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Purpose: Racial and socioeconomic disparities have been reported in the management of appendicitis. Perforated appendicitis (PA) is used as an index for barriers to care due to delays in treatment. This study evaluates the effect of racial and socioeconomic differences on the likelihood of PA in a universally insured national healthcare system.Methods: A retrospective review of pediatric patients enrolled in TRICARE who underwent appendectomy during a 5-year period was performed. Logistic regression was used to examine the association between ethnicity, age, gender, parent, or guardian marital status and deployment status of the active duty parent, type of facility, and type of admission with the odds of perforated appendicitis.Results: A total of 3124 children met inclusion criteria. One-third of children carried the diagnosis of PA. Increased odds of PA was associated with younger age of patient among children of military personnel with enlisted ranks and senior officer ranks.Conclusion: In a universal healthcare system, no disparities across race with regard to presentation of appendicitis were identified. Increased odds of perforated appendicitis were observed in younger patients, but this was demonstrated in families of both high and low socioeconomic status. Universal coverage does appear to eliminate some barriers to healthcare. [ABSTRACT FROM AUTHOR]

Background: Secondary signs of appendicitis on ultrasound may aid with diagnosis in the setting of a non-visualized appendix (NVA). This role has not been shown in the community hospital setting.Materials and Methods: All right lower quadrant ultrasounds performed in children for clinical suspicion of appendicitis over a 5-year period in a single community hospital were evaluated. Secondary signs of inflammation including free fluid, ileus, fat stranding, abscess, and lymphadenopathy were documented. Patients were followed for 1 year for the primary outcome of appendicitis. These data were analyzed to determine the utility of secondary signs in the diagnosis of acute appendicitis when an NVA is reported.Results: Six hundred and seventeen ultrasounds were reviewed; 470 of these had an NVA. Of NVAs, 47 (10%) of patients were diagnosed with appendicitis. Sensitivity and specificity of having at least one secondary were 38.3% and 80%, respectively. The positive and negative predictive values of having at least one secondary sign were 17.3% and 92%, respectively.Conclusion: These data suggest that the absence of secondary signs has a strong negative predictive value for appendicitis in the community hospital setting; however, the full utility of secondary signs may be limited in this setting. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the feasibility of a flipped classroom progamme, designed and implemented by medical students, in communicating nutrition education to fourth-grade school students aged 9–10 years and to characterise teachers’ assessments of the progamme, which was designed to minimise the burden placed on teachers. Design: Each student–participant served as control before and as case after exposure to the novel healthSLAM (hS) curriculum. The results on the pre-tests and post-tests were matched and compared. Teachers completed a one-time survey after observing the new curriculum. Setting: The study was conducted in 2013 in the fourth-grade classrooms of an elementary school in Derry Township, Pennsylvania, USA. Methods: The hS progamme included a web-based video that delivered nutrition education didactics and a classroom portion in which medical students guided exercises to reinforce nutrition concepts discussed in the video. A pre-test and post-test were given to students, and teachers completed a survey to determine the effects of the curriculum on nutrition knowledge, and teacher surveys were administered to assess the appropriateness and acceptability of the curriculum. In all, 166 students’ pre- and post-tests from nine different classrooms were analysed. Results: Significant improvements in nutrition knowledge in both median and mean test scores were found (p < .001), and the raw pre-test and post-test score distributions were found to be homogeneous across the nine different classrooms studied. Teachers reported the new curriculum to be feasible and grade-appropriate. Conclusion: The hS programme, rooted in flipping pedagogy using a video didactic lecture and an activity-based classroom session to reinforce concepts, appeared to communicate nutrition information successfully and was seen as both feasible and acceptable by teachers. [ABSTRACT FROM AUTHOR]