Publications by authors named "Ali Asma"

39 Publications

A Multi-Site Evaluation of A National Employee Wellness Initiative at the Department of Veterans Affairs.

Glob Adv Health Med 2022 3;11:21649561211053805. Epub 2022 Mar 3.

U.S. Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA.

Background: The Department of Veterans Affairs (VA) seeks to transform its health care delivery from disease-centered, episodic care to a holistic and patient-centered model known as the Whole Health System (WHS) of care. Employee engagement and buy-in are crucial to this cultural transformation. The VA aspires to provide employees with opportunities to experience whole health in their personal and professional lives through a national Employee Whole Health (EWH) program. Although there are national recommendations, different local facilities may have unique strategies and challenges as they implement this program.

Objective: This study aimed to conduct a program evaluation of EWH at three different VA facilities across the United States in order to identify facilitators and barriers to the implementation of EWH.

Methods: The team used the RE-AIM framework to develop an interview guide to assess various domains of implementation. Quantitative data on whole health offerings at each site were gauged using a national employee education platform. Standardized employee-related metrics at each site were assessed using the annual, national VA employee survey.

Results: EWH has had variable implementation at the three sites. Sites noted main facilitators as employee interest as well as available skills and expertise for delivering complementary and integrative care to employees. Limited staffing for EWH and a lack of dedicated employee time were cited as barriers. The infrastructure to perform local program evaluations to demonstrate effectiveness and impact were missing.

Conclusion: Employee engagement in whole health activities has the potential to support the VA's mission to transform its health care delivery model. Currently, the use of EWH and its potential impact are difficult to discern based on available information. Local sites need guidance to conduct program evaluations and find creative solutions to enhance employee participation. A robust measurement system to demonstrate effectiveness is paramount to ensure the success of this initiative.
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http://dx.doi.org/10.1177/21649561211053805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8902194PMC
March 2022

Risk Factors for Rebound After Correction of Genu Valgum in Skeletal Dysplasia Patients Treated by Tension Band Plates.

J Pediatr Orthop 2022 Apr;42(4):190-194

Department of Orthopaedics, Nemours Childrens Hospital, Delaware, Wilmington, DE.

Background: Growth modulation using tension band plates (TBPs) is increasingly important for lower limb deformity correction in patients with skeletal dysplasia (SKD). Development of rebound deformity is a concern after TBP removal. Data regarding this complication are rare; therefore, we evaluated the prevalence and risk factors for rebound deformity in children with SKD undergoing correction of genu valgum using TBP.

Methods: All patients with SKD with genu valgum treated by TBP at the distal femur or/and proximal tibia at a single center were reviewed. Inclusion criteria were: (1) minimum 2-year follow-up after TBP removal or having revision surgery for rebound deformity and (2) implant removal age for girls 14 years and below and boys 16 years and below. Exclusion criteria were any femoral/tibial osteotomies during TBP treatment or follow-up. A change of ≥3 degrees of mechanical lateral distal femoral and/or medial proximal tibial angle was accepted as rebound deformity and analyzed statistically.

Results: Thirty-three patients (59 limbs; 52 femur and 29 tibia physes) met our criteria. Mean follow-up after implant removal was 43.7 months. Rebound deformities were seen in 43 limbs (39 femurs and 13 tibias). Boys had more rebound than girls; however, this was not influenced by body mass index. Femurs had more rebound than tibias. Patients in the rebound group were younger than the nonrebound group. Time from application to removal of TBP was shorter in the rebound versus nonrebound group. Overcorrected limbs had more rebound deformity than not overcorrected. The difference in growth velocity of lower limbs in the rebound versus nonrebound group was statistically significant. Patients with epiphyseal dysplasia had more rebound than metaphyseal dysplasia, but this was not statistically significant.

Conclusion: Risk factors for developing a rebound deformity after correction of genu valgum using TBP in SKD included male sex, TBP surgery at a young age, short duration of TBP implantation, overcorrected extremity (mechanical axis deviation ≤1), and high percent growth velocity after TBP removal.

Level Of Evidence: Level IV-retrospective study.
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http://dx.doi.org/10.1097/BPO.0000000000002053DOI Listing
April 2022

Elongation-Derotation-Flexion Casting Treatment of Early-Onset Progressive Scoliosis in Skeletal Dysplasia.

J Pediatr Orthop 2022 Mar;42(3):e229-e233

Nemours Children's Hospital, Delaware, Wilmington, DE.

Background: Early-onset scoliosis in children with skeletal dysplasia is progressive, contributing to cardiopulmonary restrictive disease. Serial elongation-derotation-flexion (EDF) casting, used in other etiologies of scoliosis to delay curve progression, may be beneficial in maximizing spine growth. Our hypothesis is serial EDF casting can be safely used as a temporary alternative to surgery, delaying progression and preserving growth, to treat scoliosis in skeletal dysplasia.

Methods: All patients with skeletal dysplasia treated at a single institution with serial EDF casting for scoliosis were reviewed retrospectively. Radiographic parameters: Cobb angle of major and minor curves, curve location, thoracic height, thoracolumbar height, space available for lung, and rib vertebra angle difference were measured before casting (C1), in first casting (C2), in last casting (C3), and out of last casting (C4). Peak inspiratory pressure (PIP) values were monitored and recorded during the casting application.

Results: Eleven patients met the inclusion criteria (mean 9.7 castings). The mean duration of EDF serial casting was 35 months. The mean major Cobb angles were 54 degrees° (C1), 30 degrees (C2), 37 degrees (C3), and 49 degrees (C4) with no statistically significant differences. The mean minor Cobb angles were 35 degrees (C1), 25 degrees (C2), 33 degrees (C3), and 51 degrees (C4) with no statistically significant differences. The mean thoracic heights were 130 mm (C1), 155 mm (C2), 173 mm (C3), and 160 mm (C4). The 19-mm mean difference between C2 and C3 represents spinal growth. The PIP-1, PIP-2, and PIP-3 mean values were 15, 27, and 18 cmH2O, respectively. Changes in PIP-1 and PIP-2 and PIP-2 and PIP-3 were statistically significant.

Conclusion: Serial EDF casting can delay surgical scoliosis correction in children younger than 7 years with a diagnosis of skeletal dysplasia. Our study showed that serial casting controls progression of the major curve and allows longitudinal growth of the spine with possible expansion of lung volume for nearly 3 years. During cast application, PIP increased with molding and traction, and improved until windowing and trimming of the cast.

Level Of Evidence: Level IV-retrospective study.
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http://dx.doi.org/10.1097/BPO.0000000000002037DOI Listing
March 2022

Anemia among pregnant women in internally displaced camps in Mogadishu, Somalia: a cross-sectional study on prevalence, severity and associated risk factors.

BMC Pregnancy Childbirth 2021 Dec 14;21(1):832. Epub 2021 Dec 14.

Faculty of Medicine & Surgery, Jazeera University, Mogadishu, Somalia.

Background: Anemia in pregnancy is a serious global public health problem in most developing countries and a major cause of maternal morbidity and mortality. Somalia which already had very high maternal mortality ratio of 829 per 100,000 live births, pregnant women in internally displaced camps (IDPs) remain at most exposed. The aim of the study was to determine the prevalence, severity and associated risk factors of anemia among pregnant women in internally displaced camps in Mogadishu, Somalia.

Methods: A community based cross-sectional study was conducted among 383 households in the most IDP settled districts in Mogadishu. Every pregnant mother in these sampled households who was voluntarily consented was targeted. A sample of blood was also taken by pricking the fingertip and inserted into hemoglobin meter. Those with Hb < 11 g/dl from hemoglobin meter had been taken another sample of 3 cc blood and put into EDTA tube for CBC analysis to identify the type of anemia. Data on risk factors were collected using structured pretested questionnaire via an interview. Collected data was coded and entered in SPSS- Version 22 for analysis. Descriptive analysis, bivariate chi-square and multivariate logistic regression were done.

Results: The overall prevalence of anemia among study participants was 44.4% (95%CI: 39.5-49.3%), where severe and moderate anemia were 11.8 and 47.0% respectively. In addition all anaemic cases were microcytic hypochromic anemia. Young maternal age, low Family income, fewer/zero parity, being at third or second trimesters, lack of ANC attendance during pregnancy, lack of iron supplementation during pregnancy, taking tea immediately after meal during pregnancy, lower/zero frequency of daily meat and vegetables consumption during pregnancy were associated risk factors of anemia.

Conclusion: The anemia prevalence from this study was severe public health problem. Several factors were found to be associated with anemia during pregnancy. Measures has to be taken to curb the problem by including them mass iron supplementation and health education towards identified risk factors.
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http://dx.doi.org/10.1186/s12884-021-04269-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670163PMC
December 2021

Population awareness of cardiovascular disease risk factors and health care seeking behavior in the UAE.

Am J Prev Cardiol 2021 Dec 25;8:100255. Epub 2021 Sep 25.

Health Informatics and Smart Health Department, Health Regulation Sector, Dubai Health Authority, Dubai, United Arab Emirates.

Objectives: We aimed to determine the awareness, knowledge, and attitude of people residing in Dubai, United Arab Emirates, regarding cardiovascular disease (CVD) risk factors. Our aim was to further identify prospects to increase awareness of modifiable CVD risk factors and influence behavior.

Methods: This observational study was conducted in Dubai: a global city in the United Arab Emirates. Participants were selected using simple randomization approach in primary health care centers, and a questionnaire was implemented based on literature review.

Results: Out of 1020 individuals approached, 738 agreed to participate in the study (response rate of 72%).The majority of participants surveyed had good knowledge and attitude toward CVD (528, 71.5% and 445, 60% respectively); yet, poor/fair practice related to CVD risk factors (553, 75%). Predictive Margins of Knowledge Scores were significant for age (<.01), academic level (<.0001), and nationality (<.0001) (Table 5). Participants aging 40-49, non-UAE subjects, and university/Postgraduate academic level scored better on the knowledge. Demographics predictor for practice score was highly significant for age (=.0001) and BMI (=.0001). Those aging ≥50 and obese participants scored higher on practice toward CVD risk factors. Knowledge score was significant predictor of practice and attitude toward CVD risk factors (=.0001, <.0001).

Conclusions: Although more than half of the current study participants had high knowledge and attitude toward CVD, their behaviors were not satisfactory. It is necessary to establish more effective educational interventions intended to promote positive health behaviors. Public health providers need to explain to the public that knowledge and proper actions regarding the reduction of risk factors are associated with reduced CVD and mortality.
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http://dx.doi.org/10.1016/j.ajpc.2021.100255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495097PMC
December 2021

Applications and Error Ratios of Calibration Techniques in EOS, Orthoroentgenogram, and Teleoroentgenogram for Length Measurement: A Comparative Study.

J Pediatr Orthop 2022 Jan;42(1):e21-e26

Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

Background: Accurate length measurements of extremity bones are essential in treating limb deformities and length discrepancies in children.

Objective: This study aimed to determine errors in common techniques used to measure lower limb lengths in children.

Methods: Precision and instrument errors in length measurements were studied utilizing electro-optical system (EOS), orthoroentgenogram, and teleoroentgenogram The goal was to measure a 70-cm metallic rod phantom (average length of the lower extremity of a 10-year-old boy in the 50th percentile) in 3 phases. In Phase 1, the length measurements were performed in an EOS unit with internal calibrations, a magball/magstrip in various scan positions, and measurement with TraumaCAD software. In Phase 2, the measurements were repeated utilizing a single radiation "shot" teleoroentgenogram. In Phase 3, an orthoroentgenogram was utilized with a radiopaque ruler reference. The reliability and validity of measurements were calibrated by 4 physicians (a radiologist, senior orthopaedic attending, and 2 orthopaedic fellows).

Results: EOS measurements utilizing internal references had excellent accuracy (for a 700-mm real length, magnification error (ME)] of 0.09%. Teleoroentgenogram with a magball reference and measurements performed with automatic calibration by TraumaCAD program results in ME of 1.83% with insignificant intraobserver/interobserver difference. Teleoroentgenogram with a magball or magstrip reference measured manually showed that the magball has higher intraobserver/interobserver variance than magstrip, with a 6.60 and 0.33-mm SD, respectively. The length by manual measurement utilizing the magstrip has ME of 2.21%. Orthoroentgenogram is accurate with ME of 0.26%, but does not allow anatomical analysis and is also radiation-costly.

Conclusion: EOS and orthoroentgenogram are very accurate for length measurements. Teleoroentgenogram is less accurate in measuring length; however, addition of an external reference (magball, magstrip) placed lateral to the target improves accuracy. Automatic calibration with computer-based analysis of the external reference improves the accuracy more than manual calibration. If manual calibration is utilized, the length measurement is less accurate with the magball than the magstrip.

Level Of Evidence: Level II-comparative in vitro study.
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http://dx.doi.org/10.1097/BPO.0000000000001931DOI Listing
January 2022

Is a Cancer-Associated Ubiquitin Hydrolase, Novel Tumor Suppressor, and Chromosome Instability Gene Deleted in Neuroblastoma.

Cancer Res 2021 03 22;81(5):1321-1331. Epub 2020 Dec 22.

Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.

Deubiquitinating enzymes are increasingly recognized to play important roles in cancer, with many acting as oncogenes or tumor suppressors. In this study, we employed a bioinformatics approach to screen for enzymes from this family involved in cancer and found as a potent predictor of poor outcomes in neuroblastoma, an aggressive childhood cancer. resides in a region commonly deleted in neuroblastoma, yet was independently associated with poor outcomes in this disease. Deletion of in a murine model resulted in degradation of collapsin response mediator protein 2 (CRMP2), a regulator of axon growth, guidance, and neuronal polarity. Cells lacking USP24 had significant increases in spindle defects, chromosome missegregation, and aneuploidy, phenotypes that were rescued by the restoration of CRMP2. USP24 prevented aneuploidy by maintaining spindle-associated CRMP2, which is required for mitotic accuracy. Our findings further indicate that is a tumor suppressor that may play an important role in the pathogenesis of neuroblastoma. SIGNIFICANCE: This study identifies the chromosome instability gene as frequently deleted in neuroblastoma and provides important insight into the pathogenesis of this aggressive childhood cancer.
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http://dx.doi.org/10.1158/0008-5472.CAN-20-1777DOI Listing
March 2021

Assessment of knowledge, attitude and practice regarding breast self examination among females in Karachi.

J Pak Med Assoc 2020 Nov;70(11):1985-1989

Department of Research and Evaluation, College of Physicians and Surgeons, Karachi, Pakistan.

Objective: To assess the knowledge, attitude and practice regarding breast self-examination among women in an urban setting.

Methods: The Knowledge, Attitude and Practice study was conducted from May to July 2018 at the Department of Gynaecology and Obstetrics at Naseer Hussain Shaheed Hospital and the Institute of Infectious Disease, Karachi, and comprised women aged 15 years or above who were attending the outpatient department. Data was collected using a pre-designed questionnaire and was analysed using SPSS 23.

Results: There were 385 women with a mean age of 30.09±7.09 years. Overall, 259 (67.3%) subjects had adequate knowledge about breast self-examination, 123 (31.9%) had appropriate practices and 187 (48.6%) had positive attitude.

Conclusions: Overall knowledge level regarding breast self-examination was found to be inadequate.
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http://dx.doi.org/10.5455/JPMA.25836DOI Listing
November 2020

Relationships between Key Functions of Patient-Provider Communication, Trust, and Motivation across White, African American, and Hispanic/Latino Patients with Asthma.

Health Commun 2022 04 16;37(4):450-456. Epub 2020 Nov 16.

Department of Clinical and Administrative Pharmacy, University of Georgia.

Patient-provider communication is essential for providing effective care for asthma patients. However, little is known about key functions of communication and their relationships with outcomes in asthma patients across racial/ethnic groups. This study assessed asthma patients' perceptions of key functions of patient-provider communication, and examined associations between key functions, trust, and motivation across racial/ethnic groups. In this study, a sample of 470 US adults responded to an assessment of patient-provider communication, trust, and motivation through an electronically administered survey. Key functions of patient-provider communication included: exchanging information, responding to emotions, making decisions, enabling self-management, managing uncertainty, and fostering relationships. Results showed no differences in the mean scores of key functions of communication across racial/ethnic groups. The key function fostering relationships was positively associated with trust and motivation in both Whites and African Americans. However, the key function making decisions was associated with trust, and the key function managing uncertainty was associated with motivation only for Hispanic/Latinos. Results suggest different cultures may place different values on key functions of communication which may engender trust and motivation. Practical implications and suggestions for future research are discussed.
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http://dx.doi.org/10.1080/10410236.2020.1848758DOI Listing
April 2022

A systematic review examining the relationship between food insecurity and early childhood physiological health outcomes.

Transl Behav Med 2020 10;10(5):1086-1097

Department of Psychology, College of Science & Health, DePaul University, Chicago, IL, USA.

Food insecurity, or limited access to nutritious foods, is a significant public health concern especially among vulnerable populations including infants and young children in low-income households. While literature to date has thoroughly examined the psychological and behavioral impacts of food insecurity on children, no known study to date has specifically synthesized the literature exploring the relationship between food insecurity and physiological health outcomes during early childhood. The purpose of this study was to review the literature on physiological health outcomes associated with food insecurity during early childhood among children aged 0-5 years in developed countries. Our literature search sources included PubMed, PsycInfo, CINAHL, and Embase databases. A total of 657 articles published up to September 2019 were reviewed for eligibility by two coders, with a third reviewer in cases of disagreement. Eighty-three articles remained after screening by abstract, with a final 27 studies ultimately included in the final synthesis. This review is registered with PROSPERO and adhered to PRISMA guidelines. In total, 20 articles (74%) noted significant relationships between food insecurity and physiological health outcomes in young children. Findings included an association with overweight or obesity (n = 9), anemia (n = 3), poor child health (n = 3), low birth weight (n = 3), chronic illness (n = 1), special health care needs (n = 1), and increased cortisol (n = 1), in young children who experience food insecurity. Identifying relationships between food insecurity and health outcomes during early childhood has the potential to inform future prevention interventions to reduce health disparities in these vulnerable populations.
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http://dx.doi.org/10.1093/tbm/ibaa021DOI Listing
October 2020

Chronological effects of non-steroidal anti-inflammatory drug therapy on oxidative stress and antioxidant status in patients with rheumatoid arthritis.

Clin Rheumatol 2021 May 3;40(5):1767-1778. Epub 2020 Oct 3.

Faisalabad Medical University, Faisalabad, 38000, Pakistan.

Introduction/objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing pain and inflammation in rheumatoid arthritis and other joint- and muscle-associated diseases. However, the extensive, long-term, and over the counter administration of NSAIDs may cause various side effects in the patients. In the present study, the chronological effect of NSAIDs on oxidative stress and antioxidant status in patients with rheumatoid arthritis was studied.

Methods: The study included 100 female individuals categorized in four major groups: (1) control group consisting of age- and gender-matched healthy individuals, (2) NRA-NSAID individuals taking NSAIDs without any history of RA, (3) RA individuals with a history of RA but not taking NSAIDs, and (4) RA-NSAID individuals with chronic RA and taking NSAIDs for a long period. The sera of the participants were analyzed for the oxidative stress and antioxidant status.

Results: The RA-NSAID group showed the significantly highest oxidative stress, in terms of malondialdehyde content and lipid-reducing ability as determined in thiocyanate and hemoglobin-induced linoleic acid systems. However, the free radical scavenging ability of the RA-NSAID group, against 2,2-diphenyl-1-picrylhydrazyl, hydroxyl, superoxide, and 2,2-azino-bis-tetrazolium sulfate radicals, was found to be lower than those of the other study groups. The regression analysis of the experimental data showed a significant positive relationship between duration of NSAID intake and malondialdehyde production, lipid-reducing ability, and metal chelating ability in the RA-NSAID patients. The free radical scavenging abilities of the RA-NSAID group were negatively correlated with the duration of NSAID intake.

Conclusions: The prolonged use of NSAIDs significantly increased the oxidative stress and decrease the antioxidant potential of both the RA patients and NRA individuals. The study provides awareness to the public particularly the RA patients regarding the risk of oxidative stress-associated abnormalities caused by the frequent and prolonged use of NSAIDs for temporary relief from pain. Key Points • The study presents the effects of long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) on antioxidant status of patients with rheumatoid arthritis. • The continuous administration of NSAIDs has been found to significantly increase the oxidative stress of the patients with rheumatoid arthritis as well as the individuals with no signs of rheumatoid arthritis. • The prolonged NSAID therapy also decreased the antioxidant potential of the patients with rheumatoid arthritis as well as the individuals with no signs of rheumatoid arthritis. • The study would be a significant and valuable contribution to the literature for the awareness regarding the use of NSAIDs.
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http://dx.doi.org/10.1007/s10067-020-05438-0DOI Listing
May 2021

Comparing the use of Arabic decision aid to usual care. A multicenter randomized controlled trial for Arabic speaking metastatic colorectal cancer patients in Saudi Arabia.

Saudi Med J 2020 May;41(5):499-507

Ministry of Health, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To evaluate the effect of decision aids (DAs) for metastatic colorectal cancer (mCRC) patients in the Arabic language.

Methods: A multi-centered randomized control trial was used to evaluate the effect of Arabic DA use with usual care for mCRC patients compared to usual care alone. Patients were recruited from 4 main oncology centers in Saudi Arabia: King Fahad Medical City, Riyadh; King Khalid University Hospital, Riyadh; King Saud Medical City, Riyadh; and King Fahd Specialist Hospital, Dammam, Saudi Arabia, between March 2016 and  October 2018. The final follow up was in April 2019. The study measured patient understanding of prognosis, treatment options, and the level of the patient's anxiety.

Results: Ninety-two patients were included in the analysis; 51 in the intervention group. A small proportion of both (DA with usual care and usual care) understood that mCRC was incurable (8% and 5%) of the 2 groups, respectively. There was no significant difference between groups in anxiety level; however, a time effect both initially and after one month was significantly higher than at 6 month.

Conclusion: The study shows that a higher level of patient's baseline understanding lowered anxiety levels over time.  Decision aids group presented low levels of anxiety over time than those provided the usual care. We recommend  using Arabic DA in the oncology centers dealing with mCRC patients, aiming to empower patients in decision making.
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http://dx.doi.org/10.15537/smj.2020.5.25064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253845PMC
May 2020

Labral tears with axial plane disorders.

Jt Dis Relat Surg 2020 ;31(1):109-14

Department of Orthopedics and Traumatology, Faculty of Medicine Dokuz Eylül University, Izmir, Turkey.

Objectives: This study aims to determine if there is an axial plane coverage insufficiency in patients with symptomatic labral tears compared to the contralateral asymptomatic side and healthy control subjects.

Patients And Methods: This retrospective study was conducted between December 2017 and January 2019. Thirty patients (21 males, 9 females; mean age 28 years; range, 20 to 36 years) operated due to unilateral symptomatic acetabular labral tears secondary to femoroacetabular impingement were evaluated. Twenty asymptomatic patients (13 males, 7 females; mean age 27±9 years; range, 19 to 36 years) were included in the control group. The relationship between acetabular morphology and labral tear was investigated with the comparison of unilateral symptomatic hips with contralateral asymptomatic hips and the control group by using radiological parameters on plain radiographs and computed tomography.

Results: When the patient group symptomatic side was compared to the control group, acetabular anteversion angle (A A A) and alpha (α) angle were higher, while posterior acetabular sector angle and horizontal acetabular sector angle were lower. When the asymptomatic side was compared to the control group, AAA was higher in the patient group. There was no difference between the symptomatic and asymptomatic sides in the patient group; the symptomatic side yielded a higher α; angle.

Conclusion: Posterior axial plane coverage deficiency in combination with cam deformity (increased α angle) seems to play a role in the pathogenesis of symptomatic acetabular labral tears, even creating a side-to-side difference in some individuals.
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http://dx.doi.org/10.5606/ehc.2020.70193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489133PMC
August 2020

A cysteine near the C-terminus of UCH-L1 is dispensable for catalytic activity but is required to promote AKT phosphorylation, eIF4F assembly, and malignant B-cell survival.

Cell Death Discov 2019 10;5:152. Epub 2019 Dec 10.

1Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905 USA.

The enzyme UCH-L1 is a neuro-endocrine and germinal center B-cell marker that contributes to the development and aggressive behavior of mature B-cell malignancies. While mutations in this enzyme have been associated with Parkinson's disease, relatively little is known about the molecular features associated with the biochemical activities of UCH-L1. Here we use a survival-based complementation assay and site-directed mutagenesis and identify a novel role for the C-terminus of UCH-L1 in supporting cell survival. The C220 residue is required for UCH-L1 to promote the assembly of mTOR complex 2 and phosphorylation of the pro-survival kinase AKT. While this residue was previously described as a potential farnesylation site, destruction of the putative CAAX motif by adding a C-terminal epitope tag did not interfere with cell survival, indicating an alternate mechanism. We used proximity-based proteomics comparing the proteomes of wild-type and C220S UCH-L1 and identified a selective loss of association with RNA-binding proteins including components of the translation initiation machinery. As a consequence, the C220S mutant did not promote the assembly of the eIF4F complex. These data identify a novel role for the C-terminus of UCH-L1 in supporting pro-survival and metabolic activities in malignant B-cells. This finding may lead to the development of therapeutics with selective activity towards malignancy that potentially avoid neuronal toxicities.
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http://dx.doi.org/10.1038/s41420-019-0231-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904616PMC
December 2019

Consensus on the Role of Antibiotic Use in SSI Following Spinal Surgery.

Clin Spine Surg 2020 04;33(3):E116-E126

Department of Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA.

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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http://dx.doi.org/10.1097/BSD.0000000000000856DOI Listing
April 2020

An Unusual Presentation of Insert Dislocation and MCL Rupture in Unicompartmental Knee Replacement with 2 Years Postoperative Results: Does It Functional?

Case Rep Orthop 2019 14;2019:2634738. Epub 2019 May 14.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey.

According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2 year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.
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http://dx.doi.org/10.1155/2019/2634738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536961PMC
May 2019

A dermatomyositis/lichen planus overlap syndrome presenting with erythroderma: A case report.

SAGE Open Med Case Rep 2019 2;7:2050313X19845174. Epub 2019 May 2.

Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.

This case report describes a novel presentation of a lichen planus and dermatomyositis overlap syndrome. The patient presented with pruritic and painful violaceous erythroderma with biopsy reports suggestive of both lichen planus and dermatomyositis. The patient failed first-line treatment with prednisone and hydroxychloroquine and eventually required treatment with methotrexate and intravenous immunoglobulin to achieve control of her disease. Overlap syndromes have been described between lichen planus and lupus erythematosus; however, to date, little has been described about a dermatomyositis/lichen planus overlap.
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http://dx.doi.org/10.1177/2050313X19845174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498764PMC
May 2019

Teaching Genomic Pathology: Translating Team-Based Learning to a Virtual Environment Using Computer-Based Simulation.

Arch Pathol Lab Med 2019 04 30;143(4):513-517. Epub 2018 Nov 30.

From the Departments of Pathology (Dr Haspel) and Medicine (Dr Huang), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; the American Society for Clinical Pathology, Chicago, Illinois (Dr Ali and Mr Smith); the Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Atkinson); the Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque (Dr Chabot-Richards); the Department of Pathology, UH Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Elliott); the Department of Pathology, NorthShore University HealthSystem and the University of Chicago Pritzker School of Medicine, Evanston, Illinois (Dr Kaul); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas (Dr Powell); Baylor Scott and White Central Region Pathology and Texas A&M Medical School, Temple (Dr Rao); the Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Rinder); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Vanderbilt); and the Department of Pathology and Laboratory Medicine, Larner College of Medicine and University of Vermont Medical Center, Burlington (Dr Wilcox). Dr Ali is now with AA Associates, Oak Park, Illinois. Mr Smith is now with Intracon Spain, Barcelona, Spain.

Context.—: Developing skills related to use of computer-based tools is critical for practicing genomic pathology. However, given the relative novelty of genomics education, residency programs may lack faculty members with adequate expertise and/or time to implement training. A virtual team-based learning (TBL) environment would make genomic pathology education available to more trainees.

Objective.—: To translate an extensively implemented in-person TBL genomic pathology workshop into a virtual environment and to evaluate both knowledge and skill acquisition.

Design.—: Using a novel interactive simulation approach, online modules were developed translating aspects of the TBL experience into the virtual environment with a goal of acquisition of necessary computer-related skills. The modules were evaluated at 10 postgraduate pathology training programs using a pre-post test design with participants deidentified. A postmodule anonymous survey obtained participant feedback on module quality and efficacy.

Results.—: There were 147 trainees who received an email request to voluntarily participate in the study. Of these, 43 trainees completed the pretest and 15 (35%) subsequently completed the posttest. Mean overall scores were 45% on the pretest compared with 70% on the posttest ( P < .001; effect size = 1.4). Posttest improvement of results was similar for questions testing acquisition of knowledge versus skills. Regarding the 19 participants who took the survey, 18 (95%) would recommend the modules to others and believed they met the stated objectives.

Conclusions.—: A simulation-based approach allows motivated pathology trainees to acquire computer-related skills for practicing genomic pathology. Future work can explore efficacy in a nonvoluntary setting and adaptation to different specialties, learners, and computer tools.
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http://dx.doi.org/10.5858/arpa.2018-0153-OADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467077PMC
April 2019

Early Eruption of Teeth in Girls.

J Coll Physicians Surg Pak 2018 Sep;28(9):725

Department of Paedodontics, KMU Institute of Dental Sciences, Kohat, Pakistan.

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http://dx.doi.org/10.29271/jcpsp.2018.09.725DOI Listing
September 2018

Changing Practice Patterns for Cytotechnologists: A Comparative Analysis of Data from the 2009 and 2015 ASCP BOC Practice Analysis Surveys.

Lab Med 2018 Jul;49(3):195-202

Department of Continuing Professional Education, American Society for Clinical Pathology, Chicago, Illinois.

Background: The American Society for Clinical Pathology (ASCP) Board of Certification (BOC) surveys US certified cytotechnologists (CTs) at approximately 5-year intervals to gain information about current practice patterns. Although the purpose of this survey is to inform valid content development for the BOC CT examination, comparative longitudinal analysis of the survey data provides information about changes in cytotechnology practice.

Materials And Methods: BOC Practice Analysis Survey data for 2009 and 2015 were examined, comparing survey demographics and performance of laboratory tasks. The 2015 survey added tasks not previously surveyed and considered them emerging when performed by a majority of respondents.

Results: Two hundred thirty-five participants completed the survey in 2015 and 151 in 2009. Respondents reported an overall decrease in performing conventional Papanicolaou tests (-25.3%). Respondents reported increases in morphologic tasks such cytologyehistology correlation (17.5%), cell-block interpretation (17.5%), and preliminary interpretation of histochemical stains (e.g., mucin and Grocott's methenamine silver stain) (16.7%), as well as quality assurance tasks. Majority-performed, newly surveyed tasks included touch prep preparation (57.8%) and interpretation (59.2%) and ancillary test triage (59.6%). Molecular tasks such as tumor identification (6.8%) and preparation of cytology specimens for oncology molecular testing (9.4%) did not meet majority reporting thresholds.

Conclusions: Although performance of the Papanicolaou test is declining, CTs report increases in additional morphologic as well as other laboratory tasks. Emerging tasks (2015) focus on FNA specimens. Knowledge of cytology practice patterns will help guide development of education and training resources toward maintaining an appropriately trained workforce.
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http://dx.doi.org/10.1093/labmed/lmy040DOI Listing
July 2018

The American Society for Clinical Pathology's 2016-2017 Vacancy Survey of Medical Laboratories in the United States.

Am J Clin Pathol 2018 Mar;149(5):387-400

ASCP Evaluation, Measurement and Assessment Department, Chicago, IL.

Objectives: To determine the extent and distribution of workforce shortages within the nation's medical laboratories.

Methods: The 2016-2017 Vacancy Survey was conducted through collaboration between the American Society for Clinical Pathology's Institute of Science, Technology, & Policy in Washington, DC, and the Evaluation, Measurement, and Assessment division and Board of Certification in Chicago, Illinois. Data were collected via an internet survey that was distributed to individuals who were able to report on staffing and certifications for their laboratories.

Results: Results of the 2016-2017 Vacancy Survey shows decreased vacancy rates for laboratory positions across all departments surveyed compared with 2014. While overall, the data show that vacancy rates are decreasing, overall retirement rates and certification requirements are higher.

Conclusions: Focus on the qualifications and certification status of laboratory professionals would be crucial factors in addressing the needs of the laboratory workforce. The field needs to intensify its efforts on recruiting the next generation of laboratory personnel.
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http://dx.doi.org/10.1093/ajcp/aqy005DOI Listing
March 2018

Changing practice patterns for cytotechnologists: a comparative analysis of data from the 2009 and 2015 ASCP BOC Practice Analysis Surveys.

J Am Soc Cytopathol 2018 Sep - Oct;7(5):232-239. Epub 2018 Jul 1.

Department of Continuing Professional Education, American Society for Clinical Pathology, Chicago, Illinois.

Background: The American Society for Clinical Pathology (ASCP) Board of Certification (BOC) surveys US certified cytotechnologists (CTs) at approximately 5-year intervals to gain information about current practice patterns. Although the purpose of this survey is to inform valid content development for the BOC CT examination, comparative longitudinal analysis of the survey data provides information about changes in cytotechnology practice.

Materials And Methods: BOC Practice Analysis Survey data for 2009 and 2015 were examined, comparing survey demographics and performance of laboratory tasks. The 2015 survey added tasks not previously surveyed and considered them emerging when performed by a majority of respondents.

Results: Two hundred thirty-five participants completed the survey in 2015 and 151 in 2009. Respondents reported an overall decrease in performing conventional Papanicolaou tests (-25.3%). Respondents reported increases in morphologic tasks such cytology-histology correlation (17.5%), cell-block interpretation (17.5%), and preliminary interpretation of histochemical stains (e.g., mucin and Grocott's methenamine silver stain) (16.7%), as well as quality assurance tasks. Majority-performed, newly surveyed tasks included touch prep preparation (57.8%) and interpretation (59.2%) and ancillary test triage (59.6%). Molecular tasks such as tumor identification (6.8%) and preparation of cytology specimens for oncology molecular testing (9.4%) did not meet majority-reporting thresholds.

Conclusions: Although performance of the Papanicolaou test is declining, CTs report increases in additional morphologic as well as other laboratory tasks. Emerging tasks (2015) focus on FNA specimens. Knowledge of cytology practice patterns will help guide development of education and training resources toward maintaining an appropriately trained workforce.
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http://dx.doi.org/10.1016/j.jasc.2018.04.002DOI Listing
July 2018

Hemorrhagic Shock as Complication of Intramural Intestinal Bleeding.

Case Rep Gastrointest Med 2017 12;2017:5424631. Epub 2017 Feb 12.

Radiology Department, Habib Thameur University Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

. Mural intestinal hematoma (MIH) is an uncommon complication of anticoagulant therapy. Hemorrhagic shock has been rarely reported as a revealing modality. . We report two cases of shock induced by mural intestinal hematoma in patients under oral anticoagulant for aortic prosthetic valve and atrial fibrillation. Patients were admitted to the ICU for gastrointestinal tract bleeding associated with hemodynamic instability. After resuscitation, an abdominal CT scan has confirmed the diagnosis showing an extensive hematoma. Medical treatment was sufficient and there was no need for surgery. . Gastrointestinal bleeding associated with shock in patients treated by oral anticoagulant should alert physicians to research a probable MIH. Urgent diagnosis and appropriate medical treatment can avoid surgical interventions.
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http://dx.doi.org/10.1155/2017/5424631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337317PMC
February 2017

Learning Scaffolds: Progressive Instructional Design for Multidisciplinary Problem-Based Learning.

J Contin Educ Health Prof Summer 2016;36 Suppl 1:S56-7

Dr. Ali and Dr. Parks: Division of Learning and Educational Research, American Society for Clinical Pathology, Chicago, IL. Ms. Bogie: Education and Training Department, American Society of Hematology. Dr. Rabin and Ms. Panday: The France Foundation, Old Lyme, CT.

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http://dx.doi.org/10.1097/CEH.0000000000000103DOI Listing
October 2018

Report of the results of the International Clinical Cytometry Society and American Society for Clinical Pathology workload survey of clinical flow cytometry laboratories.

Cytometry B Clin Cytom 2017 11 3;92(6):525-533. Epub 2016 Aug 3.

Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Background: Thorough review of current workload, staffing, and testing practices in clinical laboratories allows for optimization of laboratory efficiency and quality. This information is largely missing with regard to clinical flow cytometry laboratories. The purpose of this survey is to provide comprehensive, current, and accurate data on testing practices and laboratory staffing in clinical laboratories performing flow cytometric studies.

Methods: Survey data was collected from flow cytometry laboratories through the ASCP website. Data was collected on the workload during a 1-year time period of full-time and part-time technical and professional (M.D./D.O./Ph.D. or equivalent) flow cytometry employees. Workload was examined as number of specimens and tubes per full time equivalent (FTE) technical and professional staff. Test complexity, test result interpretation, and reporting practices were also evaluated.

Results: There were 205 respondent laboratories affiliated predominantly with academic and health system institutions. Overall, 1,132 FTE employees were reported with 29% professional FTE employees and 71% technical. Fifty-one percent of the testing performed was considered high complexity and 49% was low complexity. The average number of tubes per FTE technologist was 1,194 per year and the average number of specimens per FTE professional was 1,659 per year. The flow cytometry reports were predominantly written by pathologists (57%) and were typically written as a separate report (58%).

Conclusions: This survey evaluates the overall status of the current practice of clinical flow cytometry and provides a comprehensive dataset as a framework to help laboratory departments, directors, and managers make appropriate, cost-effective staffing decisions. © 2016 International Clinical Cytometry Society.
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http://dx.doi.org/10.1002/cyto.b.21398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931807PMC
November 2017

Does Taking the Fellowship In-Service Hematopathology Examination and Performance Relate to Success on the American Board of Pathology Hematology Examination?

Am J Clin Pathol 2016 Jul 29;146(1):107-12. Epub 2016 Jun 29.

American Board of Pathology, Tampa, FL.

Objectives: The biannual Fellow In-Service Hematopathology Examination (FISHE) assesses knowledge in five content areas. We examined the relationship between taking the FISHE and performance on it with outcomes on the first attempted American Board of Pathology Hematology subspecialty certifying examination (ABP-HE).

Methods: The pass rate between the ABP-HE candidates who took the spring FISHE and those who did not were compared. The likelihood of fellows passing the ABP-HE based on their percentiles on the FISHE was also assessed.

Results: ABP-HE candidates who took the spring FISHE had a higher pass rate (96.4%) than those who did not (76.1%, P < .001). Spring FISHE performance, including total percentile and percentiles in four of five FISHE content areas, was only a weak predictor of passing the ABP-HE.

Conclusions: Candidates who take the spring FISHE do better on the ABP-HE than those who do not. Most fellows passed the first attempted ABP-HE regardless of FISHE performance. Whether this is due to fellows making use of the FISHE as a self-evaluation tool to help identify and then correct their knowledge deficiencies remains to be determined.
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http://dx.doi.org/10.1093/ajcp/aqw085DOI Listing
July 2016

Using a Team-Based Learning Approach at National Meetings to Teach Residents Genomic Pathology.

J Grad Med Educ 2016 Feb;8(1):80-4

Background: Accumulating data suggest that team-based learning (TBL) is more effective than lecture-based teaching strategies. Educational sessions at national meetings, however, tend to be lecture-based, and unlike most examples of TBL, involve participants who do not know each other or the instructor.

Objective: We evaluated a 1-day TBL genomic pathology workshop for residents held at 3 national meetings.

Methods: A committee of experts developed the workshop. Prior to attending, participants were provided access to readings and asked to answer preparation questions. Each of the 4 modules within the workshop consisted of a 60-minute TBL activity flanked by 15- to 30-minute preactivity and postactivity lectures. We used surveys to acquire participant evaluation of the workshop.

Results: From 2013-2014, 86 pathology residents from 61 programs participated in 3 workshops at national meetings. All workshops were well received, with over 90% of attendees indicating that they would recommend them to other residents and that the material would help them as practicing pathologists. An incremental approach facilitated decreasing faculty presence at the workshops: the first 2 workshops had 7 faculty each (1 facilitator for each team and 1 circulating faculty member), while the final workshop involved only 2 faculty for 6 teams. For this final session, participants agreed that circulating faculty provided adequate support. Participant "buy-in" (requiring completion of a preworkshop survey) was critical in enabling a TBL approach.

Conclusions: These results demonstrate that TBL is a feasible and effective strategy for teaching genomic medicine that is acceptable to pathology residents at national meetings.
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http://dx.doi.org/10.4300/JGME-D-15-00221.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763384PMC
February 2016

Acute traumatic posterior fracture dislocation of the elbow in pediatric patients: impact of surgery time and associated fractures on outcome.

J Pediatr Orthop B 2016 Sep;25(5):434-8

aDepartment of Orthopaedics and Traumatology, Istanbul Faculty of Medicine bDepartment of Orthopaedics and Traumatology, Memorial Hospital Atasehir cDepartment of Orthopedics and Traumatology, Acibadem University, Acibadem Maslak Hospital, Istanbul dDepartment of Orthopaedics and Traumatology, Ağri Government Hospital, Agri, Turkey.

This study assessed the effect of the time interval from initial injury to surgery and the presence of associated fracture on functional outcomes after acute posterior elbow fracture dislocation. Twenty-six pediatric patients were evaluated with respect to operation time point (within 24 h vs. later) and associated fracture retrospectively. The Mayo Elbow Performance Index (MEPI) score was used to assess functional results. The MEPI score was 91 (80-100) in patients with one associated fracture and 83 (75-95) (P=0.02) in patients with more than one associated fracture. The MEPI score in patients treated within 24 h was 90.3 (75-95) and in those treated later than 24 h, it was 88.6 (75-100) (P=0.6). Treatment time (within 24 h vs. later) does not affect outcomes, but increasing numbers of associated injuries affect outcomes negatively. Level of study: Level IV case series.
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http://dx.doi.org/10.1097/BPB.0000000000000281DOI Listing
September 2016

The American Society for Clinical Pathology's 2014 vacancy survey of medical laboratories in the United States.

Am J Clin Pathol 2015 Sep;144(3):432-43

From the American Society for Clinical Pathology (ASCP) Institute of Science, Technology, and Policy, Washington, DC; and.

Objectives: To determine the extent and distribution of workforce shortages within the nation's medical laboratories. Historically, the results of this biennial survey have served as a basis for additional research on laboratory recruitment, retention, education, marketing, certification, and advocacy.

Methods: The 2014 Vacancy Survey was conducted through collaboration between American Society for Clinical Pathology's Institute of Science, Technology, and Policy in Washington, DC, and the Evaluation, Measurement, and Assessment Department and Board of Certification in Chicago, Illinois. Data were collected via an Internet survey that was distributed to individuals who were able to report on staffing and certifications for their laboratories.

Results: Data reveal increased overall vacancy rates since 2012 for all departments surveyed except cytology and cytogenetics. Also, results show higher anticipated retirement rates for both staff and supervisors. Overall certification rates are highest among laboratory personnel in cytogenetics, hematology/coagulation, and flow cytometry departments and lowest among phlebotomy, specimen processing, and anatomic pathology.

Conclusions: Factors such as retirement and the improving economy are driving the need for more laboratory professionals. Recruitment of qualified laboratory professionals in the workforce and students in laboratory programs will be the key in fulfilling the higher vacancies revealed from the survey results in 2014.
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http://dx.doi.org/10.1309/AJCPN7G0MXMSTXCDDOI Listing
September 2015

Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment.

Transfusion 2015 Jun 19;55(6):1355-61. Epub 2014 Dec 19.

American Society for Clinical Pathology (ASCP), Chicago, Illinois.

Background: Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care.

Study Design And Methods: Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine.

Results: A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful.

Conclusion: Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education.
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http://dx.doi.org/10.1111/trf.12968DOI Listing
June 2015
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