1
|
Lapp V, Ben Khallouq B, Bentley D, Kirkland A, Dykstra-Nykanen J, Ayotte K. Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children? AORN J 2024; 119:59-71. [PMID: 38149889 DOI: 10.1002/aorn.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 10/05/2022] [Accepted: 01/11/2023] [Indexed: 12/28/2023]
Abstract
National standards for surgical site infection (SSI) prevention for children remain elusive. Our institution developed a presurgical antisepsis protocol that included the three components of chlorhexidine gluconate bathing wipes, chlorhexidine gluconate oral rinse, and povidone-iodine nasal swab. This retrospective cohort study examined data from electronic health records to compare SSI rates before and after protocol implementation. We included children aged 2 through 11 years undergoing any surgical procedure with the use of an incision in the OR (N = 1,356). We did not find any difference in the occurrence of SSI before and after the protocol was implemented. Logistic regression showed that an infection present at the time of surgery was the only significant predictor of an SSI. The implementation of a presurgical antisepsis protocol was not associated with SSI rate reduction in this pediatric cohort.
Collapse
|
2
|
Walters J, Paradise Black N, Yurttutan Engin N, Cohen DE, Ben Khallouq B, Chen JG. Race and Gender Differences in Pediatric Milestone Levels: A Multi-Institutional Study. Clin Pediatr (Phila) 2023:99228231200985. [PMID: 37735881 DOI: 10.1177/00099228231200985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The Accreditation Council for Graduate Medical Education milestones assess resident competency in 6 domains. We hypothesized that disparities in milestones exist across race and gender in pediatric residencies. This is a retrospective, cross-sectional, multi-institutional study (3 pediatric residencies, 1446 scores; 316 residents). African American residents received the lowest scores in patient care (PC) (P = .030), medical knowledge (MK) (P = .005), practice-based learning and improvement (PBLI) (P = .003), professionalism (PROF) (P < .001), and interpersonal communication skills (ICS) (P = .005). Differences were most pronounced in PROF (African American mean 3.35 [SD .75], Asian 3.51 (.66), Hispanic 3.58 (.66), white 3.59 (.67)). Female residents received higher scores than male residents in PC (P = .002) and system-based practice (SBP) (P = .049). Female interns received higher MK scores, 2.53 (.44) versus 2.48 (.48), P = .044, but lower scores as third years, 4.00 (.43) versus 4.14 (.45), P = .030. In this study, pediatric milestones differed based on race and gender.
Collapse
Affiliation(s)
- Jamee Walters
- Johns Hopkins All Children's Hospital Pediatric Residency Program, St. Petersburg, FL, USA
| | - Nicole Paradise Black
- Division of Medical Education, Department of Pediatrics, University of Florida Pediatric Residency, Gainesville, FL, USA
| | - Nesrin Yurttutan Engin
- Studer Family Children's Hospital, Ascension Sacred Heart, Community Health Northwest Florida-Trinity Pediatrics, University of Florida Pediatric Residency Program, Pensacola, FL, USA
| | - Debra E Cohen
- Studer Family Children's Hospital, Ascension Sacred Heart, University of Florida Pediatric Residency Program, Pensacola, FL, USA
| | - Bertha Ben Khallouq
- Department of Gynecology and Obstetrics, Orlando Health Winnie Palmer Hospital, Orlando, FL, USA
| | - J Gene Chen
- Department of Pediatric Medical Education, University of Florida Pediatric Residency Program at Orlando Health, Orlando, FL, USA
| |
Collapse
|
3
|
Sanchez KJ, Sanchez RA, Ben Khallouq B, Ellis DB. Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach. Anesth Analg 2023; 137:234-246. [PMID: 37010957 DOI: 10.1213/ane.0000000000006480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.
Collapse
Affiliation(s)
- Kyle J Sanchez
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Bertha Ben Khallouq
- Orlando Health Winnie Palmer Hospital for Women and Babies, Orlando, Florida
- University of Central Florida, Orlando, Florida
| | - Dan B Ellis
- Jacksonville University, Jacksonville, Florida
| |
Collapse
|
4
|
Abstract
The Association of American Medical Colleges declared it essential that medical students receive instruction on the health needs of lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI+) individuals. The integration of LGBTQI+ health and instruction in medical curricula, however, is scant. A pre-post confidential survey study was completed by first-year medical students (N = 103; 85% response rate) in the context of classroom instruction. The California State University Northbridge instrument assessed students' perspectives on LGBTQI+ Patient-Care, Comfort with LGBTQI+ Patient Interactions, Gender and Sexuality, Civil Rights, and LGBTQI+ Education. Post-instruction, students reported a significant increase in understanding of bisexuality (p = .02), being transgender (p = .006), and LGBTQI+ couples' adoption rights (p = .003). The findings support the incorporation of LGBTQI+ instruction into medical curricula and suggest that educators may consider consulting pre-intervention data before teaching LGBTQI+ health content, which would allow material to be tailored toward learner-specific needs.
Collapse
Affiliation(s)
- Kyle Sanchez
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Matthew P Abrams
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Bertha Ben Khallouq
- College of Medicine, University of Central Florida, Orlando, Florida, USA
- College of Sciences, University of Central Florida, Orlando, Florida, USA
| | - Daniel Topping
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| |
Collapse
|
5
|
Abstract
PURPOSE Metformin is a common medication for patients with hyperglycemia. In adults, one well-documented side effect of metformin is vitamin B12 deficiency. However, this side effect has rarely been studied in pediatric patients. This study examined the changes of vitamin B12 level in pediatric patients being treated with metformin. METHODS Data were collected from pediatric patients (n=151) with at least 3 months of consecutive metformin intake. The effects of dose of metformin on the mean vitamin B12 level were investigated at 6, 12, 24, and 36 months. The effect of compliance of metformin intake on vitamin B12 level also was studied. RESULTS There was no significant decrease in mean vitamin B12 level at 6, 12, 24, or 36 months in patients treated with metformin. Mean vitamin B12 decrease was only noticeable (p<0.05) in patients taking a high dose of metformin with good compliance. Despite this change, the mean vitamin B12 remained well within the normal reference range. Furthermore, of the 151 patients studied, only 1 demonstrated vitamin B12 deficiency after 12 months of treatment. However, his B12 level was normal at 24 and 36 months without any vitamin B12 supplements. CONCLUSION Our findings suggest that metformin treatment in children does not cause vitamin B12 deficiency; however, the effect of long-term consistent high-dose treatment on vitamin B12 level remains unknown.
Collapse
Affiliation(s)
- Y. Miles Yu
- Pediatric Endocrinology, Nemours Children’s Hospital, Orlando, FL, USA,Address for correspondence: Y. Miles Yu Pediatric Endocrinology, Nemours Children's Hospital, Florida, 6535 Nemours Pkwy, Orlando, FL 32827, USA
| | | | | |
Collapse
|
6
|
James B, Khallouq BB, Swana H. Child access prevention legislative language and pediatric firearm injury rates. World Jnl Ped Surgery 2021; 4:e000223. [DOI: 10.1136/wjps-2020-000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BackgroudFirearm injuries are a significant public health problem facing young people in the USA. In 2015, a total of 16 878 people under 19 years old were injured or killed by firearms. To reduce firearm injuries, 29 states and Washington, DC have enacted child access prevention (CAP) legislation. CAP legislation is intended to reduce the likelihood of a minor obtaining a weapon and subsequent injury or death. This study evaluates the impact of CAP legislation based on language of the legislation, specifically it evaluates a relationship of the legal threshold of liability and the number of firearm injuries per capita of minors.MethodsData were collected from the Web-based Injury Statistics Query and Reporting System for patients less than 19 years of age who presented to emergency departments with firearm injuries in 2016. The Giffords Law Center classification was used to group states into three categories (strong/weak/no CAP) based on CAP language. Differences of firearm-related injury rates per capita were assessed.ResultsWhen controlling for population, states with CAP legislation had a 22% decrease in firearm injuries per capita compared with states without CAP legislation. States with ‘strong’ CAP legislation had a 41% decrease in firearm injuries per capita compared with states with ‘weak’ or no CAP legislation when controlling for population.ConclusionsStates with ‘strong’ CAP legislation had lower pediatric firearm injury rates per capita, but more complete data and further studies are needed to evaluate this relationship as well as other factors that may impact firearm injury rates.
Collapse
|
7
|
Pickle EO, Aguilar-Bonilla A, Khallouq BB, Stapleton S, Sandler E, Langevin AM, Libes J, Hanif I, Smith A. EPEN-51. CHILDHOOD INTRACRANIAL EPENDYMOMA: A MULTI-CENTER RETROSPECTIVE ANALYSIS. Neuro Oncol 2020. [PMCID: PMC7715978 DOI: 10.1093/neuonc/noaa222.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ependymoma is a heterogeneous disease which is resistant to improvement. Current challenges are the unreliability of histologic classification, the uncertain role of adjuvant chemotherapy, and a lack of clinical trials integrating molecular and clinical diagnostics into risk-guided therapy. Ependymoma can show surprising latency, reoccurring many years after the original diagnosis. In this study, we performed a retrospective analysis of ependymoma cases treated at six centers over a period of 12 years. A total of 73 cases were submitted from six sites; 68 cases were retained for review. Median age at diagnosis was 4.1 years and gender was reported as male (50%) and female (50%). Histologic grade was reported as Grade II (49%) and Grade III (50%)(not reported: 1). Anatomic location reported as supratentorial (27%) and infratentorial (73%). Metastatic disease was reported in 9% of patients. At diagnosis, gross total resection was achieved in 59% of cases. Twenty-eight percent of patients have died, 59% of patients are alive (with and without disease), and 13% of patients are lost to follow-up. Maximal safe surgical resection is currently the best predictor of long-term survival but was achieved in only 60% of cases. Biology-based therapy will be the next step towards improving the prognosis of pediatric ependymoma.
Collapse
Affiliation(s)
| | | | | | | | - Eric Sandler
- Nemours Children’s Health Systems, Jacksonville, FL, USA
| | | | - Jamie Libes
- University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Amy Smith
- Arnold Palmer Hospital for Children, Orlando, FL, USA
| |
Collapse
|
8
|
Chen JG, Lee S, Khallouq BB. Association of Demographics and Hospital Stay Characteristics With Patient Experience in Hospitalized Pediatric Patients. J Patient Exp 2020; 7:1077-1085. [PMID: 33457548 PMCID: PMC7786789 DOI: 10.1177/2374373520925251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is limited research on patient experience in hospitalized pediatric patients. Our aim was to investigate the association of patient demographics and hospital stay characteristics with experience in a tertiary-care, freestanding children's hospital. We conducted a retrospective cross-sectional study of patient experience surveys. We designated the highest rating as "top-box" and examined data across 8 domains, including overall assessment (OA). A total of 4602 surveys were analyzed. Top-box percentages were lower for younger patients in 6 domains, including OA (0-<1 year old: 57.6%; 1-<4 years old: 61.3%; 4-<12 years old: 68.4%; ≥12 years old: 70.2%; P < .001), and were lower for patients with private insurance in 5 domains, including OA (private 63.2%, public 68.9%; P < .001). There was no association between other demographics (gender, race/ethnicity, primary language) and OA. Overall assessment was also not associated with length of stay (P = .071) and number of consulting services (P = .703). The most important domain predictor of OA was personal issues (odds ratio = 4.79), which assessed concern, sensitivity, and communication from staff. In conclusion, patient experience was associated with age and insurance status but not hospital stay characteristics.
Collapse
Affiliation(s)
- Jerome Gene Chen
- Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, Orlando, FL, USA
- University of Florida Pediatric Residency Program at Orlando Health, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
- Jerome Gene Chen, Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, 86 W. Underwood St, Ste 202, MP 336 Orlando, FL 32806, USA.
| | - Stacey Lee
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Bertha Ben Khallouq
- Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
- University of Central Florida College of Sciences, Orlando, FL, USA
| |
Collapse
|
9
|
Pourmoghadam KK, Kubovec S, DeCampli WM, Khallouq BB, Piggott K, Blanco C, Fakioglu H, Kube A, Narasimhulu SS. Passive Peritoneal Drainage Impact on Fluid Balance and Inflammatory Mediators: A Randomized Pilot Study. World J Pediatr Congenit Heart Surg 2020; 11:150-158. [PMID: 32093557 DOI: 10.1177/2150135119888143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infants after cardiopulmonary bypass are exposed to increasing inflammatory mediator release and are at risk of developing fluid overload. The aim of this pilot study was to evaluate the impact of passive peritoneal drainage on achieving negative fluid balance and its ability to dispose of inflammatory cytokines. METHODS From September 2014 to November 2016, infants undergoing STAT category 3, 4, and 5 operations were randomized to receive or not receive intraoperative prophylactic peritoneal drain. We analyzed time to negative fluid balance and perioperative variables for each group. Pro- and anti-inflammatory cytokines were measured from serum and peritoneal fluid in the passive peritoneal drainage group and serum in the control group postoperatively. RESULTS Infants were randomized to prophylactic passive peritoneal drain group (n = 13) and control (n = 12). The groups were not significantly different in pre- and postoperative peak lactate levels, postoperative length of stay, and mortality. Peritoneal drain patients reached time to negative fluid balance at a median of 1.42 days (interquartile range [IQR]: 1.00-2.91), whereas the control at 3.08 (IQR: 1.67-3.88; P = .043). Peritoneal drain patients had lower diuretic index at 72 hours, median of 2.86 (IQR: 1.21-4.94) versus 6.27 (IQR: 4.75-11.11; P = .006). Consistently, tumor necrosis factor-α, interleukin (IL)-4, IL-6, IL-8, IL-10, and interferon-γ were present at higher levels in peritoneal fluid than serum at 24 and 72 hours. However, serum cytokine levels in peritoneal drain and control group, at 24 and 72 hours postoperatively, did not differ significantly. CONCLUSIONS The prophylactic passive peritoneal drain patients reached negative fluid balance earlier and used less diuretic in early postoperative period. The serum cytokine levels did not differ significantly between groups at 24 and 72 hours postoperatively. However, there was no significant difference in mortality and postoperative length of stay.
Collapse
Affiliation(s)
- Kamal K Pourmoghadam
- Section of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | - Stacey Kubovec
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - William M DeCampli
- Section of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Kurt Piggott
- Pediatric Cardiac Intensive Care, Orlando, FL, USA
| | | | | | - Alicia Kube
- Section of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Sukumar Suguna Narasimhulu
- University of Central Florida College of Medicine, Orlando, FL, USA.,Pediatric Cardiac Intensive Care, Orlando, FL, USA
| |
Collapse
|
10
|
Baill IC, Khallouq BB, Joledo O, Jacobs A, Larkin R, Dil N. How Postbaccalaureate Career Changer and Traditional Medical Students Differ Academically. South Med J 2019; 112:610-616. [PMID: 31796969 DOI: 10.14423/smj.0000000000001044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This retrospective descriptive study compared the academic performance of postbaccalaureate career changer students with that of traditional students during the classroom-based, science-dominated early years of medical school. Earlier studies documented the eventual success of nontraditional medical students, although we found little information specific to the medical school performance of career changers. Our objective was to determine whether postbaccalaureate career changer medical students perform differently from traditionally prepared medical students in the science-dominated early years of medical school classroom education. METHODS This study analyzed the admission data and academic performance of medical students at the University of Central Florida College of Medicine across 8 years (N = 630). Differences in performance were assessed using examination grades from the first 2 years of medical school, and US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores. RESULTS Statistically significant differences were found between traditional and career changer students for all science modules in year 1, and 4 of the 5 modules in year 2. Traditional students performed better on USMLE Step 1. Significant differences between the groups disappeared by USMLE Step 2. CONCLUSIONS Career changer medical students show a small, persistent academic lag in the first 2 years of medical school and on USMLE Step 1 scores. By USMLE Step 2 the difference disappears. Similar undergraduate grade point averages and Medical College Admission Test scores suggest that science exposure, not ability may explain these differences. An unexpected finding is the number of career changer students is not increasing proportional to the proliferation of postbaccalaureate programs in the United States. This study may benefit student advisors and residency directors, and, it is hoped, provide reassurance to career changer students.
Collapse
Affiliation(s)
- I Cori Baill
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| | - Bertha Ben Khallouq
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| | - Oloruntomi Joledo
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| | - Anna Jacobs
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| | - Robert Larkin
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| | - Nyla Dil
- From the Department of Medical Education, University of Central Florida College of Medicine; Department of Sociology, University of Central Florida, Orlando, Florida; and Office of Institutional Research at Eastern Washington University, Cheney, Washington
| |
Collapse
|
11
|
Levy M, Alvarez W, Vagelakos L, Yore M, Khallouq BB. Stand Your Ground: Policy and Trends in Firearm-Related Justifiable Homicide and Homicide in the US. J Am Coll Surg 2019; 230:161-167.e4. [PMID: 31730807 DOI: 10.1016/j.jamcollsurg.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years, several states have enacted Stand Your Ground (SYG) legislation intended to deter crime. To date, the impact of these laws on justifiable homicide (JH) and homicide (HOM) is unknown. This study was designed to compare JH and HOM rates (JHR, HR) before and after enactment of SYG laws and in states with and without (NoSYG) such legislation. STUDY DESIGN This was a retrospective analysis of justifiable homicide and homicide using 3 United States datasets from 2000 to 2017. Descriptive statistics and univariate linear regressions were used to evaluate the association of SYG laws and JH and HOM in the United States. RESULTS There were 4,594 incidents of JH and 214,630 incidents of HOM in the United States between 2000 and 2017. Stand Your Ground states accounted for most JH and HOM incidents 3,184 (69%) and 116,511 (54%), respectively. Stand Your Ground states had higher JH and HOM rates than NoSYG states (0.126 vs 0.047 and 4.663 vs 3.301 per 100,000 population, respectively; p < 0.001). Comparing periods pre- (2000 to 2004) and post-SYG (2005 to 2017) law enactment, SYG vs NoSYG states had increased JH rates of 54.9% vs 20.4%, respectively (p < 0.001); HOM rates increased 10.8% in SYG states and decreased 2.3% in NoSYG states (p < 0.001). CONCLUSIONS Stand Your Ground states had significantly higher JH and HOM rates and significantly greater increases in JH and HOM rates pre- vs post-SYG law enactment compared with NoSYG states. These results raise questions about the potential adverse consequences of policies such as the SYG law in the US.
Collapse
Affiliation(s)
- Marc Levy
- Orlando Health Arnold Palmer Hospital for Children, Department of Surgery, Division of Pediatric Surgery, Orlando, FL.
| | | | | | | | - Bertha Ben Khallouq
- Orlando Health Arnold Palmer Hospital for Children, Specialty Diagnostic Laboratory, Orlando, FL
| |
Collapse
|
12
|
Reimer D, Russell R, Khallouq BB, Kauffman C, Hernandez C, Cendán J, Castiglioni A. Pre-clerkship medical students' perceptions of medical professionalism. BMC Med Educ 2019; 19:239. [PMID: 31262283 PMCID: PMC6604300 DOI: 10.1186/s12909-019-1629-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/23/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Professionalism instruction and assessment is a core component of medical education, and essential for professional identity formation (PIF). Thus, understanding the socialization of medical students to the values of the profession (i.e., medical professionalism), and how these may evolve, warrants continued understanding. METHODS The purpose of this study was to examine and compare pre-clerkship (first and second year) medical students' perceptions of professionalism. First and second year medical students participate in this study. This was a two-phase mixed-methods cohort study conducted across two academic years (2014-2015 and 2015-2016). In Phase I, first and second year medical students participated in a nominal group technique (NGT) session. NGT data was analyzed qualitatively to generate a card-sorting exercise of professionalism attributes for Phase II. In Phase II, data from the sorting task was analyzed using Principle Component Analysis (PCA). RESULTS The PCA for first year students derived a 7-factor solution. Factors (i.e., professionalism domains) identified were: Self-management and patient-centeredness, ethics and professional reputation, dependability, self-awareness and self-improvement, image, proficiency and lifelong learning and integrity. The PCA for second year students derived a 5-factor solution; factors identified were: "Good Doctor" attributes, responsibility, ethics, innovation and self-improvement and unbiased. CONCLUSIONS Identification and organization of attributes into an overarching professionalism mental model provide a window into the active reconstruction of students' professional identity during the nascent stages of medical education. M1 professionalism domains were more consistent with the conventional professional image of the physician (e.g. Ethics and Professional reputation, Dependability, Integrity), whereas, M2 domains reflected a more global view (e.g., "Good Doctor" attributes, Responsibility, Ethics). This study provides a lens into the dynamic nature of students' PIF and encourages educators to evaluate PIF pedagogy at their own institutions.
Collapse
Affiliation(s)
| | | | - Bertha Ben Khallouq
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Christine Kauffman
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Caridad Hernandez
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Juan Cendán
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Analia Castiglioni
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| |
Collapse
|
13
|
Fragapane L, Li W, Ben Khallouq B, Cheng ZJ, Harris DM. Comparison of knowledge retention between high-fidelity patient simulation and read-only participants in undergraduate biomedical science education. Adv Physiol Educ 2018; 42:599-604. [PMID: 30251892 DOI: 10.1152/advan.00091.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
High-fidelity patient simulation (HFPS) is expensive in money and faculty resources. There has been a recent push to increase the use of HFPS for undergraduates to teach basic science. However, it is still unclear if HFPS is superior to other cost-effective modalities for learning, and there have been limited studies comparing HFPS directly with other methods. The purpose of this study was to compare learning between three groups: 1) students who participated in a HFPS after reading material (RS); 2) students who reread material (RR) individually; and 3) students who had no intervention or reading (CON). Quizzes (10 true/false questions) were given presimulation, immediately after the simulation (post-sim 1), and 1 wk later to all groups (post-sim 2). Ninety-seven undergraduate students consented to include their data in the study. All groups scored the same on the presimulation quiz (median of 6). The RR and RS scored significantly higher than the CON group on post-sim 1 (medians 8 vs. 6). All groups performed similarly on post-sim 2. A questionnaire also showed that students had increased perceived confidence about pathophysiology. These data suggest that a single-time use of HFPS for knowledge learning for undergraduate students is not more effective than other methods. Future studies need to determine whether increasing the number of HFPS and developing social learning networks could make HFPS more effective for undergraduates. Additionally, future studies should focus on soft skill development, such as confidence, critical thinking, and teamwork/communication skills, as opposed to knowledge acquisition.
Collapse
Affiliation(s)
- Lauren Fragapane
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| | - Wei Li
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| | - Bertha Ben Khallouq
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| | - Zixi J Cheng
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine , Orlando, Florida
| | - David M Harris
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| |
Collapse
|
14
|
Garcia M, Daugherty C, Ben Khallouq B, Maugans T. Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet. J Neurosurg Pediatr 2018; 21:535-541. [PMID: 29451451 DOI: 10.3171/2017.10.peds17177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Internet is used frequently by patients and family members to acquire information about pediatric neurosurgical conditions. The sources, nature, accuracy, and usefulness of this information have not been examined recently. The authors analyzed the results from searches of 10 common pediatric neurosurgical terms using a novel scoring test to assess the value of the educational information obtained. METHODS Google and Bing searches were performed for 10 common pediatric neurosurgical topics (concussion, craniosynostosis, hydrocephalus, pediatric brain tumor, pediatric Chiari malformation, pediatric epilepsy surgery, pediatric neurosurgery, plagiocephaly, spina bifida, and tethered spinal cord). The first 10 "hits" obtained with each search engine were analyzed using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, which assigns a numerical score in each of 5 domains. Agreement between results was assessed for 1) concurrent searches with Google and Bing; 2) Google searches over time (6 months apart); 3) Google searches using mobile and PC platforms concurrently; and 4) searches using privacy settings. Readability was assessed with an online analytical tool. RESULTS Google and Bing searches yielded information with similar CRAAP scores (mean 72% and 75%, respectively), but with frequently differing results (58% concordance/matching results). There was a high level of agreement (72% concordance) over time for Google searches and also between searches using general and privacy settings (92% concordance). Government sources scored the best in both CRAAP score and readability. Hospitals and universities were the most prevalent sources, but these sources had the lowest CRAAP scores, due in part to an abundance of self-marketing. The CRAAP scores for mobile and desktop platforms did not differ significantly (p = 0.49). CONCLUSIONS Google and Bing searches yielded useful educational information, using either mobile or PC platforms. Most information was relevant and accurate; however, the depth and breadth of information was variable. Search results over a 6-month period were moderately stable. Pediatric neurosurgery practices and neurosurgical professional organization websites were inferior (less current, less accurate, less authoritative, and less purposeful) to governmental and encyclopedia-type resources such as Wikipedia. This presents an opportunity for pediatric neurosurgeons to participate in the creation of better online patient/parent educational material.
Collapse
Affiliation(s)
| | | | | | - Todd Maugans
- 1University of Central Florida College of Medicine; and.,2Division of Pediatric Neurosurgery, Nemours Children's Hospital, Orlando, Florida
| |
Collapse
|
15
|
Abstract
Background and Objectives: Laparoscopic surgery can be complicated by condensation and debris on the lens obscuring the visual field, increasing the risk of surgical error and injury to the patient. Despite, development of possible solutions, little is known regarding the quantitative measure of time lost during surgery because of an obscured visual field. Without this knowledge, the cost of laparoscopic lens fogging cannot be quantified and compared to the cost of antifogging devices. In the present study, we investigated the amount of time a laparoscope is withdrawn for cleaning during surgery. Methods: This was a prospective, observational study of patients (n = 52) who underwent laparoscopic surgery at Florida Hospital Celebration Health. Patient's age, gender, and body mass index, operative time, wound class, estimated blood loss, type of procedure, and complication (if any) were collected. In addition, intraoperative information on the number of times and total amount of time the laparoscope was withdrawn because of obscured visual field were recorded. Results: Eighty-two percent (43) of the procedures required laparoscope withdrawal because of fogging. Increased operative time, increased blood loss, and patient age correlated with the number of times (P < .05) and amount of time (P < .05) the laparoscope was withdrawn. Discussion: There was a significant correlation between increased laparoscope withdrawal because of an obscured visual field with increased EBL, operative time, and patient age. Possible explanations include change in body composition with age, the increased viewing angles required for more complex procedures, and increasing intraoperative effect on the surgeon of the poor visual field caused by fogging and debris.
Collapse
Affiliation(s)
- Danielle Abbitt
- University of Central Florida College of Medicine, Department of Faculty and Academic Affairs, Orlando, Florida, USA
| | - Bertha Ben Khallouq
- University of Central Florida College of Medicine, Department of Faculty and Academic Affairs, Orlando, Florida, USA
| | - Jay Redan
- Medical Director of Minimally Invasive Surgery, Florida Hospital-Celebration Health Professor of Surgery, Voluntary Faculty, University of Central Florida College of Medicine
| |
Collapse
|
16
|
Nguyen K, Ben Khallouq B, Schuster A, Beevers C, Dil N, Kay D, Kibble JD, Harris DM. Developing a tool for observing group critical thinking skills in first-year medical students: a pilot study using physiology-based, high-fidelity patient simulations. Adv Physiol Educ 2017; 41:604-611. [PMID: 29138219 DOI: 10.1152/advan.00126.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
Most assessments of physiology in medical school use multiple choice tests that may not provide information about a student's critical thinking (CT) process. There are limited performance assessments, but high-fidelity patient simulations (HFPS) may be a feasible platform. The purpose of this pilot study was to determine whether a group's CT process could be observed over a series of HFPS. An instrument [Critical Thinking Skills Rating Instrument CTSRI)] was designed with the IDEAS framework. Fifteen groups of students participated in three HFPS that consisted of a basic knowledge quiz and introduction, HFPS session, and debriefing. HFPS were video recorded, and two raters reviewed and scored all HFPS encounters with the CTSRI independently. Interrater analysis suggested good reliability. There was a correlation between basic knowledge scores and three of the six observations on the CTSRI providing support for construct validity. The median CT ratings significantly increased for all observations between the groups' first and last simulation. However, there were still large percentages of video ratings that indicated students needed substantial prompting during the HFPS. The data from this pilot study suggest that it is feasible to observe CT skills in HFPS using the CTSRI. Based on the findings from this study, we strongly recommend that first-year medical students be competent in basic knowledge of the relevant physiology of the HFPS before participating, to minimize the risk of a poor learning experience.
Collapse
Affiliation(s)
- Khoa Nguyen
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Bertha Ben Khallouq
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Amanda Schuster
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Christopher Beevers
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Nyla Dil
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Denise Kay
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - Jonathan D Kibble
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| | - David M Harris
- Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
| |
Collapse
|
17
|
Abstract
OBJECTIVE To understand key drivers of patient satisfaction in pediatric hematology/oncology. METHODS The "top-box" scores of patient satisfaction surveys from 4 pediatric hematology/oncology practices were collected from 2012 to 2014 at an integrated Children's Health Network. One item, "Likelihood of recommending practice," was used as the surrogate for overall patient satisfaction, and all other items were correlated to this item. RESULTS A total of 1244 satisfaction surveys were included in this analysis. The most important predictors of overall patient satisfaction were cheerfulness of practice ( r = .69), wait time ( r = .60), and staff working together ( r = .60). The lowest scoring items were getting clinic on phone, information about delays, and wait time at clinic. CONCLUSION Families bringing their children for outpatient care in a hematology/oncology practice want to experience a cheerful and collaborative medical team. Wait time at clinic may be a key driver in the overall experience for families with children with cancer. Future work should be directed at using this evidence to drive patient experience improvement processes in pediatric hematology/oncology.
Collapse
Affiliation(s)
- Josh Davis
- 1 Penn State Milton S. Hershey Medical Center, PA, USA
| | | | | | - Paul Rosen
- 2 Nemours Children's Health System, Wilmington, DE, USA
| |
Collapse
|