Standard Course Research Articles

Clinical diversity and main directions of medical rehabilitation of dorsopathies of cervical-thoracic localization

Introduction. The high prevalence and increase in cases of seeking medical help for pain in dorsopathies determines the relevance of this problem. Among all the conditions included in the study of health care costs, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CTD), which are most common in developed countries and are characterized by a variety of clinical forms. In our opinion, a comprehensive method of treating CTD with the mandatory use of non-drug methods of therapy is the most optimal.Aim. Determination of the relationship between the pathogenetic form of CTD (verification of pain triggers) and a personalized method of treating patients, containing a combination of drug therapy and a rehabilitation complex of physiotherapeutic, psychotherapeutic effects.Materials and methods. Patients with CTD were included in the study. Neurological status assessment and biomechanical tests were carried out for accurate clinical verification of pathogenetic forms of CTD. Depending on the choice of treatment, respondents were stratified into comparable groups. The main group included patients to whom the original technique was applied, which implied a combination of drug therapy, a complex of rehabilitation physiotherapy and psychotherapeutic effects (n = 155), the control group (n = 65) – respondents who received a standard course of therapy. The statistical analysis included a comparative assessment of the intensity of pain syndrome, static-dynamic and reflex disorders before and after therapy.Results. Both methods have shown their effectiveness. The original technique more effectively reduced the intensity of pain syndrome, reduced the frequency of reflex disorders (p < 0.05), significantly reduced static-dynamic disorders in all subgroups (p < 0.05), while the standard significantly reduced them only in the subgroup with uncomplicated forms of CTD, without achieving a therapeutic effect in complicated CTD.Conclusion. The original method of therapy of patients with HCG has confirmed its effectiveness.

The Socratic method in developing spoken English discussion discourse markers: A case study

Socratic pedagogy is a systematized method that encourages learners to question themselves and each other - without being judgmental. It aims at boosting empathy and developing an ability to reach informed conclusions. It supports the acquisition of social skills and fosters collaboration while helping them to think critically, deepen their understanding, and find reality in equilibrium. In reaching for insights, students acquire vital skills, knowledge, and practices. Socratic learning depends on how participants can use systematic dialogue. This study monitored the effects of students' use of specific discourse markers (DMs) over a series of speaking tasks undertaken in Socratic seminars. Each task was devised to support the learning objectives of a standardized English language course given to pre-service English teachers in Turkey. Recordings were used to provide feedback to ten participants and then analyzed for appropriate use of spoken DMs. The findings of the study revealed solid evidence of accurate and contextually appropriate DM usage as the number of appropriate DM use increased significantly in the seminars conducted at the end of the intervention period.

FORMATION OF AN INCLUSIVE APPROACH IN THE EDUCATION OF CHILDREN WITH SPECIAL EDUCATIONAL NEEDS (UKRAINIAN EXPERIENCE)

The purpose of the study is to rethink the standardized course curriculum in accordance with an inclusive approach. The method of analyzing secondary data made it possible to put forward the hypothesis that a modern Ukrainian school should be both regular and adapted to the needs of all students who attend it, considering their differences and special educational needs. Results. The article analyzes the formation of an inclusive approach to the education of children with special educational needs in Ukrainian education based on the professional activity of a teacher's assistant (accompanying person), reveals the dilemmas faced by a school attendant in search of his professional identity, which puts him on the verge of another profession - the profession of a teacher. The novelty of the work lies in the disclosure of the problems of interprofessional relations and the field of activity of teacher assistants, which has not yet been disclosed. Based on the experience of the focus group, the author presents her own approach to inclusive education of children with special educational needs. Conclusions. The analysis has revealed a diverse typology of teacher assistants' positions in inclusive schools in Ukraine, which reflects the delimitation of territories and borders, which complicates cooperation. It is recommended to create a national reference system of skills for teacher assistants to clearly define their scope of work in working with children with special educational needs and establish joint work trajectories with teachers. This will help to integrate knowledge, skills, and attitudes across the education sector, improve their performance and change their skills.

Anatomic donor surgeries increase self-efficacy in physical therapy education: Use of live versus recorded viewing.

Anatomy serves as a foundational course in physical therapy education, but, due to its early placement in the curriculum, may have limited clinical application at that point of a student's education. Thus, augmenting a standard dissection course with surgical procedures can enhance the clinical relevance and knowledge of the anatomical structures involved in those surgeries. Doctor of Physical Therapy students viewed a variety of cadaveric orthopedic and cardiothoracic surgeries performed by a surgeon. Students unable to participate live viewed the recorded surgeries. Participants completed a 10-point Likert scale survey, developed by the researchers, pre- and post-viewing, on self-efficacy of knowledge, patient intervention and communication. Data analysis revealed improved self-efficacy of knowledge of the anatomy and the surgical procedures, confidence in treating patients undergoing those surgeries, and confidence communicating with surgeons, regardless of whether students viewed the surgeries live or recorded. Students participating in this experience expressed a clear value enhancement on their education. Programs should feel confident that this type of experience in the curriculum, whether live or recorded, will have a positive effect on student self-efficacy as related to the relationships and pertinence of anatomical structures involved in the surgeries, the surgical procedures, treating patients having undergone those surgeries, and interprofessional communication.

Central and Peripheral Fatigue Evaluation during Physical Exercise in Athletic Horses by Means of Raman Spectroscopy.

The evaluation of the performance levels in athletic horses is of major importance to prevent sports injuries. Raman spectroscopy is an innovative technique that allows for a rapid evaluation of biomolecules in biological fluids. It also permits qualitative and quantitative sample analyses, which lead to the simultaneous determination of the components of the examined biological fluids. On the basis of this, the Raman spectroscopy technique was applied on serum samples collected from five Italian Saddle horses subjected to a standardized obstacle course preceded by a warm-up to evaluate the applicability of this technique for the assessment of central and peripheral fatigue in athletic horses. Blood samples were collected via jugular venipuncture in a vacutainer tube with a clot activator before exercise, immediately after exercise, and 30 min and 1 h after the end of the obstacle course. Observing the obtained Raman spectra, the major changes due to the experimental conditions appeared in the (1300-1360) cm-1 and (1385-1520) cm-1 bands. In the (1300-1360) cm-1 band, lipids and tryptophan were identified; in the (1385-1520) cm-1 band, leucine, glycine, isoleucine, lactic acid, tripeptide, adenosine, and beta carotene were identified. A significant effect of exercise was recorded on all the sub-bands. In particular, a change immediately after exercise versus before exercise was found. Moreover, the mean lactic concentration was positively correlated with the Raman area of the sub-band assigned to lactic acid. In this context, the application of Raman spectroscopy on blood serum samples represents a useful technique for secondary-structure protein identification to investigate the metabolic changes that occur in athletic horses during physical exercise.

Case of left atrial myxoid sarcoma with lung metastases presented as a cardiogenic shock: a case report and literature review.

We are presenting a case of a 41-year-old female with left atrial myxoid sarcoma, which was presented with a cardiogenic shock picture. She underwent surgical excision of the mass and was discharged in good condition. After discharge, she deteriorated and was found to have lung metastases. Primary cardiac sarcomas, due to their rarity and poor prognosis, are often diagnosed at an advanced stage of the disease and lack sufficient data to establish a standard course of treatment. The cornerstone of therapy is surgical resection. However, novel therapeutic approaches must be developed. Primary cardiac tumors should be suspected in adult patients with progressive dyspnea, and a biopsy should also be done to determine the histopathological pattern of the mass and estimate the overall prognosis and outcomes.

Intramammary and systemic use of antimicrobials and their association with resistance in generic Escherichia coli recovered from fecal samples from Canadian dairy herds: A cross-sectional study.

Antimicrobial resistance (AMR) in animals, including dairy cattle, is a significant concern for animal and public health worldwide. In this study, we used data collected through the Canadian Dairy Network for Antimicrobial Stewardship and Resistance (CaDNetASR) to: (1) describe the proportions of AMR in fecal E. coli, and (2) investigate the relationship between antimicrobial use (AMU) (intramammary and systemic routes, while accounting for confounding by other variables) and AMR/multidrug resistance (MDR - resistance to ≥ 3 antimicrobial classes) in fecal E. coli from Canadian dairy farms. We hypothesized that an increase of the AMU was associated with an increase in AMR in E. coli isolates. A total of 140 dairy farms across five provinces in Canada were included in the study. Fecal samples from pre-weaned calves, post-weaned heifers, lactating cows, and farm manure storage were cultured, and E. coli isolates were identified using MALDI-TOF MS. The minimum inhibitory concentrations (MIC) to 14 antimicrobials were evaluated using a microbroth dilution methodology. AMU was quantified in Defined Course Dose (DCD - the dose for a standardized complete treatment course on a standard size animal) and converted to a rate indicator - DCD/100 animal-years. Of 1134 fecal samples collected, the proportion of samples positive for E. coli in 2019 and 2020 was 97.1% (544/560) and 94.4% (542/574), respectively. Overall, 24.5% (266/1086) of the E. coli isolates were resistant to at least one antimicrobial. Resistance towards tetracycline was commonly observed (20.7%), whereas resistance to third-generation cephalosporins, fluoroquinolones, and carbapenems was found in 2.2%, 1.4%, and 0.1% of E. coli isolates, respectively. E. coli isolates resistant to two or ≥3 antimicrobial classes (MDR) was 2.7% and 15%, respectively. Two multilevel models were built to explore risk factors associated with AMR with AMU being the main exposure. Systemic AMU was associated with increased E. coli resistance. For an increase in systemic AMU equivalent to its IQR, the odds of resistance to any antimicrobial in the model increased by 18%. Fecal samples from calves had higher odds of being resistant to any antimicrobial when compared to other production ages and farm manure storage. The samples collected in 2020 were less likely to be resistant when compared to samples collected in 2019. Compared to previous studies in dairy cattle in North America, AMR in E. coli was lower.

Correction of the prooxidant-antioxidant balance disorders in patients with diabetic kidney disease

The present study aimed to evaluate the effect of sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin therapy on the prooxidant-antioxidant balance (PAB) in patients with diabetic kidney disease.
 Methods. A total of 88 patients with type 2 diabetes mellitus (DM) and diabetic nephropathy (DN) were included in this single-center randomized open-label prospective study. All patients were randomly divided into 2 groups: 45 patients received a standard course of treatment, which included antidiabetic drugs, renin-angiotensin-aldosterone system blockers, and HMG-CoA reductase inhibitors (statins). In addition to the standard therapy, the remaining 43 patients were prescribed the SGLT2 inhibitor dapagliflozin 10 mg per day. Patients were re-examined after 6 months of treatment. The blood PAB was calculated as the ratio of total hydroperoxides (THP) to total antioxidant activity (TAA). The level of THP and TAA was determined by the colorimetric method.
 Results. PAB was significantly elevated in type 2 DM patients with nephropathy due to TAA decrease and THP level increase when compared to the control group. The highest values of PAB were found in the late stages of DN in patients with glomerular filtration rates <60 ml/min/1.73m2. In patients who received dapagliflozin, significant PAB elevation by 30,55% (р < 0.05) was observed as well as THP decrease and TAA increase in blood. In the standard therapy group, no significant changes in PAB parameters were detected.
 Conclusions. Add-on treatment with dapagliflozin resulted in a more significant improvement of the PAB in patients with DN in comparison with standard treatment.

Child Health Essential Skills Stations (CHESS): Development, Implementation, and Evaluation of an Undergraduate Child Health Clinical Skills Course

Background: Teaching undergraduate medical students clinical skills in a child health setting is a particular challenge for clinical educators. Students spend less time with pediatric patients and have fewer opportunities to practice clinical skills. The coronavirus (COVID-19) pandemic further reduced students’ opportunities to observe and practice skills in the workplace. This has necessitated a greater shift towards teaching skills in a "skills lab" setting, which allows for simulated practice in a safe environment. This study reports the design, implementation, and evaluation of a standardized course that utilizes the "skills lab" to train undergraduate medical students in five clinical skills important to child health. Objectives: This study aimed to implement and evaluate a standardized undergraduate clinical skills course for child health and improve students' confidence in performing child health clinical skills. Methods: Evaluations were carried out over approximately one academic year, with a total of 174 participants from a single medical school in the United Kingdom. Qualitative and quantitative data were collected, examining students' self-reported confidence (pre- and post-course) along with free-text course evaluations. A paired t-test was used to calculate the mean difference in students' pre- and post-course confidence scores. Qualitative evaluations were analyzed for themes using framework analysis. Results: The students had greater confidence in all measured learning outcomes following the course. Qualitative data, examined using framework analysis, suggested that the course was valued by students, who felt it was relevant to their future practice. Numerous written comments suggested particular content and teaching methods that were strengths of the course, including practical elements, small group teaching, and feedback from tutors. Conclusions: Implementing a child health clinical skills course in a skills lab setting is feasible and valued by students. The course increased the self-reported confidence of the studied cohort and might therefore support them in practicing these skills with actual patients. Further studies are required to determine whether these effects demonstrate longevity and whether they translate to increased competence in performing the taught skills.

The effects of complex therapy with the additional dapagliflozin intake on the copeptin level in the blood serum of patients with diabetic nephropathy

Objective — to determine the effects of drug therapy with inclusion of sodium‑glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin on the blood levels of copeptin as a biomarker of renal and vascular lesions in patients with diabetic nephropathy (DN) at various disease stages.
 Materials and methods. Examinations involved 83 in‑hospital patients with DN, treated in the clinic of L. T. Mala National Institute of Therapy. Patients were divided into 2 groups depending on the therapy. 42 patients received a standard course of treatment, including antidiabetic drugs, renin‑angiotensin‑aldosterone system blockers and statins. In addition to standard therapy, the remaining 41 patients were administered SGLT2 inhibitor dapagliflozin in a dose of 10 mg per day. Patients were re‑examined after 6 months treatment. Determination of the copeptin level in blood serum was carried out by the enzyme immunoassay method using the set of reagents Human CPP Elisa Kit manufactured by FineTest, China.
 Results. The results of investigation of the effects of complex nephroprotective therapy on the lipid profile indicators in patients with type 2 diabetes mellitus (DM2) demonstrated significant decrease in the levels of total cholesterol by 11.78% (р <0.05), triglycerides by 19.75% (р <0.05) and non‑significant increase of high‑density lipoproteins by 5.10%. In patients with DM2 and with glomerular filtration rate (GFR) >90 mL/(min · 1.73 m2) (I stage chronic kidney disease (CKD)) the level of copeptin after treatment decreased by 19.3% (p <0.05); in patients with (DM2) and GFR of 60—89 mL/(min · 1.73 m2) (CKD II stage) — by 18.9% (p <0.05), and with GFR of 45—59 mL/(min · 1.73 m2) (CKD III stage) — by 24.8% (p <0.05). The significant decrease of copeptin levels was revealed in diabetic patients with both preserved and reduced GFR. In DM2 patients with normal GFR, the copeptin level after standard treatment decreased by 17.6% (p <0.05), and in case of dapagliflozin administration by 20.6% (p <0.05). In patients with reduced GFR, blood serum copeptin levels decreased by 18.9% (p <0.05) after standard therapy, and by 22.1% (p <0.05) under the influence of dapagliflozin.
 Conclusions. Complex therapy with the use of SGLT2 inhibitor dapagliflozin contributed to more significant reduction of copeptin levels in patients with DN compared to the standard treatment, regardless of the kidneys’ functional state. The decrease of copeptin levels against the background of the improved main clinical and laboratory parameters indicates not only an improvement in the kidneys’ functional state, but also reduction of cardiovascular risk in this group of patients.

Medical Student Perceptions of Sociocultural Issues in Healthcare: A Multisite Study of Medical Spanish Education

Theory Cultural competence and humility are core elements of medical education in a diverse society. Language is inseparable from culture, as language informs, indexes, frames, and encodes both culture and worldview. Spanish is the most common non-English language taught in U.S. medical schools, yet medical Spanish courses tend to artificially separate language from culture. It is unknown to what extent medical Spanish courses advance students’ sociocultural knowledge or patient care skills. Hypotheses Based on current predominant pedagogy, medical Spanish classes may not adequately integrate sociocultural issues relevant to Hispanic/Latinx health. We hypothesized that students who completed a medical Spanish course would not demonstrate significant gains in sociocultural skills following the educational intervention. Method An interprofessional team developed a sociocultural questionnaire, and 15 medical schools invited their students to complete the questionnaire before and after completing a medical Spanish course. Of participating schools, 12 implemented a standardized medical Spanish course and three served as control sites. Survey data were analyzed regarding: (1) perceived sociocultural competence (recognition of common cultural beliefs, recognition of culturally normative non-verbal cues, gestures, and social behaviors, ability to address sociocultural issues in healthcare context, and knowledge of health disparities); (2) application of sociocultural knowledge; and (3) demographic factors and self-rated language proficiency (Poor, Fair, Good, Very Good, or Excellent) on the Interagency Language Roundtable scale for healthcare (ILR-H). Results Overall, 610 students participated in sociocultural questionnaire between January 2020 and January 2022. After the course, participants reported an increased understanding of cultural aspects of communication with Spanish-speaking patients and the ability to apply sociocultural knowledge to patient care (all p < 0.001). When analyzed by demographic factors, students who identified as Hispanic/Latinx or as heritage speakers of Spanish tended to report increased sociocultural knowledge/skills following the course. When examined by Spanish proficiency, preliminary trends showed that students at both ILR-H Poor and Excellent levels did not demonstrate gains in sociocultural knowledge or ability to apply sociocultural skills. Students at sites with a standardized course were likely to improve sociocultural skills in mental health conversations (p < 0.001) while students at control sites were not (p = 0.05). Conclusions Medical Spanish educators may benefit from additional guidance on teaching sociocultural aspects of communication. Our findings support that students at ILR-H levels of Fair, Good, and Very Good are particularly well-suited for gaining sociocultural skills in current medical Spanish courses. Future studies should explore potential metrics to evaluate cultural humility/competence within actual interactions with patients.

Current postgraduate training in emergency medicine in the Nordic countries

BackgroundEmergency Medicine (EM) is an independent specialty in all five Nordic countries. This study aims to evaluate the structure of post-graduate EM training in the area.MethodsA leading hospital or hospitals in EM training in each country were identified. An e-survey was sent to each hospital to gather data on patient volume and physician staffing, curriculum, trainee supervision, and monitoring of progression in training.ResultsData were collected from one center in Iceland and Norway, two in Finland and Sweden, and four centers in Denmark. The data from each country in Denmark, Finland, and Sweden, were pooled to represent that country. The percentage of consultants with EM specialist recognition ranged from 49–100% of all consultants working in the participating departments. The number of patients seen annually per each full time EM consultant was almost three times higher in Finland than in Sweden. In Iceland, Denmark, and Sweden a consultant was present 24/7 in the ED but not in all centers in the other countries. The level of trainee autonomy in clinical practice varied between countries. Requirements for completing standardized courses, completing final exams, scientific and quality improvement projects, and evaluation of trainee progression, varied between the countries.ConclusionsAll Nordic countries have established EM training programs. Despite cultural similarities, there are significant differences in how the EM training is structured between the countries. Writing and implementing a standardized training curriculum and assessment system for EM training in the Nordic countries should be considered.

Progressive Calcification of Supraspinatus Tendon in Patients With Calcific Tendinitis: Two Case Reports

Background. Calcific tendinitis (CT) is a common disease characterized by the presence of calcific deposits in the tendons of the rotator cuff. CT has a wave-like course, and the formed calcification tends to be resorbed. The lysis of the calcium deposits is characterized by a strong pain syndrome, and the site of the calcification is replaced by collagen.&#x0D; The aim to demonstrate clinical observations in which the deposited calcification in the rotator cuff did not resorb but increased over time.&#x0D; Cases presentation. We report on two rare clinical cases of an increase in calcification of the rotator cuff in patients aged 51 and 50 years old. Calcific tendinitis occurred with periods of remission and exacerbation. During exacerbations, conservative treatment was carried out, including courses of massage, physiotherapy, and pain relief therapy. In one case, a single injection of a hormonal drug was performed. Control X-rays and MRI during one of the exacerbations showed an increase in the size of the calcifications. Due to the lack of effect from conservative treatment and the detected increase in calcifications, a decision was made to perform surgical treatment. Arthroscopic removal of calcifications with re-fixation of the supraspinatus tendon and elimination of internal damage was performed on both patients. Good results were noted on the follow-up examination according to the ASES orthopedic score, as well as clinical examination data.&#x0D; Conclusion. The presented case reports illustrate the possible increase in calcification, unlike the standard course of the disease, in which the calcification is resorbed. Further study of this pathology is necessary to establish the causes and mechanisms of calcification increase over time and its dependence on the phase of the disease.

Groupoid and algebra of the infinite quantum spin chain

It is well known that certain features of a quantum theory cannot be described in the standard picture on a Hilbert space. In particular, this happens when we try to formally frame a quantum field theory, or a thermodynamic system with finite density. This forces us to introduce different types of algebras, more general than the ones we usually encounter in a standard course of quantum mechanics. We show how these algebras naturally arise in the Schwinger description of the quantum mechanics of an infinite spin chain. In particular, we use the machinery of Dirac-Feynman-Schwinger (DFS) states developed in recent works to introduce a dynamics based on the modular theory by Tomita-Takesaki, and consequently we apply this approach to describe the Ising model.

Visual Learning Equity: A Course Auditing System of Skin Color in Preclinical Medical Education.

Visual learning equity is a health justice effort in response to the lack of representation of brown and black skin images in medical education. This paucity creates a knowledge gap and decreases providers' competence in managing skin disease in minoritized populations. Herein, we aimed to create a standardized course auditing system to assess the use of brown and black skin images in medical education. We performed a cross-sectional analysis of the 2020-2021 preclinical curriculum at one US medical school. All human images in the learning material were analyzed. Skin color was categorized as light/white, medium/brown, and dark/black using the Massey-Martin New Immigrant Survey Skin Color Scale. We included 1,660 unique images in our analysis; 71.3%, (n=1,183) were light/white, 16.1% (n=267) were medium/brown and 12.7% (n=210) were dark/black. Dermatologic images of skin, hair, nails, or mucosal disease made up 62.1% (n=1,031) of the images and 68.1% (n=702) were light/white. The pulmonary course presented the highest proportion of light/white skin (88.0%, n=44/50) and the dermatology course presented the lowest proportion of light/white skin (59.0%, n=301/510). Images of infectious diseases were more frequently presented in darker skin colors (χ2 [2]=15.46, P&lt;.001). Light/white skin was the standard used for visual learning images in the medical school curriculum at this institution. The authors outline steps to perform a curriculum audit and diversify medical curricula to ensure the next generation of physicians are educated to care for all patients.

RT-PACE: Phase I/II study of adjuvant whole pelvic hypofractionated radiotherapy for non-metastatic cervical and endometrial cancer.

TPS5631 Background: Whole pelvic radiation therapy (WPRT) improves locoregional control in women with high-intermediate and high-risk endometrial cancer. The standard treatment course consists of 25-28 fractions (5-5.5 weeks) of 1.8-2 Gy/fraction, and is delivered using intensity-modulated radiation therapy (IMRT), which allows for superior sparing of normal tissue with a subsequent lower rate of acute and late toxicity compared to less conformal treatment techniques. Moderate hypofractionation (HF, &gt;2 Gy/fraction) has been studied in other disease sites, such as breast and prostate cancer, and is associated with lower or comparable toxicity, improved patient convenience, and greater cost savings compared to standard fractionation. However, HF has not been well-studied in the setting of WPRT for gynecologic cancers. Methods: This phase I/II multi-institutional study evaluates the feasibility, safety, and toxicity profile of HF-WPRT in women with non-metastatic cervical or endometrial cancers who have undergone curative hysterectomy and are recommended adjuvant WPRT by their treating physician. Concurrent chemotherapy is not allowed, but can be administered sequentially prior to or after WPRT. Para-aortic radiation or nodal boosts are not allowed, however vaginal brachytherapy boost is permissible. Phase I is a safety study of increasing dose-per-fraction. All treatment regimens have an approximate biologic effective dose of 53 Gy (α/β =10). A keyboard design is utilized to identify the maximum tolerated dose-per-fraction (MTD), defined in this study as the regimen that is associated with a CTCAE grade 3+ gastrointestinal/genitourinary toxicity rate of ≤10% on the last day of WPRT. There are 3 dose cohorts of increasing dose-per-fraction. Phase II will accrue 64 evaluable patients to HF-WPRT using the MTD determined in phase I. The primary endpoint is to evaluate the change in patient-reported gastrointestinal toxicity from baseline to the last day of WPRT using the EPIC bowel score. The study is powered to compare results to the RTOG 1203 IMRT standard fractionation arm. The phase 1 portion of the study completed accrual; the phase II portion opened in April 2022 with a fractionation of 42.56 Gy in 16 fractions. Secondary endpoints include genitourinary toxicity (EPIC, CTCAE), quality of life (FACT-Cx, PRO-CTCAE), financial toxicity (FACIT-COST), and decision-making (Decision Regret Scale). Pelvic control at 2 years is an exploratory endpoint. Clinical trial information: NCT04683653 .

Compounding Education in US PharmD Curricula

ObjectiveTo determine the extent of compounding education (CE) offered in United States (US) doctor of pharmacy curricula. MethodsA 24-item survey instrument addressing various aspects of CE was developed and validated. An email containing the link to the survey instrument was shared with instructors of compounding at 122 of 141 accredited schools and colleges of pharmacy in the US. ResultsOf these, 112 schools and colleges responded, rendering a survey response rate of 91.8%. Survey results indicate that CE is offered to a similar extent either as a required standalone course or as integrated instruction as part of a standard course. Whereas 70.8% of programs reported mostly hands-on training in CE in their curricula, there were about 11% programs that mostly offered didactic instruction in CE. Dispersed systems and semisolid formulations are the most prepared in nonsterile compounding, while proper hand washing, garbing, and gloving are the most taught techniques in sterile compounding. Compounding education is delivered principally by pharmaceutics faculty (62.3%) compared to practice faculty (32.1%). ConclusionThe survey determined the extent to which CE is addressed across different schools and colleges of pharmacy in the US. Although some institutions lack minimal nonsterile or sterile compounding facilities, they may improve by modeling the established programs in the country. Leadership at pharmacy institutions may need to allocate funds for CE, and support faculty who instruct in compounding.

Does practice make perfect? Laparoscopic training mainly improves motion efficiency: a prospective trial

Training improves skills in minimally invasive surgery. This study aimed to investigate the learning curves of complex motion parameters for both hands during a standardized training course using a novel measurement tool. An additional focus was placed on the parameters representing surgical safety and precision. Fifty-six laparoscopic novices participated in a training course on the basic skills of minimally invasive surgery based on a modified Fundamentals of Laparoscopic Surgery (FLS) curriculum. Before, twice during, and once after the practical lessons, all participants had to perform four laparoscopic tasks (peg transfer, precision cut, balloon resection, and laparoscopic suture and knot), which were recorded and analyzed using an instrument motion analysis system. Participants significantly improved the time per task for all four tasks (all p < 0.001). The individual instrument path length decreased significantly for the dominant and non-dominant hands in all four tasks. Similarly, both hands became significantly faster in all tasks, with the exception of the non-dominant hand in the precision cut task. In terms of relative idle time, only in the peg transfer task did both hands improve significantly, while in the precision cut task, only the dominant hand performed better. In contrast, the motion volume of both hands combined was reduced in only one task (precision cut, p = 0.01), whereas no significant improvement in the relative time of instruments being out of view was observed. FLS-based skills training increases motion efficiency primarily by increasing speed and reducing idle time and path length. Parameters relevant for surgical safety and precision (motion volume and relative time of instruments being out of view) are minimally affected by short-term training. Consequently, surgical training should also focus on safety and precision-related parameters, and assessment of these parameters should be incorporated into basic skill training accordingly.

18F-FMISO PET-guided dose escalation with multifield optimization intensity-modulated proton therapy in nasopharyngeal carcinoma.

The purpose of this study was to evaluate the radiotherapy planning feasibility of dose escalation with intensity-modulated proton therapy (IMPT) to hypoxic tumor regions identified on 18F-Fluoromisonidazole (FMISO) positron emission tomography and computed tomography (PET-CT) in NPC. Nine patients with stages T3-4N0-3M0 NPC underwent 18F-FMISO PET-CT before and during week 3 of radiotherapy. The hypoxic volume (GTVhypo) is automatically generated by applying a subthresholding algorithm within the gross tumor volume (GTV) with a tumor to muscle standardized uptake value (SUV) ratio of 1.3 on the 18F-FMISO PET-CT scan. Two proton plans were generated for each patient, a standard plan to 70Gy and dose escalation plan with upfront boost followed by standard 70GyE plan. The stereotactic boost was planned with single-field uniform dose optimization using two fields to deliver 10 GyE in two fractions to GTVhypo. The standard plan was generated with IMPT with robust optimization to deliver 70GyE, 60GyE in 33 fractions using simultaneous integrated boost technique. A plan sum was generated for assessment. Eight of nine patients showed tumor hypoxia on the baseline 18F-FMISO PET-CT scan. The mean hypoxic tumor volume was 3.9 cm3 (range .9-11.9cm3 ). The average SUVmax of the hypoxic volume was 2.2 (range 1.44-2.98). All the dose-volume parameters met the planning objectives for target coverage. Dose escalation was not feasible in three of eight patients as the D0.03cc of temporal lobe was greater than 75GyE. The utility of boost to the hypoxic volume before standard course of radiotherapy with IMPT is dosimetrically feasible in selected patients. Clinical trials are warranted to determine the clinical outcomes of this approach.

Clinical Course and Outcome of Cardiovascular Manifestations in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection in Georgia.

A SARS-CoV-2 infection is usually characterized by a very mild clinical course in the pediatric population. However, children can be severely affected, and clinical manifestations may differ from adults, mainly in terms of post-COVID-19 infection complications already known as multisystem inflammatory syndrome in children (MIS-C). As the name suggests, this condition involves many systems, including the cardiovascular system, clinical manifestations of which include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. This research aims to define the cardiac manifestations caused by multi-inflammatory processes occurring after acute SARS-CoV-2 infection, possibly find a correlation between a certain cardiac abnormality and inflammatory markers, and evaluate the dynamics of cardiovascular complications and how treatment affects it. From February 2020 to March 2022, 103 patients with MIS-C were hospitalized and treated at M.Iashvili Children's Central Hospital, Tbilisi, Georgia. Based on our results, 55% of them had cardiovascular involvement with various manifestations involving coronary artery dilation, valvular insufficiencies, heart rate abnormalities, and pericardial effusion. Our study revealed that only one statistically significant correlation was observedbetween D-dimer levels and heart rate abnormalities, but there was no correlation between these two values. All of the MIS-C patients reported in our study have received standardized treatment courses with steroids, intravenous immune globulin (IVIG), or IVIG combined with steroids; each patient's illness has resolved without any sequelae, and cardiac manifestations have returned to baseline. Nevertheless, systematic longer-term follow-up is needed to provide clarity on the evolution of medium- and long-term cardiac outcomes in MIS-C.