Independent Residents Research Articles

Nutrition among nursing home residents: results from the NutriCare study

BackgroundOlder adults living in nursing homes (NHs) are considered a vulnerable population in terms of nutrition. The aim of the present study was to explore the usual intake of energy, macronutrients, and specific food groups, along with offers in the NH menus on a nationally representative sample of Slovenian NH residents and compare dietary patterns with the established recommendations.MethodsThe study was conducted as part of a cross-sectional NutriCare study on 317 residents (65–101 years) from 20 Slovenian NHs in 9 health regions. Relatively independent residents were selected using quota sampling by sex and age. Data collection involved interviews and anthropometric measurements. Usual dietary intake was assessed by a multiple-source method from two 24-h dietary recalls and food frequency questionnaires. Adherence of dietary intake to the recommendations and dietary composition of NH menus were assessed. The Mini Nutritional Assessment (MNA) was used to explore nutritional status.ResultsNotable variability in energy and macronutrient intakes was observed with some participants showing intakes below and others above the recommended values. A high prevalence of BMI > 30 kg/m2 was observed in 39% of participants, indicating potential discrepancies between total energy intake and expenditure. The usual intake of fat was 36% of total energy intake (TEI). The intake of foods of animal origin exceeded dietary guidelines. Intake of carbohydrates (46% TEI in men and 47% TEI in women) as well as dietary fibre (20 g/day for both sexes) was below recommendations. A scarce intake of fruits, vegetables, and cereals was observed. In total, 40% of men and 35% of women had usual daily protein intakes lower than 1 g/kg of body weight. The protein content of breakfast and dinner could be improved. NH residents consumed little food from outside NH. The usual nutrient and food group intakes of residents reflected the NH menu offers.ConclusionThe study results on the usual intake of energy, macronutrients, specific food groups, and offers in the NH menus indicate the potential for optimisation. According to the World Health Organisation, the prevalence of BMI > 30 kg/m2 is notable and warrants attention. Careful meal planning and regular monitoring of the nutritional status of NH residents should be considered.

Effect of insurance type on Management of Vancouver B Periprosthetic Fractures: length of stay, discharge destination and cost implications.

To assess the effect of private versus public insurance on hospital length of stay, discharge destination, and costs in managing Vancouver B periprosthetic femoral fractures (PFF). A retrospective cohort study of PFF patients operatively managed at five public trauma centers. The primary outcome was hospital length of stay. Secondary outcomes included discharge destination and costs related to implants and hospital beds. The study included 195 PFF cases (133 public, 62 private). Private patients had lower ASA scores (2.8 versus 3.1, P = 0.006) and were more likely to come from independent residences (87% versus 74%, P = 0.045). Private patients spent 8 fewer days in the hospital (12 ± 8 versus 20 ± 19 days, P < 0.001) and were more often discharged to rehabilitation (74% versus 48%, P = 0.003). Public hospital costs were higher for public patients ($37 456 versus $25 324, P = 0.005), largely due to longer stays. Implant costs were similar between private and public patients, but patients that underwent revision surgeries increased costs significantly compared to patients that underwent open reduction and internal fixation alone ($6257 versus $3511, P < 0.001). Private insurance was linked to shorter hospital stays and increased discharge to rehabilitation. Public PPF patients incur an average cost of $37 456 for public hospitals, compared to $25 324 for private patients. Delays in public patient rehabilitation access may prolong hospital stays, suggesting a need for alternative care pathways, such as PPF tailored home-based rehabilitation and support programs.

Independent Plastic Surgery Match Regional Trends Comparing In-person and Virtual Interview Cycles.

There is a trend toward matching in a different region than previous training for the independent plastic surgery match cycles from 2019 to 2021, which differs from the trend to match within the same region for integrated plastic surgery programs. Notably, residency interviews transitioned from in-person to virtual in 2020 due to the coronavirus pandemic. Therefore, we compared in-person versus virtual interview match trends from 2019 to 2023. Zip codes and regions of each successfully matched plastic surgery applicant's medical school, residency, and plastic surgery program were gathered from publicly available data for the 2019 and 2020 in-person interview cycles and 2021, 2022, and 2023 virtual interview cycles. Although regions did not differ significantly in the proportions of positions each year (P = 0.85), there was a trend toward fewer positions in each region from 2019 to 2022. Overall, applicants were more likely to match in a different region as their medical school or residency during virtual compared with in-person interviews (P = 0.002 and P = 0.04). Applicants matched to programs further from their medical school zip code in virtual interview years (P = 0.02). There was no significant difference in distance between surgical residencies and plastic surgery residencies between the two time periods (P = 0.51). Trends toward matching into a different region than prior training after the switch to virtual interviews could be attributed to applicant accessibility to interview broadly. However, this could also be due to the decreased number of independent residency positions over the years, requiring applicants to move regions and travel further from where they began their training.

청동기시대 주거의 증축과 사회경제적 의미

Looking at the area distribution of South Korean Bronze Age dwellings, the area distribution varies from very large to small throughout the entire period. Large residential areas disappear in the later period, but the area of residence is still not uniform even in the villages in the later period. This means that the extension of dwellings was common throughout the entire period. In the archaeological data, many dwellings that have been interpolated throughout the entire period from the early to the late period are identified, and the expansion patterns show differences depending on the period. There is no significant change in the minimum residential area from the early stage to the late stage, but the maximum extension limit is 200㎡ in the early stage, 80㎡ in the early stage, and 60㎡ in the late stage. According to this, the family size is estimated to be 2 to 50 people in the early stage, 2 to 40 people in the first half, and 4 to 12 people in the later stage. The difference in expansion patterns according to the period reflects the social demand of the residence style, from the early to early ‘large family joint residence’ to the later ‘generational independent residence’. In addition, ‘collaboration and labor intensification’ is interpreted as a socio-economic background that requires ‘large family co-residence’, and ‘differentiation of production units and strengthening of household independence’ are interpreted as a socio-economic background that requires ‘independent residence by household’.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery.

Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans. After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant. Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans. This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

The Gender Gap in Interventional Radiology: Barriers, Opportunities, and the Role of the Integrated IR Residency

To review the gender gap in Interventional Radiology (IR) and explore the role of the Integrated IR residency. A retrospective review of gender demographic data of medical school applicants to Integrated IR residency from 2016-2021, and active residents/fellows ("trainees") in IR and peer specialties from 2007 to 2021. Women comprised 21.0% of medical student applicants to the Integrated IR residency in the 2020-21 academic year, versus 12.9% of Diagnostic Radiology (DR) resident applicants to the Independent IR residency; these figures have stayed relatively constant since 2016-17 and represent a statistically significantly difference (p=0.000044). The Integrated pathway has become the dominant source of IR trainees, growing from 4.4% in 2016-17 to 76.3% in 2020-21 (p=0.0013). From 2007 to 2021, the percentage of all IR trainees who were female grew from 10.5% to 20.3% (p=0.005). From 2017 to 2021, the percentage of Integrated IR residents who were female grew from 13.3% to 22.0% (p=0.053, 19.1% year-over-year growth), and has been higher than the percentage of female Independent IR residents (p=0.048). Women continue to be underrepresented in IR, though this gender gap is improving. The Integrated IR residency appears to have majorly contributed to this improvement, consistently supplying more women into the IR pipeline than through the fellowship/Independent IR residency. Women are significantly better represented among current Integrated IR residents than Independent residents. The now-dominant Integrated IR pathway must increase women recruitment for continued gender gap improvement.

6. The Influence of Integrated vs Independent Pathway and Hospital Type on Plastic Surgery Post-Residency Plans Unchanged by Global Pandemic

Background: Statements are often made about what percentage of plastic surgery (PRS) residents go into fellowship vs. private practice vs. academia after graduation. However, few objective studies have been completed. This project is designed to illuminate career choices of PRS residents immediately after graduation from 2018-2022 and secondarily, determine if the pandemic had any measurable impact. Methods: Publicly available data was obtained from institution websites or program queries. Demographic data was collected including sex/gender, training pathway, primary residency, length of training, and post-residency fellowship vs private practice job vs academic job vs military appointment. Comparison of percentages between pre-Covid and post-Covid (2018-19 vs 2020-22), training pathways (independent vs integrated), institution type (private vs public) and program rank (per Doximity) were analyzed using Fisher’s exact test. P values were 2-sided and comparisons with P < 0.01 were considered significant. Statistical analysis was performed using SAS software. Results: Data was collected for 691 graduates across 64 training programs (28% independent, 71% integrated). Most graduates pursued fellowship-training (61%) followed by 28% direct to private practice, 5% direct to academic practice and 1% assumed a military post. Independent residents were more likely to pursue private practice (40%vs.26%, p=0.001), while integrated residents were more likely to pursue additional fellowship training (49%vs70%, p<0.0001). Public institution graduates are more likely to go into private practice (37%vs.23%, p=0.0002), while private institution residents are more likely to pursue fellowship (55%vs.72%, p<0.0001). However, pandemic (p=0.31) and institutional rank (p=0.11) showed no association. Conclusion: In this report, we present career choice trends amongst PRS trainees. We found independent residents more likely to pursue private practice, perhaps due to prolonged training period (minimum 8 years vs 6 years), while integrated residents were more likely to pursue fellowship training. Public/State institution graduates were more likely to pursue private practice, potentially influenced by more exposure to community faculty than trainees in private academic settings. This study demonstrates that training pathway and institution type have a significant impact on post-graduation plans, whereas global pandemic and institutional rank do not. This information can be used by programs and students as they plan for the future.

INDICATORS AND TRENDS CHARACTERIZING POPULATION MIGRATION

Based on the fact that several hundred thousand Latvian citizens have chosen another country as their independent residence and do not want to re-emigrate. Migration is one of the most pressing problems of the Latvian economy. Migration is, by its definition, the movement of people of working age between different territories, both in the short and long term. Within the framework of the study, the hypothesis put forward, that in the analysed period the decrease of the population as a result of migration shows positive tendencies, which was partially confirmed.

COVID-19 Elective Surgery Shutdown and Operative Experience for Graduating Plastic Surgery Independent Residents.

The initial wave of the COVID-19 pandemic led to a temporary shutdown of elective procedures. The purpose of this study is to evaluate how the elective surgery shutdown impacted case log numbers for graduating plastic surgery independent residents. The Accreditation Council of Graduate Medical Education graduate self-reported case logs were retrospectively compiled for graduating independent track plastic surgery residents for the year before the pandemic (2019), 4 months into the pandemic (2020) and 16 months into the pandemic (2021). Procedures were grouped into resident review committee area and totals for each area were used for analysis. Average number of cases and standard deviations were compiled. Percent change was calculated comparing each year to the prepandemic baseline. Statistical significance was determined with Student t tests comparing average number of cases. Coefficients of variation were calculated to assess for changes in interprogram variation. Average case numbers were then compared with minimum case requirements necessary for graduation. The Accreditation Council of Graduate Medical Education graduation case log statistics were available for 238 independent residents. There were no statistically significant differences in average case number for graduating independent residents for total reconstructive breast, trunk, hand and upper extremity, or total reconstructive procedures between graduation years. The average case number of total lower extremity reconstruction increased from 2019 to 2020 (average = 83-97.4, P = 0.02). The average total number of breast aesthetic cases increased between all years (average = 92, 98, 114), with the average increase from 2019 to 2021 being statistically significant ( P = 0.02). Differences in head and neck aesthetic deformities and trunk and extremity deformities between years were not statistically significant. The average case number for all graduating plastic surgery independent residents exceeded the minimum case log requirements. The temporary hold on elective procedures during the pandemic decreased the opportunity for plastic surgery trainees to meet minimum case log requirements. Case log data for graduating plastic surgery independent residents demonstrate that despite the temporary suspension, the pandemic did not greatly impact the average resident case numbers.

Hydration Practices in Maltese Residential Care Homes for Older Adults

Despite consensus about the preventable nature of dehydration, it remains particularly prevalent among older adults residing in residential care home settings. The aim of this study is to explore current hydration practices in residential care homes in Malta. An exploratory qualitative approach was adopted to provide an in-depth understanding of staffs practices for supporting residents hydration in care homes for older adults. Following a feasibility study to increase the overall methodological rigour, thirty-one staff participants across six residential care homes, covering all the six regions of Malta, participated in either face-to-face or online semi-structured interviews. Data was analysed through open coding, followed by axial coding. Peer debriefing amongst the research team was carried out until agreement was reached about the final themes. Three main themes emerged from the data: culture of promoting fluid intake; challenges in supporting older adults to achieve optimum hydration; and hydration practices and approaches. A hydration-promotion culture was evident across all care homes. However, there was a lack of consistency in monitoring hydration and daily fluid targets which emphasises the need for staff training and implementation of clear and accessible guidelines, policies and/or procedures in relation to hydration care within residential settings for older adults. Future research attention should focus on establishing an evidence-based approach to monitoring hydration status and identifying residents at risk of dehydration. Difficulty in monitoring the fluid intake of independent residents was highlighted and we contend that this group of residents should not be overlooked in view of the risk of dehydration. Employing robust and rigorous methods to establish the effectiveness and implementation of innovative approaches would help in making valid contributions to the local evidence base on hydration care in residential care settings.

Anythink for CT-based aorta root measurements before transcatheter aortic valve replacement: measurement consistency with 3mensio and impact on short-term prognosis

To evaluate the consistency and reproducibility of aortic root measurements by Anythink, a semi-automated preoperative CT analysis software, with those of 3mensio. Sixty-seven patients undergoing transcatheter aortic valve replacement (TAVR) in the First Medical Center of Chinese PLA General Hospital from December, 2016 to February, 2022 were retrospectively enrolled in this study. A cardiology resident who completed his professional training used both the software Anythink and 3mensio (as the gold standard) to reconstruct the aortic root model and analyze the parameters of the aortic annulus and the surrounding structures. The correlation and consistency of the measurement results of two software were analyzed. Two independent residents also used Anythink software to repeat the measurements for the same patient for assessment of the reproducibility of Anythink measurements. The valve models were selected based on the measurements by Anythink and 3mensio, and similarities and differences of the two software in clinical valve selection were assessed. The measurements of the distances from the anulus plane to the left and right coronary ostium, average diameter of the anulus, anulus area, anulus perimeter, and the angle between the annulus and horizontal plane did not differ significantly between the two software (P > 0.05), and their measurements showed positive correlations (r= 0.884-0.981, P < 0.01). The intra-group and inter-group correlation coefficients of the anulus parameters measured by Anythink ranged from 0.894 to 0.992 and from 0.651 to 0.954, respectively. The Kappa-test values of valve models selected by Anythink and 3mensio based on the average diameter, area diameter and perimeter diameter were 0.886, 0.796 and 0.775, respectively. The intra-group Kappa values for the valve models selected based on Anythink measurements were 0.819, 0.841, and 0.795, and the inter-group Kappa values were 0.812, 0.812, and 0.768, respectively. Compared with the measurements by 3mensio, the recommended area diameter measured by Anythink was slightly greater in patients with postoperative paravalvular leakage, but slightly smaller in patients with postoperative new-onset conduction block. Anythink has excellent measurement consistency and high reproducibility for aortic root measurements, and trained cardiologists can use Anythink to obtain accurate aortic root parameters before TAVR.

Assessing Use of Gender Diverse Language in Patient Education Materials on Breast Reconstruction.

Background:Utilizing inclusive terminology in patient education materials is an increasing area of focus in plastic surgery. Over 300,000 cases of breast cancer were diagnosed in 2020, affecting cisgender and gender diverse patients alike. Both cisgender and gender diverse patients may choose to undergo breast reconstruction. This study aims to assess the use of inclusive language in online patient education materials on reconstruction after breast cancer.Methods:Materials were collected from all academic hospitals with a plastic surgery integrated and/or independent residency program, 97 in total. Programs were further classified by the presence of a comprehensive gender program. Materials were analyzed for gender diverse terminology outlined by the National LGBTQIA+ Health Education Center. A chi-square test evaluated for statistical significance of inclusive terminology based on the presence or absence of a comprehensive gender program.Results:The majority (75%) of programs referenced cis women alone, with 25% referring to both men and women or using gender neutral terms such as “patients.” Although most (85%) programs wrote in second person (“you”), 15% used she/her/hers pronouns alone, and no programs utilized gender diverse language outlined by the National LGBTQIA+ Health Education Center. The presence or absence of a comprehensive gender program was not predictive of the use of inclusive terminology (P = 0.32).Conclusions:This study found that only 25% of breast reconstruction materials contained inclusive gender terminology. Plastic surgeons should provide patient education materials with language that supports members of a gender diverse population to facilitate a safe, inclusive space and conversation.

16. Reliability of a Case-Based Oral Examination by Case and Competency for Evaluation of Plastic Surgery Residents

Background: An oral examination was developed for administration to integrated and independent residents in their final three years of training at multiple Plastic Surgery residency programs. Questions were designed to assess specific skills as outlined in the ACGME six core competencies. Using the combined scores for each case, residents were able to be given feedback on their performance. Our aim is to assess the reliability of our examination by case and by competency. Methods: A unique 8-case oral examination was administered yearly from 2013 to 2019 at multiple Plastic Surgery residency programs. We evaluated one specific examination that was administered in Spring 2019 in 3 states to 38 Plastic Surgery residents from 8 programs. Each item in each case was labeled to target a specific core competency. There was a total of 48 patient care items, 10 medical knowledge items, 5 professionalism items, 4 practice-based learning and improvement items, 4 systems-based practice items, and 1 communication skills item. Reliability was assessed by cronbach’s alpha coefficient calculated for the entire exam, for each unique case, and for each competency. Results: The entire 72-item examination was highly reliable (cronbach’s alpha = 0.91). The cronbach’s alpha coefficients were higher by case than by competency. 7 of the 8 cases were reliable (cronbach’s alpha > 0.70, range 0.45 - 0.82). The competency with the highest reliability was patient care (cronbach’s alpha = 0.87) and the lowest reliability was systems-based practice (cronbach’s alpha = 0.14). Communication skills could not be assessed as there was only one item. Conclusion: The reliability of the examination in total is excellent and it shows promise to be used on a broader scale in a standardized fashion. The reliability of the cases is good and may be used to assess resident knowledge of specific case content. While patient care and medical knowledge are reliably assessed in this exam, further work needs to be done to adequately evaluate for the other 4 core competencies.

Leadership Roles, Academic Appointments, and Scholarly Activity-Does a Fellowship after Plastic Surgery Training Make a Difference?

Background Fellowship training is becoming more popular in plastic surgery, with over half of residents pursuing advanced training. Here, we investigate how clinical and research fellowship training impacts career trajectory and scholastic achievement in academic plastic surgery. Methods Plastic surgery faculty members, from programs recognized by the American Council of Academic Plastic Surgeons, were identified using institutional Web sites. Data extracted included faculty demographics, training history, academic positions, and research productivity. Continuous and categorical variables were compared using t -tests and chi-square, respectively. Results In total, 949 faculty members were included, with 657 (69%) having completed fellowship training. Integrated program residents were more likely to complete a fellowship when compared with independent residents ( p < 0.0001). Fellowship trained faculty were more likely to have graduated from a higher ranked residency program, in terms of both overall and research reputation ( p = 0.005 and p = 0.016, respectively). When controlling for years in practice, there was no difference found in number of publications, Hirsch index (h-index), or National Institutes of Health funding between faculty between the two cohorts ( p > 0.05). In a subanalysis comparing hand, craniofacial, microsurgery, and research fellowships, those who completed a research fellowship had higher h-indices and were more likely to reach full professor status ( p < 0.001 and p = 0.001, respectively). Fellowship training had no effect on being promoted to Chief/Chair of departments ( p = 0.16). Conclusion Fellowship training is common among academic plastic surgeons. In this study, both clinical and research fellowships were associated with various aspects of academic success. However, fellowship training alone did not affect attainment of leadership positions.

Feasibility trial of an integrated treatment \u201cActivate for Life\u201d for physical and mental well-being in older adults

BackgroundPain and fatigue are common chronic conditions faced by older adults. Integrated interventions to address pain and fatigue may therefore be particularly useful for older adults, especially those interventions that target mobility and psychosocial well-being. The present study describes feasibility and participant satisfaction for an integrated eHealth treatment to address pain and fatigue in a sample of older adults living in a low-income independent residence facility and their own homes in the community.MethodsThree treatment combinations were compared in a randomized repeated measures design to determine if adding components of breathing retraining and behavioral activation to the existing Otago program (for strength and balance) affected feasibility and patient satisfaction. Specifically, 30 older adults were randomly allocated to: Arm1: the Otago alone (n = 10); Arm 2: Otago + Gentle Yoga and Yogic Breathing (n = 10); or Arm 3: Otago + Gentle Yoga and Yogic Breathing + Behavioral Activation (combination was named ‘Activate for Life’ n = 10). Feasibility measures included recruitment rate, session completion characteristics, and satisfaction with the program.ConclusionData from this study provide support for the feasibility of an integrated program to address physical and mental well-being of older adults. Future fully powered studies should now focus on assessment of clinical outcomes and refinement of individual components.Trial registrationRegistered in clinicaltrials.gov with the identifier: NCT03853148.

Tracking raw material flow through a continuous direct compression line. Part II of II: Predicting dynamic changes in quality attributes of tablets due to disturbances in raw material properties using an independent residence time distribution model

Continuous manufacturing of pharmaceuticals promises many advantages regarding economics and quality. However, tracing deviating material in such processes is much more challenging than in batch processes due to axial back-mixing. The literature has proven the traceability of disturbances in the active pharmaceutical ingredient (API) by residence time distribution (RTD) models. Nevertheless, pharmaceutical quality attributes (QAs) and disturbances are not limited to the API content. The present study investigates different disturbances affecting the particle size in a direct compression by recording various QAs. The application of a tracer-based model demonstrates the generalizability of RTD models regarding tracing the propagation of nonconforming material. The model applied may predict the appearance of deviating material in the tablets accurately up to 60 s. However, nonlinear and dynamic effects complicate predicting values of the QAs. Due to dynamic effects, tablet masses deviate up to 2.5 percentage points from values measured in steady-state, at an acceptable total deviation of 7.5 %. Consequently, if other QAs are critical, the transfer of control concepts developed for the API content will be challenging due to such effects different from API-based disturbances. Additionally, higher tolerances for errors will be required considering those deviations.

Social Media Use among Plastic and Reconstructive Surgery Residency Programs in the United States.

Social media have grown exponentially in the United States over the past 15 years. Despite its widespread use in plastic surgery, the role of social media within plastic surgery training programs has yet to be well defined.1,2 Therefore, the purpose of our study was to determine the prevalence, purpose, and ethical principles guiding social media use in plastic surgery training programs within the United States. A survey questionnaire was designed using Research Electronic Data Capture software (REDCap; developer, Vanderbilt University). The survey included questions about participant and program demographics and detailed questions regarding social media use. The survey was emailed to 135 program directors and division chiefs, as well as 88 program coordinators. The program coordinators were asked to distribute the survey to residents at their respective programs. Completed responses were recorded and analyzed. Forty-five faculty responded, resulting in a 33 percent response rate for the faculty group. An additional 30 responses were received from the trainee group. Sixty-seven percent of the faculty responses were from program directors and 33 percent were from division chiefs. Eighty percent of the trainee responses were from integrated residents and the remaining 20 percent were from independent residents. Seventy-six percent of programs reported having an official social media account, similar to results obtained by Azoury et al.3 Instagram appeared to be the most popular platform in our study, with 85 percent of programs using it (Fig. 1). The most common reasons for social media use were branding (77 percent), education (74 percent), and residency recruitment (66 percent). Our study found that the majority of social media accounts were managed by residents (65 percent) (Fig. 2).Fig. 1.: Social media platforms used by plastic surgery training programs compared to those used by plastic surgery trainees for personal use.Fig. 2.: The composition of personnel directly managing professional plastic surgery program social media accounts.Sixty-nine percent of faculty reported social media increased the reach of the program to potential applicants. This is likely due to increasing number of applicants using online resources to find information about training programs before submitting applications.4,5 Only 22 percent of programs reported using social media as a screening tool during the residency interview process. Of those programs that did, 70 percent reported it affected whether an applicant received an interview. Almost all plastic surgery trainees had at least one personal social media account (97 percent). Preferred platforms are shown in Figure 1. Only 19 percent of trainees currently had a separate professional account. However, 52 percent of trainees planned to have a professional social media account after completing training. Sixty-nine percent of faculty reported having guidelines for social media use at their university. Fifty-one percent reported not having formal training for residents and faculty. Breach of patient privacy was reported by 11 percent of programs and 31 percent had professionalism concerns. Only 58 percent of programs had reprimands in place for inappropriate use. Overall, our data suggest that social media use is common among plastic surgery training programs. The most popular social media platform appears to be Instagram. While many universities have guidelines to govern institutional social media use, the majority do not provide residents with formal training in this arena. Further studies should focus on the development of proper training modules for social media use by residency training programs and possibly governing societies. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this article. Abhishek Jain, B.A.College of Medicine Daniel Crane, M.D.Sami Tarabishy, M.D.Division of Plastic Surgery Isis Scomacao, M.D.Fernando A. Herrera, M.D.College of Medicine and Division of Plastic SurgeryMedical University of South CarolinaCharleston, S.C.

Weather, Built Environment, or Personal Factors: Predictors of Walking by Independent Living Residents With Frailty

Environmental factors influence older adult physical activity. However, the evidence about which factors lead to increased physical activity is mixed and few have studied how these factors affect those with frailty or living in retirement communities. This study investigated how environmental and weather factors influence physical activity among pre-frail and frail older adults residing in independent living retirement communities. We used ActivPal accelerometers to measure 7-day step counts among (n=108) pre-frail and frail residents in 9 independent living residences in metropolitan Chicago. We conducted environmental audits using the MAPS Abbreviated tool and collected National Weather Service Station data (temperature, precipitation, and daylight minutes) during the ActivPal periods. Participants were on average 80.0 years, 74% female, and average daily step count was 3,450 (range 151 - 11,663). Four buildings were in suburban areas and 5 in urban areas and four were private-pay residences while 5 offered subsidized rent. ANOVA results showed private-pay buildings had higher total MAPS scores than subsidized buildings (p=0.001), and urban buildings had higher total MAPS scores than suburban buildings (p < 0.000). Mean step differences were non-significant between different building types: (mean steps = 3,317 private-pay, 3,629 subsidized, 3,536 urban, 3,350 suburban). Pearson product-moment correlations showed a positive association between steps and MAPS positive streetscape features (p=0.011). Multiple regression analysis showed higher temperature days, precipitation, and more minutes of daylight were associated with higher step counts (p=.04). Given the dramatic variation in individual step counts, future research should investigate personal factors that contribute to activity among independent living residents.

Feasibility trial of an integrated treatment "Activate for Life" for physical and mental well-being in older adults

Professional caregivers rely on formal training when managing pain among patients with dementia, but family caregivers (FCGs) lack this foundation. Instead, FCGs use informal sources that may reflect a values-driven decision-making process. Few studies have examined how FGCs’ personal values impact pain management for dementia patients. We sought to examine the influence of personal values on pain management among FCGs for community-dwelling older adults with dementia using qualitative descriptive methods. Twenty-five adult FCGs, aged from 29 to 95, were recruited in central Virginia. Participants were predominantly white, married, female, and high school graduates. We conducted semi-structured interviews that were audio recorded and analyzed using constant comparative analysis. Four themes emerged: 1) Priority for pain management: when quality of life is valued over other factors (i.e., length of life), priorities focused on no pain, leading to better pain management; 2) Moral perspectives: negative views toward drugs, especially opioids, led to less use and greater report of pain; 3) Beliefs about alternative therapy: negative views led to less likely use of non-traditional approaches and reports of more pain, and 4) Personal experience of pain: past personal experiences of pain (negative or positive) influenced the priority placed on pain management and the FCG’s ability to provide effective pain management. The diverse views held by FCGs demonstrate a value-based process and suggest a modifiable factor in pain management. Helping FCGs reflect biases while reinforcing values that improve pain management would lead to improve pain and quality of life for older adults with dementia.

Quantifying the Pipeline of Ethnically Underrepresented in Medicine Physicians in Academic Plastic Surgery Leadership.

The lack of underrepresented in medicine (UIM) physicians in academic plastic surgery is emerging as a critical issue. Lack of diversity has a negative effect on patient care and on the culture of our health care system. This study reports the current status of ethnically UIM physicians in the plastic surgery pipeline, starting from the medical student level and progressing to national leadership positions. The Electronic Residency Applications Service, National Resident Matching Program, Association of American Medical Colleges, and professional Web sites for journals and national societies were accessed for racial demographic information from 2008 to 2019. Over the past decade, there has been no change or a slight decrease in representation of Blacks among plastic surgery residency applicants, trainees, and academic faculty, at half or less than expected, compared with US Census data. The first point of drop-off occurs at the resident (3.8% of integrated and 5.6% of independent residents) to faculty level (<2.8%). Two percent of program directors and department heads/division chiefs are Black. The next point of drop-off occurs at the national level: there has never been a Black president of American Society of Plastic Surgeons or Plastic Surgery Foundation, and there are no Black editors-in-chiefs of major plastic surgery journals.Following LatinX American surgeons down the pipeline over the past decade, there has been no change or a decrease in representation among plastic surgery residency applicants, resident physicians, and academic faculty, at one-third or less than expected, compared with US Census data. The first point of drop-off occurs at the faculty (4.8%) to local leadership level (0% of program directors and department heads/division chiefs) where there is no representation of LatinX. Once this drop-off occurs, there is no recovery at the national leadership level. In order for our profession to reflect our nation's demographics, academic plastic surgery is in need of a paradigm shift now. Attrition of UIM physicians in plastic surgery begins at medical school graduation and persists through surgical training, faculty appointments, and attainment of leadership positions. Creative and innovative commitment to diversity and inclusion is necessary.