Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates.

OBJECTIVE: Feeding neonates orally while on nasal continuous positive airway pressure (nCPAP) is a common practice. We hypothesize that pressurized airflow provided by nCPAP will alter the swallowing mechanism in neonates, increasing the risk of aspiration during oral feeding. STUDY DESIGN: Infants receiving nCPAP with a RAM cannula and tolerating at least 50% of their feeding orally were included in the study (one term; six preterm infants). Each participant underwent a videofluoroscopic swallow study while on nCPAP and off nCPAP. A non-parametric signed-rank test was used for paired data. RESULT: The incidence of deep penetration (P=0.03) and aspiration (P=0.01) decreased significantly off-nCPAP compared with on-nCPAP. However, the incidence of mild penetration (P=0.65) and nasopharyngeal reflux (P=0.87) remained the same under both conditions. CONCLUSION: Oral feeding while on-nCPAP significantly increases the risk of laryngeal penetration and tracheal aspiration events. We recommend caution when initiating oral feedings on nCPAP.

Hidradenitis suppurativa: a review with a focus on treatment data.

Hidradenitis suppurativa (HS) is a chronic disease of the follicular unit that often leads to marked impairment of quality of life and usually affects the axillary, perineum and inframammary regions resulting in tender subcutaneous nodules, abscesses, fibrosis and sinus tract formation. New updates on HS underscores the role of various genes as well as the innate and adaptive immune response in its pathogenesis. Although every patient requires an individualized approach to treatment, topical therapy and antibiotics are mainly used for mild to moderate disease, whereas various systemic immune modulators and/or surgical approaches play a pivotal role in moderate to severe disease. New treatments using various immune modulators, laser modalities and other novel agents provide clinicians with better ways of managing HS.

Termination of a mandatory radiology clerkship at the Albert Einstein College of Medicine: a survey of student opinion.

RATIONALE AND OBJECTIVES: The Albert Einstein College of Medicine has replaced a mandatory third-year radiology clerkship with a new family medicine rotation. This was done, ostensibly, to influence student career choice. We surveyed students to quantify their perceptions about the former radiology course. METHODS: Questionnaires were sent to 498 present and former Albert Einstein College of Medicine students. Eight questions attempted to quantify the students' perceptions about the educational value of the radiology clerkship and assess its impact on subsequent career choice. RESULTS: The mandatory clerkship taught the fundamentals of X-ray interpretation and the most efficacious ways of imaging disease processes. Students viewed the clerkship as useful and important for a well-rounded medical education. Most would have taken the course as an elective had it only been offered as such and would now encourage junior students to do likewise. The mandatory radiology clerkship did not influence the career choice of most survey respondents. CONCLUSIONS: The former mandatory radiology clerkship had been an important part of student education at Albert Einstein College of Medicine, and its termination is unlikely to affect student career choice.

A survey of radiology clerkships at teaching hospitals in the United States.

RATIONALE AND OBJECTIVES: The nature and extent of medical school radiology clerkships were qualified. METHODS: Questionnaires were sent to 126 medical school radiology departments in the United States. Queries were made regarding length and requirements for clerkships, methods of teaching, methods of student evaluation, and responsibility for these functions. RESULTS: Fifty-seven responses (45%) were received. Methods of student teaching varied, but most departments relied on readout sessions, watching procedures, "show-and-tell" sessions, didactic slide and film presentations, and various other methods. Emphasis of most student clerkships was placed on teaching imaging disease processes rather than on how to read x-rays. A written examination was most commonly used to evaluate student performance. Most teaching was done by full-time faculty, with lesser contributions from part-time faculty, fellows, and residents. CONCLUSIONS: The nature and extent of medical school radiology clerkships in departments responding to the survey varied, but most conformed, at least in part, to standards based on survey results and the published literature.

Comparison of fixed and adjustable window width and level settings in the CT evaluation of diffuse lung disease.

OBJECTIVE: The purpose of this investigation was to assess the utility of allowing free adjustment of window width and level in comparison with the use of a fixed lung window in the CT evaluation of diffuse lung disease. MATERIALS AND METHODS: Six radiologists each judged 36 cases (28 diffuse lung disease and 8 normal) using a standardized form. In half of the sessions, images were viewed in a fixed lung window (level = -500 HU; width = 2,000 HU). In the other sessions, the observer was able to adjust the window and level freely while viewing the images. Each case was seen twice in separate sessions: once in a fixed lung window and once with window width and level adjusted by the reader. A variety of diagnostic features were evaluated using a 5 point scale. These included visibility of fine lung structures, abnormalities of the lung parenchyma, and overall evaluation of the lung. RESULTS: The visibility of lung structures was not improved with adjustable window settings. Receiver operating characteristic (ROC) analysis showed fixed windows to be superior to adjustable windows for overall evaluation of the cases [fixed A(z) = 0.90, adjustable A(z) = 0.84, p < 0.05, jackknife method]. Time to rate each case was increased by 15% with window width and level adjustment. CONCLUSION: Free adjustment of window width and level produced no improvement in reader performance over that achieved with fixed window width and level.