Elective Options Research Articles

1240 Life Expectancy of Octogenarians Following EVAR

Abstract Background The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients. Method A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October 2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using the SPSS software to calculate a Kaplan-Meier curve. Results 294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median: 75); 87.4% were male. 169 patients died during follow up (n = 64 ≥80 years, n = 105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0 - 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1 - 152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p = 0.017). Median years post-EVAR for ≥80 years was 3.02 - 4.98 and <80 years was 5.12 - 6.87. Conclusions Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be considered when discussing elective options with patients and their relatives.

106 Life expectancy of octogenarians following EVAR

Abstract Background The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients. Methods A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using SPSS software to calculate a Kaplan-Meier curve. Results 294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median 75); 87.4% were male. 169 patients died during follow up (n=64 ≥80 years, n=105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0- 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1-152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p=0.017). Median years post-EVAR for ≥80 years was 3.02-4.98 and <80 years was 5.12 – 6.87. Conclusion Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be taken into account when discussing elective options with patients and their relatives.

Book Reviews

Book Reviews

Penn State College of Medicine.

Penn State College of Medicine.

Qu’est-ce qu’un héritage social ?

This article attempts to answer the question of what is “social inheritance.” First, the article focuses on resolving an apparent contradiction: if on the one hand a social being is conditioned by inheritance, the social conditions that also lie at the core of individuals call for emancipation from or renouncement of this inheritance. The focus is on highlighting how much what one designates as the identity of the individual is always more than a management of its singular inheritances; it is a continuous activity of remodeling of said inheritances with acquired experiences and elective options, a process I have called the mythogenic activity of social subjects. Finally, the article establishes that social heritage is to be considered more as a retrospectively constructed entity than as a given determinant of the future.

Medical students' preparation for the transition to postgraduate training through final year elective rotations.

Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a “transitional year”. Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training.Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: their preferred specialty at the start of the transitional year, electives they chose during this year and reasons for these choices, and whether the transitional year electives changed their career considerations. Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%). Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty preferences or resulted in a more clear insight.Conclusion: We conclude that students use the transitional year electives to focus on their future postgraduate training program, i.e. for orientation and to align their curriculum vitae with their preferred specialty, resulting in spontaneous early specialty streaming. To take advantages of this streaming, and to make sure students can transfer their experiences to other specialties if their career preferences change, individual elective Entrustable Professional Activities (EPAs), next to the core EPAs for all medical students, may serve to prepare a smooth transition to a specialty of choice and should be fully documented.

An urgent renal autotransplantation in patient with ureteral avulsion

Uretrorenoscopy (URS) has become the gold standard in the treatment of ureteral stones. Ureteral avulsion (0.1-0.3%) and ureteral perforation (1.7-6%) are the worst morbid complications of the URS. Ureteral avulsion has been mostly encountered in URS procedures for ureteral stones in the ureteropelvic junction. Renal autotransplantation is one of the elective treatment options in patients with ureteral avulsion. An urgent renal autotransplantation owing to an iatrogenic ureteral avulsion after a ureteral extraction in a 42-year-old female patient who underwent URS is presented in the light of literature.

Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics and gerontology and in quality improvement (QI) and support to implement a local QI project; in addition, elective options include webinars, audio conferences, clinical practica, and mentoring. The program is effective in improving core competencies in geriatrics and in improving clinical care for older Veterans who receive health care in rural clinics.

The Master of Science in Clinical Epidemiology Degree Program of the Perelman School of Medicine at the University of Pennsylvania: A Model for Clinical Research Training

An innovative training program to provide clinical research training for clinicians was created in 1979 at the University of Pennsylvania School of Medicine, now the Perelman School of Medicine. The program's principal and continuing aim is to provide trainees mentored experiences and the training needed to become skilled independent investigators able to conduct clinical research and develop academic careers as independent clinical investigators.The authors identify the vision that led to the creation of the master of science in clinical epidemiology (MSCE) degree program and describe today's training program, including administration, oversight, participating faculty, and trainees. They also describe the program's core curriculum, elective options, seminars on ongoing research, training in the responsible conduct of research, professional development activities, and the development and completion of a closely mentored clinical research project.Approximately 35 new trainees enter the two- to three-year program annually. Funding is provided primarily by National Institutes of Health-funded training programs and supplemented by private industry, private foundations, and employee-based benefits. More than 500 individuals have received or are currently receiving training through the MSCE program. A large percentage of former trainees maintain full-time positions in academic medicine today.The authors identify some challenges that have been met and insights regarding funding, faculty, trainees, and curriculum. Ongoing challenges include recruiting trainees from some selected highly paid, procedure-oriented specialties, maintaining sufficient mentors for the continually increasing numbers of trainees, and distinguishing applicants who truly desire a primary research career from others.

Analysis of the elective curriculum in undergraduate medical education in Croatia

Elective courses are a significant part of undergraduate medical education throughout the world, but the value provided by these courses and the reasons for choosing particular elective courses have not been studied extensively. The aim of this study was to investigate medical and dental students' experiences of elective courses in undergraduate medical education in Croatia and to gather students' recommendations for the improvement of elective courses. Medical and dental students studying under the Bologna curriculum were given a questionnaire in which they were asked for their opinions of elective courses and their suggestions as to how they might be improved. Data on elective courses were obtained from medical schools' administrative offices. The survey response rate was 92% (834/903). Medical students gave elective courses an average grade of 3.44 out of 5, whereas dental students gave a lower average of 3.15. Students' suggestions for change included introducing more practical work and recognising international student exchanges and attendance at conferences as elective options. A third of students indicated that teachers should be given additional training in leading elective courses. Analysis of the curriculum showed that elective courses in Croatian medical schools are very heterogeneous in terms of their content and the number of credits and assessment methods they involve, and are very conservative in that only structured courses are offered. Students cannot design their own courses or take more elective courses than represent 10% of their total number of credits. Student opinion should be consulted when medical schools venture into the elective curriculum so that students can feel that they are really benefiting from these subjects. Students would welcome new and personally designed strands. Elective courses are a significant part of medical education and therefore their quality and purpose need to be assessed regularly in order to ensure that they meet students' needs.

Bridging the specialist-generalist divide: a creative Master’s programme initiative

This article outlines the development of a new Master's programme that is suitable particularly for those who are interested in managing palliative care in generalist care contexts. Disseminating the essence of excellent palliative care provision, accessible by the minority to the majority in need, has been an issue for some time. National Service Frameworks identify the contribution of both education and workforce planning to facilitate such provision. A gradual shift in design of palliative programme provision has seen the emergence of education that is more malleable to varied practice contexts. This new MSc Palliative Care Programme is centred on interprofessional education, and through collaborative working, shares modules with a neighbouring university to produce financially viable provision. Essential palliative content is delivered in compulsory taught modules, however, elective options include open or work-based modules that facilitate palliative practice development tailored to specific context need. Postgraduate study, associated with leading practice, means that a few key staff can significantly impact disseminating enhanced palliative practice across care environments. In this way, in the community and in institutions where the majority of older people dying of chronic illness are cared for, resources can be used purposefully to maximize the chance of 'a good enough death' (McNamara, 2001).

ELECTIVE EXPERIENCES OF FOREIGN MEDICAL STUDENTS AT THE TEACHING HOSPITAL OF TRIBHUVAN UNIVERSITY INSTITUTE OF MEDICINE, NEPAL

This paper has attempted to document and analyze the trend and experiences of foreignmedical students enrolled in the elective programme organized by the MedicalEducation Department (MED) at the Teaching Hospital of the Tribhuvan University(TUTH), Institute of Medicine in Kathmandu. Elective documents have been analyzedfor the period between 1997-2000 and a written questionnaire survey has beenadministered to a total of 73 foreign medical students who completed elective in theyear 2000. Over a period of four years a total of 268 students had undergone electiveposting in various departments of TUTH. More than half of the students (55%) camefrom European universities. More than 60% of respondents (n=73) considered theopportunity to see variety of patients as the main strength of the elective programme.Overwhelming majority of respondents (95%) rated the learning experience as goodor excellent. The most favoured department was the Internal Medicine. The studydemonstrates the unique value of elective in enriching student learning in medicaleducation. The traditional belief that all students should have a uniform curriculumthroughout their training has been largely challenged.1The insights gained couldperhaps, inspire medical schools to seriously think about introducing elective provisionas an essential component of their undergraduate curricula.1. Medical Education Department, TU Institute of Medicine.Address for correspondence : Dr. D. S. Pant, MD, MHPED,Assistant Director & Elective Programme Coordinator,Medical Education Department, TU Institute of Medicine,P.O. Box: 1524, Kathmandu, Nepal.Email: dspant@healthnet.org.np, Home Page: www.nchped.org.npKey Words: Elective terms, overseas elective, elective experience in developingcountries, core and elective options, undergraduate medical elective.

Acoustics education in the Low Countries

This presentation is an overview of acoustics education programs found at universities and professional colleges in the Netherlands and Flanders. As has happened in many other academic areas, the traditional organization of educational programs along disciplinary lines has to a large extent made a place for an organization based on application areas. In university programs on acoustics, one finds clusters of specialized subjects that seem to be typical for schools or departments, such as audiology, audiometry, and speech therapy in medical schools, phonetics, music, and speech in humanities departments, and architectural acoustics, noise control, imaging, and fundamentals in applied sciences or engineering departments. Several professional colleges offer courses that are focused on measurement techniques, insulation properties of materials, and noise control in buildings and structures. A fundamental and broad treatment of acoustics, followed by a treatment of specialized applications in the areas of noise control engineering, architectural acoustics, or electroacoustics as elective options, is found in the Advanced Acoustics Course, organized by the Dutch and the Belgian acoustical societies and taught annually in Antwerp.

Music Comes to Yale

Music's right to a place in higher institutions of general learning in the United States has not been disputed since the turn of the century. However, this happy situation did not come about without a struggle. Although important music conservatories began to proliferate and flourish immediately after the Civil War, liberal arts colleges and universities moved slowly and cautiously in admitting music as a curricular study. It required considerable pressure in some instances to persuade them that music was indeed one of the liberal arts and not merely a trade. This is the story of what happened at Yale University, which has the dubious distinction of having moved more slowly and more warily than most other major institutions. It waited 189 years before becoming convinced. Actually, there had been a great deal of music making at Yale since its founding in 1701, with a long succession of extracurricular choral and instrumental groups marking its musical history over the years. But the administration and faculty remained adamant in their stand that music had no place in the classroom. The degree course was a rigidly prescribed program permitting no elective options whatever. Yale's clergymen presidents were determined to keep it that way and were able to do so until 1885, when a minor revolt by a liberal bloc in the faculty succeeded in overriding the administration and in gaining approval for a limited number of electives for juniors and seniors. This opened the way for music, and studies in music theory were authorized in 1890. Although the main action of this story takes place between 1885 and 1890, these five years mark only the culmination of a move to gain recognition for music study that had been under way for some thirty-five years. Involved in this effort were five separate but fatefully interlocked forces, comprising three individuals and two groups of individuals. These protagonists constituted a dramatis personae that even the scriptwriter of a television series might hesitate to use today, namely, the members of an affluent patrician family of Connecticut,

Establishing Reading Groups; Or, Selling Your Product on the Open Market

MIANY STUDENTS NOW, viewing education as mainly career preparation and orientation, are taking more science and business courses; thus, the demand from traditional students for liberal arts courses has lessened. For two reasons many of us view this decline in our course enrollments dismay. The first is a result of the same pragmatism that our students exhibit; we are concerned about our jobs and those of our colleagues. But the second is based on our fear that we will no longer have as wide a forum for cultivating in our students an appreciation for literature. Many of us teach English courses because we recognize that understanding and enjoying the aesthetic is essential in the development of the complete person. We are concerned, good cause, that a society managed by those strengths in the knowledges of business and science, and little exposure to the arts and humanities, may lack the moral and ethical vision-the fuller life-that these disciplines offer. So for both economic and aesthetic reasons we are looking for ways to carry literature beyond the confines of the classroom and into other student and adult communities. We want to insure continued reading and perhaps even to prompt the students to enroll in our courses as elective options and to encourage the adults to take continuing education courses or to enroll in a standard college program. have found that one method to achieve both these aesthetic and practical goals is to establish literary reading groups, or book clubs. am aware that many group reading ventures begin enthusiastically but end with a whimper because the members cannot agree on level of difficulty (I can't remember those Russian names!) or subject matter (I don't like books obscene language, or I won't read a book a character who is a homosexual). But in the last five years have initiated three book clubs and all are currently meeting regularly. believe that the success of these groups lies in the fact that they were structured for different, but homogeneous, audiences. My experience indicates that there are at least three reading group

Survey of Sex Education Coursework in Special Education Programs

Much has been written about the need to prepare handicapped individuals to deal with their sexuality. If they are to be taught sex education effectively, their teachers must receive adequate instruction in this crucial curriculum area. A survey was sent to the chair-persons of 185 special education teacher-training programs to determine the amount and type of coursework in sex education that their students received during their special education teacher preparation. Of the 146 programs that responded, 61% indicated that their students received some preparation in sex education. Further analysis indicates that the majority of the coursework was either elective options or a few hours of coverage within existing courses. The need for training programs to assist teachers in integrating sex education into their coursework is stressed.

New programs

This September, Lehigh University will introduce a four‐year bachelor's program in “Fundamental Sciences” that combines two or more of the traditional science or engineering disciplines into a single undergraduate major. By providing a broad foundation and flexible course with many elective options, the new curriculum is intended to prepare students for careers in such interdisciplinary fields as geophysics, materials science, and bioengineering.