Radiology residents from learners to teachers: A multi-centric study

Purpose: The teaching role of radiology residents has seldom been evaluated, and little is known about how teaching skills of radiology residents evolve throughout their training in the absence of formal teaching guidance. Our objective is to identify residents’ characteristics correlating with better teaching and compare teaching characteristics of junior and senior residents. Method: All seven medical schools in Lebanon were involved in this multi-centric study. A self-assessment questionnaire was sent to sixty-nine radiology residents and filled anonymously. Fifty-seven (83 %) responses were received and represent the study population. Data analysis was based on factors correlating with overall teaching effectiveness. A comparison of senior and junior residents’ responses was also performed. Results: Overall teaching effectiveness correlated with better knowledge, technical skills, clinical judgment, communication skills, identification and correction of learning problems, and importantly providing and receiving feedback. Senior residents rated themselves significantly better than juniors in “knowledge related to radiology” and in “technical skills” but not in “overall teaching effectiveness”. Seniors did not agree on the statement “medical students make my clinical responsibilities easier”. Although not reaching statistical significance, seniors showed a trend towards improving teaching skills. Conclusions: Overall teaching effectiveness is correlated with the adoption of proper skills and techniques. Despite the lack of formal teaching guidance, senior radiology residents are improving their techniques as teachers but still face difficulties in several domains. © 202

A streamlined pathway for transcatheter aortic valve implantation: the BENCHMARK study

Background and Aims There is significant potential to streamline the clinical pathway for patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the effect of implementing BENCHMARK best practices on the efficiency and safety of TAVI in 28 sites in 7 European countries. Methods This was a study of patients with severe symptomatic aortic stenosis (AS) undergoing TAVI with balloon-expandable valves before and after implementation of BENCHMARK best practices. Principal objectives were to reduce hospital length of stay (LoS) and duration of intensive care stay. Secondary objective was to document patient safety. Results Between January 2020 and March 2023, 897 patients were documented prior to and 1491 patients after the implementation of BENCHMARK practices. Patient characteristics were consistent with a known older TAVI population and only minor differences. Mean LoS was reduced from 7.7 +/- 7.0 to 5.8 +/- 5.6 days (median 6 vs. 4 days; P < .001). Duration of intensive care was reduced from 1.8 to 1.3 days (median 1.1 vs. 0.9 days; P < .001). Adoption of peri-procedure best practices led to increased use of local anaesthesia (96.1% vs. 84.3%; P < .001) and decreased procedure (median 47 vs. 60 min; P < .001) and intervention times (85 vs. 95 min; P < .001). Thirty-day patient safety did not appear to be compromised with no differences in all-cause mortality (0.6% in both groups combined), stroke/transient ischaemic attack (1.4%), life-threatening bleeding (1.3%), stage 2/3 acute kidney injury (0.7%), and valve-related readmission (1.2%). Conclusions Broad implementation of BENCHMARK practices contributes to improving efficiency of TAVI pathway reducing LoS and costs without compromising patient safety

Bio-inspired computation: where we stand and what's next

In recent years, the research community has witnessed an explosion of literature dealing with the adaptation of behavioral patterns and social phenomena observed in nature towards efficiently solving complex computational tasks. This trend has been especially dramatic in what relates to optimization problems, mainly due to the unprecedented complexity of problem instances, arising from a diverse spectrum of domains such as transportation, logistics, energy, climate, social networks, health and industry 4.0, among many others. Notwithstanding this upsurge of activity, research in this vibrant topic should be steered towards certain areas that, despite their eventual value and impact on the field of bio-inspired computation, still remain insufficiently explored to date. The main purpose of this paper is to outline the state of the art and to identify open challenges concerning the most relevant areas within bio-inspired optimization. An analysis and discussion are also carried out over the general trajectory followed in recent years by the community working in this field, thereby highlighting the need for reaching a consensus and joining forces towards achieving valuable insights into the understanding of this family of optimization techniques

Analysis of the Influence of Excavated Soil Sand Characteristics on the Rheological and Mechanical Properties of Hydraulic Mortars

This work investigates the effects of substituting natural sand with excavated soil sand in the formulation of hydraulic mortar developed from a self-compacting concrete (SCC). Four excavated soil sand deposits were studied to assess their physicochemical properties. Subsequently, a reference mortar (RM) was designed using the concrete equivalent mortar method. Furthermore, the effect of incorporating 30% of excavation soil sand under different moisture conditions (natural storage conditions, dry and saturated surface dry state) on the properties of mortar is studied. Spreading tests were carried out to observe how the rheological properties evolve over time. The study includes compressive and flexural strength tests at 2, 7, 14 and 28 days. The results showed that some sands had densities similar to those of natural alluvial sand, while others had lower densities. Water absorption values varied considerably from one sand to another, with some showing values ranging from 1% to 6%, while other sands had values of up to 10%. The results of spreading tests indicate that mortar made with sand in a saturated dry-surface state is more fluid than mortar made with sand in a dry state. Under all conditions, all mortars lose their fluidity over time. The variation in compressive strength among all excavated soil sand mortars compared to the reference mortar remained below 10% at 2 and 28 days, except for one sand with a high clay content. The incorporation of excavated soil sand at this percentage as a substitute for river sand led to an enhancement in the flexural strength of the mortar, with improvements of 40% and 50% observed for certain types of excavated sand. The statistical study revealed a strong relationship between the properties of the sand (in particular, the fines content and their nature, as well as the sand skeleton) and its saturation state, the flowability and the compressive strength of the mortar

Potential new indications and future studies

Despite lifestyle modification and pharmacological approaches, the rates of control of blood pressure are still not optimal. Experimental and clinical studies suggest that renal denervation therapy is an effective and safe treatment for patients with therapy-resistant hypertension leading to a reduction in blood pressure and in systemic and renal sympathetic nervous activation, which plays an important role in the development, progression and prognosis of arterial hypertension. Moreover, besides blood pressure reduction, renal denervation improves glucose metabolism, left ventricular hypertrophy and diastolic function in patients with resistant hypertension. Actually, many small clinical studies suggest that renal denervation may also be useful in diseases other than hypertension such as metabolic syndrome, sleep-related breathing disorders, chronic kidney disease and renal failure, chronic heart failure and polycystic ovary syndrome

The sympathetic nervous system in polycystic ovary syndrome: a novel therapeutic target?

Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with long-term health risks, including type 2 diabetes and vascular dysfunction in addition to reproductive sequelae. Many of the common features of PCOS, such as central obesity, hyperinsulinaemia and obstructive sleep apnoea (OSA), are associated with chronic sympathetic overactivity, suggesting that sympathoexcitation may be involved in the pathogenesis of this condition. Rodent models of polycystic ovaries have shown that ovarian sympathetic outflow may be increased, accompanied by elevated intra-ovarian synthesis of nerve growth factor (NGF) which may be involved in initiation of ovarian pathology. Patients with PCOS have evidence of increased muscle sympathetic nerve activity (MSNA), altered heart rate variability and attenuated heart rate recovery postexercise, compared with age- and BMI-matched controls, suggesting a generalized increase in sympathetic nerve activity. Active weight loss can reduce MSNA and whole body noradrenaline spillover, whereas low-frequency electroacupuncture decreased MSNA in overweight women with PCOS. Treatment of OSA with continuous positive airways pressure may reduce plasma noradrenaline levels and diastolic blood pressure and improve cardiac sympathovagal balance. Renal sympathetic denervation also reduced MSNA, noradrenaline spillover and blood pressure in two PCOS subjects with hypertension, accompanied by improved insulin sensitivity. The sympathetic nervous system may thus offer a new therapeutic target in PCOS but larger and longer-term studies are needed before these treatments can be considered in clinical practice

The autonomic nervous system as a therapeutic target in heart failure : a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology

Despite improvements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future

Renal sympathetic denervation for treatment of hypertension

Sympathetic nervous system activation of the heart, kidney and peripheral vasculature increases cardiac output, fluid retention and vascular resistance and plays an important role in acute and chronic BP elevation. Renal sympathetic denervation via a percutaneous radiofrequency catheter based approach is a safe and effective procedure that lowers BP in patients with resistant hypertension. Exploratory studies in patients with resistant hypertension and a variety of comorbidities, including insulin resistance/metabolic syndrome, obstructive sleep apnea and the polycystic ovary syndrome, have shown benefit of renal denervation in attenuating the severity of the comorbid conditions, as well as reducing BP. However, more studies are needed to further address the long term effects of renal denervation and its safety and effectiveness in other disease states such as congestive heart failure