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Psychological status and work rehabilitation program outcomes
No full textInjuries occurring at work can have consequences exceeding the physical impairments including an impact on one\u27s mental health. This retrospective cohort study aimed to determine whether components of mental health correlate to outcomes of a work rehabilitation program. The sample included 355 participants treated between 2017 and 2020 at Aurora BayCare Medical Center in Green Bay, Wisconsin. The OSPRO Yellow Flag Assessment Tool, Beck\u27s Depression Inventory, the Patient Health Questionnaire-2, Pain Anxiety Symptoms Scale, and the Tampa Scale of Kinesiophobia were administered to patients in the work rehabilitation program. The assessments indicated a weak positive correlation between the varying psychological factors assessed and the duration of stay within the work rehabilitation program and a weak negative correlation between the percentage of job demands met at discharge. A patient\u27s psychological status was found to be associated with outcomes with a work rehabilitation program
National survey of neonatal-perinatal medicine fellows on postresuscitation debriefing
No full textDebriefing can be a powerful tool to facilitate improvement of performance after a resuscitation event. This study characterizes the debriefing experience of neonatal-perinatal medicine (NPM) fellows in the neonatal intensive care unit (NICU), operating room, and delivery room in the United States.An anonymous 13-item electronic survey was distributed to NPM program directors across the United States, who were asked to forward it to their respective NPM fellows. The survey addressed the frequency and timing of debriefings, access to formal training, and comfort levels with debriefing.Ninety-five responses were collected, with all participants having taken part in at least one medical resuscitation. Debriefings occurred approximately 25% of the time following a resuscitation, typically within 6 hours. Twenty percent of respondents reported feeling somewhat or very uncomfortable leading a debriefing, while 84% believed debriefings improve team performance. Despite 72% reporting no formal debriefing training, 94% expressed interest in receiving such training.This national survey on NPM fellows highlights inconsistent debriefing practices despite recognized benefits. Limited formal training remains a barrier, but a strong interest in further education presents an opportunity to improve training through the incorporation of structured debriefing frameworks into fellowship curricula. · Although NPM fellows often debrief resuscitations, 72% reported no formal training.. · Formal debriefing training can improve debriefing quality and enhance patient outcomes.. · NPM programs should implement structured debriefing to better prepare their fellows.
A live tumor fragment platform to assess immunotherapy response in core needle biopsies while addressing challenges of tumor heterogeneity
No full textBackground: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, providing durable and even curative responses. However, most patients do not respond and current biomarkers (eg, programmed death 1 ligand 1 [PD-L1]), mismatch repair deficiency [dMMR]/high microsatellite instability [MSI] and tumor mutational burden) lack predictive accuracy. Ex vivo profiling of patient-derived tumor fragments shows promise as a predictive biomarker but relies on substantial surgical tissue to mitigate intra-specimen heterogeneity. Innovations are needed that address these challenges, particularly where limited tissue is available such as in core needle biopsies (CNBs).
Methods: Live tumor fragments (LTFs) were generated from 59 human tumor resections and 31 CNBs from patients enrolled in observational clinical trials (ClinicalTrials.gov identifiers: NCT05478538, NCT05520099, NCT06349642) to assess cytokine induction following ICI treatment. LTFs were encapsulated in hydrogel and cultured ex vivo for up to 72 hours. A sequential treatment strategy that applies control and treatment within the same well was used with response to ICI or αCD3/αCD28 assessed using a multiplex secretome assay. Viability was assessed using established metabolic assays and dynamic optical coherence microscopy.
Results: LTFs maintained viability and retained T cells responsive to stimulation throughout ex vivo culture. Multiplex immunofluorescence and immunohistochemistry showed key components of the tumor microenvironment, including relative proportions of CD4+ and CD8+ immune cell populations, were preserved. Specimens positive for PD-L1 or dMMR/MSI-high were enriched for cytokine upregulation, including T-cell response cytokines IFNγ and CXCL10, after αPD-1 treatment. To demonstrate clinical applicability of the sequential treatment strategy, CNBs from patients with lung, gastrointestinal or kidney cancer were profiled and differential cytokine induction in response to ICI treatment was observed.
Conclusions: The novel ex vivo platform presented is capable of detecting T-cell response to ICI treatment by using a sequential treatment strategy. This approach addresses challenges associated with cross-well heterogeneity in tissue composition and requires half as much tissue as a cross-well comparison, mitigating tissue limitations typically associated with non-surgical biopsies. Importantly, the platform is compatible with established functional assays as well as non-destructive spatial imaging, enabling researchers to characterize response to ICI longitudinally. Ongoing trials will enable clinicians to assess platform performance in predicting response to immunotherapy.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12967-025-07378-2
Connection, 1996 August 5
No full textSinai Samaritan Medical Center, Milwaukee, WI: Internal publication for staff and volunteers. This issue has updates on the construction of the buildings on the east side of 12th St.https://institutionalrepository.aah.org/alldocuments/2235/thumbnail.jp
Nivolumab plus ipilimumab (N+I) in patients (pts) with colorectal cancer (CRC) with BRCA1/2 alterations (alts): Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study
No full textImproving the communication of urgent and significant unexpected diagnoses in anatomic pathology
No full textObjective: To identify challenges, opportunities, and best practices for improving the communication of urgent and significant unexpected diagnoses in anatomic pathology, to enhance diagnostic excellence and patient safety.
Methods and results: The American Society for Clinical Pathology convened a group of eleven pathologists from diverse practice settings who discussed the challenges, opportunities, and best practices for improving communication of urgent and significant unexpected findings in anatomic pathology. Through structured discussions, the group identified the challenges such as variability in definitions of urgent and significant unexpected diagnoses and lack of standardized protocols. The group developed a set of best practices and strategies to support timely notification, clear documentation, and standardized communication processes within the healthcare teams to ensure appropriate patient management based on the communicated diagnoses.
Conclusions: Timely and effective communication of urgent and significant unexpected findings in anatomic pathology is essential for patient safety. Standardized definitions and protocols, combined with collaborative strategies, can improve diagnostic accuracy and clinical outcomes. Future research should focus on building an evidence base to support these practices and evaluate their impact on patient care
Use of entrustable professional activities for reliable overall entrustment decisions
No full textPurpose: Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed.
Method: During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision.
Results: A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice.
Conclusions: This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).Teaser text: This study sought to determine how many entrustable professional activities are necessary to make high reliability overall entrustment decisions about pediatric resident readiness for unsupervised practice
Risks of failure in advanced trauma life support courses
No full textINTRODUCTION: The Advanced Trauma Life Support (ATLS) course is the common standard for care and disposition of trauma patients across both designated and nondesignated trauma centers. Evidence of individual student risk factors for ATLS course performance are minimal.
METHODS: A retrospective study was conducted using ATLS course data for hybrid student and refresher courses taught in 2022-2023 from a single American College of Surgeons Regional Committee on Trauma. Marginal performance was defined as a post-test score of \u3c 80% on the written examination or failing the practical test on the first attempt. Univariable analysis by predictor was completed using the χ test and Mann-Whitney U tests, as appropriate. Multivariable analysis was completed with logistic regression analysis.
RESULTS: Among 996 students in the study, 191 (19%) were identified as having marginal ATLS course performance. Marginal performance was significantly more common in the student course (24%) than in the refresher course (9%). Marginal performers differed by medical degree and training status, medical specialty, and level of their home institution trauma center designation. In regression analysis, lower pretest score was associated with higher odds of marginal performance. As compared to advanced practice providers, an attending physician status was associated with lower odds of marginal performance.
CONCLUSIONS: Marginal performance varies by specialty, training level, and home institution trauma center designation. Future work is needed to identify and support at-risk students in both initial and refresher hybrid ATLS courses