Search

Background: Within the current medical workforce, diversity is limited among surgical specialties. However, diversity allows physicians to provide culturally competent care. This paper discusses the trends in racial, ethnic, and gender representation within different surgical subspecialties with an emphasis on neurosurgery over a 20-year time frame., Methods: A retrospective review of data collected by the Accreditation Council for Graduate Medical Education over the past twenty years, as reported in Journal of the American Medical Association, was conducted. Residents from 5 surgical specialties were evaluated based on gender, race, and ethnic identifications from 2002 to 2022. One-way analysis of variance was performed to compare the levels and retention rates of racial, ethnic, and gender diversity within these specialties., Results: Analysis of resident demographics of the 5 surgical specialties reveals an overall trend of increasing diversity over the study period. Over the past 20 years, neurosurgery had an overall increase in Asian (+5.1%), Hispanic (+3.0%), and female (+11.4%) residents, with a decrease in White residents by 2.1% and Black residents by 1.1%. Among the surgical specialties analyzed, otolaryngology had the greatest overall increase in minority residents. Notably, there has been an overall increase in female residents across all 5 surgical specialties, with the highest in otolaryngology (+20.3%) which was significantly more than neurosurgery (P < 0.001)., Conclusions: This chronological analysis spanning 20 years demonstrates that neurosurgery, like other specialties, has seen a growth in several racial and ethnic categories. Relative differences are notable in neurosurgery, including Black, Asian, Hispanic, and White ethnic categories, with growth in females, but at a significantly lesser pace than seen in otolaryngology and plastic surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: Clinical trial registries are important for gaining an overview of ongoing research efforts and for deterring and identifying publication bias and selective outcome reporting. The reliability of the information in trial registries is uncertain., Objective: To assess the reliability of information across registries for trials with multiple registrations., Evidence Review: For this systematic review, 360 protocols of randomized clinical trials (RCTs) approved by research ethics committees in Switzerland, the UK, Canada, and Germany in 2012 were evaluated. Clinical trial registries were searched from March to September 2019 for corresponding registrations of these RCTs. For RCTS that were recorded in more than 1 clinical trial registry, key trial characteristics that should be identical among all trial registries (ie, sponsor, funding source, primary outcome, target sample size, trial status, date of first patient enrollment, results available, and main publication indexed) were extracted in duplicate. Agreement between the different trial registries for these key characteristics was analyzed descriptively. Data analyses were conducted from May 1 to November 30, 2020. Representatives from clinical trial registries were interviewed to discuss the study findings between February 1 and March 31, 2021., Findings: The analysis included 197 RCTs registered in more than 1 trial registry (151 in 2 registries and 46 in 3 registries), with 188 trials in ClinicalTrials.gov, 185 in the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), 20 in ISRCTN, and 47 in other registries. The agreement of key information across all registries was as follows: 178 of 197 RCTs (90%; 95% CI, 85%-94%) for sponsor, 18 of 20 (90%; 95% CI, 68%-99%) for funding source (funding was not reported on ClinicalTrials.gov), 154 of 197 (78%; 95% CI, 72%-84%) for primary outcome, 90 of 197 (46%; 95% CI, 39%-53%) for trial status, 122 of 194 (63%; 95% CI, 56%-70%) for target sample size, and 43 of 57 (75%; 95% CI, 62%-86%) for the date of first patient enrollment when the comparison time was increased to 30 days (date of first patient enrollment was not reported on EudraCT). For results availability in trial registries, agreement was 122 of 197 RCTs (62%; 95% CI, 55%-69%) for summary data reported in the registry and 91 of 197 (46%; 95% CI, 39%-53%) for whether a published article with the main results was indexed. Different legal requirements were stated as the main reason for inconsistencies by representatives of clinical trial registries., Conclusions and Relevance: In this systematic review, for a substantial proportion of registered RCTs, information about key trial characteristics was inconsistent across trial registries, raising concerns about the reliability of the information provided in these registries. Further harmonization across clinical trial registries may be necessary to increase their usefulness.

Objectives: This study sought to compare the 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and transferred via pre-hospital triage strategy for primary percutaneous coronary intervention (PCI) with those transferred via inter-hospital transfer within a large suburban region in Canada., Background: Primary angioplasty is the preferred therapy for STEMI if it is done within 90 min of door-to-balloon time by an experienced team in a high-volume center., Methods: Patients identified to have STEMI on the ambulances equipped with electrocardiography bypassed the local hospitals and were sent directly to the PCI center, whereas other patients that were picked up by ambulances without electrocardiographic equipment were transported to the local hospitals where the diagnosis of STEMI was made and were re-routed to the PCI center. Patient demographic data, clinical presentation, procedural data, in-hospital course, and vital statistics were prospectively recorded in a provincial cardiac registry., Results: A total of 167 patients were brought into the PCI center via pre-hospital triage strategy, and 427 patients were brought in via inter-hospital transfer during a 2-year study period. Baseline demographic data, infarct location, cardiovascular history, and hemodynamic status were similar between the 2 groups. When compared with the inter-hospital transfer group, a significantly higher proportion of pre-hospital triaged patients achieved the 90-min door-to-balloon time benchmark (80.4% vs. 8.7%, p < 0.001) and post-procedural Thrombolysis In Myocardial Infarction flow grade 3 after the emergency procedure (97.6% vs. 91.4%, p = 0.02). In addition, the pre-hospital triage strategy was associated with a significantly lower 30-day (5.4% vs. 13.3%, p = 0.006) and 1-year (6.6% vs. 17.5%, p = 0.019) mortality. Pre-hospital triage was an independent predictor for survival at 1 year (hazard ratio: 0.37, 95% confidence interval: 0.18 to 0.75, p = 0.006)., Conclusions: Pre-hospital triage strategy was associated with improved survival rate in patients undergoing primary PCI in a regional STEMI program., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Atherosclerosis manifests as a broad spectrum of clinical pathology involving both coronary and noncoronary circulation. Peripheral artery disease (PAD) and coronary artery disease (CAD) have an important negative impact on each other with respect to treatment options and prognosis. The issue is further compounded by the underdiagnosis and undertreatment of PAD among CAD patients. There are compelling reasons why cardiovascular specialists should take an active role in the care of patients with global atherosclerotic disease. Several areas that impact cardiac patient care and thus are of particular interest to the cardiologists are renal artery disease causing hypertension or renal insufficiency; carotid artery stenosis in precoronary bypass patients; subclavian artery disease causing myocardial ischemia in patients with internal mammary bypass graft; and aortoiliofemoral arterial obstruction causing reduction in exercise tolerence and limitation in arterial access. Risk factor modifications for primary and secondary prevention are similar between CAD and PAD. Moreover, interventional cardiologists possess the necessary skills, which are transferable from coronary intervention to peripheral revascularization. To optimize outcomes, it is important for cardiovascular specialists to have a good foundation of knowledge about the natural history, treatment options and lesion selection. Collaboration with multidisciplinary specialists, including vascular surgeons and neurologists, is advisable for the treatment of PAD.

There is a scarcity of population-based epidemiological investigations concerning the prevalence of epilepsy among alcoholics, and of alcoholism among epileptic patients. Available data seem to suggest that the prevalence of epilepsy among alcoholics is at least triple that in the general population, and that alcoholism may be more prevalent among epileptic patients than in the general population. The term "alcoholic epilepsy" has been used with varying definitions in different investigations. It is suggested that a uniform definition be adopted so as to minimize confusion when comparing data from different laboratories. Although there is general agreement that excessive alcohol intake can increase the frequency of seizures in epileptic patients, limited available data suggest that light to moderate social alcohol drinking may not affect seizure frequency. However, epileptic patients should be warned about the possible adverse effects of alcohol, especially those who have refractory forms of epilepsy. Except for a few anomalous cases, evidence for the direct seizure-provoking effect of alcohol is not strong. This is because it is difficult to pinpoint alcohol as the only etiology; more likely, alcohol is only one factor among others (e.g., head trauma, cerebral infarct, alcohol withdrawal, and metabolic effects of alcohol) in provoking seizures. Because seizures are a symptom and not a disease, it is often difficult to distinguish epileptic seizures from alcohol-withdrawal seizures. Patients with only the latter kind of seizures should not need chronic antiepileptic medication.