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Lund S, Griffeth EM, Williamson A, Collings A, Gudmundsdottir H, Han A, Kearse L, Kratzke IM, Wilkins P, Prokop LJ, Cook DA. Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis. Acad Med 2024:00001888-990000000-00773. [PMID: 38412483 DOI: 10.1097/acm.0000000000005673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race. METHOD MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender. RESULTS The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median 90 per study) and 2,763 supervisors (median 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were -0.12 (95% confidence interval [CI] = -0.19, -0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and -0.05 (95% CI = -0.11, 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy. CONCLUSIONS Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences, is warranted.
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Affiliation(s)
- Sarah Lund
- S. Lund is a general surgery resident and assistant professor of medical education, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2214-5916
| | - Elaine M Griffeth
- E.M. Griffeth is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-0425-2710
| | - Andrea Williamson
- A. Williamson is a general surgery resident, University of Utah Hospital, Department of Surgery, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-6676-9651
| | - Amelia Collings
- A. Collings is a general surgery resident, University of Louisville School of Medicine, Department of Surgery, Louisville, Kentucky; ORCID: https://orcid.org/0000-0003-4534-0116
| | - Hallbera Gudmundsdottir
- H. Gudmundsdottir is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-1297-2769
| | - Amy Han
- A. Han is a general surgery resident, Cleveland Clinic, Department of Surgery, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-7862-4177
| | - LaDonna Kearse
- L. Kearse is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-3076-8374
| | - Ian M Kratzke
- I.M. Kratzke is a general surgery resident, University of North Carolina Department of Surgery, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-6849-4412
| | - Parvathi Wilkins
- P. Wilkins is a simulation fellow, Mayo Clinic, Multidisciplinary Simulation Center, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-8606-1714
| | - Larry J Prokop
- L.J. Prokop is a librarian, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7197-7260
| | - David A Cook
- D.A. Cook is professor of medicine and medical education; director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science; and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. ORCID: https://orcid.org/0000-0003-2383-4633
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Portelli Tremont JN, Kratzke IM. Letter re: Letter to the Editor: Reply to Srihari et al. Am Surg 2024; 90:159. [PMID: 34472990 DOI: 10.1177/00031348211041556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ian M Kratzke
- Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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3
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Portelli Tremont JN, Adams UC, Holloway AD, Kratzke IM, McIntyre SA, Udekwu PO, Pressley CM. The Effect of Area Social Deprivation on Health Behavior and Health Care Utilization in an Adult Trauma Population. Am Surg 2023; 89:3253-3255. [PMID: 37501309 DOI: 10.1177/00031348231157854] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Social determinants of health may mediate health disparities, but these variables are not routinely measured in clinical practice. This is a retrospective, single-institution study that evaluates the effect of area deprivation on outcomes after trauma admission. Adult trauma patients 18 years and older were eligible. Patients were stratified into high-area (HSD) or low-area (LSD) social deprivation cohorts using zip code of residence. Regression modeling was used to explain the association between HSD, sociodemographic characteristics, and clinical outcomes. Patients who resided in HSD areas made up 29.5% of the study population, were more likely to be younger, male, and identify as a non-White race. Patients in the HSD cohort were also less likely to be admitted to the ICU (OR 0.84, CI 0.71-0.98) and discharged with additional services (OR 0.73, CI 0.57-0.94). We found that independently, area social deprivation affects trauma outcomes and the resources a patient is provided after discharge.
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Affiliation(s)
- Jaclyn N Portelli Tremont
- Department of Surgery, WakeMed Health and Hospitals, Raleigh, NC, USA
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Ursula C Adams
- Department of Surgery, WakeMed Health and Hospitals, Raleigh, NC, USA
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Alexa D Holloway
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Ian M Kratzke
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Sarah A McIntyre
- Department of Surgery, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Pascal O Udekwu
- Department of Surgery, WakeMed Health and Hospitals, Raleigh, NC, USA
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Kratzke IM, Goss RS, Razzaque S, Shih A, Steele PL, Nurczyk KM, Gerber DA. Navigation Improves Tumor Ablation Performance: Results From a Novel Liver Tumor Simulator Study. Am Surg 2023; 89:1693-1700. [PMID: 35098720 DOI: 10.1177/00031348221075748] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The efficacy of microwave ablation in treating hepatic tumors requires advanced ultrasound skills. Failure of proper technique has the potential for either under- or over-treatment and possible harm to the patient. Emprint SX™ navigation provides surgeons with intra-operative, real-time navigation through augmented reality localization of the ablation antenna and the expected ablation zone. We hypothesize that incorporating this technology leads to improved targeting and optimizes ablation coverage. This study utilizes a simulated model to evaluate ablation outcomes using Emprint SX™ navigation vs standard ultrasound. METHODS Surgical residents and faculty were recruited from a single institution. Using a novel tumor ablation simulator, participants performed ablations via 2 modes: standard ultrasound guidance (STD) and Emprint SX™ navigation (NAV). Primary outcome was the percentage of under-ablation. Secondary outcomes included percentage of over-ablation, time to complete trial, and number of attempts to position antenna. RESULTS 281 trials were performed by fifteen participants, with 47% female and 60% novice ablationists. Under-ablation volume decreased by a mean of 16.3% (SEM ±12.9, P < .001) with NAV compared to STD. Over-ablation volume decreased by a mean of 14.0% (±8.2, P < .001). NAV time was faster by a mean of 32 seconds (±24.9, P < .001) and involved fewer antenna placement attempts by a mean of 1.3 (±1.0, P < .001). For novice ablationists, all outcomes were improved with NAV and novices saw larger improvements compared to experienced ablationists (P = .018). DISCUSSION In a simulated model, NAV improves ablation efficacy and efficiency, with novices gaining the greatest benefit over standard ultrasound.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan S Goss
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Sharif Razzaque
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Alex Shih
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Paula L Steele
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kamil M Nurczyk
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David A Gerber
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
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5
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Kratzke IM, Barnhill JL, Putnam KT, Rao S, Meyers MO, Meltzer-Brody S, Farrell TM, Bluth K. Self-compassion training to improve well-being for surgical residents. Explore (NY) 2023; 19:78-83. [PMID: 35534424 DOI: 10.1016/j.explore.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Burnout remains prevalent among surgical residents. Self-compassion training may serve to improve their well-being. OBJECTIVE To evaluate the impact on well-being of a self-compassion program modified for surgical residents. DESIGN This is a 3-year, mixed-methods study using pre-post surveys and focus groups to identify areas for programmatic improvement and the subsequent impact of the modifications. SETTING A single academic institution. PARTICIPANTS Surgical residents participating in a self-compassion program. INTERVENTIONS A self-compassion program adapted from a larger course to fit the needs of surgical residents. MAIN OUTCOME MEASURES Themes relating to the program's strengths and weaknesses were identified through participant focus groups. Well-being was assessed through validated measurement tools, including The Maslach Burnout Inventory (MBI), Patient Health Questionnaire-9, Perceived Stress Scale, and Spielberger State-Trait Anxiety Inventory-6. RESULTS 95 residents participated in the self-compassion program, of which 40 residents completed both surveys (total response rate: 42%). All participants demonstrated severe burnout pre-program, based on scores of at least one of the MBI subscales. Emotional exhaustion scores improved post-program, with larger improvements seen after program modifications (2018: 58% vs 2020: 71%). Focus group findings demonstrated that residents need a safe and distraction-free space to practice self-compassion, and program engagement improved following modifications.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA.
| | - Jessica L Barnhill
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7200, Chapel Hill, NC 27599-7200, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Sanjana Rao
- Physiology Graduate School, North Carolina State University, 1020 Main Campus Drive, Room 2300A, Raleigh, NC 27695-7102, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Suite 304, MacNider Hall, Chapel Hill, NC 27514, USA
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6
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Kratzke IM, Kapadia MR. Resident Assessment-What Is Our Mission? JAMA Surg 2022; 157:925. [PMID: 35947393 DOI: 10.1001/jamasurg.2022.3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill
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7
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Mazur LM, Khasawneh A, Fenison C, Buchanan S, Kratzke IM, Adapa K, An SJ, Butler L, Zebrowski A, Chakravarthula P, Ra JH. A Novel, Theory-Based Virtual Reality Training to Improve Patient Safety Culture in Department of Surgery of a Large Academic Medical Center: Protocol of a Mixed-methods Study (Preprint). JMIR Res Protoc 2022; 11:e40445. [PMID: 36001370 PMCID: PMC9453584 DOI: 10.2196/40445] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. Objective We aim to assess the effect of VR training on health care workers’ (HCWs’) understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. Methods This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs’ understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. Results Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. Conclusions Our findings will help assess the effectiveness of VR training in improving HCWs’ understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties.
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Affiliation(s)
- Lukasz M Mazur
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Amro Khasawneh
- Industrial Engineering Department, School of Engineering, Mercer University, Macon, GA, United States
| | - Christi Fenison
- Academic Technology Services, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Shawna Buchanan
- Academic Technology Services, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Ian M Kratzke
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Karthik Adapa
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Selena J An
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Logan Butler
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Ashlyn Zebrowski
- Division of Healthcare Engineering, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Praneeth Chakravarthula
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, United States
| | - Jin H Ra
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Kratzke IM, Woods LC, Adapa K, Kapadia MR, Mazur L. The Sociotechnical Factors Associated With Burnout in Residents in Surgical Specialties: A Qualitative Systematic Review. J Surg Educ 2022; 79:614-623. [PMID: 34836841 DOI: 10.1016/j.jsurg.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/28/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The consequences of burnout remain prevalent within general surgery training programs, yet there is no comprehensive description of the factors associated with burnout. Using sociotechnical systems theory, this review aims to qualitatively evaluate the factors associated with burnout in surgical residents. DESIGN A systematic review of the literature was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was conducted using PubMed, Web of Science, Scopus, and Embase. Two reviewers independently selected studies, extracted data, and assessed quality, with a third reviewer acting as a moderator to resolve conflicts. The Systems Engineering Initiative for Patient Safety framework was utilized to categorize factors as either contributing to or mitigating burnout. The study was registered with PROSPERO (CRD42021237448). SETTING Included studies were conducted within the United States and published prior to November 11, 2020. PARTICIPANTS Included studies were peer-reviewed primary data, that were written in English and evaluated the sociotechnical factors associated with burnout in surgical residents. RESULTS A total of 4387 articles were identified and after review, 15 studies were included for analysis. Reported burnout rates ranged from 17 to 94%, with a total mean rate of 57%. Factors found to contribute to burnout include financial stress, work-life imbalance, excessive charting, insufficient job resources, poor social support, and mistreatment. Mitigating factors include having time away from work, increased didactics, supportive faculty, attending social events, and the presence of program-based wellness initiatives. Consequences of burnout include depression, substance abuse, and decreased job satisfaction. CONCLUSIONS Reported burnout rates among surgical residents are high. A complex number of sociotechnical factors were found to contribute to burnout, yet many factors are also shown to mitigate burnout. Surgical residencies may address burnout by making changes based on the presence or absence of these factors within their program.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Lindsay C Woods
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karthik Adapa
- Division of Health Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lukasz Mazur
- Division of Health Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kratzke IM, Portelli Tremont JN, Marulanda K, Carter TM, Reid TD, Perez AJ, Kapadia MR. Healthcare Disparity Education for Surgical Residents: Progress Made, More Needed. J Am Coll Surg 2022; 234:182-188. [PMID: 35213439 DOI: 10.1097/xcs.0000000000000041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/25/2022]
Abstract
BACKGROUND Healthcare disparities are an important determinant of patient outcomes yet are not standardized within surgical resident education. This study aimed to determine the prevalence and design of current healthcare disparities curricula for surgical residents and included a resident-based needs assessment at a single institution. STUDY DESIGN A national survey evaluating the presence and design of healthcare disparities curricula was distributed to general surgery program directors via the Association of Program Directors in Surgery Listserv. A related survey was administered to all general surgery residents at a single academic institution. RESULTS One hundred forty-six program directors completed the survey, with 68 (47%) reporting an active curriculum. The most frequently taught topic is regarding patient race as a healthcare disparity, found in 63 (93%) of existing curricula. Fifty-two (76%) of the curricula were implemented within the last 3 years. Of the 78 (53%) programs without a curriculum, 8 (10%) program directors stated that their program would not benefit from one. Thirty-four (45%) of the programs without a curriculum cited institutional support and time as the most common barriers to implementation. Of the 23 residents who completed the survey, 100% desired learning practical knowledge regarding healthcare disparities relating to how race and socioeconomic status affect the clinical outcomes of surgical patients. CONCLUSIONS Less than half of general surgery training programs have implemented healthcare disparities curricula. Resident preferences for the format and content of curricula may help inform program leaders and lead to comprehensive national standards.
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Affiliation(s)
- Ian M Kratzke
- From the Department of Surgery, University of North Carolina, Chapel Hill, NC
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10
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Kratzke IM, Zhou G, Mosaly P, Farrell TM, Crowner J, Yu D. Evaluating the Ergonomics of Surgical Residents During Laparoscopic Simulation: A Novel Computerized Approach. Am Surg 2022:31348211047505. [PMID: 35045763 DOI: 10.1177/00031348211047505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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 Assessment of residents' body positioning during laparoscopy has not been adequately investigated. This study presents a novel computer vision technique to automate ergonomic evaluation and demonstrates this approach through simulated laparoscopy. METHODS Surgical residents at a single academic institution were video recorded performing tasks from the Fundamentals of Laparoscopic Surgery (FLS). Ergonomics were assessed by 2 raters using the Rapid Upper Limb Assessment (RULA) tool. Additionally, a novel computer software program was used to measure ergonomics from the video recordings. All participants completed a survey on musculoskeletal complaints, which was graded by severity. RESULTS Ten residents participated; all performed FLS in postures that exceeded acceptable ergonomic risks as determined by both the human and computerized RULA scores (P < .001). Lower-level residents scored worse than upper-level residents on the human-graded RULA assessment (P = .04). There was no difference in computer-graded RULA scores by resident level (P = .39) and computer-graded scores did not correlate with human scores (P = .75). Shoulder and wrist position were the greatest contributors to higher computer-graded scores (P < .001). Self-reported musculoskeletal complaints did not differ at resident level (P = .74); however, all residents reported having at least 1 form of musculoskeletal complaint occurring "often." CONCLUSIONS Surgery residents demonstrated suboptimal ergonomics while performing simulated laparoscopic tasks. A novel computer program to measure ergonomics did not agree with the scores generated by the human raters, although it concluded that resident ergonomics remain a concern, especially regarding shoulder and wrist positioning.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, 6797University of North Carolina, Chapel Hill, NC, USA
| | - Guoyang Zhou
- School of Industrial Engineering, 228927Purdue University, West Lafayette, IN, USA
| | - Prithima Mosaly
- Department of Psychiatry, 6797University of North Carolina, Chapel Hill, NC, USA
| | - Timothy M Farrell
- Department of Surgery, 6797University of North Carolina, Chapel Hill, NC, USA
| | - Jason Crowner
- 2613MedStar Heart and Vascular Institute, Baltimore, MD, USA
| | - Denny Yu
- School of Industrial Engineering, 228927Purdue University, West Lafayette, IN, USA
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11
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Reid TD, Kratzke IM, Dayal D, Raff L, Serrano P, Kumar A, Zendel A, Herdman V, Gallaher J, Carlson R, Charles AG, Desai CS. The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature. Artif Organs 2021; 46:578-596. [PMID: 34816462 DOI: 10.1111/aor.14120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation. METHODS This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre- or post-transplant) and donors who underwent Veno-arterial or Veno-venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. RESULTS Forty-one articles were identified that fit criteria. A total of 183 donors were placed on ECMO, with recipient complication profiles and mortality that mirrored rates from standard criteria donors. Sixty-one recipients were placed on ECMO intraoperatively or postoperatively. Most patients experienced at least one complication with infections as the most common cause and minimal complications specifically related to ECMO use. Multisystem organ failure (MSOF) and infections were more common among liver recipients who died compared to those who survived. Overall mortality at 90 days was 45.9%. Causes of death were most commonly MSOF and infections. CONCLUSIONS ECMO use in adult liver transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO parallel that of recipients from standard criteria donors, and morbidity and mortality of recipients placed on ECMO are similar to other ECMO populations.
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Affiliation(s)
- Trista D Reid
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian M Kratzke
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diana Dayal
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Raff
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pablo Serrano
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aman Kumar
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Zendel
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victoria Herdman
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Gallaher
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca Carlson
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony G Charles
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Trauma and Acute Care Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chirag S Desai
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Transplant Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Kratzke IM, Reid TS, Raff L, Kumar A, Dayal D, Zendel A, Rodriguez PS, Carlson R, Desai CS. Outcomes of Abdominal Organs Transplanted from Donors on Extracorporeal Membrane Oxygenation: A Qualitative Systematic Review. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kratzke IM, Steele PL, Gerber DA. Navigation Improves Tumor Ablation Performance: Results from a Novel Liver Tumor Simulator Study. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Affiliation(s)
| | - Ian M Kratzke
- Department of Surgery, University of North Carolina, Chapel Hill
| | - Sonia L Sugg
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
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15
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Portelli Tremont JN, Kratzke IM, Motameni A, Nunoo R, Chung A. Laparoscopic-Assisted Transgastric Endoscopic Retrograde Cholangiopancreatography With Placement of a Biliary Stent to Treat Traumatic Intrahepatic Bile Duct Disruption in a Patient With Roux-en-Y Gastric Bypass. Am Surg 2021:31348211025756. [PMID: 34116597 DOI: 10.1177/00031348211025756] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatic injuries are common following blunt trauma and while frequently managed expectantly, biliary injury as a result of the trauma requires a high index of suspicion, a focused workup, and likely interventional treatment. A 44-year-old female with a history of Roux-en-Y gastric bypass presented after a ground level fall and was initially discharged home but represented with worsening abdominal pain and elevated liver enzymes. She was found to have a segment 5/6 biliary injury requiring laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography with common bile duct stent placement. This case represents the difficulty of diagnosing biliary injuries following blunt trauma, and the need for advanced endoscopic interventions for treatment in patients with atypical anatomy.
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Affiliation(s)
- Jaclyn N Portelli Tremont
- Division of General and Trauma Surgery, Department of Surgery, 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,Department of Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian M Kratzke
- Division of General and Trauma Surgery, Department of Surgery, 10848WakeMed Health and Hospitals, Raleigh, NC, USA.,Department of Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amirreza Motameni
- Division of General and Trauma Surgery, Department of Surgery, 10848WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Robert Nunoo
- Division of General and Trauma Surgery, Department of Surgery, 10848WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Ann Chung
- Division of General and Trauma Surgery, Department of Surgery, 10848WakeMed Health and Hospitals, Raleigh, NC, USA
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16
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Portelli Tremont JN, Kratzke IM, Williford ML, Pascarella L. A Novel Educational Tool to Improve Medical Student Knowledge Acquisition During Surgical Rotations. Am Surg 2021; 88:2309-2313. [PMID: 34082603 DOI: 10.1177/00031348211023430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND The addition of a novel education tool helps students improve understanding of general surgery topics. However, the effect of the new tool on objective exam performance is unknown. MATERIALS A 10-item card of high-yield general surgery topics was implemented in the third-year surgery clerkship. Students reviewed these topics with general surgery residents. Scores from the National Board of Medical Examiners (NBME) surgery subject exam and Step 2 Clinical Knowledge (CK) board exam were compared among students who completed the Ask-a-Resident Topic card to a control group. RESULTS Students who participated in the curriculum demonstrated significantly better scores on the NBME Surgery exam, t (236) = -2.56, P = .006. There was not a significant effect of the curriculum on Step 2 CK scores, although students who participated in the curriculum (M = 250.7, SD = 13.4) achieved higher scores than the control group (M = 247.8, SD = 14.2). DISCUSSION The novel curriculum may improve objective student performance on standardized surgery exams.
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Affiliation(s)
| | - Ian M Kratzke
- Department of Surgery, 2331University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Michael L Williford
- Department of Surgery, 2331University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Luigi Pascarella
- Department of Surgery, 2331University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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17
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Kratzke IM, Rosenbaum ME, Cox C, Ollila DW, Kapadia MR. Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters: A Randomized Clinical Trial. JAMA Surg 2021; 156:372-378. [PMID: 33704389 DOI: 10.1001/jamasurg.2021.0836] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance During the COVID-19 pandemic, wearing masks has become necessary, especially within health care. However, to our knowledge, the consequences of mask wearing on communication between surgeons and patients have not been studied. Objective To evaluate the effects of clear vs standard covered masks on communication during surgical clinic encounters. Design This randomized clinical trial examined communication between surgeons and their patients when surgeons wore clear vs covered masks in surgical outpatient clinics at a single academic medical center. New patients were recruited from participating surgeons' clinic schedules. Interventions Surgeons wore either clear masks or covered masks for each clinic visit with a new patient, based on a per-visit randomization plan. Main Outcomes and Measures The primary outcome measures included patient perceptions of (1) surgeon communication and (2) trust in surgeons, as well as (3) quantitative assessments and (4) qualitative assessments regarding patient impressions of the surgeon's mask. After the clinic encounter, patients completed a verbal survey including validated Clinician and Group Consumer Assessment of Healthcare Providers and Systems questions. Additional questions involved surgeon empathy, trust, and the patient's impression of the surgeon's mask. Data were analyzed by comparing patient data in the clear vs covered groups using Cochran-Mantel-Haenszel tests, and comments were analyzed for themes. Results Two hundred patients were enrolled from 15 surgeons' clinics spanning 7 subspecialties. When surgeons wore a clear mask, patients rated their surgeons higher for providing understandable explanations (clear, 95 of 100 [95%] vs covered, 78 of 100 [78%]; P < .001), demonstrating empathy (clear, 99 [99%] vs covered, 85 [85%]; P < .001), and building trust (clear, 94 [94%] vs covered, 72 [72%]; P < .001). Patients preferred clear masks (clear, 100 [100%] vs covered, 72 [72%]; P < .001), citing improved surgeon communication and appreciation for visualization of the face. Conversely, 8 of 15 surgeons (53%) were unlikely to choose the clear mask over their standard covered mask. Conclusions and Relevance This randomized clinical trial demonstrates that patients prefer to see their surgeon's face. Surgeons who wore clear masks were perceived by patients to be better communicators, have more empathy, and elicit greater trust. Because masks will remain part of the health care landscape for some time, deliberate attention to preserving communication within the surgeon-patient relationship is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT04595695.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina, Chapel Hill
| | | | - Chase Cox
- Department of Surgery, University of North Carolina, Chapel Hill
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill
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18
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Portelli Tremont JN, Kratzke IM, Williford ML, Pascarella L. Enhancing Medical Student Education and Combating Mistreatment During a Surgery Clerkship With a Novel Educational Tool: A Pilot Study. J Surg Educ 2021; 78:76-82. [PMID: 32600892 DOI: 10.1016/j.jsurg.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/11/2020] [Revised: 05/13/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Medical education changes dramatically from preclinical to clinical years, and the learning environment becomes key as students strive to develop clinical competence and informed career decisions. This change becomes heightened on a surgical clerkship where student mistreatment is often perceived, and the fast-paced nature of surgery can result in limited resident-student interactions and time for examination preparation. OBJECTIVE To evaluate medical student and resident perception of educational strategies during a surgical clerkship and to determine whether the addition of a novel educational tool would increase satisfaction with the surgical clerkship on examination preparation and team dynamics. SETTING University of North Carolina at Chapel Hill, Department of Surgery. STUDY DESIGN During the 2018-2019 academic year, a 10-item "Ask a Resident Topics" (ART) card of high yield general surgery topics was implemented as part of the third-year surgery clerkship curriculum. Students were asked to review a topic and then discuss it with a general surgery resident. They were expected to complete at least 6 of 10 topics by the end of the rotation for credit. At the end of the year, third-year medical students were administered a 23-item survey regarding their experience on the surgery clerkship and with the ART cards. Fourth-year medical students and those students at satellite sites who did not receive the ART cards were administered the same survey, minus specific questions about the ART card, and were used as a preintervention control. General surgery residents who participated in teaching were similarly surveyed. RESULTS Of those students that completed the ART cards, 84% felt it improved their understanding of general surgery and were more likely to report the surgery clerkship prepared them well for the NBME examination compared to those who did not (Χ2 (1, N = 87) = 4.95, p = 0.03). They were also more likely to report residents were willing to discuss surgery topics with them (Χ2 (1, N = 87) = 2.77, p = 0.10). Seventy-three percent of students thought the card did not add undue stress to their clerkship. Sixty-three percent of all students felt they were a productive member of the surgery team, and this did not vary by intervention group (Χ2 (1, N = 87) = 0.03, p = 0.9). Students who completed the ART card were more likely to report being interested in surgery than those who did not (Χ2 (1, N = 87) = 4.20, p = 0.04). Hundred percent of residents surveyed felt the ART card provided value for themselves as a teacher and for the student as a learner. CONCLUSIONS The ART card is mutually beneficial to both residents and medical students during the surgical clerkship. This tool is easy to implement, helps students improve their understanding of general surgery, increases camaraderie among the surgical team, and has a positive impact on students pursuing a career in surgery.
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Affiliation(s)
| | - Ian M Kratzke
- University of North Carolina Chapel Hill, Department of Surgery, Chapel Hill, North Carolina
| | - Michael L Williford
- University of North Carolina Chapel Hill, Department of Surgery, Chapel Hill, North Carolina
| | - Luigi Pascarella
- University of North Carolina Chapel Hill, Department of Surgery, Chapel Hill, North Carolina
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19
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill
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20
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Kratzke IM, Campbell A, Yefimov MN, Mosaly PR, Adapa K, Meltzer-Brody S, Farrell TM, Mazur LM. Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout. J Am Coll Surg 2020; 232:74-80. [PMID: 33022395 DOI: 10.1016/j.jamcollsurg.2020.08.762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Burnout is prevalent among surgical residents. Neurofeedback is a technique to train the brain in self-regulation skills. We aimed to assess the impact of neurofeedback on the cognitive workload and personal growth areas of surgery residents with burnout and depression. STUDY DESIGN Fifteen surgical residents with burnout (Maslach Burnout Inventory [MBI] score > 27) and depression (Patient Health Questionnaire-9 Depression Screen [PHQ-9] score >10), from 1 academic institution, were enrolled and participated in this institutional review board-approved prospective study. Ten residents with more severe burnout and depression scores were assigned to receive 8 weeks of neurofeedback treatments, and 5 others with less severe symptoms were treated as controls. Each participant's cognitive workload (or mental effort) was assessed initially, and again after treatment via electroencephalogram (EEG) while the subjects performed n-back working memory tasks. Analysis of variance (ANOVA) tested for significance between the degree of change in the treatment and control groups. Each subject was also asked to rate changes in growth areas, such as sleep and stress. RESULTS Both groups showed high cognitive workload in the pre-assessment. After the neurofeedback intervention, the treatment group showed a significant (p < 0.01) improvement in cognitive workload via EEG during the working memory task. These differences were not noted in the control group. There was significant correlation between time (NFB sessions) and average improvement in all growth areas (r = 0.98) CONCLUSIONS: Residents demonstrated high levels of burnout, correlating with EEG patterns indicative of post-traumatic stress disorder. There was a notable change in cognitive workload after the neurofeedback treatment, suggesting a return to a more efficient neural network.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina, Chapel Hill, NC.
| | - Alana Campbell
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Mae N Yefimov
- Neurocognition and Imaging Research Lab, University of North Carolina, Chapel Hill, NC
| | - Prithima R Mosaly
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Karthik Adapa
- Division of Healthcare Engineering, University of North Carolina, Chapel Hill, NC
| | | | - Timothy M Farrell
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Lukasz M Mazur
- Division of Healthcare Engineering, University of North Carolina, Chapel Hill, NC
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21
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22
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Kratzke IM, Strassle PD, Schiro SE, Meyer AA, Brownstein MR. Risks and Realities of Delayed Splenic Bleeding. Am Surg 2019; 85:904-908. [PMID: 31560311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina. Using ICD-9 and ICD-10 codes, patients were stratified into two cohorts, those who underwent immediate splenectomy and those who were initially managed nonoperatively. DSB was then defined as splenectomy at greater than 24 hours after presentation. Of the 1688 patients included in the study, 269 patients (16%) underwent immediate splenectomy and 1419 (84%) were managed nonoperatively initially, with 32 (2%) having delayed splenectomy. Older age (≥30 years) was associated with increased odds of having delayed splenectomy (odds ratio 4.30; 95% confidence interval 1.08, 17.17; P = 0.04). Four per cent of patients managed nonoperatively and undergoing an angioembolization procedure eventually required splenectomy. Risk factors for DSB remain elusive. Splenic artery embolization may be used as an adjuvant to splenectomy for stable patients, but it is not always a definitive treatment, and patients may still require splenectomy.
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23
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Kratzke IM, Strassle PD, Schiro SE, Meyer AA, Brownstein MR. Risks and Realities of Delayed Splenic Bleeding. Am Surg 2019. [DOI: 10.1177/000313481908500846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina. Using ICD-9 and ICD-10 codes, patients were stratified into two cohorts, those who underwent immediate splenectomy and those who were initially managed nonoperatively. DSB was then defined as splenectomy at greater than 24 hours after presentation. Of the 1688 patients included in the study, 269 patients (16%) underwent immediate splenectomy and 1419 (84%) were managed nonoperatively initially, with 32 (2%) having delayed splenectomy. Older age (≥30 years) was associated with increased odds of having delayed splenectomy (odds ratio 4.30; 95% confidence interval 1.08, 17.17; P = 0.04). Four per cent of patients managed nonoperatively and undergoing an angioembolization procedure eventually required splenectomy. Risk factors for DSB remain elusive. Splenic artery embolization may be used as an adjuvant to splenectomy for stable patients, but it is not always a definitive treatment, and patients may still require splenectomy.
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Affiliation(s)
- Ian M. Kratzke
- From the University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Paula D. Strassle
- From the University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Sharon E. Schiro
- From the University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Anthony A. Meyer
- From the University of North Carolina Medical Center, Chapel Hill, North Carolina
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24
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Liu J, Gallo RM, Khan MA, Iyer AK, Kratzke IM, Brutkiewicz RR. JNK2 modulates the CD1d-dependent and -independent activation of iNKT cells. Eur J Immunol 2018; 49:255-265. [PMID: 30467836 DOI: 10.1002/eji.201847755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/30/2018] [Accepted: 11/21/2018] [Indexed: 01/01/2023]
Abstract
Invariant natural killer T (iNKT) cells play critical roles in autoimmune, anti-tumor, and anti-microbial immune responses, and are activated by glycolipids presented by the MHC class I-like molecule, CD1d. How the activation of signaling pathways impacts antigen (Ag)-dependent iNKT cell activation is not well-known. In the current study, we found that the MAPK JNK2 not only negatively regulates CD1d-mediated Ag presentation in APCs, but also contributes to CD1d-independent iNKT cell activation. A deficiency in the JNK2 (but not JNK1) isoform enhanced Ag presentation by CD1d. Using a vaccinia virus (VV) infection model known to cause a loss in iNKT cells in a CD1d-independent, but IL-12-dependent manner, we found the virus-induced loss of iNKT cells in JNK2 KO mice was substantially lower than that observed in JNK1 KO or wild-type (WT) mice. Importantly, compared to WT mice, JNK2 KO mouse iNKT cells were found to express less surface IL-12 receptors. As with a VV infection, an IL-12 injection also resulted in a smaller decrease in JNK2 KO iNKT cells as compared to WT mice. Overall, our work strongly suggests JNK2 is a negative regulator of CD1d-mediated Ag presentation and contributes to IL-12-induced iNKT cell activation and loss during viral infections.
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Affiliation(s)
- Jianyun Liu
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard M Gallo
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Masood A Khan
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA.,College of Applied Medical Sciences, Al-Qassim University, Buraidah, Saudi Arabia
| | - Abhirami K Iyer
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ian M Kratzke
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Randy R Brutkiewicz
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
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25
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Walline CC, Sehra S, Fisher AJ, Guindon LM, Kratzke IM, Montgomery JB, Lipking KP, Glosson NL, Benson HL, Sandusky GE, Wilkes DS, Brutkiewicz RR, Kaplan MH, Blum JS. Allergic airway disease in mice alters T and B cell responses during an acute respiratory poxvirus infection. PLoS One 2013; 8:e62222. [PMID: 23620814 PMCID: PMC3631162 DOI: 10.1371/journal.pone.0062222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
Pulmonary viral infections can exacerbate or trigger the development of allergic airway diseases via multiple mechanisms depending upon the infectious agent. Respiratory vaccinia virus transmission is well established, yet the effects of allergic airway disease on the host response to intra-pulmonary vaccinia virus infection remain poorly defined. As shown here BALB/c mice with preexisting airway disease infected with vaccinia virus developed more severe pulmonary inflammation, higher lung virus titers and greater weight loss compared with mice inoculated with virus alone. This enhanced viremia was observed despite increased pulmonary recruitment of CD8+ T effectors, greater IFNγ production in the lung, and high serum levels of anti-viral antibodies. Notably, flow cytometric analyses of lung CD8+ T cells revealed a shift in the hierarchy of immunodominant viral epitopes in virus inoculated mice with allergic airway disease compared to mice treated with virus only. Pulmonary IL-10 production by T cells and antigen presenting cells was detected following virus inoculation of animals and increased dramatically in allergic mice exposed to virus. IL-10 modulation of host responses to this respiratory virus infection was greatly influenced by the localized pulmonary microenvironment. Thus, blocking IL-10 signaling in virus-infected mice with allergic airway disease enhanced pulmonary CD4+ T cell production of IFNγ and increased serum anti-viral IgG1 levels. In contrast, pulmonary IFNγ and virus-specific IgG1 levels were reduced in vaccinia virus-treated mice with IL-10 receptor blockade. These observations demonstrate that pre-existing allergic lung disease alters the quality and magnitude of immune responses to respiratory poxviruses through an IL-10-dependent mechanism.
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Affiliation(s)
- Crystal C. Walline
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sarita Sehra
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Amanda J. Fisher
- Center for Immunobiology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Lynette M. Guindon
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Ian M. Kratzke
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jessica B. Montgomery
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kelsey P. Lipking
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Nicole L. Glosson
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Heather L. Benson
- Center for Immunobiology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - George E. Sandusky
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - David S. Wilkes
- Center for Immunobiology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Randy R. Brutkiewicz
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Mark H. Kaplan
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Pediatrics, HB Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Janice S. Blum
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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