Factors Associated with a Label of Failure to Cope in Older Medical Inpatients: a Case-Control Study*

Background &#x0D; The term failure to cope (FTC) is often used to dismissively describe hospitalized older adults. The purpose of this study was to identify the factors associated with receiving a label of FTC. &#x0D; Methods &#x0D; Age-matched, case-control study with electronic and paper chart review identifying patient characteristics and admis­sion details. &#x0D; Results &#x0D; One hundred eighty-five patients 70 years of age or older ad­mitted to a general medicine team over two years: 99 patients with the label of FTC and 86 controls. No patients labelled with FTC came from long-term care. Characteristics associ­ated with a label of FTC included living alone (aOR 3.8, 95% CI 1.9-7.8), falls (aOR 3.8, 95% CI 1.9-7.8), rehospitalization (aOR 3.6, 95% CI 1.7-8.0), and living in an independent dwell­ing (aOR 2.4, 95% CI 1.0-5.5). A higher number of chronic medications was associated with a lower likelihood of being labelled with FTC (aOR 0.9, 95% CI 0.8-1.0). &#x0D; Conclusions &#x0D; The results suggest that FTC is a label based predominantly on social factors and has no role in a medical assessment. The patient’s home setting was the key factor in being labelled with FTC, most medical factors did not play a significant role, and a pervasive language of blame was present. </jats:p

Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

Abstract Background Inadvertent perioperative hypothermia (&lt; 36 °C) occurs frequently during elective cesarean delivery and most institutions do employ perioperative active warming. The purpose of this retrospective observational cohort study was to determine if the addition of preoperative forced air warming in conjunction with intraoperative underbody forced air warming improved core temperature and reducing inadvertent perioperative hypothermia during elective repeat elective cesarean delivery with neuraxial anesthesia. Methods We evaluated the addition of perioperative active warming to standard passive warming methods (preheated intravenous/irrigation fluids and cotton blankets) in 120 parturients scheduled for repeat elective cesarean delivery (passive warming, n = 60 vs. active + passive warming, n = 60) in a retrospective observational cohort study. The primary outcomes of interest were core temperature at the end of the procedure and a decrease in inadvertent perioperative hypothermia (&lt; 36 °C). Secondary outcomes were surgical site infections and adverse markers of neonatal outcome. Results The mean temperature at the end of surgery after instituting the active warming protocol was 36.0 ± 0.5 °C (mean ± SD, 95% CI 35.9–36.1) vs. 35.4 ± 0.5 °C (mean ± SD, 95% CI 35.3–35.5) compared to passive warming techniques (p &lt;  0.001) and the incidence of inadvertent perioperative hypothermia at the end of the procedure was less in the active warming group - 68% versus 92% in the control group (p &lt;  0.001). There was no difference in surgical site infections or neonatal outcomes. Conclusions Perioperative active warming in combination with passive warming techniques was associated with a higher maternal temperature and lower incidence of inadvertent perioperative hypothermia with no detectable differences in surgical site infections or indicators of adverse neonatal outcomes. </jats:sec

Клінічно-імунологічні можливості своєчасної діагностики раку носоглотки

An increase of the incidence rate of pharyngeal carcinoma over the last few years and its delayed diagnostics, deteriorating a prognosis of the disease, stipulate the topical character of this particular topic. Present-day investigations demonstrate the presence of Epstein-Barr’s virus in patients with nasopharyngeal carcinoma. The paper has studied the parameters of Ig G titers to VCA and NA of Epstein-Barr’s virus in patients with chronic pharyngitis and has demonstrated a correlation between the high titers of the parameters and the presence of preclinical malignization in the nasopharynx. The obtained findings may help, when forming risk groups, based on nasopharyngeal carcinoma in patients with chronic pharyngitis that will improve the value of a timely diagnosis of the disease.Актуальность темы, изложенной в статье, обусловлена ростом заболеваемости раком носоглотки, поздней диагностикой болезни, что объясняет низкий процент излечения. Исследования, которые проводились в последние годы, демонстрируют присутствие вируса Эпштейн-Барра у пациентов с раком носоглотки. В статье изучались показатели титров Ig G к VCA и NA Эпштейн-Барр вируса у пациентов с хроническим фарингитом и продемонстрирована корреляционная связь между высокими титрами показателей и наличием доклинической малигнизации в носоглотке. Эти данные могут помочь при формировании груп риска по РН у больных с хроническим фарингитом, что может способствовать своевременной диагностике болезни.Протягом останніх років ріст захворюваності на рак носоглотки та його запізніла діагностика, що погіршує прогноз хвороби, зумовлюють актуальність даної теми. Сучасні дослідження демонструють наявність вірусу Епштейн-Барра у пацієнтів, хворих на рак носоглотки. У статті вивчалися показники титрів Ig G до VCA і NA вірусу Епштейн-Барра у пацієнтів із хронічним фарингітом, і продемонстрований кореляційний зв'язок між високими титрами показників та наявністю доклінічної малігнізації в носоглотці. Отримані дані можуть допомогти при формуванні групи ризику по раку носоглотки у хворих на хронічний фарингіт, що покращить показники своєчасної діагностики хвороби

Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions

BACKGROUND: Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. METHODS: Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. RESULTS: A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CONCLUSIONS: CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT

СТЕНДОВЕ ОБЛАДНАННЯ ДЛЯ ДОСЛІДЖЕННЯ МОДЕРНІЗОВАНИХ ГВИНТОВИХ КОНВЕЄРІВ

Розроблено експериментальне обладнання для проведення досліджень гвинтових транспортно- яке дозволяє провести експериментальні дослідження цих систем згідно розроблених методик, з можливістю моделювання досліджуваних процесів в широких діапазонах з високою точністю в автоматизованому режимі керування з фіксацією необхідних результатів дослідження. Встановлені основні напрямки дослідження та гіпотези

A Multi-Site Survey Study on the Association Between the COVID-19 Pandemic and United States Anesthesiology Residents’ Mental Health

BACKGROUND:  At the onset of the coronavirus disease 2019 (COVID-19) pandemic, anesthesiology residency programs were impacted differently due to various factors such as the local severity of COVID-19, exposure to patient suffering, and inability to complete rotations. We sought to investigate the impact of local-level pandemic severity on the well-being of anesthesiology residents. METHODS:  This multi-site study surveyed postgraduate year two residents from 15 United States (US) anesthesiology programs using the Perceived Stress Scale, Mini-Z, Patient Health Questionnaire-9,WHO-5 Well-Being Index,and the Multidimensional Scale of Perceived Social Support before the pandemic (baseline survey) and during the first COVID-19 surge (post survey). RESULTS:  A total of 144 (65%) residents responded to the initial baseline survey; 73 (33%) responded to the post survey, and 49 (22%) completed both surveys. There was not a statistically significant difference in any well-being outcomes of participants between the surveys, nor was there a significant difference based on the severity of COVID-19 impact at the program's hospital. Male participants had higher perceived stress scores (β = 4.05, 95%CI: 0.42, 7.67, P = 0.03) and lower social support from family (β = -6.57, 95%CI: -11.64, -1.51, P = 0.01) at the post survey compared to female participants after controlling for baseline scores. Additionally, married participants or those with domestic partners reported higher perceived social support in the post survey (β = 5.79, 95%CI: -0.65, 12.23, P = 0.03). CONCLUSION:  The local COVID-19 severity at a residency program did not disproportionately impact well-being scores among anesthesiology residents. Those most vulnerable to diminished well-being appeared to be male and single participants. As a result, targeted well-being interventions, including those aiming to increase social support, to higher-risk resident groups may be indicated. Future work is needed to assess the longstanding COVID-19 pandemic impacts on resident well-being