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PCI. INTRODUCTION Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment. METHODS A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018-April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien-Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up. RESULTS The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44-92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57-92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57-89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one ivb and one v, according to Clavien-Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59-92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%). CONCLUSIONS The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group. BACKGROUND This paper explores a method for assessing intraoperative performance by modeling how surgeons integrate skills and knowledge through discourse. METHODS Senior residents (N = 11) were recorded while performing a simulated laparoscopic ventral hernia (LVH) repair. Audio transcripts were coded for five discourse elements related to knowledge, skills, and operative independence. Epistemic network analysis was used to model the ordered integration of the five discourse elements. RESULTS Participants with poorer hernia repair outcomes had stronger connections between the discourse elements operative planning and asking for information or advice (Operative planning), while participants with better hernia repair outcomes had stronger connections between the discourse elements giving assistant instructions and identifying errors (Operative management) (p = .006; Cohen's d = 2.79). CONCLUSION Participants with better hernia repair outcomes engaged in more operative management communication during the simulated procedure. This ability to integrate multiple operative steps and verbally communicate them significantly correlated with better operative outcomes. Zamaporvint mw BACKGROUND Medical students often have variable exposures to general surgery (GS) and subspecialty surgery (SS) during their surgical clerkship. We will evaluate the relationship between clinical exposure to GS and performance on the NBME Subject Examination in Surgery. METHODS Student data was collected retrospectively from 2015 to 2018 at a single academic institution. Students were categorized based on their clinical clerkship exposure to GS. A linear model was used to estimate the mean difference in NBME performance between GS and strictly SS exposed students while controlling for prior standardized examination scores and completion of an internal medicine clerkship prior to surgery. RESULTS 365 (67%) of 547 students were exposed to a GS rotation prior to their NBME exam. Performance on the NBME exam was comparable between GS versus SS students (μdiff = 0.37, 95% CI -0.73 to 1.48; p = .51). CONCLUSIONS Exposure to a GS rotation is not advantageous on the NBME surgery examination. Students who completed the medicine clerkship prior to surgery demonstrated superior performance on the NBME surgery examination. INTRODUCTION/OBJECTIVE To describe an outbreak of KPC-3-producing Klebsiella pneumoniae (KPN) and determine the diagnostic efficacy of MALDI-TOF in its detection. METHODS Retrospective study of the KPC-3-KPN isolated in 2 hospitals in Ciudad Real. The peak at 11,109kDa±15 was sought in the KPN spectra provided by MALDI-TOF. RESULTS We isolated 156 KPN strains that carried the blaKPC-3 gene, with a unique profile belonging to ST512 (31 strains studied). There was 25% of infected patients, 84% were nosocomial or related to health care and 93% had some underlying disease (31% of exitus in the first month). The detection of the peak showed 90% sensitivity and 100% specificity. CONCLUSIONS We detected the clonal spread of a KPN ST512 strain producing KPC-3 in 3 hospitals in Ciudad Real. In addition, we show the profitability of MALDI-TOF in the early detection of KPC-KPN. Neoplasms of the head and neck most commonly seen within the larynx are likely malignant and epithelial in origin. Although uncommon, non-epithelial types are occasionally encountered in clinical practice. Owing to the rare nature of these entities, they can lead to diagnostic and treatment uncertainty. We present our two-centre experience of nine different types of non-epithelial laryngeal tumours in this review, highlighting characteristic imaging features and discussing the recommended management strategies emerging. BACKGROUND Personality describes an enduring pattern of experiences and behaviors in the interpersonal and social sphere. Several aspects of personality, e.g., defenses, relational dynamics, and reactions, are commonly accentuated in the midst of medical care; therefore, understanding a patient's personality allows the clinician to make informed predictions about how a specific patient may respond to illness and how care interactions might be modified to optimize care engagement and outcomes. OBJECTIVE/METHODS This article provides a brief description of the personalities in the Psychodynamic Diagnostic Manual, Second Edition, and discusses how each one might inform clinical interactions. Two additional personality-like presentations-the traumatized patient and cognitive impairment-are included for clinical utility given their high prevalence in medical settings and their potential for broad impact on clinical relationships. RESULTS Personality-informed care is an approach that incorporates information about the patient's personality into the clinical relationship.