Clancywilhelmsen7474

OBJECTIVES/HYPOTHESIS Patient-reported outcome measures (PROMs) are communication tools to help patients convey their disease experience to medical providers and guide management decisions. However, the utility of healthcare outcome measures is dependent on patient literacy and readability of PROMs. If written for a more advanced literacy level, they can misestimate symptoms and add significant barriers to care, especially in the underserved. However, readability of head and neck (H&N) oncology PROMs has not been assessed. The aim of this study was to evaluate the readability of H&N oncology PROMs to assess whether they meet recommended readability levels. STUDY DESIGN Bibliometric review. METHODS Three readability measures Gunning Fog, Simple Measure of Gobbledygook, and FORCAST were used to evaluate the readability level of commonly used H&N PROMs. PROMs with sixth grade readability level or lower were considered to meet the recommendations of health literacy experts. RESULTS Eight H&N oncology PROMs were reviewed. None of H&N PROMs met health literacy experts' and National Institutes of Health recommended reading levels. Gunning Fog consistently estimated easiest readability and FORCAST the most difficult. CONCLUSIONS PROMs are important clinical tools that drive patient-centric care in H&N oncology. All H&N PROMs are written above recommended reading levels and do not meet suggested standards. selleck chemicals llc Future PROMs should be written with easier readability to accurately convey patients' H&N oncology disease experiences. LEVEL OF EVIDENCE 4 Laryngoscope, 2020. © 2020 The American Laryngological, Rhinological and Otological Society, Inc.'Cold' technologies and 'warm' hands-on medicine need to walk hand-in-hand Technologies, such as deep learning Artificial Intelligence (AI), promise benign solutions to thorny, complex problems; but this view is misguided. While AI has revolutionised aspects of technical medicine, it has brought in its wake practical, conceptual, pedagogical and ethical conundrums. For example, widespread adoption of technologies threatens to shift emphasis from 'hands on' embodied clinical work to disembodied 'technology enhanced' fuzzy scenarios muddying ethical responsibilities. Where AI can offer a powerful sharpening of diagnostic accuracy and treatment options, 'cold' technologies and 'warm' hands-on medicine need to walk hand-in-hand. This presents a pedagogical challenge grounded in historical precedent in the wake of Vesalian anatomy introducing the dominant metaphor of 'body as machine', a medicine of qualities was devalued through the rise of instrumental scientific medicine. The AI age in medicine promises to redoage. Their union will be fractious, requiring lifelong guidance provided by a perceptive medical education suspicious of 'smart' solutions to complex problems. This article is protected by copyright. All rights reserved.OBJECTIVES The objective of this study was to compare the ultrasound-measured inferior vena cava distensibility index (IVCdi), inferior vena cava distensibility variability (IVCdv), and inferior vena cava-to-aorta ratio (IVC/Ao) to other common methods to assess fluid status in mechanically ventilated pediatric critically ill patients. These methods include central venous pressure (CVP), percent fluid overload by weight (%FOw), and percent fluid overload by volume (%FOv). METHODS This was a prospective observational study of a convenience sample of 50 mechanically ventilated pediatric patients. Ultrasound measurements of the inferior vena cava and aorta were obtained, and the IVCdi, IVCdv, and IVC/Ao were calculated and compared to CVP, %FOw, and %FOv. RESULTS The median %FOw was 5%, and the median %FOv was 10%. The mean CVP ± SD was 8.6 ± 4 mm Hg. The CVP had no significant correlation with %FOw or %FOv. There was no significant correlation of the IVCdi with CVP (r = -0.145; P = .325) or %FOv (r = 0.119; P = .420); however, the IVCdi had a significant correlation with %FOw (P = .012). There was also no significant relationship of the IVCdv with CVP (r = -0.135; P = .36) or %FOv (r = 0.128; P = .385); however, there was a significant correlation between the IVCdv and %FOw (P = .012). There was no relationship between the IVC/Ao and any other measures of fluid status. CONCLUSIONS In this cohort of mechanically ventilated pediatric intensive care unit patients, many commonly used markers of fluid status showed weak correlations with each other. The IVCdi and IVCdv significantly correlated with %FOw and may have potential as markers for fluid overload in this patient population. © 2020 by the American Institute of Ultrasound in Medicine.OBJECTIVES To evaluate the usefulness of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) in diagnosing focal liver lesions (FLLs) by inexperienced radiologists. METHODS Images and clinical data from 258 patients at risk for hepatocellular carcinoma who underwent CEUS were collected retrospectively. Two trained inexperienced radiologists and 2 experienced radiologists reviewed all CEUS clips. Each inexperienced radiologist assigned a CEUS LI-RADS category for each observation and labeled it benign or malignant independently. Each experienced radiologist labeled each lesion malignant or benign independently using a conventional diagnostic method. Interobserver agreement of CEUS LI-RADS was analyzed by the κ test. link2 The overall diagnostic accuracy of the LI-RADS category and conventional diagnosis was described by the sensitivity, specificity, positive predictive value, and negative predictive value. All test results were considered significant at P  less then  .05. RESULTS A κ value of 0.774 indicated that the CEUS LI-RADS algorithm resulted in substantial consistency between the inexperienced radiologists. For the diagnosis of hepatocellular carcinoma, the sensitivity, specificity, positive predictive value, and negative predictive value were improved significantly in inexperienced radiologists using the CEUS LI-RADS compared to conventional methods. The overall diagnostic accuracy of the experienced radiologists was almost equal to that of CEUS LI-RADS categories assigned by the inexperienced radiologists. CONCLUSIONS The CEUS LI-RADS algorithm can not only obtain substantial consistency among inexperienced radiologists but also have excellent diagnostic efficacy in the differentiation of benign from malignant FLLs compared to conventional methods. As a comprehensive algorithm, the CEUS LI-RADS can act as a guide for trainees in learning how to diagnose FLLs. © 2020 by the American Institute of Ultrasound in Medicine.In the last two decades, simulation has become a key element of medical training. Trainees hone their communication skills with standardized patients as they 'break bad news' in front of an audience of their peers. They learn just how much pressure is enough while doing cardiopulmonary resuscitation on shockingly lifelike patient simulators. This article is protected by copyright. All rights reserved.OBJECTIVE To develop an automated, reproducible method for delineating hospital service areas (HSAs). DATA SOURCES/SETTING Discharge data from all Swiss acute care hospitals for the years 2013 to 2016. STUDY DESIGN We derived HSAs and hospital referral regions for Switzerland using a newly developed flow-based, automated, objective, and reproducible method using all discharge data. We compared our method to the classical, partially subjective approach used to delineate the Swiss Health Care Atlas by delineating four sets of intervention-specific HSAs. PRINCIPAL FINDINGS Based on 4 105 885 discharges, the fully automated method delineated 63 HSAs. Comparison with existing HSAs reveals good overlap and comparable measures of health utilization between the methods and shows that in the Swiss setting, our method outperforms a cluster-based approach to defining HSAs. While the classical method potentially takes an entire day to delineate the regions, our method took approximately 10 minutes. CONCLUSIONS Hospital service areas are used to analyze differences in use of health care that may indicate underuse and overuse. Our new, fully automated, objective, and reproducible method provides a useful tool for hospital services researchers that will enable them to delineate and update patient-flow-based HSAs. © Health Research and Educational Trust.OBJECTIVES Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an intraoperative ventilatory technique that allows avoidance of tracheal intubation (TI) or jet ventilation (JV) in selected laryngologic surgical cases. Unimpeded access to all parts of the glottis may improve surgical precision, decrease operative time, and potentially improve patient outcomes. The objective of this prospective, randomized, patient-blinded, 2-arm parallel pilot trial was to investigate the safety and efficacy of THRIVE use for adult patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. METHODS Twenty adult, American society of anesthesiology class 1-3 patients with body mass index (BMI)  less then  35 kg/m2 were randomly assigned to either an experimental THRIVE group or active comparator conventional ventilation group (TI or supraglottic high-frequency JV [SHFJV]). Primary outcomes included intraoperative oxygenation, anesthesia awakening/extubation time, time to laryngoscopy provide a framework for designing future adequately powered THRIVE trials. TRIAL REGISTER ClinicalTrials.gov (NCT03091179). LEVEL OF EVIDENCE II Laryngoscope, 2020. link3 © 2020 The American Laryngological, Rhinological and Otological Society, Inc.In their article in this issue of Medical Education, XX describe the nature of touch as a salient form of non-verbal communication that builds human connection through invoking empathy for patients.1 Their work introduces a humanist form of touch into professional practice that led me to wonder about the tension between our desire to maintain a sense of humanism among our practitioners and our teaching processes that promote the technification of medical expertise. By technification of medical expertise, I mean the repurposing of a human social activity to function as a procedural or diagnostic skill designed to gather data about the patient and determine what aspect of the patient requires curing. This article is protected by copyright. All rights reserved.KEY POINTS Sleep restriction has previously been associated with the loss of muscle mass in both human and animal models. The rate of myofibrillar protein synthesis (MyoPS) is a key variable in regulating skeletal muscle mass and can be increased by performing high-intensity interval exercise (HIIE), although the effect of sleep restriction on MyoPS is unknown. In the present study, we demonstrate that participants undergoing a sleep restriction protocol (five nights, with 4 h in bed each night) had lower rates of skeletal muscle MyoPS; however, rates of MyoPS were maintained at control levels by performing HIIE during this period. Our data suggest that the lower rates of MyoPS in the sleep restriction group may contribute to the detrimental effects of sleep loss on muscle mass and that HIIE may be used as an intervention to counteract these effects. ABSTRACT The present study aimed to investigate the effect of sleep restriction, with or without high-intensity interval exercise (HIIE), on the potential mechanisms underpinning previously-reported sleep-loss-induced reductions to muscle mass.