Exploring the content of epilepsy fellowship program websites: an analysis of information available to applicants.

BACKGROUND: Program websites are essential resources in the process of residency and fellowship application. We evaluated the information furnished on these resources by Epilepsy fellowship programs. The extent of information provided was compared across geographic zones, academic affiliation, and national ranking. METHODS: A list of Epilepsy fellowship programs was derived from the Fellowship and Residency Electronic Interactive Database (FREIDA). Links to program websites were obtained directly from FREIDA or using Google's search engine. Online data was categorized to reflect program information, education, recruitment, compensation, epilepsy center-specific information, and social media presence. Data points under each category were collected to develop a standardized scoring system. The frequency of criterion present was compared across geographic zones, academic affiliation, and national ranking using parametric and non-parametric statistical tests. Significance was determined at a p-value ≤ 0.05 for all cases. The study utilized IBM SPSS version 28 and Python 3.11.3. RESULTS: We analyzed 80 Epilepsy fellowship programs. The most reported feature was the program director's name and email (100.0%). The least reported features included board pass rates (1.3%), preparatory boot camp (8.8%), and post-fellowship placements (11.3%). Programs were found to be well-represented on X (88.8%), Facebook (81.3%), and Instagram (71.3%). Most (85.0%) of the programs were searchable through Google. The scores for program information, education, recruitment, compensation, epilepsy center-specific information, and social media visibility did not significantly vary based on location, academic affiliation, or rank status. CONCLUSIONS: Our results demonstrate that despite an online presence, there is much room for improvement in the content available to the applicant. To improve the Match process and attract a roster of well-informed fellows, Epilepsy fellowship programs should furnish program websites with up-to-date information relevant to program information, education, recruitment, compensation, and epilepsy center-specific information.

Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient Sample Database).

Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.

Hemophilia A with a Rare Presentation of Hemarthrosis and Arthropathy Involving Multiple Joints in a Young Male Child.

Hemophilia A is an X-linked hereditary bleeding disorder that is rarely encountered by most physicians and surgeons in their practice. Patients with mild hemophilia A tend to bleed profusely after surgery or trauma whereas a severe variant may manifest as spontaneous bleeding after minor trauma, mainly into the joints and muscles. However, seldom do we find a case where the patient experiences bleeding into multiple joints at the same time. In the South Asian population, the incidence of hemarthrosis in hemophilic patients holds scarce literature, making this an under-reported entity.

Bone Age Practices in Infants and Older Children among Practicing Radiologists in Pakistan: Developing World Perspective.

Objective To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group. Materials and methods A cross-sectional survey was conducted among 147 practicing radiologists in Pakistan. A pre-validated survey form was adopted from a similar study conducted amongst members of the Society for Pediatric Radiology. The survey collected demographic information, choice of bone age assessment technique in each age group and confidence of bone age assessments in each age group. Results The hand-wrist method of Greulich and Pyle was used by 87.5% of respondents when assessing bone age in infants (less than one year), followed by Gilsanz-Ratib hand bone age method (7.3%). In children aged one to three years, Greulich and Pyle method was chosen by 85.7% of respondents, followed by Gilsanz-Ratib hand bone age method (6.1%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.1%). In children, older than three years, the Greulich and Pyle technique was used by 83.7% of respondents. This was followed by Gilsanz-Ratib hand bone age method (5.8%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.8%). 26.4% were "very confident" in bone age assessments conducted among infants. In children aged one to three years, 38.1% were "very confident". In children, greater than three years, 48.6% were "very confident" in their chosen technique. Conclusion Greulich and Pyle is the dominant method for bone age assessments in all age groups, however, confidence in its application among infants and young children is low. It is recommended that clear recommendations be developed for bone age assessments in this age group alongside incorporation of indigenous standards of bone age assessments based on a representative sample of healthy native children.

Assessing reproducibility and the effects of demographic variables on the normal macular layers using the Spectralis SD-OCT.

PURPOSE: To quantify and view the possible influence of demographic variables on normal macular layers. Additionally, we wanted to assess the reproducibility using the Spectralis SD-OCT. METHODS: A Spectralis SD-OCT machine using a commercially available algorithm was used to scan 242 healthy subjects in an outpatient setting. We examined retinal thicknesses in seven layers: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL) and retinal pigment epithelium (RPE). Combined retinal thicknesses were expressed as inner retinal layer (IRL), photoreceptor layer (PL) and total retinal thickness (TRT). Measurements were taken from each of the nine sectors defined by the Early Treatment Diabetic Retinopathy Study; the center was the fovea, the inner circle (IC) was 1-3 mm away, and the outer circle (OC) was 3-6 mm away. RESULTS: The TRT was thickest inferiorly in the IC, and superiorly in the OC. The RNFL (P=0.030), GCL (P=0.006), IPL (P=0.006), IRL (P=0.030), PL (P<0.001) and TRT (P=0.001) were found to be thicker in males. The GCL (r=0.078, P=0.001), IPL (r=0.079, P=0.001), IRL (r=0.072, P=0.002), PL (r=0.076, P=0.001) and TRT (r=0.090, P<0.001) were found to decrease with age. The INL (r=0.060, P=0.010), ONL (r=0.078, P=0.001), and RPE (r=0.066, P=0.004) were inversely related to axial length. Excellent reproducibility was observed in all layers. CONCLUSION: Our study shows differences in various retinal layers according to age, gender, and axial length. Additionally, we demonstrate excellent reproducibility of this algorithm using the Spectralis SD-OCT.

Guiding hand hygiene interventions among future healthcare workers: implications of knowledge, attitudes, and social influences.

BACKGROUND: Medical students in their clinical years play an important role in healthcare delivery, yet poor levels of hand hygiene (HH) compliance in this population raise the risk for propagating nosocomial infections. To date, there has been a lack of dedicated interventions showing sustainable improvements in HH in this population. METHODS: A multicenter, cross-sectional study was conducted among 450 medical students in their clinical years (third to fifth years). A self-administered, pre-validated questionnaire based on the World Health Organization's "Knowledge" and "Perception" questionnaires was used to explore HH knowledge, attitudes, practices, and desired interventions. RESULTS: Self-reported HH compliance was found to be low (56.8%), and moderate HH knowledge (61.8%) was observed among all study respondents. Public university students expressed greater knowledge than students in private and semi-private universities. Superior HH practices were associated with better individual HH attitudes, positive perceived HH attitudes in other healthcare workers (HCWs), and higher HH knowledge scores. The highest-rated interventions for improving HH compliance included role-modeling by HCWs, display of "clear HH instructions," and "ensuring availability of hand sanitizers." CONCLUSION: Our results call for a multifaceted approach to improve HH compliance among medical students, by ensuring adequate HH supplies/hand sanitizers, providing HH training in curricula, and effecting a cultural change mediated by professional modeling and open communication.

Transient Smartphone Blindness: Precaution Needed.

The transient smartphone blindness (TSB) is a relatively new phenomenon that affects vision. However, it warrants immediate attention by the physicians and the smartphone users, lest it leads to long-term consequences such as blindness.

Barriers to Colorectal Cancer Screening in Pakistan.

Background The prevalence of colorectal cancer (CRC) is growing in Pakistan; however, there are no national screening programs or guidelines in place to curb its development. This study was conducted with the aim of ascertaining public awareness and attitudes regarding CRC and current screening practices. Furthermore, the study assessed perceived barriers which could impact future screening processes. Methods A cross-sectional, questionnaire-based study was conducted among urban dwellers of Karachi, Pakistan. We excluded any individuals belonging to the medical profession, those diagnosed previously with CRC or having any significant co-morbidity. The validated and pre-tested questionnaire was administered among the study participants to record demographic information, awareness of CRC risk factors, symptoms and screening tests. Attitudes towards screening and perceived barriers to screening were also assessed. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20.0) (IBM Corp., Armonk, NY). A knowledge score, out of a total of 14 points was calculated to reflect a participant's overall knowledge regarding CRC risk factors and signs/symptoms. Results The prevalence of CRC screening in eligible individuals (50 years or older) was 2.6% in our study population. Positive attitudes towards CRC management and screening were observed, with 75.1% (n = 296) acknowledging the preventive role of screening tests. Despite this only 14.9% (n = 58) of study participants expressed a future desire to undergo screening. Major barriers to screening were reported to be "a lack of knowledge regarding the screening procedure", a "lack of screening facilities" and that the "screening procedure is too expensive". A majority (n = 285, 72.3%) of the participants expressed a greater willingness to undergo screening if their doctor recommended it. Conclusion A national CRC screening and awareness program should be launched to promote awareness and facilitate screening in risk groups. General practitioners are needed to play a key role in counseling patients and endorsing healthy screening practices.

Comparison of visual acuity, refractive outcomes, and satisfaction between LASIK performed with a microkeratome and a femto laser.

PURPOSE: To compare refractive outcomes, visual acuities, and satisfaction of patients between those treated with laser-assisted in situ keratomileusis (LASIK) using a Hansatome microkeratome (HM) and femto-assisted laser (FAL). METHODS: This was a retrospective analysis of 1,366 eyes in 687 patients who underwent LASIK with an HM (n=1,137) and an FAL (n=229) at the two centers of Hashmanis Hospital, Karachi, Pakistan. Refractive outcomes, including sphere, cylinder, and spherical equivalent in diopters (D), and visual acuities were assessed both preoperatively and at 1 month follow-up. Patient satisfaction was gauged by contacting the patient at the time of chart review. RESULTS: The postoperative median sphere, cylinder, and spherical equivalent values for those treated with FAL were 0.3±0.7 (-5.5-1.8), -0.5±0.6 (-5.0-1.0), and 0.0±0.7 (-6.0-1.6), respectively. For the HM arm, they were 0.0±1.28 (-10.8-6.8), -0.5±0.5 (-4.5-1.5), and -0.3±1.3 (-11.6-6.8), respectively. All preoperative values were statistically insignificant between the groups, while postoperative values were significant with P-values <0.001. Predictability and efficacy index was higher for the FAL (92.1%, 1.00) than the HM group (82.2%, 0.84). Similarly, patient satisfaction was slightly higher for those treated with FAL (93.3%) than HM (91.4%). CONCLUSION: Our large retrospective analysis of eyes that have undergone LASIK using HM and FAL shows superior refractive outcomes in the latter, with special regard to procedural efficacy and predictability.

Grooming Future Physician-scientists: Evaluating the Impact of Research Motivations, Practices, and Perceived Barriers Towards the Uptake of an Academic Career Among Medical Students.

PURPOSE: To evaluate the research trends and underlying motivations that shape intentions for the future uptake of an academic career among medical students. Further, to investigate the barriers and sought-after interventions which may optimise research outcomes in a resource-limited setting. METHODS: A cross-sectional study was conducted among 294 undergraduate (UG) medical students in Karachi, Pakistan. A self-administered questionnaire was employed to assess current research practices and future intentions, and to evaluate related motivations, barriers, and sought-after interventions. RESULTS: Almost two-thirds of medical students reported some form of involvement in medical research and expressed positive attitudes towards the same. However, intentions to pursue research at a professional level not only remained low (19.7%) but were found to decrease with each passing year of study (p<0.01). The most commonly expressed motivation for pursuing research was "admission into a residency program" (71.8%), and was associated with a decreased likelihood of pursuing research professionally. The most cited barriers to conducting UG research were a "lack of time" (72.4%), "lack of supervisors" (50.3%) and a "lack of opportunities in the university" (48.3%). A dichotomy in sought-after interventions was observed among research-naïve and research-experienced students. CONCLUSIONS: Despite promising trends in UG medical research, the intentions for uptake of an academic career remain low. Research practices driven by career enhancement alone may be detrimental. Interventions to increase research output must promote the capacity building of research-naïve students and facilitate the ongoing practices of research-experienced students.