Medicine Fellowship Research Articles

Strategic approaches in oral squamous cell carcinoma diagnostics using liquid biopsy.

Liquid biopsy is a noninvasive diagnostic technique used for monitoring cancer utilizing specific genetic biomarkers present in bodily fluids, such as blood, saliva, or urine. These analyses employ multiple biomolecular sources including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and exosomes (that contain DNA fragments) to detect genetic biomarkers that can predict, disclose, and/or monitor cancers. Levels of these biomarkers can inform on the presence of cancer, its genetic characteristics, and its potential treatment response and also provide predictive genetic predisposition information for specific cancers including oral squamous cell carcinomas (OSCC). Liquid biopsies can aid cancer management as they offer real-time dynamic information on the response to say chemotherapy or radiotherapy and recurrence following surgical excision. Unlike traditional tissue biopsies, which are invasive with a degree of morbidity and require specific tumor location sampling, liquid biopsies are noninvasive and can be repeated frequently. For oral squamous cell carcinoma, on which this review focuses, liquid biopsy of blood or saliva can be valuable in predicting susceptibility, providing early detection, and monitoring the disease's progression and response to therapy. This review gives a general narrative overview of the technology, its current medical usage, and advantages and disadvantages compared with current techniques and discusses a range of current potential biomarkers for disclosing OSCC and predicting its risk. Oral squamous cell carcinoma is all too often detected in the late stages. In future, liquid biopsy may provide an effective screening process such that cancers including OSCC will be detected in the early stages rather than later when prognosis is poor and morbidity and debilitation are greater. In this screening process, periodontists and hygienists have a critical role in that they are adept in examining mucosa, they see patients with shared risk factors for periodontitis and OSCC, namely smoking and poor oral hygiene, and they see patients frequently such that OSCC examinations should be a routine part of the recall visit. With this additional screening manpower, oral medicine and oral surgery colleagues will detect OSCC earlier and this coupled with new techniques such as liquid biopsy may greatly decrease global morbidity in OSCC.

Jeffrey A. Norton and the Multiple Endocrine Neoplasia Syndromes.

Jeffrey A. Norton could have been a professional football player but instead he chose to pursue a career in medicine and in the process became an outstanding academic surgeon. This story recounts his ascent from a small town in Massachusetts to the pinnacle of academic surgery. After graduating from high school in Albany, New York, Jeff continued his education at Dartmouth University, the State University of New York Upstate Medical University at Syracuse (SUNY Upstate Medical University), and the Department of Surgery at the Duke University School of Medicine. When he completed the surgical residency, he spent 10 years at the National Cancer Institute (NCI) where he and his colleagues made significant contributions to the diagnosis and treatment of patients with endocrine tumors. After leaving the NCI, he had highly productive years as a Professor in Departments of Surgery at Washington University, the University of California at San Francisco, and Stanford University. He became a member of every major academic surgical society and won numerous awards for his accomplishments in research. His expertise in educating medical students and surgical residents is legendary. In addition to his academic accomplishments, Jeff trained legions of young surgeons who subsequently made significant contributions in surgical investigation and clinical surgery. It is most fitting that the Stanford University School of Medicine has assembled a group of Jeffrey Norton's colleagues in academic medicine and surgery to pay tribute to his achievements as a surgical scientist.

Surgeons’ knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons

BackgroundPatients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care.MethodsThis study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association’s electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons’ management of perioperative pain in patients with opioid use disorder and perceived barriers in treatment.ResultsA total of 260 surgeons responded representing all specialties except ophthalmology. General surgery (66.5%) and plastic and reconstructive surgery (7.5%) represented the majority of responders. Ninety-five percent of surgeons reported treating a patient who used opioids in the past month and 86% encountered a patient with OUD. Nearly half (46%) reported being uncomfortable managing postoperative pain in patients with OUD. Most (67%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons, analyses identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes.ConclusionNearly half of surgeons report discomfort caring for patients with OUD with the vast majority involving a consulting service to assist with their care. Most surgeons believe that it would be helpful to have guidelines regarding the care of these patients. This provides an opportunity for increased education and training on the perioperative management of patients with OUD and further collaboration with addiction medicine, psychiatry and pain management colleagues.

Interprofessional education in undergraduate dental curricula: A systematic review.

Health professionals who effectively communicate and coordinate their work increase patient safety and quality of care. Therefore, an interprofessional education (IPE) program may be a valuable addition to the curriculum of health science courses. This study aims to verify how IPE has been implemented in undergraduate dental program curricula. This is a qualitative systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with qualitative and qualitative-quantitative studies selected in the period between 2011 and 2021. The guiding question was as follows: how has IPE been implemented in undergraduate dentistry curricula around the world? The quality of the included articles was assessed using the CASP Qualitative Checklist (2018). After the review, 22 studies were selected and data were extracted following the acronym PICo (Population, phenomenon of Interest, and COntext). The majority of studies in which IPE is included in Dentistry come from North American universities. Regarding the IPE teaching methodology, the use of active methodologies was observed and the interprofessional skills most common were role clarity, teamwork, and communication. This systematic review indicated that Dentistry is included in interprofessional activities in many studies around the world, and primarily with colleagues in medicine, nursing, and pharmacy programs. IPE teaching takes place through the use of active methodologies and develops important skills for interprofessional work.

Green Deal and Climate Pact as a Lighthouse and for Public Health in Europe

Abstract Public health professionals (PHP) have a dual task in climate change. They should persuade colleagues in clinical medicine of the importance of all the issues covered by the European Green Deal (EGD). The fact that the health sector contributes to the overall emissions of 4.4% states to the lack of awareness within the health sector itself. Strengthening the opportunities and development of the circular economy within healthcare is more than just a current issue. The second task of PHP is targeting the population digitally. The PH mission is being implemented, inter alia, through numerous activities related to environmental monitoring and assessment of the impact on health. EGD and European Climate Pact (ECP) are a lighthouse for priorities and actions in PH, bearing in mind: an ambitious goal of climate neutrality, an insistence on clean, affordable and safe energy, a strategy for a clean and circular economy. The ECP is an opportunity for citizens but especially for health professionals, to participate in climate action across Europe, to learn about climate change, develop and implement solutions. As part of the EGD, ECP aims to become a space to act on the climate crisis, and offer support for a European climate movement but also to health care professionals to act and implement innovative solutions. ECP and role of Climate pact Ambassadors give opportunities for actions in health care and wider. EGD is a leadership step in the global framework towards a healthier future and comprises all the non-EU members. The PH sector should involve the EGD as an argument for achieving goals at national levels, and align national PH policies with the goals of this document. There is a need for stronger advocacy of public health interests and sustainability into all health policies. Achieving goals requires more environmentally education process for healthcare professionals covering all of topics of climate change, PH digitalization and air pollution to a much greater extent.

797 Short-Term Review of the Presentations and Outcomes of Vocal Fold Palsy Cases Identified at a Large DGH

Abstract Aim Due to the convoluted course of the recurrent laryngeal nerves, vocal cord palsy can be a manifestation of pathologies that cross multiple surgical and medical specialties. The primary role of the vocal folds is that of airway protection. Therefore, it is important that all relevant clinicians understand this clinical scenario in order to prevent aspiration pneumonia in their patients. Method We reviewed eight months of referrals and diagnoses of patients with vocal cord paresis or palsy. This was in the setting of a tertiary Head & Neck service within a large DGH. We assessed the aetiology, management, and outcome of these cases. Results Eleven new cases were identified over the course of eight months. One was due to intrathoracic vascular pathology; one breast cancer; two from head & neck cancer; one bilateral palsy due to upper-GI cancer surgery; four from thyroid-related pathology; one lung cancer; and one idiopathic. To date, ten of eleven cases appear permanent in nature. One patient underwent in-clinic injection laryngoplasty. Two patients (18%) died within six months of diagnosis, both predictable deaths based on baseline pathology. Conclusions Our experience demonstrated the relevance of ENT (Head & Neck), Vascular, Breast, Upper-GI and Thoracic surgeons as well as medical colleagues in Endocrinology, Respiratory Medicine, and Rheumatology. We present diagnostic and management strategies to help surgical trainees across the specialties identify, manage, and refer patients to prevent complication, improve quality of life and provide access to relatively novel procedures such as awake (local anaesthetic) injection laryngoplasty.

THE PREVENTIVE POWER OF PHYSICAL ACTIVITY ON DEPRESSION AND ANXIETY: A NARRATIVE REVIEW

Background:Effective treatments for depression and anxiety include psychology and medications. It is proposed that one of the tools of self-care is physical activity (PA), which is an adjuvant treatment that may play a crucial role in managing depression and anxiety, in addition to promoting a better quality of life (QoL).Through this narrative review, we aim to summarize the latest available evidence and guide our healthcare colleagues to help anyone suffering from depression and anxiety. Summary:PubMed and Cochrane databases were systematically searched for relevantstudies published between January 2018 and June 2023 with no language restriction. Systematic reviews were included in the search. We performed the study selection in 3 stages: initially, we did screening by conducting an electronic search. Article titles and their abstracts were then screened. In the second screening stage, we assessed the full texts. In the last stage, we included studies that met our eligibility criteria. Key Messages:Based on most studies examined, we could conclude that there is an apparent positive effect on depression and anxiety in all adult age groups, nevertheless, in many physical, mental, and psychological conditions.We encourage all our colleagues in preventive medicine, family medicine, and other specialties to prescribe PA as an adjuvant therapy to prevent or treat patients suffering from depression and anxiety. In addition, we recommend that public health and community medicine professionals advocate for PA and draw and implement strategies to motivate people to include PA as a lifestyle. There are still gaps in this field, and we recommend further research and trials to add more to healthcare and science.

Postdoctoral National Institutes of Health F32 Grants: Broken Pipeline in the Development of Surgeon-Scientists.

We examined trainees in surgery and internal medicine who received National Institutes of Health (NIH) F32 postdoctoral awards to determine their success rates in obtaining future NIH funding. Trainees participate in dedicated research years during residency (surgery) and fellowship (internal medicine). They can obtain an NIH F32 grant to fund their research time and have structured mentorship. We collected NIH F32 grants (1992-2021) for Surgery Departments and Internal Medicine Departments from NIH RePORTER, an online database of NIH grants. Nonsurgeons and noninternal medicine physicians were excluded. We collected demographic information on each recipient, including gender, current specialty, leadership positions, graduate degrees, and any future NIH grants they received. A Mann-Whitney U test was used for continuous variables, and a χ 2 test was utilized to analyze categorical variables. An alpha value of 0.05 was used to determine significance. We identified 269 surgeons and 735 internal medicine trainees who received F32 grants. A total of 48 surgeons (17.8%) and 339 internal medicine trainees (50.2%) received future NIH funding ( P < 0.0001). Similarly, 24 surgeons (8.9%) and 145 internal medicine trainees (19.7%) received an R01 in the future ( P < 0.0001). Surgeons who received F32 grants were more likely to be department chair or division chiefs ( P =0.0055 and P < 0.0001). Surgery trainees who obtain NIH F32 grants during dedicated research years are less likely to receive any form of NIH funding in the future compared with their internal medicine colleagues who received F32 grants.

Cricothyrotomy : Data situation, guidelines and techniques for the definitive surgical airway

Cricothyrotomy represents the final approach to secure the airway, in the course of which less invasive measures have failed. It can also primarily be carried out to establish asecure airway. This is essential to protect the patient from asignificant hypoxia. This is acannot ventilate-cannot oxygenate (CVCO) situation, which presumably all colleagues in emergency intensive care medicine and anesthesia have already been confronted with. Evidence-based algorithms for the management of adifficult airway and CVCO have been established. If oxygenation using an endotracheal tube, an extraglottic airway device or bag-valve mask ventilation all fail, the airway must be surgically secured, i.e. using cricothyrotomy. The prevalence of the CVCO situation in aprehospital setting is ca. 1%. No valid prospective randomized in vivo studies have been carried with respect to the question of the best method.

From MPOX to the next epidemic: Words matter when talking about equity-deserving groups.

From MPOX to the next epidemic: Words matter when talking about equity-deserving groups.

Applying human factors to improve patient safety, morale and team working for oral pathology and medicine specialists.

Human error is inevitable, and therefore can be considered as a 'normal' part of everyday life. Unfortunately, error can never be eliminated completely. However, learning from our mistakes can help reduce problems in future. Fifty years ago, most clinicians paid little or no attention to the human factors (HF) that can affect individual and team performance. It has only been in the last 20-25 years that colleagues in healthcare have truly begun recognizing the importance of HF and non-technical skills in medicine and dentistry and how their application can significantly improve patient safety and aid better team working and staff morale in the clinical setting and laboratory. Personal factors such as stress, tiredness, hunger and dehydration all reduce human performance and can raise the risk of mistakes. In addition, how we work and interact with the wider team is important since many errors can occur because of ineffective communication, steep hierarchal (authority) gradients and loss of situational awareness. This short HF overview in the 50th commemorative special of JOPM issue is timely. It provides a contemporary overview of human factors and performance that the authors consider important for oral medicine and pathology colleagues and which can affect individuals and teams This article also discuss ways to reduce the chances of medical and dental error and improve patient safety.

Professional Identity in Nursing: Adopting a Systems Approach Regarding Diversity, Equity, and Inclusion.

Professional Identity in Nursing: Adopting a Systems Approach Regarding Diversity, Equity, and Inclusion.

Comments on- Time to Adequately Heed Acute Pain in the Emergency Department – More Regional Blocks Warranted

To the Editor, I read the recent article “Time to Adequately Heed Acute Pain in the Emergency Department – More Regional Blocks Warranted” by Dr. Zundert, et al. with much interest [1]. The central argument of offering adequate multimodal acute pain control to our most vulnerable patients has been the core tenant of my clinical practice and research for the last 15 years. I completely agree that If we (as the field of medicine) hope to succeed in equitable acute pain management, leveraging the skill of numerous clinicians (emergency physicians, surgeons, orthopedics, etc.) to perform single injection regional blocks will be needed [2]. Like other skills (endotracheal intubation, lumbar puncture, central venous cannulation, etc.) that have been adapted from innovators in one field and then taught to the various other specialties, ultrasound-guided regional anesthesia needs to be brought from the expert regional anesthesiologists and to the clinicians who are at the bedside caring for this cohort of patients. Working at an academic trauma center in a low resource setting, we have had to build patient-centered pain pathways that both treat acute pain as well as ensure a reduction in opioid use. With the help of our anesthesia colleague at University of California, San Francisco, we have integrated ultrasound-guided regional blocks into our clinical practice for more than 10 years in the emergency department (ED). Just as Dr. Zundert has pointed out, this collaboration between our Anesthesia and Emergency Medicine colleagues has been an amazing success, leading to timely pain control in our acutely injured patients as well as improved patient care. For hip fractures specifically, we have worked with our anesthesia and orthopedic colleagues to develop a practice standard that asks our clinicians to perform a block in under 1 hour after recognition of a hip fracture [3]. This collaborative non-siloed based practice standard between all services dealing with acutely injured patients (trauma surgery, orthopedics, anesthesia and emergency medicine) has fostered interdepartmental education, multiple research publications and most importantly improved patient care [4, 5,6, 7].

Glucocorticoid-induced hyperglycemia (GIH) in pemphigus vulgaris patient at Bangli District General Hospital: A case report

Background: Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous blistering and erosion. This is rare, but greatly affects the patient’s life quality and often cause complication of disease and therapy. Hyperglycemia is a complication due to steroid use called glucocorticoid-induced hyperglycemia (GIH). This case report describes hyperglycemia in PV treatment, which later can be a consideration of PV management.&#x0D; Case: A 44-year-old male patient complained of painful lesions on almost the whole body with a form of bullae, erosion, crusting, brittle, the Nikolsky sign (+), and Asboe-Hansen sign (+). The patient was diagnosed with PV. After he had supportive therapy and high-doses of methylprednisolone, his blood sugar is increased. Patients diagnosed by hyperglycemia state due to steroid use, then given insulin as therapy. The patient diagnosed with PV based on history taking and physical examination, but the histopathologic examination wasn’t done due to lack of modality at the hospital. The steroid was given as an immunosuppressive. Be the main therapy for PV, steroids lead hyperglycemia due to disruption of glucose metabolism, thereby increasing insulin resistance in tissues. The diagnosis of hyperglycemia due to steroid use is made in a patient with a normal sugar level before PV therapy. It occurred within the first 1-2 days of therapy. In these patients, diagnosis confirmed by increasing pre-prandial, 2 h post-prandial, and any-time glucose level, after two days methylprednisolone administration. Collaboration with internal medicine colleagues is needed.&#x0D; Conclusion: PV treatment with steroids can induce hyperglycemia, which is dangerous. The understanding mechanism is needed to make early detection and provide therapy properly.

Draft Law of Ukraine on the creation of the Self-governing Veterinary Body on the Base of International Experience

The article researched the OIE Terrestrial Animal Health Code to be a crucial part of the WTO international trade legal framework. The study established that countries wishing to become full members of the WTO should bring their legislation in line with OIE standards, according to which the veterinarian is the person with appropriate education, licensed by the independent self-governing body of the particular country. Empirical, systematic, and theoretical research methods, as well as the foreign experience of veterinary medicine colleagues from Poland, Ireland, Italy, Great Britain, and Austria, allowed the authors of this article to implement the received information concerning the creation of the statutory veterinary body into the draft law of Ukraine. The article revealed that according to Article 3.2.5. of the Terrestrial Animal Health Code of the World Health Organization, only the Self-governing Body carried the legal responsibility and acted based on legislative acts. The authors proposed the draft of the Law of Ukraine “On Professional Activity of the Doctor of Veterinary Medicine and Self-governing Body (Veterinary Parliament)”. Implementation of this Law on practice is necessary and timely because 1) veterinary medicine doctors will be united into a single body, which is interested in increasing the prestige of the profession; 2) there will be a reduction in the percentage of conflict of interests (the state provides services and the state controls the performance of these services) due to the transfer of state veterinary doctors to the private segment; 3) the state will delegate services to the self-governing body for the organization of preventive measures and measures to eliminate infectious and parasitic diseases of animals, zoonosis; 4) there will be control of “Lifelong learning” by deprivation of permission or suspension of the permit to carry out the veterinary practice.

Curriculum and Competency Assessment Program for Training Maternal-Fetal Medicine Fellows in the Performance of the Detailed Obstetric Ultrasound Examination.

Curriculum and Competency Assessment Program for Training Maternal-Fetal Medicine Fellows in the Performance of the Detailed Obstetric Ultrasound Examination.

Addressing Implicit Bias to Acknowledge the Experience of Under-represented in Medicine Colleagues and Improve Patient Care.

This article recounts episodes of implicit bias I have experienced as an emergency physician and explores how we can move in a better direction to benefit everyone. I was a toddler when my family moved to the US from Jamaica. A few years after that, I announced that I was going to be a doctor. I made this decision based on zero data. At the time, I had no idea that only 1/3 of 1% of the US population are physicians. And of that number only 2% are Black women. I walk into every patient room the same way, wearing blue scrubs &amp; a long white coat with my name embroidered on it - visibly rubbing some hand sanitizer in so they know I care about spreading germs, a stethoscope hangs on a holster from my scrub pants and a name tag is clipped to my chest with my photo with a second bright orange tag with the word DOCTOR in all caps. "Hello, I'm Dr. Ennis, I'm the emergency physician. What brings you here today?" I greet everyone in the room &amp; shake hands if offered and then I pause. Deliberately. I pause because the first and only thing they saw when I walked in the room was a black woman with dreads. Despite the costume, the optics I present do not say doctor. Addressing racism as it impacts the health of our patients and the sense of belonging for all our colleagues demands true effort &amp; focus.

Vasculogeriatrics: embracing shared care with our colleagues in geriatric medicine should not be a threat.

Vasculogeriatrics: embracing shared care with our colleagues in geriatric medicine should not be a threat.

Cellular hierarchies predict drug response in acute myeloid leukemia.

In a recent Nature Medicine study, Zeng and colleagues integrate both genomic and stem cell models of acute myeloid leukemia (AML) by deconvoluting cellular hierarchies of more than 1,000 AML samples. This work introduces a framework capable of predicting drug responses to targeted therapies in future clinical trials.

Endoscopic Evaluation of Swallowing in Patient with Tetanus Followed by Myasthenia Gravis as Its Complication

Flexible Endoscopic Evaluation of Swallowing (FEES) provides direct visualization of the pharynx and larynx immediately before and after a swallow in a patient with dysphagia. Dysphagia is the difficulty in swallowing solid or liquid food. It is a symptom of an underlying disease like tetanus and myasthenia gravis. This case report showed the important role of FEES in patients with dysphagia due to tetanus followed by myasthenia gravis as its complication. A 58-year-old man had complaints of severe difficulty in swallowing followed by complaints of fever and whole body seizures, which supported the diagnosis of tetanus. In the course of the disease, symptoms and the results of supporting examinations indicated the presence of myasthenia gravis. Comprehensive management had done with colleagues in internal medicine, neurology and medical rehabilitation. That condition improved and the complaints disappeared after one month. It can be concluded that FEES played an important role in diagnosing dysphagia. It could identify the modification of food consistencies and therapeutic maneuvers to prevent an aspiration for a patient with dysphagia as the early symptom of tetanus which caused neurotransmitter damage that broke muscle nerve junctions. It is also one of the predisposing factors for autoimmune conditions in myasthenia gravis. Correct diagnosis and comprehensive management give a better improvement for the disease.