From Race to Racism: Teaching a Tool to Critically Appraise the Use of Race in Medical Research.

INTRODUCTION: Despite the ubiquitous use of race within scientific literature, medical trainees are not taught how to critically appraise the use of racial categories. We developed a tool to appraise the use of race in medical literature and a workshop to teach this approach. METHODS: Third-year medical students and second- and third-year residents participated in workshops between 2015 and 2018. We evaluated our UME workshop with a postworkshop survey. We evaluated our GME workshop with a pretest, immediate posttest, and 6-month posttest on self-assessed knowledge, skills, and use of the Critical Appraisal of Race in Medical Literature (CARMeL) tool in subsequent journal clubs. RESULTS: We delivered this workshop to 560 students and 82 residents. Of the initial 140-student cohort evaluating the workshop, 99 (71% response rate) highly rated clarity of presentation, quality of teaching, and quality of slides. Of PGY 2 and PGY 3 residents, 67 (82% response rate) rated the workshop greater than 4.5 out of 5 on quality, clarity, and appropriateness of content. Residents had significant improvements in self-assessed knowledge and skills immediately after the session and 6 months later. Of residents, 74% reported using the CARMeL tool in subsequent presentations. DISCUSSION: We designed the CARMeL tool and a workshop to teach it. Trainees rated this workshop as useful, with the majority of residents later applying the tool. Limitations included a lack of objective assessment of knowledge acquisition. We recommend that institutions invest time in faculty development and pair new faculty with those experienced in anti-oppressive facilitation.

Single-System Experience With Outpatient Transradial Uterine Artery Embolization: Safety, Feasibility, Outcomes, and Early Rates of Return.

OBJECTIVE. The purpose of this study was to assess feasibility and rate of patients returning to the hospital when a same-day discharge protocol is used for patients undergoing transradial uterine artery embolization (UAE) for symptomatic fibroids. MATERIALS AND METHODS. A total of 374 patients who underwent transradial UAE with a same-day discharge protocol between April 2013 and June 2019, with documented follow-up, were included in this single-health-system retrospective study. Angiographic images and procedural reports were reviewed for technical success (defined as bilateral embolization). Electronic medical records were reviewed for patient and fibroid characteristics, adverse events, clinical success (defined as documented improvement in symptoms or patient satisfaction), and unplanned clinic visits, emergency department visits, and readmissions within 30 days of UAE. Univariate and multivariate analyses were used to identify risk factors for unplanned visits. RESULTS. Eight (2.1%) patients required conversion to inpatient stay (mean length of stay, 1.4 days; range, 1-3 days). The median postprocedure observation time was 3.7 hours (range, 1.1-12.5 hours). Technical success was achieved in 94.7% of patients, with 2.4% requiring crossover to the femoral artery for access. Clinical success was achieved in 86.0% of patients, with 6-month reductions in uterus and dominant leiomyoma volume of 30.4% and 42.9%, respectively. Rates of unplanned clinic visits, emergency department visits, and readmissions were 3.2%, 5.1%, and 0.5%, respectively. Patients with submucosal fibroids or pain as an indication for UAE were significantly more likely to have unplanned visits. CONCLUSION. Transradial UAE for symptomatic fibroids can be performed using a same-day discharge protocol with low rates of patients returning to the hospital. Submucosal location and pain as an indication for UAE were predictors of early return.

Assessing long term quality of life in geriatric patients after elective laparoscopic cholecystectomy.

INTRODUCTION: While cholecystectomy is shown to be safe in older patients, few existent studies investigate associated quality of life. This study examines quality of life in symptomatic geriatric patients after elective laparoscopic cholecystectomy. METHODS: Patients ≥65 years of age who underwent elective laparoscopic cholecystectomy at a tertiary care center were administered the 12-Item Short Form Survey (SF-12) and a gastrointestinal survey pre-operatively and post-operatively (within 6 and 18 months of surgery). Quality of life characteristics were compared amongst visit type in univariate and multivariate settings, with a mixed-model regression. RESULTS: Our sample included 30 patients. Pain frequency (p = 0.004) and pain severity (p = 0.013) scores improved with each subsequent visit type. SF-12 mental health aggregate score improved overall from pre-operative to long term follow-up (p = 0.0403). DISCUSSION: Our findings suggest that health-related quality of life in geriatric patients improves after elective laparoscopic cholecystectomy in the short and long term. SUMMARY: Quality of life was assessed in symptomatic geriatric patients undergoing elective laparoscopic cholecystectomy. Pain frequency, pain severity, and the SF-12 mental health aggregate scores improved overall from pre-operative to post-operative visit types.

Innate humoral immune defences in mammals and insects: The same, with differences ?

The insect immune response demonstrates many similarities to the innate immune response of mammals and a wide range of insects is now employed to assess the virulence of pathogens and produce results comparable to those obtained using mammals. Many of the humoral responses in insects and mammals are similar (e.g. insect transglutaminases and human clotting factor XIIIa) however a number show distinct differences. For example in mammals, melanization plays a role in protection from solar radiation and in skin and hair pigmentation. In contrast, insect melanization acts as a defence mechanism in which the proPO system is activated upon pathogen invasion. Human and insect antimicrobial peptides share distinct structural and functional similarities, insects produce the majority of their AMPs from the fat body while mammals rely on production locally at the site of infection by epithelial/mucosal cells. Understanding the structure and function of the insect immune system and the similarities with the innate immune response of mammals will increase the attractiveness of using insects as in vivo models for studying host - pathogen interactions.