Medicine Section Research Articles

Remdesivir, Renal Function and Short-Term Clinical Outcomes in Elderly COVID-19 Pneumonia Patients: A Single-Centre Study.

BackgroundRemdesivir, an antiviral agent able to reduce inflammatory cascade accompanying severe, life-threatening pneumonia, became the first drug approved by the Food and Drug Administration for the treatment of hospitalized patients with coronavirus 2 related severe acute respiratory syndrome (SARS CoV2). As from its previously known clinical indications, the use of remdesivir in the presence of severe renal impairment is contraindicated; however, the impact of remdesivir on renal function in aging patients has not been elucidated.Subjects and MethodsThis retrospective observational study involved 109 individuals consecutively admitted in internal medicine section, Azienda Ospedaliero Universitaria Pisana hospital, in November–December 2020 due to a confirmed diagnosis of SARS CoV2 and receiving remdesivir according to international inclusion criteria. Biochemical variables at admission were evaluated, together with slopes of estimated glomerular filtration rate (eGFR) built during remdesivir treatment. Participants were followed until discharge or exitus.ResultsPatients were stratified according to age (80 formed the study cohort and 29 served as controls); CKD stage III was present in 46% of them. No patients showed any sign of deteriorated renal function during remdesivir. Fourteen patients in the elderly cohort deceased; their eGFR at baseline was significantly lower. Recovered patients were characterized by a relevant eGFR gaining during remdesivir treatment.ConclusionWe show here for the first time as remdesivir does not influence eGFR in a cohort of elderly people hospitalized for SARS CoV2, and that eGFR gain during such treatment is coupled with a better prognosis.

Current practices and policies regarding the use of high-flow nasal cannula on general pediatric inpatient wards in Canada.

High-flow nasal cannula (HFNC) oxygen therapy has become a common treatment for respiratory conditions in children. To our knowledge, no study has described practice patterns for HFNC on pediatric inpatient wards in Canada. The aim of this study was to survey current practices and policies regarding the use of HFNC on the ward in children's hospitals in Canada. We conducted a web-based survey of Pediatric Hospital Medicine section chiefs in major tertiary care hospitals in Canada. The primary outcome was the proportion of hospitals that use HFNC on the general pediatric ward. Secondary outcomes included indications for HFNC, initial and maximum flow rates, maximum FiO2, method of nutrition delivery while on HFNC, level of nursing and respiratory therapist care required, criteria for pediatric intensive care unit transfer, and subjective successes and challenges of implementing a ward-based HFNC policy. The section chief survey response rate was 100% (15/15). Eight centres (53%) allowed the use of HFNC outside of an intensive care setting. Six centres initiated HFNC on the ward, while two centres only accepted patients after HFNC had been initiated in an intensive care setting. Other practices and policies varied considerably from centre to centre. Our study reveals that approximately half of tertiary children's hospitals in Canada currently use HFNC on the ward and utilize a range of practices and policies. Other centres are considering implementation. Further research is needed to inform best practices for HFNC therapy, support stewardship of health care resources, and promote safe patient care.

Prioritization of Pediatric Palliative Care Field-Advancement Activities in the United States: Results of a National Survey

BackgroundThe field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified 11 potential “next step” actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their “actionable importance.” MethodsInvitations to the survey were distributed in October 2019 to interdisciplinary PPC health care professionals via email to two major listservs, one hosted by the Section of Hospice and Palliative Medicine of the American Academy of Pediatrics, the other by the Center to Advance Palliative Care. Respondents rated the “actionable importance” of items relative to each other via a discrete choice experiment. Median importance scores are reported for each item. ResultsOne hundred seventy-seven individuals responded to the survey. The majority (62.2%) were physicians, with nurses (16.4%), advanced practice nurses (7.9%), and social workers (7.3%) being the other most common responders. The top five potential actions, in descending rank order, were: Determine what parents value regarding PPC (median score of 17.8, out of a total score of all items of 100); Define and disseminate core primary PPC curriculum (median, 15.3); Develop PPC national representation strategy and tactics (median, 12.3); Create PPC-specific program development toolkit (median, 10.9); and, Analyze payment and financing ratios (median, 9.6). ConclusionsThose seeking to advance the field of PPC should take into account the findings from this study, which suggest that certain actions are more likely to have a beneficial impact on moving the field forward.

Defensive medicine and cesarean sections in Brazil.

Brazil has a high rate of cesarean sections (CS) that cannot be solely justified by women's clinical conditions; thus, other causes, for example, CS on maternal request and physicians’ fear of litigation as possible influencing factors, cannot be overlooked.This study aimed to identify through a survey whether Brazilian gynecologists and obstetricians (GOs) perform defensive CS.In this cross-sectional, descriptive study, a questionnaire was administered. The target population comprised of GOs who were members of premier Brazilian professional associations of gynecology and obstetrics. A total of 403 GOs participated in the survey using an obstetrics questionnaire about litigation and defensive medicine (DM). Statistical analyses were performed on pairs of variables to determine the risk factors of performing CS due to concerns of complications during vaginal delivery and to avoid lawsuits.The mean age of the GOs was 47.7 years who were mostly female (58.3%) and having worked professionally in both public and private sectors (71.7%). Of all participants, 80.6% had been sued or knew an obstetrician who had been sued. The obstetricians who had been sued or who knew a colleague that had been sued exhibited a significantly higher likelihood of performing defensive CS than physicians who had not been sued or did not know physicians who had been sued. The perception of a higher risk of lawsuits against obstetricians influenced the practice of DM and led to a more than six-fold increase in CSs in specialists with this perception compared to specialists who did not believe the presence of an increased risk of litigation in obstetrics existed.The majority of Brazilian GOs perform defensive CS. It is important to consider DM as one of the causes of high CS rates in Brazil and include it in the development of public policies to reduce these CS rates.

Study on the Treatment Strategy of Batches of the Wounded and Partial First-Aid Procedures in Public Emergencies in Tertiary General Hospitals

Objective: The purpose is to formulate treatment strategies of batches of the wounded and partial first-aid procedures, and further improve the emergency rescue capability of hospitals. Methods: This study analyzed the emergency treatment case that we participated in. In this case, we used various means to start the emergency plan, run the emergency procedures, optimize diagnosis, treatment, and rescue procedures, mobilize medical rescue resources, provide a reference for emergency command decisions, formulate a set of coping strategies of tertiary general hospitals on public emergencies. Results: Through the scientific and effective management of our hospital, 20 wounded have been discharged from the hospital and achieved the ideal effect of zero deaths in the hospital. Conclusions: The new mode of first-aid and health emergency management on the scene of modern disaster needs to find ways to minimize the loss of life and property brought by public emergencies, integrate the various sections of modern disaster medicine, integrate a large number of international and domestic basic and clinical research achievements of disaster first-aid, and upgrade to information, digital system.

Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993-2017) : Suicides and natural deaths in prison.

We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan's three detention facilities. These deaths were divided into two types: natural deaths (n=135; 59.5%) and violent deaths (n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.

A Survey of Tranexamic Acid Use by US Tactical Emergency Medical Support Providers.

Tactical Emergency Medical Support (TEMS) providers may encounter severe traumatic injuries, with associated hemorrhagic shock, coagulopathy, and hyperfibrinolysis. Tranexamic acid (TXA) administration represents a potential intervention in this operational environment. This study evaluated TXA availability and use among US tactical medical personnel supporting law enforcement tactical teams. An anonymous on-line survey of the American College of Emergency Physicians (ACEP) Tactical Emergency Medicine (TEM) section was administered. Fifty respondents were included in the final study. Fifty-four percent reported TXA availability, with 14% reporting its use at least once in the past year. Additional available resuscitative products included crystalloids (88%) and packed red blood cells (6%). Twenty-five respondents reported managing ≥ 1 patient(s) with hemorrhagic shock in the past year. Resuscitative measures included crystalloids (96%), TXA (68%), and blood products (16%). Overall, 88% of respondents were supportive of TXA use. Full-time teams, those with = 3 monthly callouts, and teams that carried blood products were more likely to have TXA. Half of respondents reported managing a patient with hemorrhagic shock in the past year. Although 88% were supportive of TXA use, only 54% reported availability. Tactical teams with higher call volume and more resources were more likely to carry TXA. Further studies evaluating TEMS patient wounding patterns and barriers to TXA utilization are required.

Development of Web Based Online Medicine Delivery System for COVID-19 Pandemic

Average Bangladeshis spend a significant amount of income on medicine. A reliable and fast online medicine delivery system is not ubiquitous. Most people buy medicine from the local Pharmacies. They need to go to medicine stores to buy the specific medicine prescribed by the specialized doctors. Sometimes all prescribed medicines are not available in local Pharmacies therefore people need to go to other areas to buy the medicines. It is very time consuming and people need to spend money as well for this. In our country, traffic jams are a very big problem. People waste longer time on the road due to traffic jams. Here most of the pharmacies are closed at night time but sometimes in an emergency situation medicine is very essential. In this case an online web based e-commerce medicine delivery system is needed very much. In addition, currently the whole world is suffering due to COVID-19 pandemic. Coronavirus is very contagious which we all know. In this pandemic time it is not risk free to go out to buy medicine from the pharmacies. Due to COVID-19, medicine scarcity is also an important issue. In this situation, an online medicine delivery system can play an important role. By considering the above mentioned facts, a reliable and fast online solution is proposed. This paper presents the development of a web based online medicine delivery system. A reliable, fast, safe and user-friendly online based e-commerce web application has been developed in this paper. Medicine delivery system has also been included with this proposed system. This platform is a dynamic web application built in Hypertext Preprocessor (PHP) based Laravel framework with a powerful back end. It is hosted on a dedicated Virtual Private Server (VPS). This system is lightning fast and optimized very well for searching engines. With the help of the developed platform, drugs will be available at one’s doorstep very fast, safely and reliably. In this system, users can choose a medicine section of their choices and go through all the items that the system provides. Users can then select the desired drug items, add them to cart and then proceed to payment. It has payment integration of Cash on Delivery (COD) systems. After developing the system it has been tested and it works fine. It is a one-stop solution where people can find various medicines including COVID-19 related medicines and other items in this online platform. Besides medicine, here you can also find other health care products like food supplements, birth control products, hair care products, skincare products, beauty products, etc. People can order their required medicines or other medical related available items from online and the delivery support will provide the products door to door for the users. Using this system now users can get their needed medicine without leaving home. They can save money and they do not need to go out in this pandemic situation to buy medicine. In this crucial situation, the online medicine delivery system is very helpful and it will act as a blessing for the people.

Diagnostic performances and clinical usefulness of comprehensive non-commercial software for renogram analysis: Values of renal output efficiency and normalized residual activity in suspected kidney outflow obstruction

Introduction/Objective. Nuclear Medicine Section of IAEA has developed the software for dynamic renal scintigraphy, which allows calculation of advanced parameters of drainage: renal output efficiency (OE) and normalized residual activity (NORA). The aim of this study was to validate IAEA software by comparing results of parameters of renal drainage in normal subjects against their established reference values and to assess diagnostic accuracy of OE and NORA in distinguishing between obstruction/unobstruction. Methods. Fifty-five patients with suspected obstruction and 36 kidney donors were investigated. Group A consisted of 24 obstructed kidneys, Group B of 37 kidneys with dilated urinary tract, and Group C of 72 normal kidneys. Forty-minute acquisition was applied. Furosemide was administered after 20 minutes. Post-micturition image was acquired at 50 minutes. The analyzed parameters were as follows: OE at 20 minutes (OE20) and at the end of the furosemide test (OE40), NORA at 20 minutes (NORA20) and after micturition (NORAPM). One-way ANOVA was used for evaluating the differences between the groups. Ability of OE40 and NORAPM to distinguish between obstruction/unobstruction was determined by ROC curve analysis. The sensitivity, specificity, area under the curve, and cut-off values were analyzed. Results. Excellent agreement of our results with established OE and NORA values was found. The difference between the groups was significant for OE20, OE40, NORA20, and NORAPM (p < 0.001). Cut-off values for obstruction were 82% and 0.11 for OE40 and NORAPM, respectively. Conclusion. IAEA software gives reliable analysis of diuretic renography and helps to better diagnose obstruction. IAEA should be encouraged to produce final version of the software and to release it online.

Dermatological manifestations of psychic ailments

An increase in the number of patients with psychodermatological manifestations and the identification of a certain comorbidity during the course of diseases in patients with a dermatological profile makes us take a fresh look at this problem. Psychodermatology is one of the relevant and, at the same time, the least studied areas of modern medicine, which is at the junction of psychiatry and dermatovenereology. Psychiatry and psychotherapy studies the inner world of a person; Dermatovenerology deals with the diagnosis and treatment of diseases of the human skin and its appendages, and psychodermatology combines these two sections of medicine. In the modern world, as a result of increasing the amount of incoming sensory information, accelerating the rhythm of life, the action of harmful environmental factors, a person can be subjected to excessive psycho-emotional stress, leading to the development of mental disorders. Often it is skin rashes that are an objective manifestation of such disorders. Early diagnosis of psychodermatosis and signs of obsessive-compulsive pathology in sick people contributes to the timely identification of the category of people at risk of psychotic reactions and mental illness. This is especially true for young patients. Against the background of hormonal changes in the body, the crisis of adolescence, the increased educational load on them at school, the destroyed institute of family and marriage, an overabundance of sensory information and physical inactivity, the incidence of psychodermatosis throughout the world, including in our country, is increasing.

The science of eye diseases in Saint Petersburg in the XVIII century

A brief overview of the state of Russian medicine of the XVII century is presented firstly. The main attention is paid to the treatment of eye diseases during the XVIII century and the influence of famous foreign doctors and scientists on the origin and formation of Russian ophthalmology and its scientific basis. Special attention is paid to the role of the outstanding Dutch doctor and world-famous scientist G. Burhaave, who was called the teacher of the whole Europe, in the development of medicine and identification of ophthalmology as an independent section of medicine and as a special discipline. This contributed to the further development of ophthalmology not only in Europe but also in Russia. The important role of the Vienna ophthalmology school and its representatives, including G.Y. Beer, Y. Bart, J.Ya. Morenheim and others, is stated in relation to the formation of the Russian scientific school of ophthalmology, which was the successor of Vienna best traditions. Great attention is paid to scientific papers and textbooks on ophthalmology published in the XVIII century in Russian. We also studied the student book by G. Burhaave Public lectures on eye diseases that was the main textbook of the XVIII century for medical students throughout Europe and was published in Russia in 1798. We also analyzed the little-known in Russia handwritten document from the funds of the Russian State Historical Archive an essay by the Austrian doctor of medicine and surgery Professor J. Ya. Plenka Doctrina de morbisoculorum (Doctrine of Eye Diseases) translated into Russian by the doctor of medicine A. Maslovsky (1798). A. Maslovsky dedicated the translation of this recognized in Europe scientific work to the Chief Director of the Medical College Baron A. I. Vasiliev. On September 23, 1818, according to the Highest Order of Emperor Alexander the I the first department of optics in Russia was established at the Saint Petersburg branch of the Medical and Surgical Academy with the approval of doctor of medicine and surgery I. E. Grubi in the position of full professor.

Effect of 24/7 attending coverage in the neonatal intensive care unit on fellow education

BackgroundThere is a current change in type of attending coverage in the Neonatal Intensive Care Unit (NICU) from home calls to 24/7 in house coverage. Effects of this increased attending physician presence on education of NICU fellows has not been studied. The objective of this study is to evaluate the fellows’ perception of in house attending coverage on their education and evaluate its effect on their perceived autonomy.MethodsA secure, anonymous, web-based survey was designed using RedCap. The web-based survey was sent via the section of Neonatal Perinatal Medicine of the American Academy of Pediatrics, to all members of Training & Early Career Neonatologists. Questions were focused on perception of IH attending coverage on fellows’ educational experience including the respondent’s perceived ability to make independent decisions (autonomy). Chi-square tests were used to compare responses between groups, with Fisher Exact tests used when the expected cell frequencies were small.ResultsOne hundred and twenty-three surveys were analyzed, that included responses from 82 fellows & 41 early career neonatologists. 52% reported having 24/7 attending in-house (IH) coverage. Thirty of the 123 respondents experienced a change in model of attending coverage during their training. Among these 30, only 26.6% preferred the model of attending IH coverage. The respondents currently working in IH models, when compared to those in non-IH coverage models felt IH attending coverage was beneficial for fellow education (p < 0.05) but was less likely to give fellows autonomy for decision making (p = 0.02).ConclusionIn our survey respondents with in house attending, had a more favorable view of its benefit on fellow education. Institutions practicing or considering IH attending coverage should consider use of adequate measures to balance fellow supervision and education.

Interviu cu Adrian Majuru, căștigătorul premiului Academiei Române, „Henri H. Stahl” în sociologie, pentru cartea Francisc Iosif Rainer. Biografia unui proiect de viață (1874-1944), Editura Oscar Print, București, 2018

Back in 1879 two Romanian Academy’s prizes were established for science and literature: „Gheorghe Lazăr” and „Ion Heliade Rădulescu” (www.acad.ro). The prizes of the Romanian Academy „are awarded to Romanian scientists and artists living here or abroad for their contribution (…) to the development of Romanian culture and science” (www.acad.ro). Since 1996, the Romanian Academy is awarding yearly excellence in domains corresponding to its scientific sections: I Philology and literature, II Historical sciences and archeology, III Mathematics, IV Physics, V Chemistry, VI Biology, VII Geonomic, VIII Technical section, IX Agricultural and Forestry section, X Medicine section, XI Economic, juridical and sociology section, XII Philosophy, theology, psychology and pedagogy section, XIII Art, architecture and audiovisual section and XIV Science and technology of information section. Under the section XI Economic, juridical and sociological sciences, two awards are available for Sociology area: „Dimitrie Gusti” and „Henri H. Stahl”. This interview is conducted with the winner of „Henri H. Stahl” awarded in 2020. More details on history of these awards as well as guidelines and 1998-2017 lists are available on https://acad.ro/premiileAR/pag_premii.htm.

Actual Issues of the Cardiac Complications Risk Assessment and Correction in Non-Cardiac Surgery

Worldwide, more than 200 million non-cardiac surgeries are performed annually, and this number is constantly increasing; cardiac complications are the leading cause of death in such surgeries. So, in a multicenter study conducted in 27 countries, cardiovascular complications were present in 68% of cases of death in the postoperative period. Registers of recent years have shown that the number of such complications remains high, for example, with a dynamic assessment of troponins, perioperative myocardial damage was detected in 13-18% of cases. This review provides a critical analysis of the step-by-step algorithm for assessing cardiac risk of non-cardiac operations considering the emergence of new publications on this topic. The review discusses new data on risk assessment scales, functional state assessment, the use of non-invasive tests, biomarkers, the role of preventive myocardial revascularization in the preoperative period, and drug therapy. The issues of non-cardiac operations after percutaneous coronary intervention, perioperative myocardial damage are considered separately. The review emphasizes the difficulties in obtaining evidence, conducting randomized clinical trials in this section of medicine, which do not allow obtaining unambiguous conclusions in most cases and lead to inconsistencies and ambiguities in the recommendations of various expert groups. This review will help practitioners navigate this issue and help to use the optimal diagnostic and treatment strategy before performing non-cardiac surgery.

Using Telementoring to Share Best Practices on COVID-19 in Post-Acute and Long-Term Care Facilities.

Using Telementoring to Share Best Practices on COVID-19 in Post-Acute and Long-Term Care Facilities.

Prevalence of Birth Defects among Neonates Born at the Philippine General Hospital from 2011 to 2014

Objective. The study aimed to determine the prevalence of birth defects among neonates born at the Philippine General Hospital (PGH) from January 2011 to December 2014.&#x0D; Methods. Monthly censuses of all deliveries from January 2011 to December 2014 were obtained from the Section of Newborn Medicine. All deliveries with birth defects were coded using International Classification of Diseases-10 (ICD -10). The codes were tallied and classified as either an isolated, part of a recognizable syndrome, chromosomal syndrome or multi-malformed case (MMC). Period prevalence was then calculated.&#x0D; Results. There was a total of 20,939 deliveries from 2011 to 2014 in PGH, of which 574 babies (2.74%) had a diagnosis of at least one birth defect. Two-hundred seventy-three babies (47.56%) had isolated defects; 130 (22.65%) with defects in MMC; 106 (18.47%) with defects as part of recognizable syndromes; and 65 (11.32%) with defects as part of chromosomal syndromes. One in 36 births has at least one birth defect, which is higher than that reported in other Asian countries.&#x0D; Conclusion. Birth defects are significant causes of morbidity and mortality. Results of this study provide baseline data that can be used for future studies on the causation of such birth defects, and can be used to formulate policies on primary and secondary prevention. For a tertiary hospital like PGH, these data can serve as a guide towards allocation of resources and manpower towards the more common birth defects.

Making the Case for Limited Physiologic Monitoring in a Data-Hungry World.

Megan* paced the small hospital room, pausing to peer anxiously at the sleeping infant in a white plastic crib. As I introduced myself, Megan laughed nervously and explained her unease: “For the first time in her life, Riley is sleeping unmonitored,” she said, glancing again at her 5-month-old infant. Before today’s admission for bronchiolitis, Riley’s sleep routine included strapping on her Owlet, a pulse oximetry–based home infant monitor. “It’s ironic,” Megan pointed out. Now, hospitalized for a respiratory illness, Riley would ostensibly have less monitoring than at home. “Seeing her numbers makes me feel safer. What’s the harm?” Megan asked. Megan’s question gets to the heart of pediatric hospital medicine’s struggle to transition away from continuous pulse oximetry monitoring of stable patients with bronchiolitis and at the sentiments explored by Chi et al1 in “Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations.” The clinical downsides to continuous monitoring of such patients, including overdiagnosis of hypoxemia, increased length of stay, alarm fatigue and delayed alarm response time among nurses, are well characterized.2–4 Given that bronchiolitis is responsible for over 100 000 hospitalizations a year,5 … Address correspondence to Irit R. Rasooly, MD, MSCE, Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, 3500 Civic Center Blvd, Buerger Center for Advanced Pediatric Care, 12th Floor, Philadelphia, PA 19104. E-mail: rasoolyi{at}email.chop.edu

Sports medicine market – growth factors and forecasts

Sports medicine bridges the gap between science, health and exercise. It involves a combination of physicians, physical therapists, athletic trainers and sports scientists to provide the best possible care for sports injuries and illnesses. The paper demonstrates the overall market review of sports medicine and its scope of expansion during the estimation timeframe. Firstly, the study centers around the key factors driving the sports medicine market over the analysis period. Secondly, with growing price competition and technological advancement in implants, the industry is projected to witness entry of new companies during the forecast period. The study also provides information about the various types of treatment systems that are accessible to treat sports-related injuries. Consequently, the growing popularity of sports and healthy lifestyle has enabled hospitals and clinics to open separate sports medicine section in the medical setting.

Analysis of the Sports Medicine Section of the Orthopaedic In-Training Examination: Improvements in Levels of Evidence and Question Taxonomy Over a 12-Year Period.

There has been a recent shift within the orthopedic literature to publish articles with higher levels of evidence. In this investigation, the trends in question taxonomy and the levels of evidence of the references for sports medicine questions on the Orthopaedic In-Training Examination (OITE) during a 12-year period were evaluated. Sports medicine questions were obtained from the OITEs administered between 2005 and 2007 and between 2014 and 2016. The taxonomy of each question was characterized, and levels of evidence for all references were assigned using American Academy of Orthopaedic Surgeons guidelines. Question taxonomy and article levels of evidence from 2005 to 2007 were compared with those from 2014 to 2016. Sports medicine questions comprised 8% of the OITEs in both examination groups. The questions from 2014 to 2016 had a higher mean taxonomic level (2.26 vs 1.52, P=.0001) and a greater proportion of studies with high levels of evidence (levels 1 and 2) (21% vs 10%, P=.027). However, references with low levels of evidence or nonprimary resources made up 82.2% and 68.5% of the total references on the older and more recent examinations, respectively. References from 2014 to 2016 were, on average, 2 years older than those from earlier examinations. This study indicated that sports medicine questions on recent OITEs cite references of higher levels of evidence and contain higher taxonomic question structure than examinations 10 to 12 years ago. However, the majority of questions still cite articles with low levels of evidence or nonprimary sources. These findings can be used to guide resident education and continue improvements in the selection of references for questions on the Sports Medicine section of the OITE. [Orthopedics. 2020;43(5):e460-e464.].

Sexual Orientation and Gender Identity Data Collection: Clinical and Public Health Importance

AffiliationsCarl G. Streed Jr is with the Department of Medicine, Center for Transgender Medicine and Surgery and the Section of General Internal Medicine, Boston University School of Medicine, Boston, MA. Chris Grasso, Sari L. Reisner, and Kenneth H. Mayer are with the Fenway Institute, Boston, MA. Sari L. Reisner is also with the Department of Medicine, Brigham and Women’s Hospital, Boston, MA. Kenneth H. Mayer is also with the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.