Showing papers in "Southern Medical Journal in 2019"

Anemia with prgnancy

Abstract: Anemia is the commonest medical disorder in pregnancy and severe anemia is associated with poor maternal and perinatal outcome. It is one of the most important health problems among women from 18 to 45 years of age in the world. Anemia in pregnancy is considered as one of the major risk factors for contributing 20-40% of maternal deaths directly or indirectly through cardiac failure, preeclampsia, antepartum haemorrhage, postpartum haemorrhage, and puerperal sepsis. As well as to low birth weight which in turn might contribute to an increased percentage for infant mortality in developing countries. The prevalence of anemia in pregnancy varies considerably because of differences in socioeconomic conditions, lifestyles, and health-seeking behaviors across different cultures. Women of low socioeconomic groups and teenagers are more susceptible to anemia during pregnancy. More commonly, anemia in pregnancy is due to lack of iron and less often, it is caused by folic acid deficiency. Iron and folate supplementation is indicated during pregnancy to prevent complications. In a normal pregnancy, the hemoglobin concentration becomes diluted according to the increase in the volume of circulating blood. Anemia is diagnosed by estimating the hemoglobin concentration and examining a peripheral blood smear for the characteristic red blood cell changes

Differences in Anthropometric Characteristics among Junior Soccer and Handball Players

Abstract: The aim of this study was to obtain the relevant knowledge about signifi cant diff erences in some anthropometric characteristics of junior soccer and handball players. The sample included 40 male subjects divided into two subsamples. The fi rst subsample included 25 subjects, who train in the junior selection in the Football club Vojvodina from Novi Sad, while the other subsample included 15 subjects who train in the junior selection in the Handball club Vrbas, from Vrbas. The variables sample included 20 anthropometric measures that defi ned longitudinal and transversal dimensionality of skeleton, volume and mass of the body, and subcutaneous adipose tissue. The results is analysed in a statistical procedure marked as a signifi cance testing of two arithmetic means of the independent samples, a t-test at the level of signifi cance of p<0.05. Based on the result, it was concluded that signifi cant diff erences occur in wrist diameter, ankle joint diameter, upper arm circumference (min), upper arm circumference (max), lower leg circumference (max), upper arm skinfolf, lower arm skinfold, thigh skinfold, calf skinfold, chest skinfold and abdomen skinfold, while the signifi cant diff erence does not occur in body height, bodyweight, elbow diameter, knee diameter, lower arm circumference (min), lower arm circumference (max), upper leg circumference (min), upper leg circumference (max), and lower leg circumference (min).

Telemedicine - meaning, challenges and opportunities

Abstract: Medical service is one of the crucial policies and decent medical service is required by the population in every country. There are three main obstacles which prevent people from obtaining proper medical cares and treatments. First, the deficiency of medical staffs especially physicians which occur even in the developed countries. Second, regarding an important demographic issue, an increase in the number of the elderly makes the medical services more demanding. Finally, geographical aspect also plays a major role in healthcare inequality. The population dwelling in rural or remote areas struggle from accessing proper medical services. Information and communication technologies have become an important infrastructure upon which several domains can build in order to achieve more effective solutions. Integrating such technologies into the medical discipline results in telemedicine which is currently available across the globe. This article describes telemedicine in three key aspects including current state, challenges and opportunities based upon existing studies and implementations.

Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program.

Abstract: Objective More effective transitions and transfers of young people with sickle cell disease (SCD) into the adult healthcare setting is a focus of both primary care and specialty care medical organizations. Effective transition and transfer requires six core elements: establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring to adult care, and integrating into an adult practice. We developed a program using these six core elements. The objective of our report was to assess the development and implementation of this program. Methods We used the six core elements to develop and implement a program at Virginia Commonwealth University for children and adolescents with SCD to transition to adult health care. Results We assessed individuals' differences by age and grade, their independent living skills, their feelings about moving to adult care; tallied and analyzed several assessment scales; and assessed transfer success and patient retention. Conclusions The principles and lessons we learned in developing and implementing this program over 5 years, accompanied by caring, flexible, and dedicated care team members, often can overcome even severe barriers to care transitions.

Location and survival of MNEs' subsidiaries: Agglomeration and heterogeneity of firms

Abstract: Research summary Our study provides a quasi–replication of Shaver and Flyer (2000), which was among the first studies that challenged the positive role of agglomeration in determining companies' location choice and performances, thus changing the way management scholars view companies' attitude towards agglomeration forces. We employ the same research design, specification and tests, and a different population, to discuss the generalizability of the original study. Building on the framework of Shaver and Flyer (2000), our findings offer intriguing new empirical evidence highlighting the importance of the differential between entering foreign firms and host country firms as a crucial condition in understanding agglomeration forces and adverse selection mechanisms. Managerial summary Our exercise confirms that agglomeration forces act differently on stronger versus weaker multinational enterprises (MNEs). However, we find that stronger MNEs tend to avoid location in highly specialized areas when they are afraid of knowledge leakages towards host country–based rivals that have enough absorptive capacity to benefit and improve their competitive advantages. Managerial implications are quite relevant. Indeed, when MNEs avoid co–location in highly specialized areas, they also limit their own access to local knowledge and other agglomeration economies, such as supply networks and qualified workforce. Thus, MNEs managers need to design and implement devices that, on the one hand prevent local leakages of their knowledge and, on the other, do not hinder their access to local unique knowledge and resources.

Sports Activities in Obese Teenagers Improve Social Inclusion and Health

Abstract: Obesity is known to be a major risk of whole range of cardio vascular, metabolic and respiratory disorders. The etiology of obesity can be genetic, hormonal and determine the central obesity (or visceral or android). It is characterized by the deposit of fat especially abdominal and recognizable by a waist-hip ratio of more than 0.85 in women and 0.95 in ‘man, and the peripheral (or subcutaneous or gynoid) that shows a ratio of less than 0.85 in women and 0.95 in men. The research was carried out in order to monitor and improve the correct use of the respiratory function of obese adolescents by developing a sports program aimed at reducing body weight and enhancing motor skills on 60 subjects (30 males and 30 females) aged between 14 and 16 years for a period of eight months. Results showed a reduction in body weight for almost all participants. For 26 subjects, the reduction was around 10%, while for others it was around 8%. Only 8 subjects did not signifi cantly change their weight. The improvement of the motor program, on average, was about 9.5%. The phenomenon of obesity is often one of the factors of discomfort conditions in adolescence that slows down the process of social inclusion and highlights “paramorhism” that has negative eff ect on the respiratory function. Sport is one of the most important activities to combat the problem of weight gain because, through the rules of sports disciplines, it favors the acquisition of correct lifestyles.

Radiologic versus Endoscopic Placement of Gastrostomy Tube: Comparison of Indications and Outcomes at a Tertiary Referral Center.

Abstract: Objectives Percutaneous gastrostomy tube placement is performed in patients requiring long-term enteral nutrition. Although both endoscopic and fluoroscopic techniques may be used, there are inherent risks and potential complications associated with both procedures that are not generally known to referring physicians. The purpose of this study was to compare and contrast indications for placement and procedurally related complications between fluoroscopic and endoscopic gastrostomy tubes techniques at a tertiary care facility. Methods A retrospective cohort study was performed. All consecutive patients with either percutaneous endoscopic (PEG) or percutaneous radiologic (PRG) gastrostomy tube placement between October 2011 and January 2013 were eligible for inclusion. Basic demographic information, American Society of Anesthesiologists score, procedure indication, laboratory data, and use of anticoagulation were recorded. Both direct and indirect procedural complications were documented if they occurred 30 days after gastrostomy tube placement, and were classified and scored based on severity and need for further intervention. Results A total of 297 patients met the inclusion criteria, 150 of whom had gastrostomy tubes placed fluoroscopically and 147 of whom had them placed endoscopically. There was no statistically significant difference in direct complications within the first 30 days (PEG 6.8% vs PRG 8%); however, the type of complication observed varied between the two groups. Although superficial wound infections and buried bumpers were more common in the PEG group, bleeding was more common in the PRG group. Conclusions Placement of gastrostomy tubes either endoscopically or fluoroscopically is relatively safe with similar indications. Although the complication rate between the two groups was not significant, the types of procedural complications observed did vary.

CrossFit Training Impact on the Level of Special Physical Fitness of Young Athletes Practicing Judo

Abstract: The high level of individual physical fitness of athletes is one of the main factors in achieving sports success in martial arts. This study aimed to assess CrossFit training’s impact on the level of physical fitness of young (16-17 years old) athletes practising judo. The athletes’ competitive activity data was also assessed. The young athletes (n=33) demonstrated athletic performance at a level approaching that of elite athletes. They were randomly divided into approximately two equal groups. During the training of one of the groups (n=16), CrossFit sessions were used. The obtained data were evaluated using SJFT, the level of lactate concentration in blood and a comparative analysis of the judoists’ competitive coefficients (CC). Statistical analysis was performed using the Mann-Whitney U-test. A significant (p<0.05) athletic superiority has been revealed among those who used CrossFit training in the coefficient of active combat time (СС–3) in competitive matches. SJFT indicators of both athlete groups show a positive trend. Increased dynamics of blood lactate concentrations after exercises were detected among both groups. Moreover, among the athletes who used CrossFit training, blood lactate level data were significantly (p<0.05) higher, averaging 14.54±0.51 mmol/l. The duels percentage won by athletes who used CrossFit training was considerably higher than those athletes who did not use CrossFit training (59% vs 54%).

Role of Physician Gender in the Modern Practice of Obstetrics and Gynecology: Do Obstetrician-Gynecologists Perceive Discrimination from their Sex?

Abstract: OBJECTIVES It is unclear whether obstetrician-gynecologists (OBGYNs) experience gender discrimination as a result of patient and organizational gender preferences. Our objective was to evaluate whether the gender preference for OBGYNs resulted in perceptions of discrimination by the physician while simultaneously assessing their patients' views for choosing their OBGYN. METHODS A survey assessed whether OBGYNs' perceptions of patients and employers' preferences for gender in selecting an OBGYN affected their clinical practice and resulted in feelings of discrimination. Providers' patients simultaneously completed a survey to explore the role of gender in the selection of their OBGYN. The Mann-Whitney U test was used for comparisons. A P < 0.05 was considered statistically significant. RESULTS Thirty-four physicians (97% response rate) and 803 patients (81% response rate) completed the survey. The majority of male physicians agreed that their gender negatively affects their patient practice volume (60%), whereas no female physicians agreed with this statement (0%, P < 0.01). Female physicians were more likely to agree (46%) that they are discriminated against because of gender in terms of salary as compared with male physicians (20%, P = 0.049), however. Although more women who see a female OBGYN (compared with those who see a male OBGYN) perceive that their physician's gender is important to them (62% versus 20%, P < 0.01), the most frequent reason all women chose their OBGYN is the "rating" of the physician. CONCLUSIONS Female and male OBGYNs perceive bias because of their gender; however, the former is because of compensation and the latter is because of patient preferences. The majority of women choose their OBGYN based on the physician's rating and not on the physician's sex, however.

Epidemiology and Risk Factors of Hepatocellular Carcinoma in Egypt

Abstract: Hepatocellular carcinoma (HCC) is the most prevalent primary cancer of the liver accounting for 75% to 85% of primary liver cancers worldwide. It is the sixth most prevalent cancer in the globe and the fourth most prevalent cause of death from cancer, it occurs in males 2 to 3 times higher than in females. Geographical distribution of HCC varies throughout the world being highest in East Asia and sub-Saharan Africa. In general, HCC risk factors include viral infections, cirrhosis, alcohol, non-alcoholic fatty liver disease (NAFLD), aflatoxins, diabetes mellitus and obesity. Egypt has the world's second highest incidence of HCC, which can be ascribed to the elevated prevalence and complications of the hepatitis C virus (HCV). An active surveillance for HCC together with screening programs for HCV and initiation of antiviral therapy with new potent direct acting antivirals (DAAs) at an early stage for patients with chronic HCV infection are the most important steps to reduce the risk of HCC in Egypt.

Gender Difference, Nutritional Supplements and Drug use in Sport to Enhancing Performance: an Italian Revision over the Last Decade

Abstract: In last years, there has been a multitude of studies on doping, such as in recreational and in amateur sport. The extent of this phenomenon was clarified for special populations (like e.g. bodybuilders) and for special substances (mostly for anabolic steroids). Doping is present in sportsmen and women; the reasons why may be many and various. The aim of this study is to discover the gender disparity of drugs addiction as doping practice and breakdown by sport bodies and gender. The data show the anti-doping test took place on Italian professional athletes during the last years: from 2007 to 2017. Data showed are originated from the report commissioned by the Italian Ministry of Health. About checked doped athletes there are significant gender differences in doping attitude and/or in doping profiling. First of all, males seem to be more exposed to doping than females. The prohibited substances most frequently used by females athletes are diuretics and masking agents (10 athletes in 2014), cannabinoids (5 in 2007) and stimulants (5 in 2011) compared to males athletes who use mostly anabolic agents (27 in 2017), cannabinoids (20 in 2012) and diuretics and masking agents (17 in 2011 e 2014). The addiction of doping substances, depends on various factors related to gender, but what drives men and women is the sense of gratification and ego orientation. Nowadays a significant number of women joined official and Olympic competitions. Doping to enhance female sport performances took importance from the two last decades of the past century.

Frequency, Timing, and Types of Medication Ordering Errors Made by Residents in the Electronic Medical Records Era.

Abstract: Objectives To describe associations between resident level of training, timing of medication orders, and the types of inpatient medication ordering errors made by internal medicine residents. Methods This study reviewed all inpatient medication orders placed by internal medicine residents at a tertiary care academic medical center from July 2011 to June 2015. Medication order errors were measured by pharmacists' reporting of an error via the electronic medical record during real-time surveillance of orders. Multivariable regression models were constructed to assess associations between resident training level (postgraduate year [PGY]), medication order timing (time of day and month of year), and rates of medication ordering errors. Results Of 1,772,462 medication orders placed by 335 residents, 68,545 (3.9%) triggered a pharmacist intervention in the electronic medical record. Overall and for each PGY level, renal dose monitoring/adjustment was the most common order error (40%). Ordering errors were less frequent during the night and transition periods versus daytime (adjusted odds ratio [aOR] 0.93, 95% confidence interval [CI] 0.91-0.96, and aOR 0.93, 95% CI 0.90-0.95, respectively). Errors were more common in July and August compared with other months (aOR 1.05, 95% CI 1.01-1.09). Compared with PGY2 residents, both PGY1 (aOR 1.06, 95% CI 1.03-1.10), and PGY3 residents (aOR 1.07, 95% CI, 1.03-1.10) were more likely to make medication ordering errors. Throughout the course of the academic year, the odds of a medication ordering error decreased by 16% (aOR 0.84, 95% CI 0.80-0.89). Conclusions Despite electronic medical records, medication ordering errors by trainees remain common. Additional supervision and resident education regarding medication orders may be necessary.

Health Behaviors in Rural Appalachia.

Abstract: Objectives To better understand the disproportionate burdens from cancer, cardiovascular disease, diabetes mellitus, stroke, and other chronic conditions related to energy balance, we studied diet and physical activity patterns in younger and older adults in rural Appalachia by using a nonclinical, cross-sectional, community-based sampling approach. Methods A total of 651 younger (ages 18-59) and 254 older (ages ≥60) Appalachians were recruited from 43 churches or community organizations. Participants answered questions about fruit and vegetable intake and physical activity. Analyses were adjusted for clustering within churches. Results Compared with older Appalachians, younger Appalachians consumed significantly fewer fruits and vegetables (P = 0.01) and reported significantly more moderate-to-vigorous physical activity (P = 0.01). Regardless of age, engagement in healthy behaviors was suboptimal and well below national averages. Conclusions This community-based sample demonstrated elevated behavioral risk factors that likely contribute to some of the nation's highest rates of premature mortality. Despite suboptimal dietary intake and physical activity, results indicate some potential leverage points between the generations that may be used to improve health. For example, the older generation could benefit from engaging with their younger relatives in physical activities while advocating for a better-rounded diet. Given traditions of intergenerational connectedness, mutual aid, and self-reliance, transmission of healthier behaviors across the generations may be beneficial in the rural Appalachian context.

Native Joint Septic Arthritis: Comparison of Outcomes with Medical and Surgical Management.

Abstract: Objective To determine whether there are differences in the outcomes of native joint septic arthritis (SA) in adults, based on medical versus surgical management. Methods A 10-year retrospective single-center study was conducted of patients admitted to a tertiary care hospital between January 1, 2006 and December 31, 2015 with a diagnosis of SA to compare outcomes based on the management approach taken: medical (bedside closed-needle joint aspiration) versus surgical (arthrotomy/arthroscopy). Evaluated outcomes included joint recovery, time to recovery, length of stay, disposition to home versus rehabilitation unit, recurrence of SA in the same joint, and mortality. Results Of 118 confirmed cases of SA, 48 were in prosthetic joints and 70 were in native joints, and 61 met our inclusion criteria. Forty-one (67%) patients received surgery, and 20 (33%) received closed-needle aspiration. There was no statistically significant difference in long-term outcomes between the two groups at 12 months. Patients managed medically were more likely to experience full recovery at 3 months and were less likely to need short-term rehabilitation. Conclusions Medical management with closed-needle aspiration may be an adequate approach to the treatment of native joint infections.

Understanding Media Consumption of Electronic Sports through Spectator Motivation, Using Three Different Segmentation Approaches: The Levels of Addiction, Passion, and Fan Identification

Abstract: Electronic sports (eSports), or competitive video gaming, is a type of sport that has recently expanded its horizon from being a participatory sport to a spectator sport fueled by its wide popularity. In this regard, it is necessary to investigate why fans enjoy this new sports genre as a spectator sport. This study examines motivations of eSports spectators in diff erent segments to gain a better understanding of the behaviors of this growing population. Specifi cally, this study aimed to (a) investigate eSports spectators’ motivations to discover the motives for their attachment to eSports, using eleven diff erent factors, and (b) explore diff erences in motivations among levels of addiction, fan identifi cation, and passion. An analysis of 368 eSports fans showed that they valued the Achievement and Economics factors most in watching eSports. They even experienced a sense of achievement and a certain pecuniary advantage that real sports spectators experience. In addition, the Escape factor was identifi ed as being the most important factor in explaining a passion for eSports-watching. This study also discovered signifi cant diff erences between the eleven spectator motives, demonstrating the eff ectiveness of segmentation analysis in investigating the behaviors of sports fans. In particular, the Economics and Escape factors revealed meaningful diff erences between groups for all segments. This study showed that eSports spectators watch this new type of sports based on motivations that are similar to those of existing sports fans; furthermore, it identifi ed signifi cant diff erences in spectator motivations depending on their level of involvement in eSports.

Healthcare Professionals and In-Flight Medical Emergencies: Resources, Responsibilities, Goals, and Legalities as a Good Samaritan

Abstract: Common in-flight emergencies include syncope, respiratory symptoms, nausea/vomiting, cardiac symptoms, and seizures. Flight conditions, such as changes in air pressure and humidity, can exacerbate existing chronic medical conditions. In 2017, US airlines carried 849.3 million passengers. Undoubtedly, there were many requests for in-flight medical assistance. Whenever a medical event occurs, it is standard procedure that an announcement be made by a flight attendant, requesting medical personnel to identify themselves. The 1998 Aviation Medical Assistance Act provides liability protection for a healthcare professional (HCP) acting as a good Samaritan. Nevertheless, HCPs may initially experience trepidation providing care in an aircraft. They may be unaware that a first aid kit, a emergency medical kit, and an automatic external defibrillator are on every plane. Flight crews have been trained in cardiopulmonary resuscitation, and a support system, including a ground-based consultation service, is available to provide radio assistance from an on-call physician. When multiple HCPs volunteer, the most experienced should assume leadership of care. After evaluating the ill passenger, the HCP communicates the assessment to the crew and, when necessary, to the ground-based physician. The goal of in-flight care is to medically stabilize the ill passenger and facilitate the individual's arrival at the scheduled destination for continued medical care. When unable to stabilize the passenger's condition, the decision to divert the plane rests with the flight's captain. Our article helps HCPs to best understand their resources, structured support, liability, and role during an in-flight medical event. With this knowledge of resources, a good Samaritan can confidently attend to an ill airline passenger in flight.

The Influence of the System of Physical Education of Higher Educational School on the Level of Psychophysiological Qualities of Young People

Abstract: In terms of functioning of physical education system in higher educational establishments, a four-year educational pedagogical experiment with the application of the directional technology of acquiring professional-applied motor skills was implemented. According to the results of approbation of experimental technology, a reliable improvement in the state of psychophysiological qualities was recorded in the study group: evaluation of the process of main nervous processes excitation by 125.32 Ms (p<0.001), the forces of the excitation process, internal inhibition and mobility of the main nervous processes by 145.99 Ms (p<0.001), “an adequate indicator of the relative change in the strength of the excitation process, internal inhibition and mobility of the main nervous processes” by 20.66 Ms (p<0.001).

The Prevalence and Factors Associated with Mistreatment Perception among Thai Medical Students in a Southern Medical School

Abstract: Objective: To assess the prevalence of mistreatment perception among medical students as well as to identify the types of mistreatment and their associated factors. Methods: This cross-sectional study surveyed all of the 4th to 6th year medical students at the Faculty of Medicine, Prince of Songkla University, from January to April 2017. Three questionnaires were employed: 1) Demographic data 2) Mistreatment perception, and 3) the Patient Health Questionnaire (PHQ)-9 Thai version. The data were analyzed using descriptive statistics. The results were presented as frequency, percentage, average and standard deviation. The factors associated with mistreatment perception were analyzed by means of the chi-square test and logistic regression. Results: Two hundred and ninety-eight medical students (55.0%) completed the questionnaires, 66.1% of them were female. Their mean age was 22.5+1.1 years. As to the medical students’ perception, the majority (63.4%) reported experiencing at least one incidence of mistreatment by attending physicians (53.7%), residents (36.2%) and nurses (16.4%) within the previous year. The majority of mistreatment types were verbal criticism (59.7%) and discriminative behavior (51.4%). The mistreated medical students reported consequences such as experiencing unpleasant feelings (41.3%) and burnout (35.6%). According to the PHQ-9 Thai version findings, 11.1% of all of our students had depression; however, depression did not correlate with the mistreatment perception. The significant factor that correlated with mistreatment perception was the academic year. Conclusion: More than a half of the surveyed medical students perceived being mistreated and reported experiencing unpleasant feelings as a consequence.

Propofol Versus Dexmedetomidine for Procedural Sedation in a Pediatric Population.

Abstract: OBJECTIVES Frequently, infants and children require sedation to facilitate noninvasive procedures and imaging studies. Propofol and dexmedetomidine are used to achieve deep procedural sedation in children. The objective of this study was to compare the clinical safety and efficacy of propofol versus dexmedetomidine in pediatric patients undergoing sedation in a pediatric sedation unit. METHODS A retrospective analysis of patients sedated with either propofol or dexmedetomidine in a pediatric sedation unit by pediatric emergency physicians was performed. Both medications were dosed per protocol with propofol 2 mg/kg induction and 150 μg · kg-1 · min-1 maintenance and dexmedetomidine 3 μg/kg induction for 10 minutes and 2 μg · kg-1 · h-1maintenance. The variables collected included drug dose, sedation time (time that the drug was given to the completion of the procedure), recovery time (end of the study to the return to the presedation sedation score for 15 minutes), need for dose rate changes, airway management, and adverse events. RESULTS A total of 2432 children were included- 1503 who received propofol and 929 who received dexmedetomidine. Propofol and dexmedetomidine resulted in successful completion of the study in 98.8% and 99.7%, respectively (P = 0.02). The mean recovery time for propofol was 34.3 minutes, compared with 65.6 minutes for dexmedetomidine (P < 0.001). The need for unexpected airway management was 9.7% for propofol and 2.2% for dexmedetomidine (P < 0.001). Adverse events occurred in 8.6% and 6% of patients in the propofol and dexmedetomidine groups, respectively (P = 0.02). CONCLUSIONS Propofol use led to significantly shorter recovery times, with an increased need for airway management, but rates of bag-mask ventilation (2.3%), airway obstruction (1.1%), and desaturation (1.6%) were low. No patients required intubation. Propofol is a reasonable alternative to dexmedetomidine, with a clinically acceptable safety profile.

Flexible Sigmoidoscopy Rather than Colonoscopy Is Adequate for the Diagnosis of Ipilimumab-Associated Colitis.

Abstract: Objectives Treatment with ipilimumab, a cytotoxic T lymphocyte antigen-4 approved for metastatic melanoma can result in clinically significant immune-mediated drug injury in the form of colitis. Timely diagnosis and response are essential for optimal management. The aims of our study were to determine the percentage of our patients with ipilimumab-associated colitis in which the colitis could be diagnosed by flexible sigmoidoscopy only and to describe the variations in endoscopic and histologic findings as well as the patients' clinical courses. Methods We retrospectively reviewed 244 patients with metastatic melanoma, treated them with ipilimumab, and characterized the endoscopic and histologic features for those who developed colitis. Results Of the 68 patients who presented with diarrhea, 33 were diagnosed as having ipilimumab-associated colitis. Endoscopically, all of them had involvement of the left side of the colon; none of the patients were noted to have isolated right colon involvement. Conclusions Ipilimumab-associated colitis can be diagnosed with a flexible sigmoidoscopy alone, obviating the need for full colonoscopy.

Inconsistencies in Colonic Tattooing Practice: Differences in Reported and Actual Practices at a Tertiary Medical Center.

Abstract: Objectives Accurate localization of a colonic lesion is crucial to successful resection. Although colonic tattooing is a widely accepted technique to mark lesions for future identification surgery or repeat colonoscopy, no consensus guidelines exist. The objective of this study was to determine whether the current tattooing practice at a tertiary medical center differs from recommendations in the literature and self-reported provider practice. Methods The study consisted of an observational retrospective chart review of patients who received colonic tattoos, as well as a provider survey of reported tattooing practices at a tertiary academic medical center. A total of 747 patients older than 18 years of age who underwent colonoscopy with tattoo were included. Forty-four gastroenterologists performing endoscopy were surveyed on tattooing techniques. Results In the majority of cases, neither the number of tattoos, location of the tattoo nor the distance from the lesion was specified within the report. Following the index procedure, a tattoo was detected in 75% of surgical resections and 73% of endoscopies. At the time of surgery, however, the tattoo and/or the lesion was detected approximately 94% of the time. Twenty-five endoscopists (56.8%) completed the survey. Differences were seen the between the chart review and reported practice. Most providers report placing ≥2 marks (87.2%); however, chart review revealed that only 56.2 % were tattooed with ≥2 marks. Conclusions Variation exists between the reported tattooing practice and actual practice. Despite this, most tattoos are identified at the time of surgery or repeat endoscopy. Further research is needed to determine whether a standardized approach to tattooing and reporting could improve localization at repeat endoscopy.

Trauma Providers' Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs.

Abstract: Objectives Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers' knowledge and beliefs about frailty assessment. This study sought to understand trauma providers' understanding, beliefs, and practices for frailty assessment. Methods We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors. Results were analyzed via mixed methods. Results One hundred fifty-one providers completed the survey (response rate 92%). Respondents commonly included calendar age as an integral factor in their determinations of frailty but also included a variety of other factors, highlighting limited definitional consensus. Respondents perceived frailty as important to older adult patient outcomes, but assessment techniques were varied because only 24/151 respondents (16%) were familiar with current formal frailty assessment tools. Perceived barriers to performing a formal frailty screening on all injured older adults included the burdensome nature of assessment tools, insufficient training, and lack of time. When prompted for solutions, 20% of respondents recommended automation of the screening process by trained, dedicated team members. Conclusions Providers seem to recognize the impact that a diagnosis of frailty has on outcomes, but most lack a working knowledge of how to assess for frailty syndrome. Some providers recommended screening by designated, formally trained personnel who could notify decision makers of a positive screen result.

Montenegro as High-Quality Sports Tourism Destination- Trends and Perspectives

Abstract: The contemporary development of tourism is characterized by the development of specific forms of tourism, among which is sports tourism. Tourism and sport are two forms of interconnected activities in the sphere of tourist recreation and their relationship dates back to the very beginning of their development. Sport in modern tourism has not only a perceptive role, but it is also an important content of the stay in which tourists become active participants of various sports: water sports, tennis, golf, skiing, riding, sports games, etc. Having on mind the potential of Montenegro for tourism development, the fact that it represents one of the main pillars of economic progress of the country, as well as the trends and perspectives on global tourist market, it is necessary to identify key advantages and disadvantages of sports tourism in Montenegro in order to improve the quality of this segment of tourist offer.

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease.

Abstract: Objectives Women with sickle cell disease (SCD) are living longer as a result of advances in the care of their underlying disease. With the population growing of women living with SCD, reproductive health issues in this population have become an emphasized area of medical care. We sought to describe current patterns of contraception use, menstruation, and quality-of-life (QOL) measures in women with SCD. Methods Using a cross-sectional study design, we administered paper surveys at two academic medical centers to women aged 10 to 55 years with SCD to capture current contraceptive use, characteristics of menstrual cycles, and QOL metrics. Results Of the 103 women who participated, 12.7% (13/102) experienced a duration of menses >7 days (defined here as prolonged menstrual bleeding). Approximately half of women (51.5%, 53/103) used some form of contraception, with depot medroxyprogesterone acetate injections and condoms being the most common. During their last menstrual periods, women with both dysmenorrhea and prolonged menstrual bleeding (6.9%, 7/102) were more likely to experience more days of poor QOL, with more nights with sleep disturbance (P = 0.001) and more days with trouble taking care of themselves (P = 0.003), as well as being unable to do things they previously enjoyed (P = 0.001), compared with those with neither phenomenon (28.2%, 29/103). Conclusions Dysmenorrhea and prolonged menstrual bleeding negatively affect the QOL of women with SCD. Menstrual histories and preventive measures for menstruation-related morbidity should be incorporated into routine evaluations of women with SCD.

Increasing Prevalence of Chronic Hepatitis C Virus Infection in a Southern Academic Obstetrical Clinic.

Abstract: Objectives The opioid epidemic has resulted in rising rates of hepatitis C virus (HCV) infection in women of childbearing age. With this changing epidemiology in mind, the Infectious Diseases Society of America/American Association for the Study of Liver Diseases guidelines were updated in 2018 to recommend screening all pregnant women for HCV infection, irrespective of risk factors. Because HCV infection can affect maternal-fetal health and result in vertical transmission, presentation for pregnancy-related medical care represents an opportunity to diagnose and manage HCV infection, as well as prepare for treatment postpartum. Methods We performed a retrospective chart review spanning 2007-2016 to examine the epidemiology of HCV infection and opioid use disorder in a southern academic obstetrical clinic and to explore the impact of new screening guidelines if implemented. Composite data from the electronic health record and individual chart review were used to determine rates of HCV infection and opioid use disorder in obstetrics, explore patient demographics, and examine perinatal outcomes. Results Rates of both opioid use disorder and chronic HCV infection increased significantly during the 10-year period of analysis. Patients diagnosed as having chronic HCV infection were primarily white (95%) and there was no observed impact of HCV on perinatal outcomes. HCV testing in pregnancy, even when patients had documented opioid use disorder, was infrequent (0.7% of all pregnancies). Documented follow-up for HCV postpartum for both mothers and infants was incomplete, with only one-third of identified HCV-exposed infants referred and only 9% receiving HCV testing at our institution. Conclusions HCV prevalence increased between 2007 and 2016, but screening and treatment of HCV in this southern obstetrical cohort was infrequent. The implementation of universal screening in pregnancy will likely identify additional cases, and an improved cascade of care will be necessary to address the HCV epidemic.

Evaluating the Burnout-Thriving Index in a Multidisciplinary Cohort at a Large Academic Medical Center.

Abstract: Objectives There has been significant discussion about the quality of burnout research, especially with regard to abbreviated measurements of burnout and/or well-being. The purpose of this study was to compare a single-item, investigator-developed question measuring perceived well-being with validated multi-item measures of burnout and well-being. Methods Between 2016 and 2017, healthcare professionals and medical students at a large academic hospital system were sent an online survey measuring the risk of burnout (Maslach Burnout Inventory), well-being (Physician or Nurse Well-Being Self-Assessment Tool), and perception of personal well-being (Burnout-Thriving Index [BTI], an investigator-developed, single-item measure). Analyses included linear and multiple regression and Pearson correlations. Results The study sample included 1365 medical students, frontline nurses, resident physicians, supervising physicians or fellows, and advanced care practitioners. There were significant differences in all Maslach Burnout Inventory and Physician or Nurse Well-Being Self-Assessment Tool subscale scores based on BTI score (all P 80% sensitivity for high emotional exhaustion, depersonalization, and low personal accomplishment. Conclusions The BTI may be used to screen for individuals who could benefit from completing a full burnout assessment and may be used to collect a quick "big picture" impression of burnout and well-being at a healthcare institution. Further research is needed to compare BTI score with known consequences of burnout and to explore differences in the relation between BTI score and psychoemotional wellness in different professional groups.

Analysis of Cadets’ Endurance Development at Higher Military Educational Institutions during the Kettlebell Lifting Training

Abstract: The influence of the kettlebell lifting training on the level of endurance development and functional abilities of the cadets’ cardiovascular system in the course of study is examined in the article. Cadets of the 1st–5th years of study (n=474) who were studying according to the current system of physical training (group А, n=416) and cadets who were attending a kettlebell lifting class (group B, n=58) took part in the research. The study of the level of endurance development was conducted during the following tests: 3 km race, 5 km accelerated march, and the obstacle course (400 m). The cardiovascular system functioning was examined concerning these indicators: heart rate, arterial blood pressure, Robinson’s index, and heart rate recovery from a standard load. The improved indicators of the endurance and cardiovascular system of group B cadets have been reliably determined (р<0.05–0.001) which proves the efficiency of the kettlebell lifting training concerning the future officers’ formation of physical readiness for professional activity.

Emergency Medicine Resident-Driven Point of Care Ultrasound for Suspected Shoulder Dislocation.

Abstract: OBJECTIVE To determine the impact of implementing a musculoskeletal in-service educational intervention for emergency medicine (EM) residents on the use of point-of-care ultrasound (POCUS) to diagnose and manage shoulder dislocations in the emergency department (ED). METHODS This study was conducted in the ED of an academic teaching hospital in Miami, Florida. It consisted of a short in-service educational intervention on how to perform and interpret POCUS, followed by an open, prospective convenience sample study in patients with clinical suspicion of shoulder dislocation. Twenty EM residents, with no prior shoulder scanning training, participated in the study. In all of the cases, the findings of the shoulder US were compared with radiographs, which were considered the reference standard. EM residents enrolled patients, and obtained and interpreted the shoulder US images. RESULTS Seventy-eight patients were evaluated to rule out shoulder dislocation and/or fracture. Diagnosis of the dislocated shoulder was made in 55 of 78 patients, 53 of whom had anterior dislocations. Resident-driven POCUS had a sensitivity and specificity of 100% to diagnose and rule out, respectively, shoulder dislocations and relocations. There were no differences in the number of dislocations diagnosed and relocated by early and advanced EM residents. Results from a POCUS were available 22 ± 2.8 minutes sooner than x-ray for initial diagnosis and 27 ± 2.9 minutes (P < 0.0001) sooner than x-ray for assessment of reduction. CONCLUSIONS EM resident physicians, with no previous training in shoulder US imaging, exposed to a brief in-service musculoskeletal education intervention, were able to diagnose shoulder dislocations via POCUS with high sensitivity and specificity. Shoulder US for dislocation should be a core component in EM training.