Developing a career in academic paediatrics

Many trainees think about research towards the end of clinical training, but at that stage, it may be too late to get the most from the limited opportunities that remain. Ideally, trainees should consider research early in their career. For some, a career in academic paediatrics may be attractive, in which case following the clinical academic pathway as outlined by the National Institutes of Health Research may be appropriate. For others, research may be part of a wider clinical training. This article discusses a variety of research opportunities available to trainees, and offers advice on a career in academic paediatrics.     

Predictors of Disease Recurrence after Venoplasty and Stent Placement for May–Thurner Syndrome

PurposeTo identify factors independently associated with disease recurrence after venoplasty and stent placement for May–Thurner syndrome (MTS).Materials and MethodsFifty-nine consecutive patients (age, 47 y ± 15; 93% female) were identified who had undergone endovascular stent placement for MTS. Patient charts were reviewed for demographic data, risk factors for venous thrombosis, comorbidities, and venous inflow or outflow at first follow-up (3 wk to 6 mo after treatment). Logistic regression was used to identify independent predictors of symptom recurrence or repeat intervention, and multivariate analysis of variance and receiver operator characteristic curve analysis were used to assess relationships between degrees of in-stent stenosis and other variables in the 73% of patients with available cross-sectional imaging. Median follow up was 20.7 months (interquartile range, 4.7–49.5 mo).ResultsAll procedures were technically successful. Disease recurrence, defined as symptom recurrence following initial postprocedural resolution, was observed in 38% of patients. No preprocedural variable was found to be independently predictive of disease recurrence; however, poor venous inflow or outflow were both strongly associated with recurrent disease, with adjusted odds ratios and 95% confidence intervals of 38.02 (3.76–384.20; P = .002) and 7.00 (1.15–42.71; P = .04), respectively. Higher degrees of in-stent stenosis were also associated with symptom recurrence, with an area under the curve of 0.93 (P = .000002) and 39%–41% stenosis being 78%–83% sensitive and 88%–92% specific for symptom recurrence.ConclusionsThese results suggest that cross-sectional imaging can help differentiate patients in whom closer follow-up may be warranted after venoplasty and stent placement for MTS and also guide counseling regarding prognosis.     

明代浙派中医名家楼英调治不孕症思想初探

[目的]总结明代浙派中医名家楼英调治不孕症的学术特点及遣方用药经验，以期对不孕症的诊治提供新的思路与参考。[方法]通过对楼氏所著《医学纲目》中有关不孕症的章节加以研究分析，总结楼氏治疗不孕症的诊治心得，浅析其治疗不孕症的学术特点及用药经验，并引用三种证型加以说明。[结果]楼氏在提炼明代以前医学名家治疗不孕症的学术思想基础上，结合自身临床经验，认为不孕症的主因有气血不足、痰瘀气滞、体质偏颇、男方精气不足等，治疗该病以调和气血为原则，通过养血益气、行气化瘀、温经暖宫、化痰祛湿、温通督脉诸法辨证施治。文中所引痰塞胞络型、阴虚血亏型、瘀滞胞宫型三种不孕证型，充分体现了楼氏以健脾化痰、滋阴养血、化瘀通络为治则，采用丹溪植芝汤、增损三才丸、荡胞汤为主方调治不孕症的诊疗思路。[结论]楼氏认为不孕症是由多因素引起的女性机体气血失和，难以摄精成孕，其治疗当以调和气血为总则，辨证论治，其学术思想具备临床价值，同时也体现了明代浙派中医诊治不孕症的源流及特色。     

《经穴解》学术特色及学术影响探析

《经穴解》为明末清初齐鲁针灸医家岳含珍所著,全书学术特色鲜明:从分经辨证、病候辨证、人迎寸口脉辨证三方面了阐述了经络辨证的价值,积极探讨经络与脏腑之间的联系。注重经络辨证与脏腑辨证相结合;从腧穴的主治功能、经脉循行交会与气血盛衰的关系、地理方位等多角度对书中穴名进行解释,可以窥探分析穴位的气血盛衰,提供了认知腧穴的基本思路;以“五脏互藏”理论为指导阐述腧穴主治病证,体现了其从整体辨证论治、注重经络与脏腑关联的学术特点,揭示了脏腑之间的复杂联系。该书论述全面细致,阐释深入简出,为现代针灸临床提供借鉴,促进了齐鲁医学的传承与发展。     

Validation and confirmatory factor analysis of the pediatric Adherence Barriers to Continuous Positive Airway Pressure Questionnaire

ObjectiveTo evaluate and refine a newly proposed factor structure for the Adherence Barriers to Continuous Positive Airway Pressure Questionnaire (ABCQ) and to present psychometric data from a large, geographically diverse sample of children and young adults with sleep disordered breathing (SDB) treated with positive airway pressure (PAP).MethodsA sample of 181 patients prescribed PAP for treatment of SDB, ages 8–21 years, and caregivers (n = 234) of patients ages 2–21 years, completed the ABCQ during routine sleep medicine clinic visits. Adherence data from participants' PAP machines were obtained via electronic download, providing objective data on PAP adherence immediately preceding the clinic visit during which the ABCQ was completed.ResultsA three-factor structure (1. Behavior, Beliefs, Environment, 2. Emotional Barriers, & 3. Physical Barriers) exhibited good model fit in confirmatory factor analysis. Results indicate that the ABCQ has strong psychometric properties, including good internal consistency among subscales and strong convergent validity with objectively measured PAP adherence. Analysis of the Receiver Operator Characteristic Curve (ROC) yielded an ABCQ total cut-off score of 46.5 for patient report and 53.5 for caregiver report. Scores above the cutpoint predicted nonadherence to PAP, defined as failure to use PAP for ≥4 h on 70% of nights.ConclusionsThe three-factor ABCQ appears to be a useful patient- and caregiver-report instrument to measure barriers to PAP treatment in children and young adults with sleep disordered breathing.