Results From Complex Abdominal Reconstruction at Non-Academic Institution can Favorably Compare to Major Academic Centers: An Abdominal Core Health Quality Collaborative Database Review.

BACKGROUND: Many complex abdominal hernias are referred to tertiary academic institutions for evaluation and treatment. The purpose of this study was to compare clinical outcomes from complex abdominal hernia repairs and abdominal wall reconstructions at a community hospital vs high volume academic centers participating in Abdominal Core Health Quality Collaborative (ACHQC). METHODS: Patients undergoing elective complex abdominal hernia repair were identified in our community setting and treated between 2016 and 2019. These results were then compared to Academic centers in the ACHQC database. Complex hernia definition was limited to those who have undergone any myofascial advancement procedure for homogeneity. Informed consent was obtained, and study was IRB approved. All data was de-identified. RESULTS: A total of 180 patients underwent complex abdominal hernia repair at our community hospital. The ACHQC database identified 6299 patients meeting criteria at participating academic centers. Demographics were similar between the two groups including hernia grade, size and wound class. Academic centers tended to have patients with previous component separations (25.7% vs 10.6%) and immunosuppressed (7.2% vs 2.8%), while the community hospital patients included more patients with tobacco use (18.9% vs 12.1%) and hypertension (65% vs 54.9%). Operative times were significantly less at the community hospital, patients requiring >240 minutes of time for repair at academic centers (39.6% vs 5%). Postoperatively length of stay was significantly shorter at the community hospital group averaging 3.7 days vs academic centers of 6 days (P < .05). Although overall complications were less in the community hospital group (26.5% vs 19.4%). Readmission within 30 days was nearly twice as frequent in the community hospital group (14.4% vs 7.7%). CONCLUSION: Community hospitals can provide comparable care and surgical expertise as major academic centers in regard to complex hernias in a large majority of cases. There is a need for dedicated care coordination and continuous review of supporting staff and outcomes is necessary to assure quality care. There is still a need to identify which patients would benefit from treatment at an academic center as opposed to a community hospital in order to maximize patient access and outcomes at both types of hospital setting. Further investigation needs to be performed regarding criteria for which patients should be transferred to academic centers for their complex hernia care. Identifying patients who would benefit from treatment at Academic Centers as opposed to Community hospitals should continue to be investigated.

Prevalence and Correlates of Prohibited Questions in Internal Medicine and Pediatrics Fellowship Interviews During One Appointment Year.

PURPOSE: This study sought to investigate how frequently applicants to internal medicine (IM) and pediatrics fellowships are subjected to prohibited questions, how correlates of these interview questions compare between IM and pediatrics fellowship applicants, and which applicant subgroups are most affected. METHOD: The National Resident Matching Program (NRMP) emailed an anonymous survey to all applicants for the 2021 appointment year to the Medical Specialties Matching Program (i.e., IM fellowship Matches) and Pediatric Specialties Fellowship Match who certified rank order lists (ROLs). The survey addressed specific questions regarding the use of legally prohibited questions and questions that violate the NRMP's Match Participation Agreement during interview-related activities. Experiences of respondents were compared by preferred subspecialty and respondent demographics within IM and pediatrics. RESULTS: The final response rates of IM and pediatrics fellowship applicants who certified ROLs, including complete and partial surveys, were 21.7% (1,483/6,847) and 23.4% (385/1,648), respectively. Of the IM and pediatrics respondents, 432/1,296 (33.3%) and 97/366 (26.5%), respectively, reported being asked at least one prohibited demographic question. The most commonly asked prohibited questions pertained to relationship or marital status (IM: 312/1,296, 24.1%; pediatrics: 69/367, 18.8%), national origin (IM: 200/1,296, 15.4%; pediatrics: 30/365, 8.2%), and family planning (IM: 104/1,288, 8.1%; pediatrics: 14/366, 3.8%). Nearly 25% of IM and pediatrics respondents reported being asked to identify other programs they applied to or interviewed with. Most often, these questions came from program faculty (IM: 238/303, 78.5%; pediatrics: 69/88, 78.4%) or program directors (IM: 84/303, 27.7%; pediatrics: 18/88, 20.5%). CONCLUSIONS: Substantial proportions of IM and pediatrics fellowship applicants reported being asked prohibited questions during fellowship interview-related activities. Additional educational efforts are needed to eradicate such questions from the interview process.

Brief Psychodynamic Psychotherapy: A Review and Illustrative Case Vignette.

In this fictional case vignette, the authors illustrate the inclusive criteria and supportive-interruptive continuum techniques utilized in brief psychodynamic therapy (BPT), a therapeutic strategy designed to shorten psychotherapy from months to weeks in certain types of patients. The authors provide examples of a fictional dialogue between a young adult patient with generalized anxiety disorder (GAD) and ruminating thoughts and her therapist to demonstrate how the therapeutic techniques of BPT (interpretation, confrontation, clarification, encouragement to elaborate, empathic validation, advice and praise, and affirmation) can be used in clinical practice. Each example dialogue is followed by a brief practice point discussion reviewing the technique(s) used. In addition to giving patients insight into their conflicts so that they can access appropriate coping skills, BPT techniques can also reveal important information about the patient to the clinician that might enhance treatment outcomes-in this case, undiagnosed obsessive-compulsive disorder (OCD), which was causing significant stress to the patient. This revelation subsequently led to a comorbid diagnosis of OCD, which was managed with appropriate pharmacotherapy, enhancing treatment outcomes for the patient. BPT continues to show promise in treating a wide variety of psychiatric conditions due to its time efficiency and effectiveness. Clinicians should note that adhering to the recommended patient selection criteria for BPT is imperative for good outcomes. Additional data are needed to assess what specific diagnoses are indicated for optimal results using this modality, as well as its long-term outcomes.