Search

Objectives: Sentinel Lymph Node (SLN) mapping is recommended for patients with endometrial carcinoma to reduce the rate of full lymphadenectomy and its associated morbidity such as lymphedema. Obesity is a risk factor for endometrial carcinoma, and many patients are morbidly obese at the time of diagnosis. The goal of this study is to examine the impact of body mass index (BMI) on the success rate of SLN mapping using indocyanine green (ICG) and near-infrared imaging. Methods: A retrospective cohort study was performed of women with endometrial carcinoma undergoing robotic hysterectomy and SLN mapping with ICG between March 2016 and August 2019. Robotic surgery cases were identified from the hospital financial system that were coded with a primary diagnosis of Endometrial Cancer, a procedure of hysterectomy, and a cost code for indocyanine green. A total of 369 cases were identified. A total of 28 cases were excluded because no dye was used or SLN mapping was not attempted due to extent of disease. Preoperative patient characteristics and surgical outcomes including SLN mapping success rate were compared across World Health Organization BMI groups. Results: BMI was categorized as normal weight (BMI 18.5 - 24.9, 41 patients), pre-obesity (BMI 25.0 - 29.9, 48 patients), obesity class I (BMI 30.0 - 34.9, 71 patients), obesity class II (BMI 35.0 - 39.9, 70 patients), and obesity class III (BMI ≥40, 111 patients). Across BMI groups, patient age and ASA category were significantly different, with younger ages and higher ASA scores in the higher BMI groups. BMI groups did not differ in the number of prior abdominal surgeries or FIGO Grade. Uterine weight, diameter and procedure time were all significantly different across BMI groups, with higher weights, diameters and procedure times in the higher BMI groups. Estimated blood loss and depth of myometrial invasion were not significantly different. In the cohort, 85% had FIGO Stage 1 disease. For procedures with successful unilateral or bilateral SLN detection, the mean number of lymph nodes removed per side was not significantly different across BMI groups. The overall bilateral SLN mapping success rate for the cohort was 68.9%. However, the bilateral SLN mapping success rate was significantly lower in patients with obesity class III (54.1%) compared with patients who were less obese (76.1%, p Download : Download high-res image (438KB) Download : Download full-size image Conclusions: Patients with class III obesity (BMI > 40) have a significantly lower success rate for SLN mapping when compared with all other BMI categories (54.1% vs 76.1%, respectively, p

Academic juries have a long tradition as a method of educating students and assessing their work. This tradition has been limited to a relatively narrow range of disciplines, such as architecture and various fi ne and performing arts. This article describes the case of an online graduate-level Instructional Design and Technology (IDT) program adopting and adapting a jury structure to support the development and assessment of students’ electronic portfolios. A key com ponent of the adoption and adaptation is the continuous e ff orts to improve the impact of juries across their 10-year implementation (2005-2015) in the IDT program. Therefore, this paper explicates the history of jury establishment and development within the IDT program, reports two evalua tions that provide students’ perspectives about juries, and details the IDT faculty members’ response to those evalua tions in an e ff ort to further improve juries as a program-wide innovation .

The goal of this study was to compare outcomes for robotic, laparoscopic, and open hysterectomy procedures for endometrial cancer as well as to investigate whether specific patient demographic, comorbidity, and severity variables were associated with the type of hysterectomy performed. A retrospective review was conducted of hysterectomy procedures for patients discharged from October 1, 2008 and September 30, 2012. Preoperative characteristics included age, BMI, number of past abdominal surgeries, and comorbidities. Intraoperative and postoperative characteristics included uterine weight and diameter, American Society of Anesthesiologists physical status classification, lymph-vascular space involvement, FIGO stage and tumor grade. Outcomes included operative time, estimated blood loss, length of stay, conversion to open, other intraoperative and postoperative complications, readmissions within 30 days and lymph node yield. The robotic and laparoscopic cohorts show no significant differences in patient or tumor characteristics, while the open cases represent patients with increased complexity. In general, laparoscopic cases were shorter than robotic and open cases. Laparoscopic cases had fewer conversions to open than robotic cases. Robotic and open cases had significantly higher lymph node yield than laparoscopic cases. The reduction in surgical time and conversion rates in the laparoscopic cohort may be related to the reduction in node dissection performed.

Background This study was designed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures. Methods A prospective, randomized, controlled study of subjects who were randomized into control (drain) and experimental (fibrin) groups was conducted. Results Analysis of 82 patients showed similarly matched groups. Seroma formation rate was 45.5% in the control group and 36.8% in the fibrin glue group (P = 0.43). The rate of wound complications was similar. Aspirate volumes were significantly greater in the fibrin glue group. Drain placement saved patients >$366 over fibrin glue. Conclusions Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost involved, cumbersome technique, and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.

PURPOSE: Appropriate thermoregulation affects both morbidity and mortality in the neonatal setting. Nurses rely on information from temperature sensors and radiant warmers or incubators to appropriately maintain a neonate's body temperature. Skin temperature sensors must be repositioned to prevent skin irritation and breakdown. This study addresses whether there is a significant difference between skin sensor temperature readings from 3 locations on the neonate and whether there is a significant difference between skin sensor temperatures compared with digital axillary temperatures. SUBJECTS: The study participants included 36 hemodynamically stable neonates, with birth weight of 750 g or more and postnatal age of 15 days or more, in a neonatal intensive care unit. Gestational age ranged from 29.6 to 36.1 weeks at the time of data collection. DESIGN: A method-comparison design was used to evaluate the level of agreement between skin sensor temperatures and digital axillary thermometer measurements. METHODS: When the neonate's skin sensor was scheduled for routine site change, 3 new skin sensors were placed—1 each on the right upper abdomen, left flank, and right axilla. The neonate was placed in a supine position and redressed or rewrapped if previously dressed or wrapped. Subjects served as their own controls, with temperatures measured at all 3 skin sensor sites and followed by a digital thermometer measurement in the left axilla. The order of skin sensor temperature measurements was randomly assigned by a computer-generated number sequence. MAIN OUTCOME MEASURES: An analysis of variance for repeated measures was used to test for statistical differences between the skin sensor temperatures. The difference in axillary and skin sensor temperatures was calculated by subtracting the reference standard temperature (digital axillary) from the test temperatures (skin temperatures at 3 different locations), using the Bland-Altman method. The level of significance was set at P PRINCIPAL RESULTS: No statistically significant differences were found between skin temperature readings obtained from the 3 sites (F2,70 = 2.993, P = .57). Differences between skin temperature readings and digital axillary temperature were also not significant when Bland-Altman graphs were plotted. CONCLUSIONS: For hemodynamically stable neonates in a supine position, there were no significant differences between skin sensor temperatures on abdomen, flank, or axilla or between skin sensor temperatures and a digital axillary temperature. This may increase nurses' confidence that various sites will produce accurate temperature readings.

Background Control measures were instituted in a neonatal intensive care unit (NICU) in Syracuse, New York, when a neonatologist became ill with mumps after returning from Africa. Two health care providers (HCPs) who worked with the neonatologist developed parotitis within 13 days of exposure. Outbreak control included furloughing the neonatologist and the 2 HCPs until after 5 days of the onset of parotitis, cohorting and isolating all exposed infants in the NICU, and implementing droplet precautions. All susceptible HCPs were immunized, and all HCPs were required to wear surgical masks when within 3 feet of patients. Results Five HCPs developed parotitis. The neonatologist and 2 of the HCPs were confirmed cases, and 2 other HCPs did not meet the case definition. Twenty-six HCPs who worked in other units of the hospital besides the NICU developed nonspecific signs and symptoms of illness. Of the 2,904 HCPs tested, 287 (10%) had negative antibody results, and 153 (8%) were age 40 years or older. Of the 287 HCPs with negative antibody titers, 200 (70%) received the mumps-measles-rubella vaccine in response to this effort. No cases of mumps were reported in exposed infants, children, or adult patients during the time of exposure. Conclusion Infection control efforts, including vaccinating susceptible HCPs and instituting droplet precautions, might have prevented mumps infection in the NICU patients.

Implications for midwifery education, practice or policy: A national approach to development of publicly funded homebirth programs will provide valuable knowledge for midwifery managers, and women to make birth place choices in Australia. Relevance of this work to the audience: We hope the audience will become aware of the National Publicly Funded Homebirth Consortium and their ability to act as a resource to help develop more programs around the country.

The antimicrobial susceptibility of clinical isolates of the Bacteroides fragilis group was determined at six community hospitals (one large, greater than 600 beds; and five smaller, 96-325 beds). Imipenem was the most active beta-lactam with 100% of isolates being sensitive at 4 micrograms/ml. The percentage of isolates inhibited at 16 micrograms/ml (and 32 micrograms/ml) for the 7-alpha-methoxy antibiotics was: cefoxitin 66 (90); moxalactam 73 (85); cefotetan 68 (72); cefmetazole 40 (61). Metronidazole, chloramphenicol, and clindamycin were active against 100%, 100%, and 89% at breakpoints of 8 micrograms/ml, 8 micrograms/ml, and 4 micrograms/ml, respectively. The activity of several beta-lactams in our report differed slightly from that reported from university teaching hospitals. There were differences at many of the breakpoints for activity of some of the beta-lactam antibiotics for isolates from the large community hospital as compared with the combined isolates from the smaller community hospitals. Interestingly, the pattern was one of more resistance at the smaller community hospitals.

In a comparative study, 47 patients received Timentin, a combination of ticarcillin plus clavulanic acid, or piperacillin to treat serious urinary tract infections. Thirty-nine infections in 38 patients were clinically evaluable (21 in the Timentin-treated group and 18 in the piperacillin-treated group). These included pyelonephritis (10 in the Timentin-treated group and five in the piperacillin-treated group), bladder infections with sepsis (11 in the Timentin-treated group and 11 in the piperacillin-treated group) and bladder infections without fever (two in the piperacillin-treated group). The addition of clavulanic acid to ticarcillin greatly enhanced the susceptibility of five of the 28 evaluable pathogens in the Timentin-treated group (two Escherichia coli isolates, two Staphylococcus aureus isolates, and one Klebsiella pneumoniae isolate). The minimal inhibitory concentrations at which 50 and 90 percent of the bacterial growth was inhibited were 4 and 64 micrograms/ml, respectively, for Timentin, and 4 and 32 micrograms/ml, respectively, for piperacillin. All evaluable patients had a satisfactory symptomatic response at the end of the trial. Of 28 evaluable pathogens treated with Timentin, 18 were eradicated up through the one-week post-therapy evaluation period; of 27 evaluable pathogens treated with piperacillin, 18 were eradicated up through the same time period. Eradicated pathogens included E. coli (six of 13 in the Timentin-treated group and six of 11 in the piperacillin-treated group), other Enterobacteriaceae (three of three in the Timentin-treated group and eight of 10 in the piperacillin-treated group), Pseudomonas aeruginosa (two of four in the piperacillin-treated group), enterococcus (two of three in the Timentin-treated group and two of two in the piperacillin-treated group), staphylococcal species (four of five in the Timentin-treated group), and other organisms (three of four in the Timentin-treated group). Resistance did not develop in any of the persisting pathogens. Adverse effects thought possibly to be related to the study drugs were minimal and included rash in one Timentin-treated patient and diarrhea in another.