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Primary Pulmonary Choriocarcinoma With Lymph Node Metastasis: A Case Report and Brief Review
No full textChoriocarcinoma is a malignant germ cell tumor containing syncytiotrophoblasts and secreting human chorionic gonadotropin (β-hCG), often associated with a poor prognosis. Reports of primary choriocarcinoma of the lung with lymph node metastasis are extremely rare in the literature. Here, we report a surgically treated case of primary pulmonary choriocarcinoma in a 32-year-old woman. Surgery was followed by three cycles of chemotherapy with etoposide, methotrexate, actinomycin D, leucovorin calcium, cyclophosphamide, and vincristine. Her post-treatment PET scan showed no evidence of disease, and her β-hCG remains at nadir level. She is currently on monthly hCG surveillance and is in good condition
Respiratory equality: let\u27s stop playing favorites with COVID-19 in the healthcare setting
No full textSummary of: Reaching Structurally Vulnerable Populations Using Low-Barrier COVID-19 Testing Clinics Co-Created with Community Based Organizations
Get PDFThe COVID-19 pandemic disproportionately affected people from structurally vulnerable communities. There was a need to improve COVID-19 testing in these communities to reduce viral spread and connect to treatment.
Study @ Reaching Structurally Vulnerable Populations Using Low-Barrier COVID-1 by David Ngandu, Gloria D Sclar et al.https://knowledgeconnection.mainehealth.org/nnectr/1004/thumbnail.jp
Development and Evaluation of a Rural Longitudinal NRP® Telesimulation Program (MOOSE: Maine Ongoing Outreach Simulation Education)
No full textOBJECTIVES: Neonatal resuscitation is a high acuity, low-occurrence (HALO) event and many rural pediatricians report feeling underprepared for these events. We piloted a longitudinal telesimulation (TS) program with a rural hospital\u27s interprofessional delivery room teams aimed at improving adherence to Neonatal Resuscitation Program (NRP®) guidelines and teamwork. STUDY DESIGN: A TS study was conducted monthly in one rural hospital over a ten month period from November 2020 to August 2021. TS sessions were remotely viewed and debriefed by experts. Sessions were video recorded and assessed using a scoring tool with validity evidence for NRP® adherence. Teamwork was assessed using both TeamSTEPPS 2.0 Team Performance Observation Tool and Mayo High-Performance Teamwork Scale. RESULTS: We conducted ten TS sessions in one rural hospital. There were 24 total participants, who rotated through monthly sessions, ensuring interdisciplinary team composition was reflective of realistic staffing. NRP® adherence rate for full code scenarios improved from a baseline of 39% to 95%. Compared with baseline data for efficiency, multiple NRP® skills improved (e.g. cardiac lead placement occurred 12x faster). Teamwork scores showed improvement in all domains. CONCLUSIONS: Our results demonstrate that a TS program aimed at improving NRP® and team performance is possible to implement in a rural setting. Our pilot study showed a trend towards improved NRP® adherence, increased skill efficiency, and higher quality teamwork and communication in one rural hospital. Additional research is needed to analyze program efficacy on a larger scale and to understand the impact of training on patient outcomes
Medical School Curricula and the Role of Third-Party Resources in Medical Student Urology Education
No full textOBJECTIVE: To assess the quality and extent of the urology education provided to medical students both by third-party resources (TPRs) and by the curriculum provided by medical schools METHODS: TPRs were assessed by systematically comparing the content of the 4 most common resources (Anking, Pathoma, Uworld, and First Aid) to the American Urological Association\u27s Medical Student Curriculum (AUA-MSC). Medical school curricula were assessed via a survey sent to the top-150 allopathic medical schools in the United States. The survey asked about clinical and pre-clinical exposure to urology received by medical students at their school. RESULTS: The TPRs for Step 1 together covered 73.3% of the AUA-MSC topics, and for Step 2 covered 81.9%. First Aid covered 49.5% of Step 1 topics and 58.4% of Step 2 topics, Uworld covered 58.6% and 67.9%, respectively, and Anking covered 61.8% and 58.8%, respectively. Pathoma covered 28.1% of Step 1 topics. Survey results showed that 33/39 (84.6%) of schools have required urology coursework in preclinical years, but only 3/39 (7.7%) have required urology rotations in the third or fourth years. Of those without required rotations, 35/36 (97.2%) indicated that they offer an elective rotation in urology. CONCLUSION: There is little emphasis placed on urology after the preclinical years of medical school, pointing to a need for greater exposure to these topics regardless of the student\u27s selected specialty. This need stems from incomplete knowledge provided by TPRs compared to the AUA-MSC. Drawing attention to this gap can provide insight for those creating future iterations of medical curricula and shed light on areas in need of improvement, which would ultimately benefit both patients and providers
Effectiveness of Community Education for Breast Cancer Screening
No full textOBJECTIVE: Screening based on individual risk factors results in detection of earlier, more curable breast cancer. There is expectation that improved public education about the importance of personalized screening will result in earlier diagnoses and reduced breast cancer mortality. The purpose of this study is to evaluate the effectiveness of community education on patient perceptions about risk-based screening. METHODS: This study is Health Insurance Portability and Accountability Act-compliant and institutional review board exempt. A standardized curriculum was used by radiologists and experts to conduct nine 1-hour patient education sessions between October 2018 and January 2019 about breast cancer risk factors and screening options. Patient participants completed voluntary, anonymous pre-event and post event surveys to determine if the presented educational program led to attitude changes. Survey results were summarized using statistical analysis including mean, median, range, and percentage of participants responding and comparison of pre- and post event fear and anxiety. RESULTS: Of 336 education session participants, 59.5% (200/336) completed the pre-event and 44.3% (149/336) completed the post event surveys, Respondents reported decreased anxiety and fear regarding breast cancer screening following educational sessions, with 36.1% (64/178) reporting anxiety pre-event compared to 23.3% (31/133) post event, although the difference was not statistically significant (P = .96). Additionally, 64.7% (55/85) of participants stated they were more likely to schedule breast cancer screening based on individual risk factors, and 98.0% (145/148) of participants reported increased knowledge on post event surveys. CONCLUSION: This study demonstrates the importance and effectiveness of community-based educational programs in increasing knowledge of risk-based screening and potentially reducing anxiety related to screening
Interaction between cold ischemia time and Kidney Donor Profile Index on postrenal transplant outcomes
No full textWe analyzed whether there is an interaction between the Kidney Donor Profile Index (KDPI) and cold ischemia time (CIT) in recipients of deceased donor kidney transplant (KTs). Adults who underwent KTs in the United States between 2014 and 2020 were included and divided into 3 KDPI groups (≤20%, 21%-85%, \u3e85%) and 4 CIT strata (85%. Increasing KDPI and CIT were associated with worse post-KT outcomes. Contrary to our hypothesis, howerver, the interaction between KDPI and CIT was statistically significant only for PGNF and DGF and eGFR at 6 months. Paradoxically, the negative coefficient of the interaction suggested that increasing duration of CIT was more detrimental for low and intermediate-KDPI organs relative to high-KDPI grafts. Conversely, for mortality, graft survival, and DCGS, we found that the interaction between CIT and KDPI was not statistically significant. We conclude that, high KDPI and prolonged CIT are independent risk factors for inferior outcomes after KT. Their interaction, however, is statistically significant only for the short-term outcomes and more pronounced on low and intermediate-KDPI grafts than high-KDPI kidneys
SMART Meetings
Get PDFA one year look at how the CHA executive team focused on opportunities to have fewer yet more productive meetings! In this presentation we will discuss the details that help shape improvement around the challenge of too many meetings and share the results from lessons learned at PBMC and Waldo
Emergency Department SpO/FiO Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients
No full textBACKGROUND: Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO/FiO) ratio is a non-invasive assessment of respiratory dysfunction substituted for the PaO:FiO ratio in Sequential Organ Failure Assessment scoring. We hypothesized that emergency department (ED) SpO/FiO ratios correlate with requirement for mechanical ventilation in COVID-19 patients. Our objective was to identify COVID-19 patients at greatest risk of requiring mechanical ventilation, using SpO/FiO ratios. METHODS: We performed a retrospective review of patients admitted with COVID-19 at two hospitals. Highest and lowest SpO/FiO ratios (percent saturation/fraction of inspired O) were calculated on admission. We performed chi-square, univariate, and multiple regression analysis to evaluate the relationship of admission SpO/FiO ratios with requirement for mechanical ventilation and intensive care unit (ICU) care. RESULTS: A total of 539 patients (46% female; 84% White), with a mean age 67.6 ± 18.6 years, met inclusion criteria. Patients who required mechanical ventilation during their hospital stay were statistically younger in age ( = 0.001), had a higher body mass index ( \u3c .001), and there was a higher percentage of patients who were obese ( = 0.03) and morbidly obese ( \u3c .001). Shortness of breath, cough, and fever were the most common presenting symptoms with a median temperature of 99°F. Average white blood count was higher in patients who required ventilation ( = \u3c0.001). A highest obtained ED SpO/FiO ratio of ≤300 was associated with a requirement for mechanical ventilation. A lowest obtained ED SpO/FiO ratio of ≤300 was associated with a requirement for intensive care unit care. There was no statistically significant correlation between ED SpO/FiO ratios \u3e300 and mechanical ventilation or intensive care unit (ICU) requirement. CONCLUSION: The ED SpO/FiO ratios correlated with mechanical ventilation and ICU requirements during hospitalization for COVID-19. These results support ED SpO/FiO as a possible triage tool and predictor of hospital resource requirements for patients admitted with COVID-19. Further investigation is warranted