female in the couple may have different attitudes toward choosing PGD vs. PND. The objective of this study was to determine if men and women in the same couple with at least one child with a genetic disorder will have significantly different attitudes toward choosing PGD vs. PND. Methodology: In this cross-sectional clinical study, couples with at least one child with a genetic disease attending the King Faisal Specialist Hospital Research Center, Genetic Counseling Clinic (KFSH-RC, GCC), Riyadh, Saudi Arabia were asked to complete an anonymous survey about their attitudes towards PGD vs. PND. The responses were compared between men and women in couples. The study was conducted during May 2017. Results: A total of 38 couples provided complete surveys. In terms of preference for PGD vs. PND, there were no significant differences in aggregate between men and women (p > 0.05). Over half the couples agreed (were concordant) on all statements about PGD vs. PND. An almost equal number of couples with members who disagreed (were discordant) had women preferring PND vs. men preferring PND compared to PGD. Conclusion: This study showed that members of couples sampled were generally in agreement about their preference for PGD vs. PND. Among discordant couples, there was no preference among women for PGD vs. PND. Studies like this are important to help clinicians understand intra-couple dynamics in genetic counseling.

Background Health care-associated infections, specifically catheter-associated urinary tract infections (CAUTIs), can cause significant mortality and morbidity. However, the process of collecting CAUTI surveillance data, storing it, and visualizing the data to inform health policy has been fraught with challenges. Objectives No standard has been developed, so the objective of this article is to present a prototype solution for dashboarding public health surveillance data based on a real-life use-case for the purposes of enhancing clinical and policy-level decision-making. Methods The solution was developed in open source software R, which allows for the creation of dashboard applications using the integrated development environment developed for R called RStudio, and a package for R called Rshiny. How the surveillance system was designed, why R was chosen, how the dashboard was developed, and how the dashboard features were programmed and function will be described. Results The prototype dashboard includes multiple tabs for visualizing data, and allows the user to interact with the data by setting dynamic filters. Controls were used to facilitate the interaction between the user and application. Rshiny is reactive, in that when the user (e.g., clinician or policymaker) changes the parameters on the data, the application automatically updates the visualization as well as parameters available based on current filters. Conclusion The prototype dashboard has the potential to enhance clinical and policy-level decision-making because it facilitates interaction with the data that provides useful visualizations to provide such guidance.

BackgroundUnfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success.ObjectiveThe purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US.MethodsA narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations.ResultsBased on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field.ConclusionsRecommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.

Background: The rate of periodontitis in the US population has been estimated to be close to 50%. Patients with periodontitis, especially those who smoke, suffer from a high rate of tooth loss. The purpose of this analysis is to evaluate predictors of poor oral health and oral health habits among smokers and determine if trying to quit smoking is associated with better oral health or oral health habits in smokers in the United States.Methods: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. After limiting the dataset to smokers, the designated exposure was respondent’s report of trying to quit smoking (yes/no). Two logistic regression models were developed. One model identified factors associated with having a most recent dental visit longer than 1 year before the survey. The second model identified factors associated with loss of six or more teeth. Both models were controlled for confounding factors.Results: After controlling for confounding, among smokers ...

Introduction: Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Method: Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. Results: The three major themes identified from the participants’ stories were “fear/anger and disappointment” (FAD), “road/journey to success/overcoming challenges” (RJO), and “moving forward” (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. Discussion: NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.

Although course management systems (CMSs) provide technology platforms that help faculty members adopt better techniques for teaching and learning, and training contributes to faculty information technology (IT) use, many higher education faculty members do not complete CMS training programs, resulting in underuse of CMSs. Therefore, the overall purpose of this research was to address how instructor perceptions influence willingness to complete IT training on CMSs, and to discern techniques university administrators can implement to improve training completion rates and, ultimately, CMS adoption rates. The basic design of the study was a cross-sectional survey. Data were obtained from 102 public university faculty members who responded to an anonymous, web-based survey about their perceptions of the relative advantage, compatibility, complexity, trialability, and observability of their institution’s CMS. The data were analyzed using multiple linear regression models. Compatibility, defined as the degree to which instructors perceive the CMS as being consistent with their existing values, past experiences, and current or future teaching needs, was statistically significantly associated with willingness to complete online and in-person CMS training after controlling for other factors. Major findings suggest that faculty training on the CMS is not “one size fits all.” If greater use of CMSs by faculty is to be achieved, university administrators should consider compatibility of teaching style with CMS adoption when developing and promoting CMS training.

Recombinant factor VIIa (rFVIIa, NovoSeven RT, Novo Nordisk) was approved by the Food and Drug Administration (FDA) in 1999 for the prevention and treatment of bleeding episodes in hemophilia patients with inhibitors against clotting factors.[1][1] After its approval, rFVIIa was regarded as a “

Background Numerous factors have been linked to surgical career choice, including the quality of third-year surgical clerkship. The vast majority of studies also selectively evaluate one or only a few variables that link to surgical career choice, so relative impact cannot be assessed. This study simultaneously evaluates the majority of variables linked to surgical career choice in previous research so that the relative contributions of each of these variables with respect to surgical career choice can be determined. Study Design Surveys before, during, and after the third-year surgical clerkship included student demographics, background, and values (eg, importance of money, controllable lifestyle), and student reactions to the third-year surgical clerkship. The dependent variables in this study included interest in surgery at the beginning and end of the clerkship and matching into a surgical residency. Results Both univariate and multivariate analyses generally supported findings in the literature, but the strengths of these associations reported previously might not have been accurate. In this study, the surgical resident match odds ratio for students starting the clerkship already knowing they wanted to be a surgeon was 22.46; the next highest associations were 4.65 and 3.37, which corresponded to earlier exposure to a surgical specialty and earlier exposure to general surgery, respectively. Differences in career choice for general surgeons and surgical specialists were also explored. Conclusions Although the experience of the clerkship is related to career choice, the largest impact of the clerkship is for those already interested in a surgical career. Interest in a surgical career largely develops before the third-year clerkship. Implications of the results for recruiting greater numbers of students into surgical careers are discussed.

Purpose: Rhabdomyolysis (RM) is a skeletal muscle disorder resulting in severe cellular injury caused by vigorous physical activity and other systemic etiologies. RM is associated with significant morbidity, such as acute renal failure, and can be fatal. RM that occurs in the US Active Duty Army (ADA) results in time lost from training, deployment, and combat. We sought to systemically describe the epidemiology of ADA clinical RM by quantifying RM in terms of absolute numbers, examine rate trends, and identify soldiers at elevated risk. Methods: We used data from the Total Army Injury and Health Outcomes Database to calculate yearly RM rates in the overall ADA, as well as adjusted RM rates within soldier subpopulations for 2003�2006. Results: During this period, the absolute numbers of clinically diagnosed ADA RM ranged between 382 and 419 cases per year. Annual rates were 7�8 per 10,000, which is 300%�400% higher than the estimated US civilian population (2 per 10,000). In soldiers with a history of a prior heat injury, RM rates climbed to 52�86 per 10,000, a 7- to 11-fold increase. Increased RM rates were seen in soldiers who are male, African American, younger, less educated, and with a shorter length of service. Approximately 8% of yearly ADA RM cases resulted in acute renal failure, an estimate lower than that for the US civilian population. Conclusions: Our findings suggest that rates of RM are higher in the ADA than in the US civilian population. Rates remained fairly stable; however, relative to other ADA soldiers, those with prior heat injury, who are African American, or who have a length of service of less than 90 d are at the highest risk for RM development

Ankle and foot injuries (AFI) are a major cause of Active-Duty Army (ADA) soldiers' time lost from training and combat operations. We used the Total Army Injury and Health Outcomes Database to compute the rates of AFI to identify high-risk ADA groups for the years 2000–2006. During this time, 16% of soldiers were clinically seen at least once for an AFI. Yearly, 60% to 70% of ADA soldiers with AFI had an ankle sprain/strain, and ankle sprain/strain had the highest 7-year rate of all AFIs (103 per 1,000). From 2000 to 2006, all AFI rates declined; however, enlisted male soldiers ≤30 years of age without an advanced degree were at highest risk. A history of an AFI in the previous 2 years increased AFI rates by 93% to 160%. Our findings provide preliminary evidence for identifying specific ADA groups at high risk of AFI; these groups should be targeted for preventive interventions.

This is the second published case report of Lleuprolide acetate for depot suspension (LD)-induced mania. Both reports detail a patient with a prior psychiatric history of both depressive and hypomanic episodes. While depression is a predictable and documented side effect of LD and menopause (especially in those with a previous history of symptoms), manic reactions are rare and unexplained. Possible causative mechanisms behind the LD-induced manic episodes are discussed, and we suggest that patients with a single previous hypomanic episode are at risk for LD-induced mania.

We developed a personal digital assistant-based knowledgebase of surgical pathology report content recommendations and performed an experimental trial to test if the knowledgebase improved report completeness. The 15 experimental group and 13 control group residents were given microscope slides and corresponding reports with the final diagnosis section blanked-out, and were asked to complete the final diagnosis section during 3 study episodes (T0, T1, and T2). At T0 (baseline), experimental group and control group produced reports of comparable completeness. During T1, experimental group was allowed to use the knowledgebase while completing reports. During T1, experimental group produced more complete reports and were better judges of report completeness than control group. At T2, when neither group used the knowledgebase, experimental group's performance was still statistically better than control group's. Use of the knowledgebase did not ensure report completeness, but was associated with more complete reports and more accurate judgments of report completeness, and this performance advantage persisted in the absence of the knowledgebase.

Introduction. Choosing surgery as a career is declining among U.S. medical students. The 8-wk third year surgery clerkship at our institution can be an intense learning experience, and we hypothesized that during this clerkship medical student quality-of-life would drop significantly from baseline, and that this drop would be greater among certain subgroups, such as women students not interested in pursuing a surgical career, and those who place a high value on a controllable lifestyle. Methods. At clerkship orientation (baseline), students were asked to complete a survey that measured quality-of-life on an 84-point scale, and depression on a 40-point scale. The quality-of-life scale was composed of select questions from the Medical Outcomes Study, and the Harvard Department of Psychiatry/ NDSD brief screening instrument was used to measure depression. Students were also asked the typical number of hours they slept per night. Demographics, attitude toward a controllable lifestyle, and top three specialties of interest were also gathered at baseline. On week 6 of the clerkship, students were surveyed on the same quality-of -life and depression scales, and asked average hours of sleep per night for the previous week. Results. From June 2005 through December 2006, 143 of 177 (81%) students agreed to participate, and after exclusions for missing data, 137 students were included in the analysis. Sixty-nine students were women (51%), and the average age was 25.8 (sd 2.6). Mean quality-of-life at baseline was 57.0 (sd 11.3) and at week 6 was 50.4 (sd 10.1) representing a statistically significant average decline of 6.6 points (P < 0.0001). Mean depression at baseline was 14.4 (sd 3.8) and at week 6 was 15.1 (sd 3.6), representing a small but significant average decline of 0.7 points (P = 0.0155). Mean sleep at baseline was 6.3 h/night (sd 0.9) and at week 6 was 5.7 h/night (sd 1.2), representing a statistically significant average decline of 0.6 h/night (P < 0.0001). Declines were similar on all outcomes between men versus women, those who ranked surgery in their top three career choices versus those who did not, and those who ranked controllable lifestyle as "very important" versus all other categories. Conclusion. Quality-of-life and sleep declines and depression increases significantly in third-year medical students from orientation to week 6 of their surgery clerkship at our institution. We look forward to studying quality-of-life on other clerkships for comparison, assessing whether the magnitude of this decline in quality-of-life predicts students avoiding a future career in surgery, and testing interventions to prevent this decline in quality-of-life during the clerkship.

Individuals with lupus anticoagulants (LA) are at risk for thromboembolism (TE). Chronic inflammation is an important characteristic in LA patients which may dispose for TE. Platelets play a key role in inflammation and TE. We therefore investigated gene polymorphisms as well as plasma levels of platelet receptors as predictors of TE in 107 LA patients. We compared 74 patients with a history of thromboembolic disease (TE+), 56 with venous thrombosis (VT), 12 with arterial thrombosis (AT), and six patients who had both, with 33 LA patients without previous thrombosis (TE-). The P-selectin Pro715 allele was slightly more frequent in VT (OR = 3.167,95% CI 0.955-10.503; p = 0.0594), but no patient with AT had this allele (OR = 0.099, 95 % CI 0.001-0.790; p = 0.0238) which therefore may protect from AT. Plasma levels of P-selectin, collected a median of 35 months (range 2-329 months) after the last thrombotic event, were higher in patients withVT (p = 0.0096) than in TE-, but not with AT (p = 0.4713). These high P-selectin levels were not explained by the P-selectin polymorphism. The CA repeat polymorphism in the 3'-noncoding region of CD154 was significantly associated with the development of AT (OR = 4.035,95 % CI 1.329-12.249; p = 0.0138). Plasma levels of CD154 were not significantly different among the subgroups. Thus, the Thr715Pro polymorphism of P-selectin and CA repeats of CD154 are differentiating between the risk for VT and AT. Further, soluble P-selectin is elevated in LA patients with previous VT, but its role to predict VT needs to be evaluated in prospective studies.

To establish the effect of a quality control failure on the performance of the LCx-GC nucleic-acid amplification assay for Neisseria gonorrhoeae (Abbott Laboratories, Abbott Park, IL) in the field, we conducted a retrospective analysis comparing the clinical and analytic performance of the recalled lots with those not implicated in the recall. Our analysis revealed no statistically significant differences between recalled lots (n = 8,686 tests) and nonrecalled lots (n = 8,699 tests) with respect to multiple parameters of assay performance, including frequency distribution of patient results ( P = .575), prevalence of indeterminate results ( P = .245), mean positive control signals ( P = .26), and within-run calibrator precision ( P = .68). The LCx-GC system’s lack of an electronic data storage and retrieval capability prevented assessment of the impact of the quality control failure on the clinical performance of recalled lots, such as the one described herein, from being conducted in real time.

Papanicolaou (Pap) test discrepancy rates between cytotechnologists (CTs) and cytopathologists (CPs) are often kept to evaluate the performance of individual CTs. This is based on the unproven assumption that the CP's diagnoses are more likely to be correct. We investigated this assumption using data from our discrepancy files and comparing them to follow-up histology. All Pap test discrepancies were noted between January 1, 2001-December 31, 2001. Surgical pathology files were then searched for follow-up histology within 9 mo of the Pap test. Histologic diagnoses were compared with the previous CT and CP diagnoses, and then judged regarding accuracy. In total, 63,376 Pap tests were evaluated between January 1, 2001-December 31, 2001. There were 795 discrepancies throughout this period (1.25%). One hundred and sixty-six cases with discrepancies had follow-up histology within 9 mo of the Pap test (20.9%). Of downgraded cases (103), CPs were more correct in 51 cases (49.5%), whereas CTs were more correct in 52 cases (50.5%). Of upgraded cases (63), CPs were more correct in 19 cases (30.2%), whereas CTs were more correct in 44 cases (69.8%). Our results suggest that CPs are not more likely to be correct than CTs when there is a discrepancy with the diagnosis of a Pap test, especially when CPs upgrade CT diagnoses. This suggests that discrepancy data may be helpful for evaluating the performance of both CPs and CTs. It may also be of educational use for both CPs and CTs to know the follow-up histology in these cases.

We sought to summarize knee injuries (KI) in the U.S. Active Duty Army (ADA) in terms of absolute numbers, examine current rate trends, and identify ADA who were at increased risk for experiencing a KI. We used the Total Army Injury and Health Outcomes Database (TAIHOD) to compute unadjusted and adjusted rates of KI, categorized by the Barell Matrix, within the ADA for the years 2000-2005. During this period, 21 to 25 per 1,000 ADA suffered from KI. The highest yearly rates were observed for knee dislocation and sprains/strains (31 per 1,000 ADA). In ADA with a history of a KI (within 2 years), rates increased nearly tenfold. Elevated KI rates were also seen in ADA with prior upper or lower leg injuries, those30 years of age, and those with a category IV Armed Forces Qualification Test score (lowest admissible in Army). ADA KI rates remained fairly stable throughout the study period. Relative to other ADA Soldiers, those with prior knee, upper leg, or lower leg injuries are at increased risk for subsequent KI.

Purpose Pancreatic cancer (PCA) is the fourth leading cause of cancer death in the United States. The male-to-female incidence and mortality ratio of PCA is 1.1–2.0. One possible explanation for this difference is that female hormone exposure is protective for the development of PCA. Several hypotheses were investigated in this systematic review: (1) increased exposure to estrogen through early menarche and later menopause is associated with a decreased risk of PCA; (2) increased exposure to pregnancy is associated with decreased risk of PCA; and (3) increased exposure to oral contraceptives and/or hormone replacement therapy is associated with decreased risk of PCA. Methods Of 371 articles identified, 10 case-control and 5 cohort studies met the criteria for our review. Odds ratios for case-control studies and hazard ratios for cohort studies and their accompanying 95% confidence intervals for analyses relevant to our hypotheses were considered in the review. Results For all 3 hypotheses, studies displayed inconsistent results, and this may have been due to the diversity of study populations, exposure quantification, analysis approach, confounding and other limitations, and biases across studies. Conclusions As there was no strong support for any of the 3 hypotheses, it appears that reproductive factors are not associated with the development of PCA in women.

We conducted a reliability study comparing single data entry (SE) into a Microsoft Excel spreadsheet to entry using the existing forms (EF) feature of the Teleforms software system, in which optical character recognition is used to capture data off of paper forms designed in non-Teleforms software programs. We compared the transcription of data from multiple paper forms from over 100 research participants representing almost 20,000 data entry fields. Error rates for SE were significantly lower than those for EF, so we chose SE for data entry in our study. Data transcription strategies from paper to electronic format should be chosen based on evidence from formal evaluations, and their design should be contemplated during the paper forms development stage.

Purpose of review Pancreatic neuroendocrine tumors are rare neoplasms often associated with a clinical syndrome. Their rarity makes a comprehensive study difficult at any single institution, while their uniqueness makes them desirable for investigation. This review summarizes recent information and advancements concerning pancreatic neuroendocrine tumor diagnosis, imaging characteristics, treatment algorithms, and staging. Recent findings Insulinomas and gastrinomas comprise the majority of functional pancreatic neuroendocrine tumors. Advances in their identification and diagnostic evaluation, imaging techniques, and treatment algorithms are presented. Furthermore, a new staging classification system has been proposed which may significantly improve the ability to conduct future multi-institutional investigations on pancreatic neuroendocrine tumors. Summary Although rare, a thorough understanding of pancreatic neuroendocrine tumors is essential for all physicians due to the wide variety of symptoms with which patients present. Currently, patients are often misdiagnosed for extended periods of time. This review summarizes the recently published literature about diagnosis, imaging, treatment, and staging of pancreatic neuroendocrine tumors.

Adrenalectomy rates seem to be increasing in Florida, possibly due to increased availability of laparoscopic adrenalectomy, identification of incidentalomas, and access to care for minorities. We hypothesized that the rate of adrenalectomies in Florida increased from 1998-2005 while characteristics of patients, diagnoses, operations, and operating physicians changed over this period.Prospectively-collected, mandatory-reported, hospital discharge data for all inpatient adrenalectomies undertaken in Florida from 1998-2005 were obtained along with Florida census and physician certification and education data. Characteristics of adrenalectomy patients, diagnoses, operations, and physicians were analyzed.1816 adrenalectomies were available for analysis. Yearly rates of adrenalectomy nearly doubled from 1.20 to 2.26 per 100,000 Florida residents (P = .0024). Overall, patient characteristics such as demographics, indications and comorbidities did not change, whereas hospital charges increased and length-of-stay (LOS) significantly decreased (P = .0031 and P.0001, respectively). There was a non-significant trend toward a yearly increase in physician volume and an inverse relationship between physician volume categories and mean LOS (P.0001).The rate of adrenalectomies is increasing in Florida. This increase was not associated with distinct trends in patient characteristics, although a significant decrease in LOS was identified. As these trends continue and adrenalectomy is applied more liberally, indications for adrenalectomy may need to be re-evaluated.

Introduction A deficit of surgeons currently exists in the health care workforce. We have designed a study that identifies predictors of students choosing a career in surgery. First, we conducted two feasibility studies, and on the basis of these data, designed a third study for addressing our specific aims. The design and one-year results for the new study are provided here. Methods For the feasibility studies, students participating in the third-year surgery clerkship at our institution were asked to complete surveys using two different study designs. For the new study, which began in June 2005, students complete surveys covering domains of interest at the beginning of the clerkship and at weekly intervals throughout the clerkship, and will be providing match results. Results The feasibility studies offered insight into ways to improve our study design. In the first year of this multi-year study, 93 students participated (response rate = 77%). Forty-five students were women (48%), and the average age was 26.09 (sd 2.85). Proportion of students rating general surgery or a surgery subspecialty in their top three choices for a career increased over the course of the clerkship by 24.7% (n = 32, 34.4% at baseline; n = 55, 59.1% at end of clerkship). Seventy-one students (76.3%) reported having a meaningful experience on the clerkship, and 30 (32.3%) received honors grades. Conclusion Our study design benefitted from the knowledge we gained from our feasibility studies. We look forward to achieving the necessary sample size in the next several years to report the final results of this study.

To determine whether certain histologic features are more common in cutaneous squamous cell carcinomas (CSCCs) arising in transplant recipients than in others, we assessed several features of CSCCs from 23 patients who had not undergone transplantation and 25 transplant recipients (size, depth of invasion, sun damage, nuclear atypia, keratinization, epidermal inclusion cyst [EIC]-like features, verrucous features [VFs], shape, and mitoses per 10 high-power fields). We analyzed relationships by using chi 2 and t tests and logistic regression analysis. Transplant recipients tended to be younger than control subjects (mean [SD] age, 56.2 [14.3]; 74.1 [10.6], respectively; P.0001) and less likely to show severe sun damage (P = .0455; chi 2). CSCCs with VFs and EIC-like features were associated strongly with transplantation: odds ratio, 12.57 (95% confidence interval, 1.28-123.47; P = .0162). No other features were associated significantly with transplant status. Posttransplant tumors commonly showed verrucous and EIC-like features mimicking benign conditions. The younger age of these patients, the frequent absence of solar elastosis, and the infrequent occurrence of well-differentiated verruco-cystic CSCC in the nontransplant population suggest a different pathogenesis in the development of these neoplasms. Pathologists should be aware of this pattern, especially when diagnosing small biopsy specimens from transplant recipients.

Introduction Rhabdomyolysis (RM) is a skeletal muscle disorder resulting in severe cellular injury caused by vigorous physical activity (exertional) as well as other systemic aetiologies (non-exertional). The sparse peer-reviewed literature on RM has limitations (eg, small samples and specialised study populations). We identified all clinically presenting RM in the entire US Active Duty Army (ADA) (2004–2007) to examine descriptive characteristics associated with RM in soldiers. Methods We utilised the Total Army Injury and Health Outcomes Database, which contains ADA personnel and health data, to develop crude and stratified annual rates. A case of RM was any soldier having an ICD-9-CM diagnosis code of 728.88 within inpatient or outpatient clinical encounter records, consistent with prior administrative data research. Soldier characteristics examined included gender, age, race, marital status, education and length of service. Results Annual rates of RM remained fairly stable, ranging from 53 to 66 RM cases per 100 000 soldiers. Subtle rate fluctuations were observed. Rates were highest for: African-Americans (AAs) (97–119 per 100 000), those with Conclusion AAs and