Critical care trainees’ career goals and needs: A Canadian survey

Designing an effective training program requires information regarding the needs, capability and aspirations of its users. Prompted by the low career satisfaction levels shown by critical care medicine (CCM) clinicians in a previous survey, and a lack of data regarding the career goals of CCM trainees in Canadian training programs, this survey-based study, which had an exemplary response rate of 85%, examined career expectations, and the barriers and enablers to career goals among individuals from adult and pediatric CCM programs across Canada.

BACKGROUND:

For training programs to meet the needs of trainees, an understanding of their career goals and expectations is required.

OBJECTIVES:

Canadian critical care medicine (CCM) trainees were surveyed to understand their career goals in terms of clinical work, research, teaching, administration and management; and to identify their perceptions regarding the support they need to achieve their goals.

METHODS:

The online survey was sent to all trainees registered in a Canadian adult or pediatric CCM program. It documented the participants’ demographics; their career expectations; the perceived barriers and enablers to achieve their career goals; and their perceptions relating to their chances of developing a career in different areas.

RESULTS:

A response rate of 85% (66 of 78) was obtained. The majority expected to work in an academic centre. Only approximately one-third (31%) estimated their chances of obtaining a position in CCM as >75%. The majority planned to devote 25% to 75% of their time performing clinical work and <25% in education, research or administration. The trainees perceived that there were limited employment opportunities. Networking and having specialized expertise were mentioned as being facilitators for obtaining employment. They expressed a need for more protected time, resources and mentorship for nonclinical tasks during training.

CONCLUSION:

CCM trainees perceived having only limited support to help them to achieve their career goals and anticipate difficulties in obtaining successful employment. They identified several gaps that could be addressed by training programs, including more mentoring in the areas of research, education and administration.     

改良Padua风险评估模型对评估内科住院患者静脉血栓栓塞症风险有效性研究

目的:回顾性验证改良Padua风险评估模型在内科住院患者中筛选静脉血栓栓塞症(VTE)的有效性。方法:采用回顾性病例对照研究设计,以2013年1月至2016年12月在广州医科大学附属第一医院内科住院患者中确诊为VTE的432例患者作为VTE组,以随机数字表法选取同时期同科室的出院诊断非VTE的864例内科住院患者为对照组,回顾性收集2组患者病史、实验室检查结果等临床资料,对所有患者进行Padua风险评估模型以及改良Padua风险评估模型评分,比较2种风险评估模型评分情况。结果:VTE组患者Padua风险评估模型评分高于对照组[(2.92±0.18)分比(1.25±0.10)分,t=16.241,P<0.05]。VTE组患者改良Padua风险评估模型评分高于对照组[(3.27±0.19)分比(1.64±0.11)分,t=14.245,P<0.05]。2组患者随着2种风险评估模型评分的升高,发生VTE的风险也相应增高,经Padua风险评估模型以及改良Padua风险评估模型判定为VTE高危患者(评分≥4分)发生VTE的风险分别是低危患者的12.72倍(95%CI:9.00~17.98,P<0.05)与8.17倍(95%CI:6.00~11.12,P<0.05)。VTE组患者经改良Padua风险评估模型判定为VTE高危患者占比高于Padua风险评估模型(48.61%比39.12%,P<0.05)。结论:改良Padua风险评估模型是基于个体危险因素对内科住院患者进行量化更加有效的VTE风险评估模型。     

Nonalcoholic fatty liver disease:Updates in noninvasive diagnosis and correlation with cardiovascular disease

Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health burden.Twenty percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of patients.And thus,the detection and diagnosis of NAFLD is important for general practitioners.Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.However,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver biopsy.The development of noninvasive diagnostic methods for NAFLD is of paramount importance.This review focuses on the updates of noninvasive diagnosis of NAFLD.Besides,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.     

Oncologic impact of preoperative prognostic nutritional index change in resected pancreatic cancer following neoadjuvant chemotherapy

BackgroundAlthough several studies have focused on the oncologic impact of the preoperative prognostic nutritional index (PNI), there is no study correlating the preoperative PNI changes with the oncologic outcome of resected pancreatic cancer following neoadjuvant chemotherapy (NAC).MethodsWe retrospectively analyzed 107 pancreatic ductal adenocarcinoma patients who underwent NAC followed by surgical resection. ΔPNI was defined as post-NAC PNI subtracted from pre-NAC PNI. Patients were divided into high (≥-1.94, n = 54) and low ΔPNI groups (<-1.94, n = 53). Long-term oncologic outcomes, such as overall survival (OS) and disease-free survival (DFS), were compared. Univariate and multivariate analysis were used to identify independent prognostic factors.ResultsThe high ΔPNI group correlated with lower pre-NAC PNI (46.96 ± 4.68 vs. 51.77 ± 5.63, p < 0.001) and higher post-NAC PNI (50.05 ± 4.80 vs. 42.56 ± 7.44, p < 0.001) more than the low ΔPNI group. The high ΔPNI group was also associated with longer OS compared with the low ΔPNI group (mean OS: 63.97 months [95% CI: 49.95–77.99] vs. 41.16 months [95% CI: 27.66–54.66], p = 0.003); there was no significant difference in DFS (p > 0.05). Multivariate analysis revealed that low ΔPNI was an independent risk factor for OS (HR, 3.516; 95% CI, 1.885–6.558; p < 0.001), but not for DFS (p > 0.05).ConclusionsLow ΔPNI (<-1.94) was an independent risk factor for the overall survival of resected pancreatic cancer patients following NAC. In the preoperative setting, improving the PNI can better the long-term oncologic outcome of this condition.     

Impact of chronic kidney disease definition on assessment of its incidence and risk factors in patients with newly diagnosed type 1 and type 2 diabetes in the UK: A cohort study using primary care data from the United Kingdom

AimTo estimate the incidence and risk factors of chronic kidney disease (CKD) in patients with newly-diagnosed diabetes using different CKD definitions.MethodsUsing UK primary care data, patients with diabetes (type 1, 4691; type 2, 109,365) and no CKD were followed to identify newly-diagnosed CKD, classified by a broad and narrow CKD definition (to capture diabetes-induced CKD, termed diabetic kidney disease, DKD). Adjusted incidence rates of CKD/DKD were calculated, and risk factors identified using Cox regression.ResultsThere were 404 CKD cases and 147 DKD cases among patients with type 1 diabetes (T1D), and 29,104 CKD cases, 9284 DKD cases among patients with type 2 diabetes (T2D). Adjusted incidence rates of CKD per 100 years were 5.4 (T1D) and 5.5 (T2D); for DKD they were 1.9 and 1.5, respectively. Risk factors for CKD/DKD were older age, high social deprivation, obesity, cardiovascular disease, hypertension and smoking. Poor glycaemic control in the year after diabetes diagnosis was a strong predictor of CKD/DKD occurrence beyond this first year, and a risk factor for CKD/DKD in T2D.ConclusionsCKD and DKD remain common in diabetics in the decade after diagnosis. Early prevention of T2D and aggressive treatment of risk factors is urgent.