Medical Center Program Research Articles

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

No Increased Risk of Major Adverse Cardiovascular Events following Nicotinamide Exposure.

Nicotinamide metabolites have recently been implicated in increased risk of major cardiovascular events (MACE). Supportive data about clinical risk of MACE for nicotinamide users is lacking. To determine whether nicotinamide use results in an increase of MACE. Retrospective cohort study of two patient cohorts, Vanderbilt University Medical Center (VUMC) and Military Veteran Program (MVP). The risk of MACE in patients exposed to nicotinamide was compared to the risk of MACE in unexposed patients. In the VUMC cohort, 1228 patients were exposed to nicotinamide based on keyword entry for "nicotinamide" or "niacinamide" and hand-review of charts, while 253 were unexposed but had documented recommendation for use. In the MVP cohort, there were 1594 with exposure to nicotinamide propensity score matched to 2694 without exposure. The primary exposure for the VUMC cohort was a confirmed exposure to nicotinamide in chart review. The primary exposure for the MVP cohort was medication entry for "nicotinamide" or "niacinamide". The primary outcome was development of MACE based on a validated phenotype. Between both cohorts, 6039 patients were included, of whom 5125 were male with a mean age of 63.2 years. Neither cohort had significant differences in mean age, sex, race and ethnicity between the nicotinamide exposed and unexposed groups. In the VUMC cohort, there was no significant association between nicotinamide exposure and the primary outcome of MACE (HR 0.76, 95% CI 0.46 - 1.25, p = 0.28). MACE prior to nicotinamide exposure was strongly associated with subsequent MACE (HR 9.01, 95% CI 5.90 - 13.70, p < 0.001). In the MVP cohort, we adjusted for MACE risk factors as potential confounding variables and saw no significant association between nicotinamide exposure and MACE (HR 1.00 95% CI 0.75 - 1.32), while history of prior MACE remained strongly associated with subsequent MACE (HR 9.50, 95% CI 6.38 - 14.1). In this retrospective cohort study of 6039 adults from two different patient populations, we found no increased risk of MACE in patients with nicotinamide exposure.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Courage to Quit® rolling group: Implementation in an urban medical center in primarily low-income Black smokers

BackgroundContinuous “rolling” tobacco group treatments may help reduce cessation disparities by increasing access among underserved people who smoke cigarettes. We evaluated the implementation of a rolling enrollment adaptation of an evidence-based tobacco treatment group intervention, Courage to Quit®-Rolling (CTQ®-R). MethodsThe 4-session CTQ®-R incorporating psychoeducation, motivational enhancement, and cognitive behavioral skills was evaluated by examining feasibility and preliminary program outcomes with a pre-post design using the SQUIRE method in a sample of 289 primarily low-income, Black people who smoke. Feasibility was measured by examining program retention. Paired t-tests evaluated changes in behavioral intentions and knowledge about smoking cessation and differences in average daily cigarettes smoked from first to last session attended. ResultsCTQ-R was feasible to implement in an urban medical center program enrolling primarily low-income Black people who smoke, with 52% attending at least 2 sessions and 24% completing the full program. Participants demonstrated improvements in knowledge of smoking cessation strategies and confidence in quitting (ps < .004). Preliminary effectiveness analyses showed a 30% reduction in average daily cigarette use, with group completers reporting greater reduction than non-completers. ConclusionsCTQ®-R is feasible and showed preliminary effectiveness for increasing knowledge about stop smoking skills and reducing cigarette smoking. ImplicationsA rolling enrollment smoking group treatment is feasible and may be effective among people who smoke who face historical and systemic barriers to tobacco treatment engagement. Evaluation in other settings and over longer periods of time is needed.

Editorial introductions.

Editorial introductions.

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System

A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6–8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anthony N. KallooAnthony N. KallooDr Anthony N. Kalloo is Chairman of Medicine at Maimonides Medical Center and Professo Emeritus of Medicine at Johns Hopkins University School of Medicine, USA. He is the former Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital (2005-2020). He has special interests in Natural Orifice Surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in Internal medicine at Howard University Hospital in Washington, D.C., USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center and NIH program. Prior to joining the faculty at Johns Hopkins in 1988, he was an Instructor in Medicine at Georgetown University. Dr Kalloo is a past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. In 2009 he was recognized as the Distinguished Educator of the Year of the Award by the American Society for Gastrointestinal Endoscopy. In 2014 he received the Endoscopy Award of the German Society of Endoscopy for outstanding Research and contribution in the field of endoscopy. In 2015 he received the BJ Vakil Oration from The Society of GI Endoscopy of India bestowed on an international expert for his contribution to the field of GI Endoscopy. He has over two hundred peer-reviewed publications and over 100 patents. In 2015 he became a member of the inaugural chapter of the National Academy of Inventors at The Johns Hopkins University. This group represents the top 3% of all Faculty inventors since 1969, and the top 1.5% of active Johns Hopkins Faculty. Dhiraj YadavDhiraj YadavDr Yadav is a Professor of Medicine and Associate Chief for Clinical Research and Academic Development in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh Medical Center, USA. He has an active clinical practice with a focus on pancreatic diseases. His research interests are in the epidemiology of acute and chronic pancreatitis, and has published several key papers on the epidemiology of pancreatitis, especially its population distributions, the role of alcohol and tobacco in pancreatitis, and the natural history of disease. He is funded by the NIH and the DoD, and is the co-chair of the NIDDK-funded Type 1 diabetes in acute pancreatitis consortium (T1DAPC). He is the co-Principal Investigator on several ongoing multicenter studies, including a longitudinal cohort study of chronic pancreatitis (PROCEED), a randomized clinical trial assessing the role of minor papilla sphincterotomy in recurrent acute pancreatitis and pancreas divisum (SHARP), an observational cohort study on the risk and mechanisms of diabetes in acute pancreatitis (DREAM), and an observational study evaluating the role of short term increase in drinking as a risk factor for pancreatitis (ACCESS-AP). Dr Yadav has over 200 peer reviewed publications and abstract submissions each. He is actively involved in resident and fellow teaching, and co-directs the Enhancing Mentoring to Improve Research in Gastroenterology (EMERGE) program in the Division of Gastroenterology, Hepatology and Nutrition at UPMC. He is a frequent speaker at national and international conferences on acute and chronic pancreatitis.

THE UNINTENDED CONSEQUENCE OF MEDICAL TRAINING: DELAYED CHILDBEARING. A SURVEY OF REPRODUCTIVE GOALS AND FERTILITY KNOWLEDGE IN MEDICAL RESIDENTS

To assess reproductive goals and baseline fertility knowledge in residents and fellows across various specialties in a university teaching hospital. Residents and fellows at the McGaw Medical Center program of Northwestern University were invited to attend informational seminars hosted by the REI division. Postgraduate trainees have insurance coverage for infertility and oocyte vitrification. Participants were asked to complete a 38-question REDCap survey to assess their reproductive goals and baseline fertility knowledge prior to the sessions. Answers from the survey were compiled and descriptive statistics were analyzed. 112 residents and fellows attended the seminars and 59 of these attendees completed the survey (54 females and 5 males). with only 3.4% aged 35 or older. The largest percentage of participants were in their third post-graduate year (27.1%) and were training in surgical specialties (35.6%). One third of the participants were single, a third were married, and the remainder were partnered. No participants had children, although 2 experienced infertility and had pursued treatment. Over 80% planned to have children and nearly 90% of those individuals hoped to have their first child by age 35. More than 70% of participants reported that they delayed childbearing due to their career. Other reasons identified for delaying pregnancy included plans for ongoing training (50.8%), as well as concerns about time (49.2%), cost (49.2%), childcare (40.7%), and parental leave (27.1%). Nearly half of participants delayed starting a family due to their partner or lack of partner. Over 70% of participants were not aware of fertility benefits and reported desire to pursue fertility treatment or oocyte cryopreservation if covered by insurance. Barriers to pursuit included cost (74.6%), lack of knowledge regarding the procedure (59.3%), initiation (55.9%), and time commitment (54.2%). Ten percent of participants reported that female fertility does not decline until age 40. One third believed that success with one IVF cycle is 80% in women under 35. Nearly 10% of participants underreported miscarriage rates for all age groups. Sixty-five percent of respondents overestimated the upper age limit for IVF success with autologous oocytes, estimating 50.5 years and 14.3% of participants believed that women over age 60 could conceive with their own eggs. Over 80% recognized that males continuously produce sperm but greater than 30% were not aware that sperm concentration decreases with age and 11% were not aware that sperm quality similarly declines. Most medical residents and fellows delay childbearing due to training. Knowledge gaps are highly prevalent in this educated population who desire children but are delaying childbearing. Education focused on the impact of age on fertility and options such as oocyte or embryo cryopreservation should be taught in medical school or during residency training.

Is it time for observational management of pneumothorax?

AL–Foley Hospital Corp/South Baldwin Regional Medical Center Program, Foley, AL The authors declare no conflicts of interest.

Deep Learning-Based Classi Fi Cation of Cancer Cell in Leptomeningeal Metastasis on Cytomorphologic Features of CSF

Background: Difficulty diagnoses of leptomeningeal metastasis and lack of typical symptoms are considerable challenges in the clinical. As CSF a gold standard in LM, it is necessary to establish a deep learning model to classify cancer cells in CSF to facility doctor early diagnosis. Method: CNN models based on ResNet-Inception-V2 or ResNet-50 are used to training cells in CSF, which is evaluated by average precision or accuracy. Besides, our research comprised the interpretation of 42 doctors with different experience and CNN in the human-machine test to validate CNN's performance. Results: The precision of cancer cells was over 95% in the CNN1 model. In the human-machine test, the cell classification model's(CNN1) accuracy was close to experts and higher than other doctors. The cancer cell classification model's accuracy (CNN2) is 10% higher than that of experts, and the time-consuming is only 1/3 of that of an expert. We successfully achieved cell training in the small cell dataset in an 8-way cell classification model(CNN3), which overall accuracy is 90%. Explanation: Deep learning can be widely used cerebrospinal fluid cytology pictures for classification. For difficult cancer classify task, CNN accuracy is higher than that of specialist doctors, and its performance is better than that of junior doctors and intern. Funding: The project described was supported by National research and development precision medicine (Program 2016YFC0904500), National Science and Technology Gold Project (81671185), Natural Science Basic Research Program of Shaanxi (Program No. 2019JQ-251), Hospital-level project of Xi'an International Medical Center (Program No. 2020ZD007). Declaration of Interest: The authors declare that they have no conflicts of interests. Ethical Approval: The study was conducted in accordance with Declaration of Helsinki and approved by the Institutional Review Boards at Xijing Hospital.

Implementing clinic to home telehealth services to promote quality of life for ambulatory oncology palliative care patients.

259 Background: The Lifespan Cancer Institute (LCI) identified strategies to improve the palliative care experience and outcomes by providing clinic to home telehealth services. LCI is an integrated academic medical center program combining three hospital programs operating at five outpatient sites. One quality goal is to embed and increase palliative care within the fabric of oncology by providing palliative telehealth in the home to avoid office visits, ED and hospital admissions. Methods: LCI’s multidisciplinary palliative care team, including administrators, physicians, advanced practice providers and community partner physicians assessed telehealth challenges with a vulnerable patient in the home setting. Process development included operations, technology, patient and staff education. The group modified existing Lifespan system workflows, clinic to clinic video for behavioral health and clinic to clinic for providers, to create the clinic to home method. This process benchmarked patient and behavioral health noting video differences with the clinic setting versus the home. Results: Outcome metrics include no show rate, chemotherapy within 14 days of death, ED/ICU within 30 days of death, patient and provider experience. Initial data shows no show rates decreased from 10% (January) to 6% (May) as telehealth increased. Patients marked deceased within 3 months of a LCI visit for January (n = 52) and May ( = 61) unfortunately did not have a negative trend for chemotherapy in the last 14 days of life (Jan: 8%, May 15%). ED and ICU visits both had modest decreases from January (ED 50%, ICU 29%) to May (ED 48%, ICU 21%). In anticipation of future Press Ganey results, patient feedback includes an increase of comfort while at home. Provider satisfaction increased with the ability to assess the patient in their own home instead of the sterile clinic environment. Encountered challenges include insurance restrictions for Rhode Island (not a rural state), technology, and remote trouble shooting. Conclusions: The success of clinic-to-home telehealth services set the foundation for the COVID-19 telehealth insurgence and led to the palliative team acting as role models to medical and radiation oncology. End of life oncology patients stayed home while having their palliative needs addressed remotely. The innovative approach to implementing telehealth services will serve as a model for future LCI telehealth programs including treatment education sessions, oral chemotherapy follow-up, survivorship and post hospital discharge assessments.

“Residents as Teachers” Workshop Improves Knowledge, Confidence, and Feedback Skills for General Surgery Residents

Surgical residents receive limited formal training in education, yet they are expected to teach medical students and one another. A "Residents as Teachers" curriculum was developed and implemented to improve residents' knowledge of educational strategies, confidence in teaching abilities, and quality of feedback given to learners. A 6-hour workshop was delivered at an academic general surgery residency program. It included 3 interactive sessions: "Teaching on the wards", "How to give and receive feedback", and "Teaching in the operating room (OR)". Pre- and postsession surveys were administered to evaluate participants' knowledge and confidence regarding teaching skills. Standard statistical analyses were used to compare pre- and postcurriculum scores. General surgery residents at Case Western Reserve University/University Hospitals Cleveland Medical Center Program attended a 6-hour educational seminar entitled "Residents as Teachers". Three attending surgeons with expertise in surgical education administered the curriculum. Twenty-four residents completed the course and surveys (5 PGY-5s, 6 PGY-4s, 4 PGY-3s, 5 PGY-2s, and 4 PGY-1s). On a 5-point Likert scale, residents' self-rating of teaching skills (pre = 1.8, post = 3.04, p < 0.001) and understanding of adult learning (pre = 1.88, post = 4.42, p < 0.001) improved significantly. The greatest gain was in describing effective strategies for teaching in the OR (pre = 1.75, post = 4.38, p < 0.001). Residents reported improved understanding of effective feedback characteristics (pre = 2.5, post = 4.33, p < 0.001), and felt more prepared to provide feedback to learners (pre = 2.73, post = 3.17, p = 0.01). Scores on 5 of 10 knowledge-based questions significantly improved following the intervention. All participants agreed or strongly agreed that the workshop improved the program's surgical education curriculum (mean score 4.42 of 5). A "Residents as Teachers" workshop improved resident confidence in teaching and feedback skills, particularly for intraoperative instruction, and improved knowledge in the 3 specific educational domains included in the session.

Wellness Principles Correlate With More Favorable Burnout Scores in Junior Anesthesiology Residents

Strategies to prevent or reduce burnout for anesthesiology residents remain relatively unexplored. We aimed to determine if participation in a wellness course would be associated with lower burnout. A prospective, case-control survey/questionnaire study was implemented within a single anesthesiology residency in a large academic medical center program. One class participated in an inaugural wellness course (n = 15) promoting particular wellness principles 4 months into their postgraduate year (PGY)-1, while another class with no course participation served as controls (n = 13). Both groups completed the Maslach Burnout Inventory (MBI) 6 months into their PGY-2 year. In addition, a survey measuring their perceived ability to implement wellness principles (regardless of course participation) as well as validated questionnaires measuring stress, depression, and sleep quality were administered. Course participants had a trend toward lower MBI depersonalization scores; however, this was not statistically significant (MBI score 7 versus 12, P = .078, Cohen d 0.71). In a multivariable model, course participation yielded lower exhaustion scores (P = .011) whereas higher stress yielded higher exhaustion scores (P = .013), and higher depression scores yielded higher depersonalization scores (P = .019). A higher perceived ability to implement the wellness principles resulted in significantly better scores in all 3 burnout components (exhaustion P = .049, depersonalization P = .004 achievement P = .001). Residents who felt they could implement wellness principles had lower burnout, regardless of course participation. Our brief course exposure had only marginal independent effects, suggesting that more longitudinal and repeated exposures to wellness training are likely required to produce a more effective outcome for mitigating burnout.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Section Editors for this issue. SECTION EDITORS Anthony N. KallooAnthony N. KallooDr Anthony N. Kalloo is a Professor of Medicine at Johns Hopkins University, Baltimore, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in Natural Orifice Surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in Internal medicine at Howard University Hospital in Washington, DC, USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an Instructor in Medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an Associate Editor of Gastrointestinal Endoscopy. He is the founder and immediate past medical director of The Hopkins Gastroenterology and Hepatology Resource Center, a 3000 page multilingual web resource for patients and physicians. He has authored over 200 scientific papers, articles, reviews and book chapters. He has also pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. NOTES was cited in 2014 as one of CNN's top ten medical innovations. Dr Kalloo is a Past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. In 2014, he received the Endoscopy Award of the German Society of Endoscopy for outstanding research and contribution in the field of endoscopy. He also received the BJ Vakil Oration from The Society of GI Endoscopy of India bestowed on an international expert for his contribution to the field of GI Endoscopy, in the year 2015. In the same year, he also became a member of the inaugural chapter of the National Academy of Inventors at Johns Hopkins University. This group represents the top 3% of all Faculty inventors since 1969, and the top 1.5% of active Johns Hopkins Faculty. Timothy B. GardnerTimothy B. GardnerDr Timothy B. Gardner grew up in Newtown, Connecticut and graduated in 1995 with a BA in History from Dartmouth College, New Hampshire, USA. He received his MD degree from the University of Connecticut, USA. He completed his internal medicine residency, chief residency and Gastroenterology fellowship at Dartmouth-Hitchcock Medical Center, USA. He received advanced training in Clinical Pancreatology and advanced endoscopy at Mayo Clinic in Rochester. In 2013, he received a Master's degree in Clinical and Translational Research from the Dartmouth Institute. He is currently an associate professor of medicine at the Geisel School of Medicine at Dartmouth. He is also the director of pancreatic disorders, director of the Gastroenterology and Hepatology fellowship program, co-director of the advanced therapeutic endoscopy fellowship and medical director of the islet cell transplant program at Dartmouth-Hitchcock Medical Center. His primary focus of research is the treatment of acute and chronic pancreatitis. He is an associate editor of the American Journal of Gastroenterology and serves on the editorial boards of Gastroenterology, Gastrointestinal Endoscopy, and the Journal of Clinical Gastroenterology.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Section Editors for this issue. SECTION EDITORS Anthony KallooAnthony KallooDr Anthony Kalloo is a Professor of Medicine at Johns Hopkins University, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in natural orifice surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in internal medicine at Howard University Hospital in Washington, DC, USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an instructor in medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an associate editor of Gastrointestinal Endoscopy. He is the Founder and Immediate Past Medical Director of The Hopkins Gastroenterology and Hepatology Resource Center (www.hopkins-gi.org), a 3000 page multilingual web resource for patients and physicians. He has authored over 150 scientific papers, review articles and book chapters. He has pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. Dr Kalloo is a Past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. Rodger LiddleRodger LiddleDr Rodger Liddle is Professor of Medicine at Duke University Medical Center. Dr Liddle received his medical degree from Vanderbilt University and performed his internship and residency in medicine at the University of California, San Francisco. He was a fellow in gastroenterology at UCSF where he also performed his postdoctoral research training. Dr Liddle has served on the faculties of UCSF and Duke University. At Duke, Dr Liddle has held numerous leadership positions, including Chief of the Gastroenterology Division. Dr Liddle is an internationally recognized investigator in the physiology of the gastrointestinal tract. Dr Liddle's research focuses on neurohormonal regulation of the pancreas and experimental models of pancreatitis.

Effect of ocular reconstruction on brain function and structure in people with age-related cataracts: a prospective controlled clinical trial

BackgroundHealthy ageing is accompanied by simultaneous decline of visual and neural function. Studies in animals and humans provide converging evidence that these functions' decrease is mostly associated with structural change in ocular and brain structure. We investigated whether regaining visual function after ocular reconstruction was associated with functional and structural changes in the brain. MethodsWe did a prospective controlled clinical trial including 21 consecutive typical ageing patients (42 eyes; mean age 63·14 years, SD 7·82) with decreased visual function and diagnosis of bilateral age-related cataracts requiring phacoemulsification surgery and multifocal or monofocal intraocular lens implantation. Before surgery and 1 week, 3 months, and 6 months after surgery, we measured visual function parameters including best corrected visual acuity (BCVA), contrast sensitivity, straylight values, and pattern visual evoked potential, and we evaluated brain function and structure with the Mini-Mental State Examination and functional magnetic resonance imaging. Paired-t test, ANOVA, and post-hoc tests were used to compare preoperative and postoperative results. The study was approved by the ethics committee of Zhongshan Ophthalmic Center of Sun Yat-sen University. Written informed consent was obtained. This trial is registered with ClinicalTrials.gov, NCT02644720. FindingsThese 21 patients with age-related cataracts had visual and brain function decline and structural alterations before surgery compared with 21 age-matched and sex-matched healthy controls without cataracts. BCVA (assessed by LogMAR) 1 week after operation (mean −0·02, SD 0·01) was significantly improved compared with baseline (mean 0·61, SD 0·06; difference 0·633, 95% CI 0·51 to 0·76, p<0·0001). Significant functional improvements measured by fractional amplitude of low frequency fluctuation values were shown in the visual cortex at 3 months after ocular reconstruction (mean 0·12, SD 0·06), compared with values before surgery (mean 0·05, SD 0·06; difference −0·076, 95% CI −0·10 to 0·05, p=0·004). A significant increase in grey matter volume (voxel-based morphometry value) occurred in the vision-related area 3 months after surgery (mean 0·42, SD 0·07) compared with baseline (mean 0·37, SD 0·09; difference −0·06, 95% CI −0·08 to −0·03, p<0·0001). No significant change was noted in non-visual cortical regions 3 months postoperatively. InterpretationThese results suggest that ocular reconstruction to restore vision is associated with improvements in brain function and structure, even after initial of cerebral function degeneration, which might have been caused by visual decline and blindness in our study group. FundingThis work was supported by the Natural Science Foundation of Guangzhou City (81570889, 81270980), the Science and Technology Program of Guangdong Province, China (2013B021800054, 2013B020400003, 15570001), and the Clinical Research and Translational Medical Center Program in Guangzhou City.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Section Editors for this issue. SECTION EDITORS Anthony KallooAnthony KallooDr Anthony Kalloo is a Professor of Medicine at Johns Hopkins University, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in Natural Orifice Surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in Internal medicine at Howard University Hospital in Washington, DC, USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an Instructor in Medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an Associate Editor of Gastrointestinal Endoscopy. He is the founder and immediate past medical director of The Hopkins Gastroenterology and Hepatology Resource Center (www.hopkins-gi.org), a 3000 page multilingual web resource for patients and physicians. He has authored over 150 scientific papers, review articles and book chapters. He has pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. Dr Kalloo is a Past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. Fred S. GorelickFred S. GorelickFred S. Gorelick, MD is a Professor of Medicine (Digestive Diseases) and Cell Biology at Yale University School of Medicine and a physician scientist who cares for patients and does research. He went to medical school and did a residency at the University of Missouri in Columbia followed by a GI fellowship at Yale University. Afterwards, he trained in research with James D. Jamieson, MD, PhD at Yale and Paul Greengard, PhD at the Rockefeller University. His laboratory studies acute cell and tissue injury using models of pancreatitis and he is specifically interested in identifying pathologic signaling pathways that can be therapeutically targeted. He also works with Dr Greengard's group to examine the proteolytic generation of the protein responsible for Alzheimer's disease. Dr Gorelick has been the Acting Chief of the Digestive Diseases Section, the Digestive Diseases Research Training Program Director and is the Deputy Director of the Yale MD-PhD Program. Dr Gorelick has also served as the President of the American Pancreatic Association and has chaired grant review committees for the NIH. His laboratory has received support for over 30 years from the NIH NIDDK and NIAAA, from the Veterans Administration, and the State of Connecticut.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anthony KallooAnthony KallooDr Anthony Kalloo is a Professor of Medicine at Johns Hopkins University, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in natural orifice surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in internal medicine at Howard University Hospital in Washington, D.C., USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an Instructor in Medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an Associate Editor of Gastrointestinal Endoscopy. He is the Founder and immediate past Medical Director of The Hopkins Gastroenterology and Hepatology Resource Center (www.hopkins-gi.org), a 3000 page multilingual web resource for patients and physicians. He has authored over 150 scientific papers, review articles and book chapters. He has pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. Dr Kalloo is a past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. Fred GorelickFred GorelickFred Gorelick, M.D. is a Professor of Medicine (Digestive Diseases) and Cell Biology at Yale University School of Medicine and a physician scientist who cares for patients and does research. He went to medical school and did a residency at the University of Missouri in Columbia followed by a GI fellowship at Yale University. Afterward, he trained in research with James D. Jamieson, MD, PhD at Yale and Paul Greengard, PhD at the Rockefeller University. His laboratory studies acute cell and tissue injury using models of pancreatitis and he is specifically interested in identifying pathologic signaling pathways that can be therapeutically targeted. He also works with Dr Greengard's group to examine the proteolytic generation of the protein responsible for Alzheimer's disease. Dr Gorelick has been the Acting Chief of the Digestive Diseases Section, the Digestive Diseases Research Training Program Director and is the Deputy Director of the Yale MD-PhD Program. Dr Gorelick has also served as the President of the American Pancreatic Association and has chaired grant review committees for the NIH. His laboratory has received support for over 30 years from the NIH NIDDK and NIAAA, from the Veterans Administration, and the State of Connecticut.

Raymond J. Harshbarger III, MD, FACS, FAAP.

Dr. Raymond J. Harshbarger III received his medical degree from the University of Rochester, New York, completed his combined residency program in general and plastic surgery at Brown University in Providence, Rhode Island, and completed a fellowship in craniofacial plastic surgery at the Children's Hospital of Los Angeles, California. Dr. Harshbarger, as a lieutenant colonel in the U.S. Army, directed the craniofacial reconstruction program from the Iraq and Afghanistan conflicts at the Walter Reed Army Medical Center in Bethesda, MD. He has also participated in many cleft and craniofacial surgery missions as part of his international humanitarian surgical work to Third World countries including Vietnam, Honduras, El Salvador, Paraguay, and the Dominican Republic. Dr. Harshbarger's areas of clinical expertise include the treatment of the cleft lip/palate, craniosynostosis, distraction osteogenesis, jaw deformities, orthognathic surgery, and facial reconstruction with a focus on panfacial fractures. Currently, Dr. Harshbarger is the craniofacial fellowship director for the University of Texas Austin/Dell Children's Medical Center program, and is actively involved in teaching and research. I want to thank Dr. Harshbarger as guest editor for this issue. He has put together an excellent group of experts for this issue.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anthony KallooAnthony KallooDr Anthony Kalloo is a Professor of Medicine at Johns Hopkins University, USA. He is the Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital. He has special interests in natural orifice surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in Internal medicine at Howard University Hospital in Washington, D.C., USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center, USA and NIH program. He was an Instructor in Medicine at Georgetown University prior to joining the faculty at Johns Hopkins in 1988. He was an Associate Editor of Gastrointestinal Endoscopy. He is the founder and immediate past medical director of The Hopkins Gastroenterology and Hepatology Resource Center (http://www.hopkins-gi.org), a 3000 page multilingual web resource for patients and physicians. He has authored over 150 scientific papers, review articles and book chapters. He has pioneered and has multiple patents including the use of Botulinum Toxin in the gastrointestinal tract, endoscopic cryotherapy and the winged biliary/pancreatic stent. He is the pioneer of Natural Orifice Translumenal Endoscopic Surgery (NOTES), a technique that will enable abdominal surgery without the use of incisions. Dr Kalloo is a past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. He is the recipient of the 2009 Distinguished Educator of the Year of the Award from the American Society for Gastrointestinal Endoscopy. Chung OwyangChung OwyangProfessor Owyang is currently Professor of Internal Medicine and Chief of the Division of Gastroenterology at the University of Michigan in Ann Arbor, Michigan, USA. He also holds the H. Marvin Pollard Chair in Gastroenterology. He received his M.D. degree from McGill University, USA and completed his post graduate training at the Mayo Clinic, USA. In 1979 he joined the medical faculty at the University of Michigan where currently he holds numerous committee and administrative appointments. He serves as Director of the Marvin Pollard Institute for Medical Research, Director of the Gastrointestinal Physiology Laboratory and is a member of numerous prestigious national and international organizations. He was a member of the National Institute of Health Study Section, the Federal Drug Advisory Board (FDA) and the American Board of Internal Medicine. He has also served on the Council of the American Gastroenterological Association and chaired the International Committee. He served as the President of the American Motility Society in 2000–2004. Professor Owyang's work has focused on the molecular mechanisms of information processing in the enteric nervous system. His research has provided important insights into the pathophysiology and treatment of human disease states which has had important physiological and clinical implications, particularly in the treatment of chronic pancreatitis and irritable bowel syndrome. His studies include the purification and characterization of the role of CCK-releasing peptide in health and in chronic pancreatitis. In addition, his laboratory is also doing studies to investigate the circuitry of the enteric nervous system in different regions of the GI tract and determine the mechanism of information processing. Professor Owyang authored more than 250 publications and co-authored with Professor Tadataka Yamada the Textbook of Gastroenterology which is considered by many to be the best in its field. In recognition of his outstanding achievements in clinical research Professor Owyang received the prestigious Joseph B. Kirsner Award in Gastroenterology. In 2012, he received the Distinguished Mentor Award from the American Gastroenterological Association and in 2013, he received the Julius Friedenwald Award, the highest honor bestowed upon a member by the AGA.