Rationale and Objectives: We aimed to assess the impact of our institution's recently created point-of-care ultrasound (POCUS) course for preclinical medical students by examining its effect on first-year-level medical knowledge, self-reported skill level, and beliefs regarding the importance of ultrasound in future clinical practice.
Materials and Methods:A total of 18 first-year medical students completed a 5-month near-peer-led training program in POCUS consisting of 3-hour teaching sessions (7), 4-hour clinical sessions (10-12), and an independent study. Students completed pre-and postprogram assessments examining (1) student perceptions about ultrasound and its importance to future careers, (2) students' self-reported skill level with ultrasound, and (3) performance on an anatomy and physiology knowledge quiz. Scores and responses were compared to 20 controls.
Results:The majority of students believed that ultrasound was useful for learning anatomy and would be important in their future clinical practice. Students who completed our training program tended to perform better than controls on a test of medical knowledge. Despite reporting far fewer hours of formal ultrasound training, control students rated their skill level comparably to POCUS-trained students.Conclusions: This study provides evidence that ultrasound is well received by medical students and may be useful for teaching basic anatomy concepts.
Background Immediate postprocedure extubation (cessation of mechanical ventilation) after free tissue transfer for head and neck reconstruction may improve outcomes, reduce intensive care unit and hospital length of stay, and reduce overall cost compared with delayed extubation in the intensive care unit. Methods Medical records of 180 consecutive patients undergoing free tissue transfer for head and neck reconstruction were reviewed. Patients immediately extubated in the operating room (immediate group, N = 63) were compared with patients who were extubated in the intensive care unit (delayed group, N = 117) by univariate and multivariate analysis. Results Medical complication rates and intensive care unit length of stay were significantly higher in the delayed extubation group (55.5 vs. 12.7%, p < 0.001, and 4.4 vs. 2.9 days, p < 0.001, respectively). Although the rate of preoperative alcohol use was similar between the two groups, significantly fewer patients underwent treatment for alcohol withdrawal or agitation in the immediate extubation group (3.2 vs. 27.4%, p = 0.001). There were no significant differences in surgical complication rates. Conclusion Immediate postprocedure extubation is associated with shorter intensive care unit length of stay, reduced medical complications, and reduced incidence of treatment for agitation/alcohol withdrawal for patients undergoing free tissue transfer for head and neck reconstruction.
To evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction. Medical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center ( = 101) or a large multidisciplinary academic medical center ( = 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings. The cancer center group had higher mean age (65.2 vs. 60 years; = 0.009) and a shorter mean operative time (12.3 vs. 13.2 hours; = 0.034). Postoperatively, the cancer center group had a significantly shorter average ICU stay (3.45 vs. 4.41 days; < 0.001). There were no significant differences in medical or surgical complications between the groups. Having surgery at the cancer center was the only significant independent predictor of a reduced ICU stay on multivariate analysis (Coef 0.73; < 0.020). Subgroup analysis, including only patients with cancer of the aerodigestive tract, demonstrated further reduction in ICU stay for the cancer center group (3.85 vs. 5.1 days; < 0.001). A cost analysis demonstrated that the reduction in ICU saved $223,816 for the cancer center group. Standalone subspecialty cancer centers are safe and appropriate settings for FTT. We found both reduced operative time and ICU length of stay, both of which contributed to lower overall costs. These findings challenge the concept that FTT requires a large multidisciplinary hospital. 4.
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