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Recurrent hemorrhagic bullae of the oral mucosa

Recurrent hemorrhagic bullae of the oral mucosa

Efficacy in Myopia Control: The Low-Concentration Atropine for Myopia Progression (LAMP) Study

The 3-year Low-Concentration Atropine for Myopia Progression (LAMP) Study has greatly enhanced knowledge of the use of low-concentration atropine for myopia control. 1 Yam JC Jiang Y Tang SM et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019; 126: 113-124 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar ,2 Yam JC Zhang XJ Zhang Y et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022; 129: 308-321 Abstract Full Text Full Text PDF Scopus (27) Google Scholar In year 1, children were randomized to receive 0.05%, 0.025%, or 0.01% atropine, or placebo. 1 Yam JC Jiang Y Tang SM et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019; 126: 113-124 Abstract Full Text Full Text PDF PubMed Scopus (267) Google Scholar Compared to the placebo, axial elongation was slowed 0.21, 0.12, and 0.05 mm by 0.05%, 0.025%, and 0.01% atropine, respectively. Myopia progression showed a corresponding slowing of 0.54, 0.35, and 0.22 D.

Increasing Discards as an Unintended Consequence of Recent Changes in United States Kidney Allocation Policy

Kidney transplantation is the preferred treatment for end-stage kidney disease.1Wolfe RA Ashby VB Milford EL et al.Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.N Engl J Med. 1999; 341: 1725-1730Crossref PubMed Scopus (3958) Google Scholar Despite a shortage of donated kidneys, the United States has the highest proportion of deceased donor kidneys (DDKs) recovered for transplant that are subsequently discarded, resulting in federal government prioritization of improving organ utilization.2Aubert O Reese PP Audry B et al.Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance.JAMA Intern Med. 2019; 179: 1365-1374Crossref PubMed Scopus (83) Google Scholar,3ESRD Treatment Choices (ETC) Model. (Accessed 5 October 2022, at https://innovation.cms.gov/innovation-models/esrd-treatment-choices-model.)Google Scholar Simultaneously, there is increased emphasis on improving equity in transplant access, including a revised allocation system (“KAS250”) in March 2021 that removed strict geographic boundaries previously used in local organ allocation in an effort to reduce geographical heterogeneity in transplant rates.4Klarman SE Formica Jr., RN The Broader Sharing of Deceased Donor Kidneys Is an Ethical and Legal Imperative.J Am Soc Nephrol. 2020; 31: 1174-1176Crossref PubMed Scopus (0) Google Scholar However, KAS250 dramatically increased the complexity of interactions between transplant centers and organ procurement organizations (OPOs),5Adler JT Husain SA King KL Mohan S Greater complexity and monitoring of the new Kidney Allocation System: Implications and unintended consequences of concentric circle kidney allocation on network complexity.Am J Transplant. 2021; 21: 2007-2013Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar and the impacts of this change on organ utilization are not yet understood. Among these 96,834 DDKs recovered during the study period, 21,411 were discarded (22%), including 13,229/64,281 (21%) pre-KAS250 and 8,182/32,553 (25%) with KAS250 (p=0.004)— an increase that occurred despite similar overall quality of recovered DDKs in both eras (median Kidney Donor Profile Index [KDPI] 48% vs 51%). DDK discard has increased across all adult donor age groups (18-60 years: 16% vs 21%; ≥60 years: 54% vs 60%, Supplemental Figure S1), among DDKs with medium (18% vs 22%) and high KDPI (64% vs 68%; Figure 1A), and for DDKs from donors after both cardiac death (22% vs 31%) and brain death (20% vs 23%; Figure 1B). Discard of low KDPI DDKs was unchanged (3% vs 3%). An interrupted time series analysis also demonstrates an accelerated increase in DDK discards after the policy change (Supplemental Figure S2). DDK discard has also increased broadly among OPOs with high, medium, and low performance ratings (Figure 1C), indicating that this is not a geographic- or OPO-specific concern. The current discard rate for kidneys if present in prior years, after accounting for differences in discard rates for different quality organs, would result in 967 and 805 fewer transplants occurring in 2019 and 2020, respectively (Supplemental Table S1). Importantly, reasons for DDK discard also shifted with KAS250, with a greater proportion of discards attributable to exhaustion of the list of eligible candidates without organ acceptance (Figure 1D), supporting logistical complexity as a driver of worsened utilization. While the absolute number of DDK transplants has increased, over 1 in 4 DDKs recovered for transplant are not being transplanted, representing missed opportunities for hundreds of patients annually and increased healthcare system cost. This unintended deleterious consequence of the allocation system change requires urgent intervention to ensure that priceless organs are not wasted and that efforts to improve geographic equity in transplant do not come at a cost of worsening DDK utilization. SAH is supported by NIDDK grant K23 DK133729. Disclosures None Download .pdf (.27 MB) Help with pdf files

Changing comorbidities and complexity among dermatology medicare patients from 2013 to 2019

To the Editor: Medical complexity affects the management and outcomes of dermatology patients. 1 Wakkee M. Nijsten T. Comorbidities in dermatology. Dermatol Clin. 2009; 27 (vi. https://doi.org/10.1016/j.det.2008.11.013): 137-147 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Therefore, we sought to determine changes in patient complexity and individual comorbidities and physician and practice factors associated with higher patient complexity.

Non-Coding RNA Investigations in Cutaneous Melanoma: A Step forward in Discovering Novel Biomarkers

Non-Coding RNA Investigations in Cutaneous Melanoma: A Step forward in Discovering Novel Biomarkers

Epilepsy with myoclonic absences: A case series

Epilepsy with myoclonic absences (EMA) is a very rare childhood generalized epilepsy syndrome (<1% of all generalized epilepsies) associated with frequent myoclonic absence seizures that was described in 1969 by Tassinari et al. [ [1] Tassinari C.A. Lyagoubi S. Santos V. et al. Study on spike and wave discharges in man. II. Clinical and electroencephalographic aspects of myoclonic absences. Rev Neurol. 1969; 121: 379-383 PubMed Google Scholar ]. Seizures are characterized by bilateral rhythmic jerks of the upper limbs, superimposed on tonic abduction of the arms [ [2] Bureau M. Tassinari C.A. Epilepsy with myoclonic absences. Brain Dev. 2005; 27: 178-184 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar ]. Ictal EEG consists of 3-Hz generalized spike-and-wave complexes that are time-locked with the upper limb myoclonus, while the EMG generally shows myoclonic jerks followed by tonic contraction of both deltoids. These seizures differ from typical absences of childhood absence epilepsy, since myoclonic jerks are generally not seen in typical absences and, if present, are subtle and spare the arms. The lack of an atonic component also distinguishes these seizures from myoclonic-atonic seizures [ [3] Specchio N. Wirrell E.C. Scheffer I.E. et al. International league against epilepsy classification and definition of epilepsy syndromes with onset in childhood: position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022; 63: 1398-1442 Crossref PubMed Scopus (46) Google Scholar ]. A recent position paper by the International League Against Epilepsy for the classification of epilepsy syndromes with onset in childhood retained EMA as an independent epilepsy syndrome and defined its diagnostic criteria [ [3] Specchio N. Wirrell E.C. Scheffer I.E. et al. International league against epilepsy classification and definition of epilepsy syndromes with onset in childhood: position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022; 63: 1398-1442 Crossref PubMed Scopus (46) Google Scholar ]. The mandatory requirements are myoclonic absences as the predominant type of seizures, and regular 3 Hz generalized spike-and-wave complexes synchronous with myoclonus.

A rapid wide complex tachycardia

A rapid wide complex tachycardia

Perioperative Considerations in Patients With Mast Cell Activation Syndrome

Mast Cell Activation Syndrome (MCAS) is a hypersensitivity disorder, and subset of Mast Cell Disease, which has become increasingly recognized over the past three decades. Since the first case reports were published in the late 1980s, 1 Akin C Valent P Metcalfe DD. Mast cell activation syndrome: proposed diagnostic criteria. J Allergy Clin Immunol. 2010; 126 (e4): 1099-1104 Abstract Full Text Full Text PDF PubMed Scopus (229) Google Scholar , 2 Roberts LJ. Carcinoid syndrome and disorders of systemic mast-cell activation including systemic mastocytosis. Endocrinol Metab Clin North Am. 1988; 17: 415-436 Abstract Full Text PDF PubMed Google Scholar significant advancements have been made to better understand MCAS characteristics and determine effective treatment strategies. With improvements in recognition and modification of diagnostic criteria, it is estimated that up to 17% of the population has MCAS, 3 Buttgereit T Gu S Carneiro-Leão L et al. Idiopathic mast cell activation syndrome is more often suspected than diagnosed – a prospective real-life study. Allergy. 2022; 77: 2794-2802 Crossref Scopus (2) Google Scholar , 4 Afrin LB Ackerley MB Bluestein LS et al. Diagnosis of mast cell activation syndrome: a global “consensus-2”. Diagnosis (Berl). 2020; 8: 137-152 Crossref PubMed Scopus (34) Google Scholar highlighting the importance of clinician education regarding this recently identified disorder. To better understand the pathophysiology of MCAS—and the pharmacologic interventions effective in its management—it is important to first begin by discussing the normal activity of mast cells.

Remdesivir saves lives. Were 3 years needed to learn that?

Remdesivir saves lives. Were 3 years needed to learn that?

Voluntary Reporting of Guideline-Directed Medical Therapy Use Rates in the Public Domain: A Challenge to the Heart Failure Community

Achieving target or maximally tolerated doses of Guideline Directed Medical Therapy (GDMT) is associated with decreased morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). 1 Greene SJ Butler J Hellkamp AS Spertus JA Vaduganathan M Devore AD Albert NM Patterson JH Thomas L Williams FB Hernandez AF Fonarow GC. Comparative Effectiveness of Dosing of Medical Therapy for Heart Failure: From the CHAMP-HF Registry. J Card Fail. 2022; 28: 370-384 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar However, in a contemporary cohort of outpatients with HFrEF, the percentage of patients achieving target doses of GDMT was woefully low, with <1% of patients achieved target doses of three foundational components of GDMT (ACE/ARB/ARNI, beta-blocker, and MRA) at one-year follow-up. 2 Greene SJ Fonarow GC DeVore AD Sharma PP Vaduganathan M Albert NM Duffy CI Hill CL McCague K Patterson JH Spertus JA Thomas L Williams FB Hernandez AF Butler J. Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019; 73: 2365-2383 Crossref PubMed Scopus (216) Google Scholar

PCOSt: A non-invasive and cost-effective screening tool for polycystic ovary syndrome

PCOSt: A non-invasive and cost-effective screening tool for polycystic ovary syndrome

Invited Commentary for Disruption of Enterohepatic Circulation of Bile Acids Ameliorates Small Bowel Resection Associated Hepatic Injury

In this issue, Tecos et al [ 1 Tecos ME Steinberger AE Guo J Rubin DC Davidson NO Warner BW Disruption of enterohepatic circulation of bile acids ameliorates small bowel resection associated hepatic injury. J Pediatr Surg. 2023; (in press) Google Scholar ] expand on their previous demonstration that parenteral nutrition (PN)-independent hepatoxicity in a murine small bowel resection (SBR) model is region dependent and may be mitigated by tauroursodeoxycholic acid (TUDCA) supplementation. Interestingly, these results contradict a previous report from their own group as to the impact of proximal vs. distal resection, seemingly due to the presence or absence of the ileocecal valve (ICV) and adjacent bowel, which differed between the two studies [ 2 Barron LK Gayer GP Roberts A Golden JM Aladegbami BG Guo J Erwin CR Warner BW Liver steatosis induced by small bowel resection is prevented by oral vancomycin. Surgery. 2016; 160: 1485-1495 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ]. Dr. Warner’s group was the first to report liver injury in a PN-independent murine SBR model [ 3 Chiang JYL Bile acid metabolism and signaling in liver disease and therapy. Liver Res. 2017 Jun; 1: 3-9 Crossref PubMed Scopus (140) Google Scholar ]. In this latest study, they reveal that proximal SBR results in greater oxidative stress in the liver as evidenced by elevated mRNA transcripts for tumor necrosis factor-α, nicotininamide adenine dinucleotide phosphate oxidase, and glutathione synthetase with a greater compensatory antioxidant response consisting of elevated lipocalin 2. Furthermore, distal SBR demonstrated decreased hepatic bile acid content, smaller total bile acid pool size, and significant changes in bile acid composition, such as a decrease in the most insoluble, toxic, and hydrophobic bile acids, as well as an increase in de novo bile acid synthesis of physiologic, less toxic, hydrophilic bile acids. Equally compelling, the hepatotoxicity and injurious bile acid profile observed in proximal SBR was mitigated by exogenous TUDCA supplementation. In addition to these intriguing observations, the authors propose a mechanism for this difference. Distal SBR results in disruption of enterohepatic bile acid recycling, leading to amplified production of more physiologic, less toxic, and more hydrophilic bile acids, resulting in less oxidative stress to the liver and ultimately decreased liver injury. While TUDCA had similar hepatoprotective effects to distal SBR, they were not identical, and thus, the authors suggest it may differ in mechanism of action. Regardless, this study expands on the identification of therapeutic targets for intestinal failure-associated liver disease.

Training and Experience Requirements for Authorized Users of Therapeutic Radiopharmaceuticals (10CFR35.390): A Critical Update

In April 2002, the US Nuclear Regulatory Commission (NRC) published a final rule for medical use of byproduct material that continued to emphasize NRC’s concerns regarding the primacy of public safety. The 2002 final rule, in combination with later clarifying rules over the course of several years, precisely documented the requirements for required hours of training and experience (T & E) including essential components of classroom and laboratory training and work experience. The regulatory schema provided that NRC-recognized medical specialty board-certified individuals, and those “who meet the requirements” specified in the regulation (known as the “alternate pathway”), would be eligible to be authorized users (AUs) of byproduct materials for the corresponding sections [ 1 US Nuclear Regulatory CommissionFederal Register Final Rule 10CFR Parts 20, 32 and 35, April 24, 2002. https://www.govinfo.gov/content/pkg/FR-2002-04-24/pdf/02-9663.pdfDate accessed: August 10, 2022 Google Scholar , 2 Wallner P.E. Lieto R.P. Dillehay G.L. et al. Training and education requirements for authorized users of therapeutic radiopharmaceuticals: changes under consideration for 10CFR35.390 and their potential impact. J Am Coll Radiol. 2019; 16: 1572-1576 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. The commission indicated its intention to periodically request review of the regulations by its Advisory Committee on the Medical Use of Isotopes (ACMUI). Notwithstanding several subsequent rulemakings to refine or clarify aspects of the initial regulatory reforms, the 2002 rules have remained essentially intact.

De-escalation in intensity or duration of dual antiplatelet therapy in patients with coronary artery disease: More than alternative treatment options

Antithrombotic therapy represents the mainstay of pharmacological treatments in patients with acute or chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) [ [1] De Servi S. Landi A. Savonitto S. et al. Tailoring oral antiplatelet therapy in acute coronary syndromes: from guidelines to clinical practice. J Cardiovasc Med. 2023; 24 Crossref Scopus (1) Google Scholar ]. Since the CURE study [ [2] Mehta S.R. Yusuf S. Peters R.J.G. et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358: 527-533 Abstract Full Text Full Text PDF PubMed Scopus (3042) Google Scholar ], dual antiplatelet therapy (DAPT) consisting of aspirin and an oral P2Y12 inhibitor has represented the standard of care for acute coronary syndrome (ACS) or PCI patients due to the greater ischemic protection compared with aspirin alone. Current guidelines recommend 6 or 12 months as default DAPT durations in patients with CCS or ACS undergoing PCI, respectively [ [3] Valgimigli M. Bueno H. Byrne R.A. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018; 39: 213-260 Crossref PubMed Scopus (1840) Google Scholar , [4] Collet J.-.P. Thiele H. Barbato E. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42: 1289-1367 Crossref PubMed Scopus (1705) Google Scholar ]. Yet, there is mounting evidence suggesting that prolonging DAPT is unavoidably associated with higher risks of major bleeding which carry similar or even worse impact on mortality than a recurrent myocardial infarction (MI) [ [5] Valgimigli M. Landi A. Ischemic and bleeding risk in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention: is it time to REACT?. Eur Heart J Acute Cardiovasc Care. 2021; 10: 1125-1128 Crossref PubMed Google Scholar ].

POvaStim: An online tool for directing individualized FSH doses in ovarian stimulation

POvaStim: An online tool for directing individualized FSH doses in ovarian stimulation

The Antifragile Radiologist

The Antifragile Radiologist

Narrowband ultraviolet B phototherapy in pediatric vitiligo: A retrospective study

To the Editor: Narrowband UV-B phototherapy (nbUV-B) is a first-line treatment for vitiligo management. 1 Mohammad T.F. Al-Jamal M. Hamzavi I.H. et al. The vitiligo working group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017; 76: 879-888 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar Previous small studies have suggested that children can acquire repigmentation comparable to that of adults. 2 Magdaleno-Tapial J. Ortiz-Salvador J.M. Valenzuela-Oñate C. Marí-Cornejo P. Esteve-Martínez A. Pérez-Ferriols A. Comparison of phototherapy in pediatric and adult patients. Actas Dermosifiliogr. 2020; 111: 41-46 Crossref PubMed Scopus (3) Google Scholar Nevertheless, concerns regarding safety, practicality, and insurance coverage arise. 3 Blundell A. Sachar M. Gabel C.K. Bercovitch L.G. The scope of health insurance coverage of vitiligo treatments in the United States: implications for health care outcomes and disparities in children of color. Pediatr Dermatol. 2021; 38: 79-85 Crossref PubMed Scopus (2) Google Scholar To assess the prevalence, efficacy, and safety of nbUV-B, we conducted a retrospective chart review of pediatric patients with vitiligo seen by our department from January 1, 2009 to December 31, 2020. In 324 identified patients, 50% were male, median age at first visit was 8.7 years (SD, 4.3 years), and median follow-up was 20 months (IQR, 8-39 months). Clinical management included nbUV-B in 126 patients (38.9%) for a mean duration of 18 months (SD 13, Table I). The youngest patient that received nbUV-B treatment was aged 3 years, and 58 (46%) patients used home nbUV-B, which is typically an out-of-pocket cost. Table IManagement of Pediatric Vitiligo Treatment n % None 28 8.6 Topical calcineurin inhibitor 284 88 Topical steroid 188 58 Oral steroid 47 15 Outdoor sun exposure 21 6.5 Topical JAK inhibitor 9 2.8 Oral JAK inhibitor 2 0.62 Topical calcipotriene 6 1.9 MKTP 13 4.0 Excimer 32 9.9 Other 14 4.3 nbUV-B phototherapy (including home) 126 39 Phototherapy characteristics Home phototherapy 58 46 Occurrence of sunburn 33 29 Occurrence of blistering 4 3.5 Occurrence of scarring 0 0 Reported skin cancer 0 0 Duration of phototherapy (n = 108), mos ∗ Twice or 3 times a week. 18 † Mean. 13 ‡ SD. JAK, Janus kinase; MKTP, melanocyte-keratinocyte transplant procedure; nbUV-B, narrowband UVB. ∗ Twice or 3 times a week. † Mean. ‡ SD. Open table in a new tab JAK, Janus kinase; MKTP, melanocyte-keratinocyte transplant procedure; nbUV-B, narrowband UVB.

An emerging new respiratory pathogen, Lophomonas blattarum, found in bronchoalveolar lavage in an immunodeficient patient with asthma

Infections with unusual organisms are frequently found in patients with primary and acquired immunodeficiency. It is estimated that 1 in 1200 individuals in the United States have a diagnosis of primary immunodeficiency, with common variable immunodeficiency (CVID) accounting for approximately 35% of the cases. 1 Boyle JM Buckley RH. Population prevalence of diagnosed primary immunodeficiency diseases in the United States. J Clin Immunol. 2007; 27: 497-502 Crossref PubMed Scopus (317) Google Scholar CVID is a heterogeneous disorder that is primarily a defect of the humoral immune system, although approximately 50% of patients have T cell defects as well. Patients with CVID have increased susceptibility to infections, particularly of the upper and lower respiratory tract, and increased incidence of autoimmune diseases and neoplasms. 2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Common pathogens causing respiratory tract infections in CVID include Streptococcus pneumoniae, Haemophilus influenza, and Staphylococcus aureus.2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Although parasitic infections can occur, the most often described is Giardia infection of the gastrointestinal tract. 2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Infections with other parasites particularly of the respiratory tract have rarely been described. Lophomonas blattarum is a flagellated protozoa found in the gut of cockroaches and termites which has been found to cause rare bronchopulmonary infections, although there are no published cases in the United States to date. 3 Martinez-Girón R Cornelis van Woerden H. Lophomonas blattarum and bronchopulmonary disease. J Med Microbiol. 2013; 62: 1641-1648 Crossref Scopus (35) Google Scholar ,4 Chaudhury A Parija SC. Lophomonas blattarum: a new flagellate causing respiratory tract infections. Trop Parasitol. 2020; 10: 7-11 Google Scholar The most often reported symptoms of L blattarum infection are fever and productive cough. The infection is usually responsive to treatment with metronidazole. 3 Martinez-Girón R Cornelis van Woerden H. Lophomonas blattarum and bronchopulmonary disease. J Med Microbiol. 2013; 62: 1641-1648 Crossref Scopus (35) Google Scholar ,4 Chaudhury A Parija SC. Lophomonas blattarum: a new flagellate causing respiratory tract infections. Trop Parasitol. 2020; 10: 7-11 Google Scholar

Integrating Ergonomics into Endoscopy Training: A Guide for Faculty and Fellows

Endoscopic procedures are physically demanding. Endoscopy-related musculoskeletal injuries (ERIs) can stem from repetitive high-force movements, especially when coupled with nonneutral body positions. 1 Shergill A.K. McQuaid K.R. Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc. 2009; 70: 145-153 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar ,2 Pawa S. Banerjee P. Kothari S. et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol. 2021; 116: 530-538 Crossref PubMed Scopus (12) Google Scholar Despite trainees commonly reporting ERIs and expressing interest in ergonomics-specific training, endoscopy ergonomics is not routinely taught during fellowship. 3 Villa E. Attar B. Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open. 2019; 7: E808-E812 Crossref PubMed Google Scholar ,4 Ruan W. Walsh C.M. Pawa S. et al. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc. 2023; 37: 248-254 Crossref PubMed Scopus (1) Google Scholar This gap represents an opportunity. We present an approach for teaching ergonomics during endoscopy training and outline key ergonomic principles to promote development of safe and effective technique at the start of endoscopists’ careers, enhance endoscopy safety, and help extend career lifespans. Additional system-wide considerations, such as endoscopy case volume, endoscope and endoscopy unit design, and alternatives to endoscopy, are beyond the scope of this trainee-focused perspective.

Mastering the Patient Handoff

Mastering the Patient Handoff