Malmberghorne5702

d and improves risk-adjusted modeling of appendicitis outcomes. Level of evidence Prospective/Epidemiologic, Level III.Background Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns [UBC-HG]). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG impacts African Americans. We hypothesized that implementation of UBC-HG would reduce rates of firearm homicide of African Americans. Methods We collected Centers for Disease Control firearm homicide counts for African American and white populations in the 50 states, 1999 to 2017. Laws were drawn from the State Firearm Laws Database. The exposure and outcome of interest were UBC-HG adoption and firearm homicide. We included non-Hispanic African American and non-Hispanic white populations. We used Poisson regression to perform a differences-in-differences analysis. A categorical variable for state accounted for time-stable state characteristics. We controlled for year to rican Americans-the population most at risk. Expanding UBC-HG may be an effective approach to reducing racial disparities in firearm homicides. Level of evidence Epidemiological, level III.Background Efforts to reduce opioid use in trauma patients are currently hampered by an incomplete understanding of the baseline opioid exposure and variation in United States. The purpose of this project was to obtain a global estimate of opioid exposure following injury and to quantify the variability of opioid exposure between and within United States trauma centers. Study design Prospective observational study was performed to calculate opioid exposure by converting all sources of opioids to oral morphine milligram equivalents (MMEs). To estimate variation, an intraclass correlation was calculated from a multilevel generalized linear model adjusting for the a priori selected variables Injury Severity Score and prior opioid use. Results The centers enrolled 1,731 patients. The median opioid exposure among all sites was 45 MMEs per day, equivalent to 30 mg of oxycodone or 45 mg of hydrocodone per day. Variation in opioid exposure was identified both between and within trauma centers with the vast majority of variation (93%) occurring within trauma centers. Opioid exposure increased with injury severity, in male patients, and patients suffering penetrating trauma. Conclusion The overall median opioid exposure was 45 MMEs per day. Despite significant differences in opioid exposure between trauma centers, the majority of variation was actually within centers. This suggests that efforts to minimize opioid exposure after injury should focus within trauma centers and not on high-level efforts to affect all trauma centers. Level of evidence Epidemiological, level III.Background Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-donor kidney transplant recipients. Donor demographics, donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal management of hemodynamic instability in organ donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during donor management and the development of DGF. Methods Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with donor data through donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during donor ma during donor management did not predict the development of DGF. Level of evidence Prognostic study, Level III.Purpose Self-assessments and peer assessments of video recordings of performance have been used in a variety of educational and professional training programs; however, there is no literature on the application of such performance assessments in physician assistant (PA) education. The purpose of this pilot study was to both explore the feasibility of adding video recordings of existing practicum examinations to a physical diagnosis course and evaluate students' self-assessments and peer assessments of the activity. Methods Fifty first-semester students who were enrolled in a 7-semester PA program participated. Three 15-minute practicums were recorded on students' personal smartphones and uploaded to a private YouTube channel. Students completed self- and peer-review questionnaires after each practicum, as well as a separate reflective questionnaire at the end of the course to garner their feedback of the video-recorded practicums on their physical examination (PE) performance. Results Students assessed their peers' performances more favorably than their own. Students reported increased awareness of their own verbal and nonverbal communication strengths and weaknesses with the use of video-recorded practicums, as well as increased motivation to practice. The majority of students found these sessions to have improved their performance and decreased their anxiety with performing a complete PE at the end of the course. Conclusions The use of periodic video recordings of PE practicums with both self-assessments and peer assessments increased the students' level of practice of these important skills, enhanced students' awareness of nontechnical aspects of patient examination, was well received by the majority of students, and may be implemented with minimal expense.Purpose Burnout among health care professionals and preprofessional health care students is of growing concern because of its detrimental effects on performance, mental health, and physical health. Research to date has focused primarily on physicians and medical students. The purpose of this study was to assess burnout and the quality of life among physician assistant (PA) students and gauge their interest in specific wellness interventions that address those issues in their PA program. Methods An online survey consisting of validated measures for burnout and quality of life was completed by 320 PA students from all 8 Virginia PA programs (n = 8). Additionally, student interest in various wellness interventions was assessed, including preferences for timing and delivery, to inform development of a tailored well-being component in the PA curriculum to reduce burnout. Results We found burnout to be prevalent among PA students, with 79.69% reporting high levels of emotional exhaustion; 56.56% of students met the criteria for cynicism. Survey participants rated stress reduction (n = 290, 90.63%) and burnout (n = 299, 93.44%) as primary issues that need to be addressed in the PA student population. Furthermore, 77.50% of participants expressed interest in participating in a wellness intervention designed to reduce burnout. Conclusion Given the high prevalence of burnout in the PA students surveyed, resources and potential interventions that reduce burnout need to be identified. The current study identified PA students' perceived needs and interest in various aspects of potential wellness interventions in the PA program. Students preferred an emphasis on stress reduction and burnout, which can be used to develop a tailored well-being curriculum to promote work-life balance and stress management for PA students.The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at an in-person meeting of stakeholder professional and patient advocacy organizations in April 2019. This article summarizes the relevant literature, existing guidance, and validated tools to guide health care providers in the prevention, early detection, and special considerations of early-onset breast cancer. Substantive knowledge gaps were noted and summarized to provide guidance for future research.Background Fetal tachycardia can occur with maternal fever (hyperthermia); therefore, a low maternal temperature (hypothermia) might produce fetal bradycardia. Cases Five cases of fetal bradycardia are presented in gestations complicated by maternal hypothermia. The fetal heart rate (FHR) tracings demonstrated stable baselines of 88-96 beats per minute with moderate variability and accelerations. All baselines returned to normal after maternal warming measures. Conclusion A possible cause for fetal bradycardia with a stable baseline and moderate variability is maternal hypothermia, a pattern not indicative of fetal hypoxia. Delivery is not indicated, and maternal warming results in FHR baseline normalization.Tuberculosis (TB) in pregnancy poses a substantial risk of morbidity to both the pregnant woman and the fetus if not diagnosed and treated in a timely manner. Assessing the risk of having Mycobacterium tuberculosis infection is essential to determining when further evaluation should occur. Obstetrician-gynecologists are in a unique position to identify individuals with infection and facilitate further evaluation and follow up as needed. A TB evaluation consists of a TB risk assessment, medical history, physical examination, and a symptom screen; a TB test should be performed if indicated by the TB evaluation. If a pregnant woman has signs or symptoms of TB or if the test result for TB infection is positive, active TB disease must be ruled out before delivery, with a chest radiograph and other diagnostics as indicated. If active TB disease is diagnosed, it should be treated; providers must decide when treatment of latent TB infection is most beneficial. Most women will not require latent TB infection treatment while pregnant, but all require close follow up and monitoring. Treatment should be coordinated with the TB control program within the respective jurisdiction and initiated based on the woman's risk factors including social history, comorbidities (particularly human immunodeficiency virus [HIV] infection), and concomitant medications.Objective To assess neonatal morbidity and mortality according to whether cephalic second twins were born after internal version followed by total breech extraction or after instructions to push. We hypothesized that interval version would result in shorter intertwin delivery intervals and lower cesarean delivery rates for the second twin and therefore better neonatal outcomes. learn more Methods These planned analyses of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries, examined births of cephalic second twins after vaginal birth of the first twin at or after 32 weeks of gestation. The internal version group of second twins born in breech presentation after obstetric maneuvers was compared with the pushing group, comprising those born in cephalic presentation. The primary outcome was a composite of neonatal morbidity and mortality. Multivariate modified Poisson regression models were used to control for potential confounders. Results Of 2,256 cephalic second twins, 487 (21.