Gunterpost4518

We sought to prospectively validate a model to predict the consumption of personal protective equipment in a pediatric emergency department during the COVID-19 pandemic. We developed the Personal Protective Equipment Conservation Strategies Tool, a Monte Carlo simulation model with input parameters defined by members of our emergency department personal protective equipment task force. Inputs include different conservation strategies that reflect dynamic reuse policies. Over the course of 4 consecutive weeks in April and May 2020, we used the model to predict the consumption of N95 respirators, facemasks, and gowns in our emergency department based on values for each input parameter. At the end of each week, we calculated the percent difference between actual consumption and predicted consumption based on model outputs. Actual consumption of personal protective equipment was within 20% of model predictions for each of the 4 consecutive weeks for N95s (range, -16.3% to 16.1%) and facemasks (range, -7.6% to 13.1%), using "maximum conservation" and "high conservation" strategies, respectively. Actual consumption of gowns was 11.8% less than predicted consumption for Week 1, gown resupply data were unavailable on Weeks 2-4. The Personal Protective Equipment Conservation Strategies Tool was prospectively validated for "maximum conservation" and "high conservation" models, with actual consumption within 20% of model predictions.Traumatic lifetime experiences can complicate peaceful dying, causing latent wounds such as posttraumatic stress disorder, moral injury, and soul injury to reemerge at the end of life. Soul injury is defined as an overlooked, unassessed wound that separates a person from his/her own sense of self. The Soul Injury Self-awareness Inventory (Soul Injury Inventory) was developed to identify unresolved losses and hurts that threaten a sense of self. The Soul Injury Inventory is a brief, 10-item instrument that opens the door to meaningful conversations with patients, caregivers, and professionals. This article describes 2 validation studies conducted to measure the reliability, internal consistency, and construct validity of the Soul Injury Inventory. In study 1, the Soul Injury Inventory was demonstrated to be a psychometrically sound tool in which all questions contributed significantly to a single factor characterized as soul injury. In receiver operating characteristic analyses, scores less than 23.5 were shown to be indicative of soul injury with optimal sensitivity and specificity. Study 2 demonstrated that the Soul Injury Inventory has excellent test-retest reliability. The Soul Injury Inventory also has strong internal consistency, as demonstrated in studies 1 and 2. These 2 validation studies, taken together, demonstrate that the Soul Injury Inventory is an excellent, invariant measure of soul injury.The aim of this study was to investigate the experiences and needs of Aboriginal community members with regard to rural community-based palliative care. Conversations with Aboriginal Elders were conducted. (In this Aboriginal community, Elders was not confined to older age. It referred to community leaders and includes [younger] emerging leaders.) The results were analyzed using descriptive analysis. Our study showed that there was a general lack of understanding of palliative care as distinct from curative care and limited awareness of services available. There was a strong need for clear information and on-call and practical support. Some concerns were expressed regarding limited awareness among health care providers of specific cultural needs. However, the home-based nature of palliative care was not, in itself, perceived as a barrier, provided that appropriate respect was displayed. We concluded that the current lack of understanding and awareness of services still impedes access to, and utilization of, care. More attention is needed for specific cultural needs. Adoption of a cultural humility approach for the promotion and delivery of palliative care seems to best fit the expressed needs and experiences of the participants.PRAME (PReferentially expressed Antigen in MElanoma) is a tumor-associated antigen that was recently found to be expressed by malignant melanocytic lesions but not by benign ones, thus resulting useful in this diagnostic field. PRAME could also be expressed by some normal tissues and nonmelanocytic tumors, suggesting as caution should be adopted to use PRAME as a "pan-melanoma" marker for the differential diagnosis with other malignant tumors. Until now, PRAME expression was exclusively investigated through single staining with a monoclonal antibody targeting PRAME and with double staining for Melan A/PRAME found to be useful in specific diagnostic sets. Herein, we studied the expression of PRAME in 40 melanocytic lesions and 23 nonmelanocytic ones using PRAME, Melan A/PRAME, and novel double staining for HMB45/PRAME. Although our results need to be validated, they support the adoption of HMB45/PRAME, alone or in combination with PRAME and Melan A/PRAME, as a helpful marker in the diagnosis of melanocytic neoplasms with a high concordance rate between primary melanoma and corresponding metastases.

This is an analysis of the first 50 in human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum whilst maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events (AE), and the secondary outcome was diagnostic view.

Fifty patients underwent outpatient (25) and surgical rectal assessment (25) with a mean age of 60 years. This included 31 males and 19 females with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48/50 uses (96%), images were captured in 48/50 uses (96%), and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a kappa of 0.225 (95% C.I. 0.144-0.305) when assessing whethers afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video which can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, 'watch and wait' and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.

Right hemicolectomy is recommended for appendiceal adenocarcinoma but may not be needed for early-stage disease.

This study aimed to determine whether appendectomy offers adequate oncologic outcomes for T1 appendiceal adenocarcinoma from a national cohort of patients.

Patients with T1 appendiceal adenocarcinoma (mucinous and non-mucinous histology) treated with either a right hemicolectomy or appendectomy between 2004-2016 were retrieved. Multivariate Cox-regression analysis was used to identify predictors of overall survival.

National cancer database.

A total 320 patients (median age 62yrs, 47% females) were identified 69 (22%) underwent an appendectomy and 251 (78%) underwent a right hemicolectomy.

Overall survival.

Non-mucinous adenocarcinoma was identified in 194 (61%) while 126 (39%) had mucinous adenocarcinoma. Out of the overall cohort, 43% had well differentiated histology, 39% had moderately differentiated disease and 4% had poorly differentiated tumors. The rate of lymph node metastasional cancer database demonstrates that appendectomy is associated with equivalent survival to right hemicolectomy for well differentiated T1 adenocarcinoma, while for moderately and poorly differentiated disease, right hemicolectomy is oncologically superior to appendectomy. See Video Abstract at http//links.lww.com/DCR/B689.

Retrospective studies suggest that watch-and-wait is a safe alternative to total mesorectal excision in selected patients with a clinical complete response after chemoradiotherapy.

Determine the proportion of rectal cancer patients who may benefit from watch-and-wait.

Retrospective analysis of data from prospectively maintained databases.

Comprehensive cancer center.

Consecutive patients with stage II or III rectal adenocarcinoma treated with TNT using induction chemotherapy between 2012 and 2019 under the care of the same surgeon.

Induction-type total neoadjuvant therapy consisted of eight cycles of leucovorin-fluorouracil-oxaliplatin or five cycles of capecitabine-oxaliplatin before chemoradiotherapy. Patients with a clinical complete response were offered watch-and-wait, and patients with residual tumor were offered total mesorectal excision.

Tumor response was assessed with a digital rectal exam, endoscopy, and MRI. Patient characteristics and recurrence-free survival were compared between ttients with stage II or III rectal cancer can benefit from a watch-and-wait approach with the aim of preserving the rectum if treated with induction-type total neoadjuvant therapy and followed by an experienced multidisciplinary team. See Video Abstract at http//links.lww.com/DCR/B688.

Approximately one-third of patients with stage II or III rectal cancer can benefit from a watch-and-wait approach with the aim of preserving the rectum if treated with induction-type total neoadjuvant therapy and followed by an experienced multidisciplinary team. See Video Abstract at http//links.lww.com/DCR/B688.

Myocardial injury after non-cardiac surgery is a strong predictor of 30-day mortality and morbidity.

The purpose was to examine the incidence of myocardial injury in patients undergoing colorectal cancer surgery in an enhanced recovery after surgery protocol and its association with 90-day mortality and morbidity.

Retrospective cohort study.

Conducted at Zealand University Hospital, Denmark between June 2015 and July 2017.

Adult patients undergoing colorectal cancer surgery were included, if troponin was measured at least twice during the first seven days after surgery. The patients were followed for 90 days.

Myocardial injury was defined as an elevated Troponin I measurement (>45 ng/l) without evidence of a non-ischemic etiology causing the elevation. Ninety-day mortality and complications were assessed.

A total of 586 patients were included of which 42 were diagnosed with myocardial injury. Thirteen patients (2%) died within 90 days of surgery. There was no significant difference in 90-day operative complications compared with patients without myocardial injury. Future research should examine prevention and treatment of myocardial injury. See Video Abstract at http//links.lww.com/DCR/B692 .

Myocardial injury occurs frequently in patients undergoing colorectal cancer surgery in an enhanced recovery after surgery protocol. Patients with myocardial injury did not have a significantly higher 90-day mortality but had higher risk of 90-day postoperative complications compared with patients without myocardial injury. Future research should examine prevention and treatment of myocardial injury. See Video Abstract at http//links.lww.com/DCR/B692 .