Median Number Of Cases Research Articles

Managing COVID-19 outbreaks in prisons - a brief review of literature and key lessons learnt.

During the COVID-19 pandemic, prisons faced a unique challenge of preventing and managing outbreaks with minimal adverse impact. This study aims to describe the epidemiology of COVID-19 in prisons, identify lessons learnt and make recommendations. The authors used the PubMed advanced search function using MeSH terms; (coronavirus, sars) AND (prisons) AND (disease outbreaks). The authors included original research reporting COVID-19 outbreaks in prisons. All other types and non-English publications were excluded. The authors used a structured data abstraction template to extract data systematically, and a second author independently abstracted data from 10% of the papers for quality assurance. The search yielded 96 hits. The authors included 15 studies meeting the inclusion criteria. These studies were from four countries. Seven studies reported individual outbreaks. The mean and median number of inmates and staff were 1,765, 1,126 and 575, 510. The mean and median number of cases among inmates and staff were 584, 464, and 72, 77. The number of reported deaths varied from 0 to 11. The authors present the prison-specific hazards grouped under human factors, healthcare factors and environmental factors. The authors also summarise interventions deployed as either primary prevention interventions, such as vaccinations, or secondary prevention interventions, including screening and contact tracing. This narrative review summarises the prison-specific hazards, which include movement of people in and out of the person, moving in new prisoners from other prisons, mixing of prisoners when transporting to courts, limited medical and isolation resources, crowded dormitories, shared lavatories, small communal facilities, poor ventilation and overcrowding. The interventions included limiting non-medical transfers into and out of the persons, assigning staff members to specific areas, encouraging face coverings among prisoners and staff and social isolation measures within the constraints of the prison setting. The interventions were adopted by prison authorities to contain and manage the outbreaks. Public Health and prison authorities need to be aware of the risk of further outbreaks of COVID-19 and other infectious diseases in these settings and implement key measures identified in this review to minimise adverse outcomes.

Implementation of Laparoscopic Nissen Fundoplications in a Developing South African Pediatric Surgical Service.

Pediatric laparoscopic Nissen fundoplication (LNF) has become the standard approach at many centers. We developed a minimal access surgery (MAS) training curriculum to enhance the delivery of MAS for pediatric patients in a resource-limited setting. We reviewed our 10-year experience in implementing and performing LNF at our institution. We described the challenges of implementing MAS training for LNF and how we addressed them. Beneficial technical considerations were described. A retrospective review was performed on all pediatric LNFs performed. We performed 268 LNFs. Specialists or trainees under supervision performed all LNFs. The trainee group performed 43 LNFs (16%). The median operative time for the specialists was 94 min (interquartile range [IQR] 50), and the trainee group was 140 min (IQR 62.5). The median number of cases performed until we improved operative time amongst the trainees was nine (IQR 3). There were seven repeat LNFs, and 11 cases were converted to open. The overall complication rate was 8.9%. A reduction in complications among specialists occurred over the years. The 30-day mortality post-LNF was 0.7%. LNF can be successfully introduced at a tertiary training centre in South Africa with good outcomes. A comprehensive quality improvement program, including MAS training, supported this.

Trend of suicide by self-immolation in a 13-year timeline: was the COVID-19 pandemic a potentially important stressor?

Self-immolation is an uncommon way of attempting and committing a suicide, with a fatality rate of 80%. The risk factors in self-immolation victims vary depending on demographic characteristics, socio-economic and cultural factors as well as religious beliefs. Whether the COVID-19 pandemic was a potentially important stressor for self-immolation is still unknown, with insufficient studies examining this issue. Therefore, in this study, we aimed to examine the trend of self-immolation in a 13-year timeline, and the potential association of COVID-19 pandemic with the increase in the incidence and severity of self-immolation injuries in Serbia in 2021. The study included hospitalized patients due to intentional burns caused by self-immolation in the period from January 1, 2008 to December 31, 2021. Joinpoint regression analysis was used for the analysis of continuous linear trends of self-immolation cases with change points. While a rising trend was observed in the 2008-2013 time segment, followed by a decline in the upcoming 2013-2016 time segment, a significant increase reached its maximum during COVID-19 pandemic (2021), with annual percent change of 37.1% (p = 0.001). A significant increase in the median number of cases per year was observed during 2021 compared to the previous periods (7.5 vs. 2). Frequency of patients with a psychiatric diagnosis vs. those without a psychiatric diagnosis was significantly higher during than before the COVID-19 period (66.7 vs. 36.1%, p = 0.046). In our study, a significant increase in the frequency of suicide attempts by self-immolation during COVID-19 pandemic was noticed. There was also an increased frequency of pre-existing psychiatric illness among patients during the pandemic period. With limited high-quality data available, the study adds to a rising body of evidence for assessment of outcomes of the pandemic on mental health and recognition of stressors for self-immolation.

Variation in pediatric orthopaedic case volume and type during residency: An updated report after Accreditation Council of Graduate Medical Education case volume minimums

BackgroundIn 2013, the Accreditation Council of Graduate Medical Education (ACGME) instituted a case minimum requirement for orthopaedic residents. It is unknown how pediatric orthopaedic case volume and variability have been affected by this change. MethodsThe ACGME orthopaedic surgery case log data from 2007 to 2020 were used to evaluate the number and type of pediatric orthopaedic procedures logged by graduating residents. The mean and median number of cases logged were compared for the years before (2007-2013) and after (2014-2020) the case minimum implementation using a Student t-test. ResultsIn the period after case minimum implementation, there were significant decreases in both overall cases (2080.6-1639.2; P < .001) and pediatric cases (328.7-264.7; P < .001) logged by residents. However, pediatric case volumes in certain areas significantly increased. Pediatric humerus/elbow procedures went up by 19.7% (29.4-35.2; P < .001), driven by an increase in fracture and dislocation treatments (21.5-28.17, 31.0%; P < .001). Similarly, pediatric forearm/wrist procedures went up by 31.7% (33.7-44.5; P < .001), driven by an increase in manipulation (19.0-31.9, 67.8%; P < .001). All other anatomic areas besides the shoulder experienced significant decreases in case volume, including spine procedures, which experienced the greatest decrease: 52.1% (28.4-13.5; P < .001). ConclusionsParadoxically, since the implementation of case minimums in 2013, residents have logged fewer overall cases and pediatric orthopaedic cases. One may hypothesize that, when residents are required to submit a certain minimum number of cases, there is little incentive to submit additional cases. Key Concepts1)The ACGME instituted a case minimum requirement for Orthopaedic surgery residents starting in 2013.2)Since 2013, residents have logged fewer pediatric orthopaedic cases.3)Since 2013, residents have logged fewer overall orthopaedic cases. Level of EvidenceIII, Cross-Sectional Study

Blunt solid organ injury: Resident operative experience on the decline

Introduction Duty-hour restrictions, improved non-operative management of injured patients, new or expanded fellowship programs, and the coronavirus disease 2019 (COVID-19) pandemic have hindered resident exposure to operative trauma in the United States. In this study, we investigated trends in resident operative experience in blunt trauma over a 22-year period. Methods Accreditation Council for Graduate Medical Education (ACGME) logs from 1999 to 2021 were reviewed. The yearly number of major trauma cases, trauma splenectomies (TS), and liver drainage/repairs (LDR) were extracted. We used the non-parametric Mann–Kendall test to analyze trends. Data are reported as mean ± standard deviation or median (estimated interquartile range, eIQR); alpha = 0.05. Results Records from 24,062 respondents were examined. The average number of trauma cases performed by all residents decreased from 42 ± 22 in 1999–2000 to 31 ± 18 in 2020–2021 ( p &lt; .01); median number of cases decreased from 36 (30, 47) to 27 (22, 36). The proportion of TS performed by chief and junior residents among all trauma cases decreased from 9.5% to 7.1% (trend test, p &lt; .01), and from 6.6% to 6.1% (trend test, p = .03) respectively. The proportion of LDR performed by chief and junior residents decreased from 6.9% to 4.7% (trend test, p &lt; .01), and from 4.3% to 3.9% (trend test, p = .03) respectively. Conclusions Number of major trauma cases and two common procedures for blunt solid organ injury decreased significantly over the past two decades. These findings should serve as an indicator that structural changes in surgery residency training programs in the United States may be necessary to safeguard resident exposure to operative trauma cases.

BS O06 Robotic-assisted bariatric surgery: a systematic review on learning curves

Abstract Background Robotic-assisted minimally invasive surgery has improved patient outcomes and experiences in various surgical disciplines, demonstrating reduced complications, postoperative pain, and length of hospital stays. Within the field of bariatric surgery, the integration of robotic systems aims to further enhance patient outcomes compared to traditional laparoscopic procedures. However, the precise learning curve (LC) for robotic bariatric surgery has yet to be clearly defined. Considering this knowledge gap, our review aims to compile and analyse the most up-to-date evidence on LC outcomes in bariatric surgery procedures. Methods In this review, we searched PubMed, Embase, and Cochrane Central Library databases up to April 2023 to identify studies reporting LC outcomes for robotic bariatric procedures. The primary outcome was the number of operations required to reach LC stabilization. Secondary outcomes included surgeon characteristics, including the number of training surgeons, their prior laparoscopic and/or robotic experience, exposure to simulated robotic training and outcome measures, including complication rates, surgery duration, and length of stay. Our study is registered on PROSPERO (CRD42023425878), and no specific grants were received from funding agencies. Results Of 432 initial results, 18 articles were included. All were observational studies reporting 27 cohorts from 2006 to 2022, involving 2084 patients. There were one to four included surgeons. The overall median number of cases to overcome the LC was 35 (IQR 15-64). For gastric bypass (RGB), the median LC was 25 (IQR 15-69), while for sleeve gastrectomy (RSG), it was 31 (IQR 20-86). The overall operation time was 185 minutes (IQR 124-197), with RGB at 152 minutes (IQR 139-196) and RSG at 98 minutes (IQR 85-110). Five studies used the CUSUM methodology, while others lacked specified LC determination approaches. Conclusions Our review highlights that the learning curve for bariatric surgery can be navigated relatively quickly and safely. However, it also reveals that the existing evidence on learning curves for robotic bariatric surgery is derived from a limited number of surgeons with unclear levels of prior surgical experience. Furthermore, the heterogeneity in evaluating learning curves poses challenges for comprehensive analysis. Future studies should aim to outline differences in outcomes between established laparoscopic methods and robotic bariatric procedures, providing further clarity in this field.

Legionellosis in Poland in 2018-2021.

The aim of this study is to compare the epidemiological situation of legionellosis in Poland in 2018-2021 to prior years, taking into account the impact of the COVID-19 pandemic in 2020-2021. The assessment is based on national surveillance data published in the annual bulletin "Infectious Diseases and Poisons in Poland" from 2013 to 2021, as well as data from Legionnaires' disease case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH NIH - NRI by sanitary and epidemiological stations or submitted to EpiBase. In Poland, both Legionnaires' disease (an acute infection that progresses to pneumonia) and Pontiac fever (a mild, flu-like sickness) are reported. In 2018-2021, a total of 255 cases of legionellosis were registered, including 236 cases of Legionnaires' disease and 19 cases of Pontiac fever. Each year, there was an increase in the number of notifications compared to the annual median number of cases from 2013-2017. The annual incidence rate in 2019 (0.23 per 100,000 population) was the highest since the start of legionellosis case registration in Poland. It declined again during the years of the COVID-19 pandemic. The notifications occurred throughout the country, but the highest notification rate was observed in the western belt of voivodeships. Pomorskie reported the highest incidence, accounting for more than 20% of all registered cases. The median incidence of Legionnaires' disease in men (0.23 per 100,000) was more than twice that of women (0.10), with the highest incidence (0.58) recorded in men 65 years of age or older. All indigenous cases of Legionnaires' disease were sporadic; all but three patients were hospitalized. State Sanitary Inspection reported 26 fatal cases of Legionnaires' disease (mortality = 11%). Twenty-four cases were linked to contaminated water systems in health-care settings, and 21 cases were likely associated with travel abroad. Although the number of notifications has increased in recent years, Legionnaires' disease is still an infrequently diagnosed respiratory infection in Poland, and the reported incidence remains one of the lowest in the entire EU. The most affected demographic group is men aged 65 and older. Improving the early diagnosis of Legionnaires' disease in healthcare settings remains a priority.

Analysis of deep learning approaches for automated prostate segmentation: literature review

Background. Delineation of the prostate boundaries represents the initial step in understanding the state of the whole organ and is mainly manually performed, which takes a long time and directly depends on the experience of the radiologists. Automated prostate selection can be carried out by various approaches, including using artificial intelligence and its subdisciplines – machine and deep learning.Aim. To reveal the most accurate deep learning-based methods for prostate segmentation on multiparametric magnetic resonance images.Materials and methods. The search was conducted in July 2022 in the PubMed database with a special clinical query (((AI) OR (machine learning)) OR (deep learning)) AND (prostate) AND (MRI). The inclusion criteria were availability of the full article, publication date no more than five years prior to the time of the search, availability of a quantitative assessment of the reconstruction accuracy by the Dice similarity coefficient (DSC) calculation.Results. The search returned 521 articles, but only 24 papers including descriptions of 33 different deep learning networks for prostate segmentation were selected for the final review. The median number of cases included for artificial intelligence training was 100 with a range from 25 to 365. The optimal DSC value threshold (0.9), in which automated segmentation is only slightly inferior to manual delineation, was achieved in 21 studies.Conclusion. Despite significant achievements in the development of deep learning-based prostate segmentation algorithms, there are still problems and limitations that should be resolved before artificial intelligence can be implemented in clinical practice.

Interactive computer-assisted learning as an educational method for learning pediatric interproximal dental caries identification

We developed a web-based tool to measure the amount and rate of skill acquisition in pediatric interproximal caries diagnosis among pre- and postdoctoral dental students and identified variables predictive for greater image interpretation difficulty. In this multicenter prospective cohort study, a convenience sample of pre- and postdoctoral dental students participated in computer-assisted learning in the interpretation of bitewing radiographs of 193 children. Participants were asked to identify the presence or absence of interproximal caries and, where applicable, locate the lesions. After every case, participants received specific visual and text feedback on their diagnostic performance. They were requested to complete the 193-case set but could complete enough cases to achieve a competency performance standard of 75% accuracy, sensitivity, and specificity. Of 130 participants, 62 (47.7%) completed all cases. The mean change from initial to maximal diagnostic accuracy was +15.3% (95% CI, 13.0-17.7), sensitivity was +10.8% (95% CI, 9.0-12.7), and specificity was +15.5% (95% CI, 12.9-18.1). The median number of cases completed to achieve competency was 173 (interquartile range, 82-363). Of these 62 participants, 45 (72.6%) showed overall improvement in diagnostic accuracy. Greater numbers of interproximal lesions (P < .001) and the presence of noninterproximal caries (P < .001) predicted greater interpretation difficulty. Computer-assisted learning led to improved diagnosis of interproximal caries on bitewing radiographs among pre- and postdoctoral dental students.

Perspectives and trends for minimally invasive surgery for hallux valgus deformity in the Asia Pacific region.

Evolving evidence and improved instrumentation have led to increasing importance of minimally invasive surgery (MIS) surgery in the treatment of hallux valgus deformity. This study aims to investigate the current trends of the practice of MIS hallux valgus surgery in the Asia Pacific region. A survey was sent via email to 30 fellowship-trained foot and ankle surgeons in 11 Asia Pacific countries, all registered with their respective national orthopaedic societies. The survey consisted of 8 questions and was designed to assess surgeon experience with MIS hallux valgus surgery, including common contraindications, satisfaction levels, learning curves and post-operative rehabilitation after MIS hallux valgus surgery. The vast majority of surgeons (63%) performed MIS hallux valgus surgery. However, only 18% of surgeons performed MIS surgery in more than half of their hallux valgus cases. A severe deformity was the most common contraindication (81%), followed by the instability of the first tarsometatarsal joint (50%), and abnormal DMAA (Distal Metatarsal Articular Angle) (38%). There was no statistically significant difference between the satisfaction score of MIS versus open surgery (p-value 0.1). The median number of cases the surgeons needed to perform before they considered themselves comfortable performing the surgery was 10 cases (range 1-100). Most surgeons allowed full weight bearing at 4-6weeks after surgery. MIS hallux valgus surgery is gaining popularity in the Asia Pacific region, with the majority of surgeons adopting this practice. The fact that severe deformity is seen as the most frequent contraindication and that MIS surgery is still not the most popular alternative demonstrates that surgeons are still circumspect when it comes to MIS surgery. Surgeons can use the findings of this study to guide their adoption of MIS practices in hallux valgus surgery and gauge well they perform in comparison to their counterparts in the Asia Pacific region.

Epidemiology of healthcare-associated SARS-CoV-2 outbreaks in Germany between March 2020 and May 2022

Outbreaks in healthcare facilities played a pivotal role in the course of the coronavirus (COVID-19) pandemic. To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in hospitals, outpatient care, and rehabilitation facilities in Germany from March 2020 to May 2022. Data from the German mandatory notification system were used to describe outbreaks by number of cases and case fatality ratio (CFR), and outbreak cases by age and gender. Using Pearson correlation, the dynamics of cases in the general population were compared with cases in healthcare-associated infection (HAI) SARS-CoV-2 outbreaks before and after the start of the vaccination campaign. Additionally, a counterfactual scenario was used to estimate numbers of prevented HAI cases, using the phase before vaccination as baseline. By the end of May 2022, 8941 healthcare-associated outbreaks were observed with 73,626 cases: 51,504 in hospitals, 15,524 in outpatient care, and 6598 in rehabilitation facilities. Median number of cases per outbreak was 4 (range: 2-342) and cases were more frequently reported in women with 46,818 (63.6%). Overall CFR was 8.1%, higher in men (12.4%) than in women (5.7%). After the vaccination campaign was fully introduced, the association between increasing incidence in the general population and consecutive outbreak cases was decreased by a factor of 10. Furthermore, our counterfactual analysis suggests that more than 55,000 outbreak cases could have been prevented until the end of 2021. The vaccination campaign in combination with non-pharmaceutical measures was key to reduce number, size and CFR of healthcare-associated outbreaks.

Performance of the Health System Network in Formosa, Argentina, in the Diagnosis of Leprosy.

Leprosy is a chronic, neglected tropical infectious disease, currently endemic in Formosa, a province in northwestern Argentina. To analyze the performance, distribution, and effectiveness of the health system in leprosy diagnosis in Formosa, we estimated the trend of the number of new cases of leprosy diagnosed between 2002 and 2019 and estimated a forecast for 2022 at the primary health care centers (PHCCs) of at the first level of care (1stLC), at district hospitals (DHs) of the second level of care (2ndLC), high-complexity hospitals at the third level of care (3rdLC), and in rural and urban areas. The general trend was calculated based on the new cases detection rate (NCDR) using the autoregressive-moving average model (ARMA). The 1stLC, 2ndLC, and 3rdLC and the rural/urban variables were assessed using a proportional Bayesian trend ARMA (TrARMA) model. A predictive model was used for estimated forecasts. Markov-Monte Carlo chains were applied with A Metropolis-Hastings's algorithm. The highest median proportion (Mp) of new cases of leprosy was diagnosed at the 2ndLC (Mp, 0.67; 97.5% credibility interval [CI] [0.56-0.77]), at the 3rdLC (Mp, 0.11; 97.5% CI [0.08-0.15]), and in urban areas (urban median proportion (uMp), 0.86; 97.5% CI [0.83- 0.88]), whereas the lowest proportion of new cases was diagnosed at the 1stLC (Mp, 0.082; 97.5% CI [0.061-0.108]) and in rural areas (rural median proportion (rMp), 0.13; 97.5% CI [0.11-0.16]). Our model predicts for 2022 that a median number of new cases of leprosy of 19.70 will be diagnosed in urban areas (97.5% CI [15.94-23.80]), and will continue to be diagnosed at the 2ndLC (median number of cases, 15.33; 97.5% CI [12.40-10.52]) and 3rdLC (median number of cases, 2.43; 97.5% CI [1.97-2.94]).

Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016–2021

IntroductionCochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated. MethodsA retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016–2021. Charges were adjusted by CMS wage index for hospital location. ResultsDuring the years of 2016–2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883–$125,394). The median CCR also did not differ throughout the years (2.7–3.1). Still, there was a larger interquartile range in 2021 (2.3–4.4) for the median CCR compared to all other years (2.1–3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020–2021 (78–79.8 %) compared to 2016–2019 (73.3–77.5 %). ConclusionsThe number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.

A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians.

There is limited knowledge on pediatric chest radiograph (pCXR) interpretation skill among practicing physicians. We systematically determined baseline interpretation skill, the number of pCXR cases physicians required complete to achieve a performance benchmark, and which diagnoses posed the greatest diagnostic challenge. Physicians interpreted 434 pCXR cases via a web-based platform until they achieved a performance benchmark of 85% accuracy, sensitivity, and specificity. Interpretation difficulty scores for each case were derived by applying one-parameter item response theory to participant data. We compared interpretation difficulty scores across diagnostic categories and described the diagnoses of the 30% most difficult-to-interpret cases. 240 physicians who practice in one of three geographic areas interpreted cases, yielding 56,833 pCXR case interpretations. The initial diagnostic performance (first 50 cases) of our participants demonstrated an accuracy of 68.9%, sensitivity of 69.4%, and a specificity of 68.4%. The median number of cases completed to achieve the performance benchmark was 102 (interquartile range 69, 176; min, max, 54, 431). Among the 30% most difficult-to-interpret cases, 39.2% were normal pCXR and 32.3% were cases of lobar pneumonia. Cases with a single trauma-related imaging finding, cardiac, hilar, and diaphragmatic pathologies were also among the most challenging. At baseline, practicing physicians misdiagnosed about one-third of pCXR and there was up to an eight-fold difference between participants in number of cases completed to achieve the standardized performance benchmark. We also identified the diagnoses with the greatest potential for educational intervention.

Variability in hospital costs for short stay emergent laparoscopic appendectomy

BackgroundAcute care surgery (ACS) diagnoses including appendicitis comprise 20% of inpatient admissions in the U.S. and 25% of hospital costs. To inform cost reduction efforts, we sought to measure variability in hospital costs for short stay emergent laparoscopic appendectomy. MethodsVIZIENT Clinical Data Base was queried for adult and pediatric patients who underwent emergent laparoscopic appendectomy for appendicitis with length of stay ≤3 days. We extracted calendar FY 2019 direct costs (DC) by age group and diagnosis code for sites reporting at least 5 cases. Costs in the database are derived from actual charges multiplied by a site- and cost center-specific cost-to-charge ratio. Labor portions are scaled by the area wage index. Sites were ranked by vigintile of DC per case to provide confidentiality and blinding. ResultsIn a total of 128 hospitals, median number of cases per site was 35.5 (Interquartile range (IQR) 20–65) with a total of 6585 cases analyzed. Highest cost centers by descending order were OR, Medical/Surgical Supplies, Routine Floor Care, Pharmacy, Emergency Room, Anesthesia, Laboratory, and CT scans, with all others each less than 2% of total costs. The relation between OR costs and total costs was strong but not complete. Mean DC per case was $4609. DC did not correlate with age, diagnosis code, or case volume per site. ConclusionsWide variation in cost of laparoscopic appendectomy among medical centers suggests potential for significant cost reduction. Strategic opportunities in cost reduction appear to lie inside and outside the OR. Key messageWide variation in cost of laparoscopic appendectomy and individual cost centers suggest a multi-pronged cost-reduction strategy should be used.

Automating Anesthesiology Resident Case Logs Reduces Reporting Variability.

The Accreditation Council for Graduate Medical Education (ACGME) case log system for anesthesiology resident training relies on subjective categorization of surgical procedures and lacks clear guidelines for assigning credit roles. Therefore, resident reporting practices likely vary within and between institutions. Our primary aim was to develop a systematic process for generating automated case logs using data elements extracted from the electronic health care record. We hypothesized that automated case log reporting would improve accuracy and reduce reporting variability. We developed a systematic approach for automating anesthesiology resident case logs from the electronic health care record using a discrete classification system for assigning credit roles and Anesthesia Current Procedure Terminology codes to categorize cases. The median number of cases performed was compared between the automated case log and resident-reported ACGME case log. Case log elements were identified in the electronic health care record and automatically extracted. A total of 42 individual case logs were generated from the extracted data and visualized in an external dashboard. Automated reporting captured a median of 1226.5 (interquartile range: 1097-1366) total anesthetic cases in contrast to 1134.5 (interquartile range: 899-1208) reported to ACGME by residents (P = .0014). Automation also decreased the case count interquartile range and the distribution approached normality, suggesting that automation reduces reporting variability. Automated case log reporting uniformly captures the resident training experience and reduces reporting variability. We hope this work provides a foundation for aggregating graduate medical education data from the electronic health care record and advances adoption of case log automation.

An educational method for learning and assessing interproximal dental caries diagnosis in children's radiographs

<h3>Background</h3> Dental caries is common in children, and intraoral bitewing radiographs are the gold standard for diagnosing interproximal caries. Accurate interpretation of radiographs is a key competency for dentists treating children to minimize the consequences of misdiagnosis. There are currently no validated methods for assessment of this important competency for Canadian dental trainees. <h3>Objective</h3> We developed an interactive computer-assisted learning (CAL) tool designed to permit the deliberate practice of pediatric bitewing radiograph interpretation. The main objective of this study was to measure the amount and rate of skill acquisition in the diagnosis of interproximal dental caries amongst dental trainees, and to determine the effect size of our education intervention. <h3>Study Design</h3> This multi-center prospective cohort study used a convenience sample of Canadian dental trainees ranging in experience from undergraduate dental education to graduate pediatric dentistry. Reference standard caries diagnosis was determined by consensus between three dental specialists. Study participants learned to interpret children's bitewing radiographs on a web-based platform by deliberately practicing 193 cases with the goal of achieving a performance benchmark of 75% accuracy, sensitivity, and specificity. Participants identified the presence/absence of interproximal dental caries, and if present, identified the specific location of all lesions. <h3>Results</h3> To date, 60 participants have completed all 193 cases, and 10 participants have achieved the performance benchmark. There was a significant increase of 17.8% (95% CI 14.6, 21.0) from mean initial to maximal accuracy amongst participants. The median number of cases to achieve competency was 180 (min 84, max 550). The effect size of the education intervention was large, with a Cohen's d=1.6 (95% CI 1.2-2.10). <h3>Conclusion</h3> The learning intervention evaluated in this study has led to effective and feasible skill improvement in the interpretation of interproximal dental caries on bitewing radiographs amongst dental trainees and may be a valuable adjunct to existing educational methods in dental radiology. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel

The Impact of the CEDD-NET on the Evaluation of Rare Disorders: A Multicenter Scientific Research Platform in the Field of Pediatric Endocrinology

Objective:The database http://cedd.saglik-network.org (CEDD-NET) has been operating since 2013 in Turkey. All pediatric endocrinologists can propose projects to this network. The aim of our study was to determine the impact of CEDD-NET on the transformation of multicenter studies into scientific publications and assess the academic characteristics of the studies that have been transcribed into publication.Methods:All the studies that were opened to patient admission on the website between August 26, 2013 and March 1, 2021 were reviewed.Results:A total of 30 studies were accepted and opened for data entry. The median data collection period was 12 (1.5-24) months, while the median number of researchers participated was 23 (3-180), the median number of cases was 120 (26-192). The average cost was $2113 (1370-3118). Out of 30 studies, data entry was completed for 27. Sixteen publications were produced from 14 studies, 13 ot them have not published yet. The median time from the end of data entry to publication of the study was 686 (168-1608) days. While the median impact factor of the journals in which the studies were published was 1.803 (1.278-5.399), the median number of citations was 6.5 (0-49), and cited by 99 times in Web of Science indexed journals in total.Conclusion:CEDD-NET appears to be productive and effective as all the publications are of high quality that have been published in the Q1-Q2 categories. This study demonstrated the benefits and necessity of establishing nationwide databases, even covering more than one country, in specialized branches, such as pediatric endocrinology where rare diseases are of concern.

SARS-Cov-2 Outbreaks in Sport and Exercise Settings: A Cross-sectional Study

Objective: This study aimed to retrospectively explore the differences between COVID-19 outbreaks, based on their association with sport/exercise practice and whether expansion among confirmed cases was observed in these settings. Method: Data from 5,327 COVID-19 outbreaks from the Epidemiological Surveillance Network of the Canary Islands were extracted between 31 January 2020 and 15 May 2021. We compared outbreaks in confirmed cases, close contacts, hospitalisations, admissions to Intensive Care Unit (ICU) and deaths. Results: The median number of cases per outbreak in sport/exercise settings with transmission was significantly larger (9 [5–16]) compared with outbreaks in other settings (4 [3–7]). Similarly, age of first case (35 [25–44] vs. 42 [30–55] years) and number of close contacts (30 [10–62] vs. 10 [5–21]) presented significant differences. However, no differences were found in number of hospitalisations, admissions to ICU and deaths per outbreak. Conclusions: Sport and exercise settings may pose a significant burden for contact tracing investigators since they tend to produce larger outbreaks. Regulations did not seem to completely control transmission. To enhance cooperation, specific recommendations and tailored advice are required according to the particular sport or exercise, the environment where it is practised and the available means of the facilities. Policies should encourage alternatives for safer sport/exercise practices.

Micrographic dermatologic surgery (MDS) diplomates: a demographic evaluation and comparison of Medicare case volume.

Micrographic dermatologic surgery (MDS) recently became a board-certified field within dermatology with the first board examination administered in October 2021. To be eligible,dermatologists must have completed a fellowship through the Accreditation Council for Graduate Medical Education (ACGME) or attest to active practice of Mohs micrographic surgery. Attestation of active practice is available from 2021-2025, after which, those sitting for the certifying examination must demonstrate completion of an ACGME-accredited fellowship. This study aimedto compile demographic information on physicians who passed the MDS board certification examination. Medicare Mohs micrographic surgery case volume was compared between fellowship-trained and non-fellowship-trained physicians as well as between members and non-members of Mohs organizations. Names of physicians who passed the examination were accessed on the publicly available American Board of Dermatology website. The Medicare database was used to screen for Mohs surgery case numbers from 2019, and the American College of Mohs Surgery (ACMS) and American Society for Mohs Surgery (ASMS) physician finder tools were used to determine active membership.Physicians not in the Medicare database and those who completed an ACGME-accredited fellowship within the past three years were excluded from case volume analysis. 1673 dermatologists passed the first certifying examination. Medicare Mohscase volumes were compared for1310 of these physicians. The median number (interquartile range (IQR)) of Mohs surgery cases was significantly higher for physicians who were ACMS/ACGME-fellowship-trained compared to those who were not (370 cases (IQR: 211-560) vs 138 cases (IQR: 37-284), p < 0.001). Members of ACMS and/or ASMS also performed a higher median number of cases compared tonon-members (334 cases (IQR: 160-526) vs 95 cases (IQR: 6-246), p < 0.001). Given the 5-year window to take the MDS examination without having completed an ACMS/ACGME-accredited fellowship, more physicians without formal training may choose to become board certified. In addition, less dermatologists may choose to complete an ACMS/ACGME-accredited fellowship since it is not required for board certification. As more dermatologists become board certified in MDS, it may become important to assess for active practice of Mohs surgery and define proficiencymetrics.