Examining the Effectiveness of Educational Tools and Elements Used in Medical Textbooks: Students' Perspective.

Background As textbooks constitute a foundational component of medical education, it is imperative to conduct a rigorous evaluation of their efficacy by examining the fundamental elements and tools utilized within these textbooks and how multiple factors may alter the effectiveness of such components. Materials and methods We conducted a cross-sectional, survey-based study where 251 subjects anonymously rated the effectiveness of different tools and elements/factors used in medical textbooks using 5-point Likert scales. The population surveyed included year 1 to 5 medical students at Alfaisal University, where students are admitted to medical school directly after high school, with an approximately equal male-to-female admission rate. Students were asked to rate the effectiveness of the following tools: chapter summary, end-of-chapter questions, tables of contents, graphic elements, diagrams, tables, flowcharts, mind maps, sidebars, and links to online resources. In admission, they were asked to rate textbooks regarding the following elements/factors: text clarity, directness to the concept intended, flow of ideas, language complexity, and clinical (vertical) and multidisciplinary (horizontal) integration. The Chi-square, post-hoc, Spearman's correlation, and Kruskall-Wallis tests were used in the statistical analysis to determine the differences and correlations in the students' self-ratings of different variables. Results The students rated tools such as diagrams and graphic elements as the most effective. Graphic elements were rated as significantly more effective by first- and fourth-year students. This corresponds to being exposed to new environments (the first exposure to the study of medicine and the first exposure to clinical clerkship), indicating their effectiveness in introducing new concepts and setting of change. Furthermore, end-of-chapter summaries and questions were rated significantly as being more effective by females (P<0.05). The aim behind using textbooks and the frequency might be governed by how students rate textbooks regarding multiple elements or factors, including directness to the concept intended, flow of ideas, and language complexity. Interestingly, all the above findings were consistent throughout all grade point average groups. Discussion In the rising age of e-learning, our study shows that the tools employed by textbooks remain effective. Our findings are partially consistent with existing literature, which underscores correlations between demographic variables and learning styles. We show that the effectiveness of various tools employed in textbooks can vary depending on the educational setting. While demographic factors generally did not impact students' perceptions of tool effectiveness, gender-specific differences were observed in the perceived effectiveness of end-of-chapter summaries and questions, with female students rating them as more effective, which aligns with existing literature. Conclusions Our study shows that students still perceive the tools employed by textbooks as effective. The perceived effectiveness of various tools utilized within textbooks may be influenced by certain demographic factors and settings, with graphics often proving the most efficacious. This study provides valuable insights for authors of medical textbooks, helping them optimize the usage of various tools by considering the specific characteristics and requirements of the intended audience.

Supradiaphragmatic Jejunal Perforation Following Total Gastrectomy With Esophagojejunostomy Reconstruction for Gastric Adenocarcinoma.

Nasogastric tube decompression is a common technique used after abdominal surgery as it is widely accepted to play a role in the management of postoperative ileus and possibly reduce anastomotic leaks after gastrointestinal surgery. However, the routine practice of nasogastric/nasoenteric tube decompression in elective abdominal surgeries has been challenged due to the increased incidence of pulmonary complications and the argued lack of expected benefit. Here, we present a rare complication of nasogastric tube drainage following a routine total gastrectomy for signet-ring cell adenocarcinoma of the cardia in a 43-year-old female. Her postoperative course was complicated with a supradiaphragmatic jejunal perforation presumably from nasogastric tube decompression resulting in a left pleural effusion. The workup included an endoscopy showing the perforation, after which the nasojejunal tube was removed and the patient was managed conservatively. She was eventually discharged on postoperative day 28.

Delayed Surgical Intervention for a Self-Inflicted Left Chest Injury From a Nail Gun: Addressing 28 Nails Six Months Post-incident.

In 2021, there were 1.7 million suicide attempts in the US, with firearms being the most common method used, comprising more than 50% of attempts. We present a case report of delayed operative intervention for foreign body removal after a suicide attempt using a nail gun fired into the left hemi thorax. Initial conservative management was complicated by the delayed presentation of hemoptysis requiring surgical intervention. We hypothesize that the delay was secondary to foreign body migration. Initial management was attempted robotically, but dense adhesions were encountered, requiring conversion to an open thoracotomy. Twenty-eight nails were removed. The post-operative course was uncomplicated.

Dedifferentiated Chondrosarcoma: Diagnostic Controversies and Emerging Therapeutic Targets.

PURPOSE OF REVIEW: The pathogenesis of dedifferentiated chondrosarcoma is controversial, and no genetic abnormality has consistently been identified in the disease. Focusing on the diagnostic challenges encountered in dedifferentiated chondrosarcoma, the following review aims at summarizing the tumor's active neoplastic pathways while highlighting therapeutic modalities that could potentially be explored to enhance patient survivorship. RECENT FINDINGS: Owing to the challenging examination of small needle biopsy sampling as well as the disease's overlapping morphological and immunohistochemical features with other bone and soft-tissue sarcomas, the diagnosis of dedifferentiated chondrosarcoma can be problematic. While combined doxorubicin- and cisplatin-based regimens remain the first-line systemic chemotherapy in the disease, ~50% of tumors carry EXT1/2 or IDH1/2 mutations, advancing EXT or IDH inhibitors as potential alternative therapies, respectively. Despite systemic chemotherapy, dedifferentiated chondrosarcoma remains an aggressive tumor with dismal prognosis and limited survival. A multidisciplinary collaboration across multiple cancer centers is warranted to yield an accurate diagnosis, understand the disease's underlying pathogenesis, develop adequate treatment, and improve patient survivorship.

Comparative growth response related to hair mineral analysis in dromedary camel calves.

Background: The dromedary camel plays a significant role in supporting the livelihood of pastoral and agropastoral systems, as well as a source of income for the national economy in arid regions. Aim: The current study was executed to check the comparative growth response in relation to hair mineral status in Marecha camel calves reared under an intensive management system and an extensive management system in Thal desert Punjab, Pakistan. Methods: Twelve male and female Camelus dromedarius calves of almost the same weight and age were divided into two groups of 6 each (3 male and 3 female). The calves of the first group were maintained at the Camel Breeding and Research Station, Rakh Mahni, in a semi-open housing system, while the second group was maintained in available housing under field conditions. Calves in the first group were fed concentrate at the rate of 1 kg/head/day along with gram straw (Cicer arientinum) ad libitum, while calves in the second group were allowed to graze/browse for 10 hours daily along with household refusals, including kitchen wastes. Water was provided twice a day. Impressum's digital weighing scale was used for fortnightly weighing. Data collected on different parameters were subjected to statistical analysis with 2 × 2 factorial arrangements of treatments under a completely randomized design. Results: After the 120-day trial period, the mean body weight and average daily gain of male and female calves were significantly increased (p < 0.05) in IMS as 80.8 ± 2.7, 77.8 ± 2.7 kg and 0.67 ± 0.02, 0.65 ± 0.02 kg/days than EMS as 64.5 ± 2.6, 52.9 ± 2.6 kg and 0.54 ± 0.02, 0.44 ± 0.02 kg/days. Intake of crop residues (p < 0.05) was found to be 6.9 ± 0.45 and 6.4 ± 0.45 kg/days for male and female calves in IMS, respectively, and 3.5 ± 0.23 for male and female calves in EMS, respectively. The conversion index g/kg average daily intake was 97.1, 101.5 and 154.3, 125.7 for male and female calves in IMS and EMS, respectively. Regarding hair mineral status, Ca, Mg, Cu, Zn, Fe, and Mn concentrations were found to be significantly different (p < 0.05) among calf groups in IMS and EMS. Conclusion: This study indicates that wool analysis and management of weight gain in camel calves should be further explored to support increased meat supply in arid regions.

Cardiac Transplantation and Consecutive Minimally Invasive Pectus Excavatum Repair.

Pectus excavatum is a common chest wall deformity with inward deviation of sternum and accompanying ribs. The depression can cause symptomatic cardiac compression, although the cardiopulmonary impact remains controversial. We present 2 cases of cardiac transplantation followed by modified minimally invasive pectus excavatum repair due to the hemodynamic consequences of the pectus deformity.

Adenoid cystic carcinoma of the submandibular gland with rare metastasis to the sternum in a 52-year-old male.

Adenoid cystic carcinoma (ACC) is a rare tumor, described as being one of the most biologically destructive tumors of the head and neck. It is the most common malignancy that affects the minor salivary glands. Lung and bones are the most common regions of ACC distant metastasis. To the best of our knowledge, herein, we report the first ever case of latent isolated sternal metastasis from ACC in a 52-year-old gentleman, who was diagnosed to have ACC of the submandibular gland, excised 10 years ago.