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Introduction: This study investigated the separate impacts of diet and pre-operative antibiotics on gut microbiome and colonic anastomotic healing using a mouse model., Methods: Male C57BL/6J mice were fed either low-fat-high-fibre (SD) or high-fat-low-fiber (WD) groups for 6 weeks, then further received either pre-operative antibiotics or a control sham before a colonic anastomotic procedure was performed. After 7 days, the anastomosis was assessed and microbiota composition and biodiversity were analyzed in anastomotic tissue and stool., Results: WD-fed mice had shorter survival (5.2 ​± ​2.3 vs. 6.9 ​± ​2.3 days, p ​= ​0.022), increased weight loss (5.55 ​± ​3.80g vs. 2.65 ​± ​2.36g, p ​= ​0.03), and reduced biodiversity compared to SD-fed mice. Pre-operative antibiotics improved anastomotic healing scores (1.33 ​± ​0.65 vs. 2.08 ​± ​0.79, p ​= ​0.02) and reduced Enterococcus faecalis growth in tissue and stool (p ​= ​0.02, p ​= ​0.02). Improved anastomotic healing correlated with lower Enterococcus abundance (p ​= ​0.04) and higher collagen III and IV levels (p ​= ​0.01, 0.04) in anastomotic tissue., Conclusion: SD promotes enhanced post-operative recovery and increased microbiome biodiversity, while pre-operative antibiotics enhance anastomotic healing by suppressing Enterococcus faecalis growth, mitigating collagen III/IV degradation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This article was migrated. The article was marked as recommended. Background: In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Entrustable Professional Activities (EPAs) that medical school graduates should be able to perform upon starting residency. The University of Pittsburgh School of Medicine (UPSOM) has surveyed our neurology clerkship students in regard to EPAs since 2017; according to this data we have been deficient in addressing EPAs 4 (enter and discuss orders/prescriptions), 11 (obtain informed consent for tests and/or procedures), and 12 (perform general procedures of a physician). We therefore developed a hybrid simulation experience encompassing these three skills, centered around lumbar puncture (LP). Methods: We created a hybrid LP simulation for students on the neurology clerkship encompassing EPAs 4, 11, and 12. Students first obtained informed consent for LP from a Standardized Patient, then performed LP on a specialized manikin. They then entered orders on CSF into a simulated patient chart. Real-time feedback was provided for all three components. Students filled out surveys to assess their perceived confidence and skill with these activities both pre- and post-simulation. Results: The percentage of students who increased their confidence with LP from minimal or less to average or more was 58.24%, 38.47%, and 26.38% for LP, informed consent, and order entry, respectively. The percentage of students who improved from not being able to perform/needing significant supervision to being able to perform with minimal supervision/ independently was 25.27%, 47.25% and 28.58%, for LP, informed consent, and order entry, respectively. These differences were all statistically significant (p Conclusions/Significance: Hybrid LP simulation was effective in increasing medical student confidence and perceived skill with EPAs 4, 11, and 12., (Copyright: © 2021 Yanta C et al.)

Objective: To identify meaningful migraine outcome measures among key stakeholders to inform value-based contracts for migraine medications., Background: Value-based contracts linking medication payments to predefined performance metrics aim to promote value through aligned incentives and shared risk between manufacturers and payers. The emergence of new and expensive pharmaceuticals for migraine presents an opportunity for value-based contract development. However, uncertainty remains around which outcomes are most meaningful to all migraine stakeholders., Methods: This study utilized a Delphi survey to incorporate views from 82 stakeholders, including patients (n = 21), providers (n = 23), payers (n = 10), employers (n = 18), and pharmaceutical company representatives (n = 10). A list of 15 migraine-related outcomes was created from a literature review and subject matter expert consultation. Stakeholders reported on the value of these outcomes through a 5-point Likert scale and selection of their top 3 most meaningful outcomes. All participants except patients and employers also used a 5-point Likert scale to rate the feasibility of collecting each outcome measure. Consensus was defined as ≥75% agreement on the importance and feasibility of an outcome (Likert scores ≥4/5 or selection of an outcome as most meaningful)., Results: After 2 rounds, consensus was achieved for importance of 9 outcomes on the Likert scale. "Decrease in migraine frequency" reached 100% agreement (82/82), followed by "increased ability to resume normal activities" (96%, 79/82). When asked to choose the 3 most meaningful outcomes, stakeholders selected "decrease in migraine frequency" (88%, 72/82) followed by "decrease in migraine severity" (80%, 66/82). The 2 measures rated as most feasibly collected were "decrease in emergency department/urgent care visits" (95%, 40/42) and "decrease in migraine frequency" (90%, 38/42). There were statistically significant differences between non-patient and patient stakeholders in selection of "decrease in emergency department/urgent care visits" [20% (12/61) vs 0% (0/21), P = .031]; and employer and patient stakeholders in selection of "decrease in work days missed" [44% (8/18) vs 5% (1/21), P = .006] and "decrease in emergency department/urgent care visits" [22% (4/18) vs 0% (0/21), P = .037] as most meaningful outcomes., Conclusions: The measures "decrease in migraine frequency" followed by "decrease in migraine severity" were identified as top priority migraine outcome measures., (© 2020 American Headache Society.)