Associates in Neurology

Complications not only affect patients but also impose a significant psychological burden on physicians. Quantitative data in neurointerventional surgery regarding the 'second victim' phenomenon are lacking. This study aimed to assess the prevalence and severity of post-traumatic stress symptoms among neurointerventionalists after major complications. A survey was developed by a committee of experienced neurointerventionalists and distributed internationally via multiple platforms. Respondents were anonymous. Demographic information, complication type, and institutional support availability were queried. Psychological distress was measured using the validated Impact of Event Scale-Revised (IES-R), which assesses intrusion, avoidance, and hyperarousal domains. Descriptive statistics and regression analyses were performed to identify factors associated with post-traumatic stress symptoms. Of 1042 invited physicians, 503 responded (48%), with 413 completing the full survey (40%). The most common pathology was cerebral aneurysm, and the most frequent complication was hemorrhage. Overall, 64% scored above the IES-R threshold for possible post-traumatic stress disorder (PTSD) (≥24), with many reaching levels (≥37) associated with long-term stress and physiological sequelae. Intrusion was the dominant symptom domain, particularly distressing reminders about the complication. Lack of institutional support was significantly associated with possible PTSD (OR 1.63, 95% CI 1.1 to 2.5, P=0.02). No differences were observed by specialty, but geographic variations were present. High stress scores persisted long after the index event. Complications exert a profound emotional and physiological toll on neurointerventionalists, with high rates of possible PTSD and a strong association with inadequate institutional support. Systematic support programs are urgently needed to safeguard physician well-being and patient safety.

Before telling you about Terzaghi’s consolidation theory that’s now nearing its 100th birthday, let me introduce myself and my unique perspective of the person our profession calls the “Father of Soil Mechanics.” I am Sergei Terzaghi, Karl Terzaghi’s grandson. I was born in 1962, just a year before my grandfather died, so what I know about him is based on hearing stories from my family and others who knew and worked with him, and studying his voluminous publications. While a number of my relatives work in closely allied professions, with more than 30 years of experience in geotechnical engineering, analytical problem solving, and troubleshooting construction site issues throughout Australia, New Zealand, and the Pacific Basin, I’m the only member of my family to carry on in the geoprofession (Figure 1).

Spontaneous coronary artery dissection (SCAD) is a spontaneous intimal tear of the coronary artery wall. A factor rarely associated with SCAD is autosomal dominant polycystic kidney disease (ADPKD). Using the PRISMA guidelines, we identified 10 unique cases of SCAD in ADPKD patients reported between 1998 and 2021. Ages ranged from 36 to 59 years, with an average of 44.6 years. The majority of patients were female (80%). Each case was diagnosed with a cardiovascular event: ST-elevation myocardial infarction (STEMI) in 40%, non-ST elevation myocardial infarction (NSTEMI) in 50%, and stable angina in 10%. Conservative management was used in 60% of cases. There is a significant gap in our understanding of the relationship between SCAD and ADPKD. Polycystin complex can lead to structural abnormalities in blood vessels, resulting in vascular leaks and vessel rupture. This suggests that ADPKD patients may have an elevated risk of arteriopathies, including coronary artery dissection.

The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research.

Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated. In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period. San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated. The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline. The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions.

The unintended pregnancy framework, a central tenet of sexual and reproductive health care delivery and research, has been depicted as an adverse outcome that should be prevented. There is growing criticism of the inadequacies of this framework, although little modification in public health guidelines, measurement, or clinical practice has been seen. This article critically reviews the literature on unintended pregnancy to encourage reflection on how this framework has negatively influenced practice and to inspire the advancement of more patient-centered care approaches. We begin by outlining the historical origins of the unintended pregnancy framework and review how this framework mischaracterizes patients' lived experiences, fails to account for structural inequities, contributes to stigma, and is built upon weakly supported claims of a negative impact on health outcomes. We close with a discussion of the relationship between health care provision and unintended pregnancy care and the implications and recommendations for realigning clinical practice, research, and policy goals.

The neurodevelopmental risks of fetal exposure are uncertain for many antiseizure medications (ASMs). To compare children at 2 years of age who were born to women with epilepsy (WWE) vs healthy women and assess the association of maximum ASM exposure in the third trimester and subsequent cognitive abilities among children of WWE. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational, multicenter investigation of pregnancy outcomes that enrolled women from December 19, 2012, to January 13, 2016, at 20 US epilepsy centers. Children are followed up from birth to 6 years of age, with assessment at 2 years of age for this study. Of 1123 pregnant women assessed, 456 were enrolled; 426 did not meet criteria, and 241 chose not to participate. Data were analyzed from February 20 to December 4, 2020. Language domain score according to the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), which incorporates 5 domain scores (language, motor, cognitive, social-emotional, and general adaptive), and association between BSID-III language domain and ASM blood levels in the third trimester in children of WWE. Analyses were adjusted for multiple potential confounding factors, and measures of ASM exposure were assessed. The BSID-III assessments were analyzed in 292 children of WWE (median age, 2.1 [range, 1.9-2.5] years; 155 female [53.1%] and 137 male [46.9%]) and 90 children of healthy women (median age, 2.1 [range, 2.0-2.4] years; 43 female [47.8%] and 47 male [52.2%]). No differences were found between groups on the primary outcome of language domain (-0.5; 95% CI, -4.1 to 3.2). None of the other 4 BSID-III domains differed between children of WWE vs healthy women. Most WWE were taking lamotrigine and/or levetiracetam. Exposure to ASMs in children of WWE showed no association with the language domain. However, secondary analyses revealed that higher maximum observed ASM levels in the third trimester were associated with lower BSID-III scores for the motor domain (-5.6; 95% CI, -10.7 to -0.5), and higher maximum ASM doses in the third trimester were associated with lower scores in the general adaptive domain (-1.4; 95% CI, -2.8 to -0.05). Outcomes of children at 2 years of age did not differ between children of WWE taking ASMs and children of healthy women. ClinicalTrials.gov Identifier: NCT01730170.

BACKGROUND A visual abstract is a graphic summary of a research article’s question, methods, and major findings. Although they have a number of uses, visual abstracts are chiefly used to promote research articles on social media. OBJECTIVE This study aimed to determine if the use of visual abstracts increases the visibility of nephrology research shared on Twitter. METHODS A prospective case-control crossover study was conducted using 40 research articles published in the <i>American Journal of Nephrology</i> (AJN). Each article was shared by the AJN Twitter account in 3 formats: (1) the article citation, (2) the citation with a key figure from the article, and (3) the citation with a visual abstract. Tweets were spaced 2 weeks apart to allow washout of the previous tweet, and the order of the tweets was randomized. Dissemination was measured via retweets, views, number of link clicks, and Altmetric scores. RESULTS Tweets that contained a visual abstract had more than twice as many views as citation-only tweets (1351, SD 1053 vs 639, SD 343) and nearly twice as many views as key figure tweets (1351, SD 1053 vs 732, SD 464). Visual abstract tweets had 5 times the engagements of citation-only tweets and more than 3.5 times the engagements of key figure tweets. Visual abstract tweets were also associated with greater increases in Altmetric scores as compared to citation-only tweets (2.20 vs 1.05). CONCLUSIONS The use of visual abstracts increased visibility of research articles on Twitter, resulting in a greater number of views, engagements, and retweets. Visual abstracts were also associated with increased Altmetric scores as compared to citation-only tweets. These findings support the broader use of visual abstracts in the scientific community. Journals should consider visual abstracts as valuable tools for research dissemination.