Major Teaching Institution Research Articles

Epidemiology of needlestick injury exposures among dental students during clinical training in a major teaching institution of China: A cross-sectional study

Background/purposeDental students are particularly vulnerable for needlestick injuries (NSI). However, the epidemiology of NSI exposures among Chinese dental students was rarely reported. The objectives of this study were to determine the prevalence of NSI among dental students in a major teaching institution of China, and to identify associated factors.Materials and methodsA self-administrated online questionnaire was developed based on previously published studies, and distributed to dental students of Class 2011–2015 recruited from Peking University School and Hospital of Stomatology.ResultsTwo hundred and sixty-eight dental students including 38.8% of males and 61.2% of females (response rate of 90.0%) completed the survey. Approximately 36.2% of the respondents had sustained at least one NSI. A total of 112 NSI cases were reported. The majority of NSIs were related to the procedures of local anesthesia administration (15.2%) and tooth cleaning or scaling (15.2%). Syringe needles, dental burs and ultrasonic chips were the most notorious devices. Statistical analysis showed significant distribution in NSI occurrence between July–September and October–December. The main cause was lapse in concentration (67.9%), followed by fatigue (22.3%). Up to 66.1% of the exposures occurred when the student was working alone, while only 10.7% with assisting. Unfortunately, 26.8% of the incidents were under-reported.ConclusionDental students are prone to needlestick injuries. The present study clearly reveals a need for increased awareness of NSI prevention among dental students. The quality of infection control education at dental teaching institutions is crucial and indispensable for reducing NSI exposures.

Hysteroscopic-Assisted Vaginal Myomectomy for a 12cm Fibroid: A Case Report

Study Objective To demonstrate the importance of resecting large intracavitary fibroids using a combination of minimally invasive techniques, particularly vaginal morcellation and hysteroscopy. Design Video case presentation. Setting A major urban teaching institution. In the operating room, the patient was placed in dorsal lithotomy. Patients or Participants 22-year-old G0 with a 12 cm intracavitary fibroid causing heavy vaginal bleeding with a starting hemoglobin of 7.3 g/dL. She was a Jehovah's Witness and would only accept a blood transfusion in the case of an absolute emergency. Interventions The patient was admitted to the hospital and underwent a gel foam uterine artery embolization preoperatively. She was also given preoperative misoprostol and tranexamic acid. She underwent a transvaginal myomectomy with hysteroscopic assistance. Measurements and Main Results Complete resection of the large intracavitary fibroid was achieved using the combined vaginal and hysteroscopic myomectomy techniques demonstrated in this video. Minimal blood loss, decreased length of stay, reduced recovery time, and decreased need for future surgery were also achieved in this case. Conclusion The preoperative blood loss reduction strategies and combined vaginal and hysteroscopic surgical approaches minimized blood loss, hospital stay, recovery time, and need for future surgery in this patient. Additionally, a blood transfusion was avoided in a patient who is Jehovah's Witness. This video demonstrates that even large intracavitary fibroids can be resected using minimally invasive techniques.

Trends in the use of dual mobility bearings in hip arthroplasty.

Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. All primary and revision THA procedures reported to AJRR from 2012 to 2018 were analyzed. Patients of all ages were included and subdivided into DM and traditional bearing surface cohorts. Patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Associations were determined by chi-squared analysis and logistic regression was performed to assess outcome variables. A total of 406,900 primary and 34,745 revision THAs were identified, of which 35,455 (8.7%) and 8,031 (23.1%) received DM implants respectively. For primary THA, DM usage increased from 6.7% in 2012 to 12.0% in 2018. Among revision THA, DM use increased from 19.5% in 2012 to 30.6% in 2018. Patients < 50 years of age had the highest rates of DM implantation in every year examined. For each year of increase in age, there was a 0.4% decrease in the rate of DM utilization (odds ratio (OR) 0.996 (95% confidence interval (CI) 0.995 to 0.997); p < 0.001). Females were more likely to receive a DM implant compared to males (OR 1.077 (95% CI 1.054 to 1.100); p < 0.001). Major teaching institutions and smaller hospitals were associated with higher rates of utilization. DM articulations were used more commonly for dysplasia compared with osteoarthritis (OR 2.448 (95% CI 2.032 to 2.949); p < 0.001) during primary THA and for instability (OR 3.130 (95% CI 2.751 to 3.562) vs poly-wear; p < 0.001) in the revision setting. DM articulations showed a marked increase in utilization during the period examined. Younger patient age, female sex, and hospital characteristics such as teaching status, smaller size, and geographical location were associated with increased utilization. DM articulations were used more frequently for primary THA in patients with dysplasia and for revision THA in patients being treated for instability. Cite this article: Bone Joint J 2020;102-B(7 Supple B):27-32.

Building capacity for aesthetic surgery in Nigeria: perspectives from the cosmetic surgery fellowship at the Ivo Pitanguy Institute Rio de Janeiro, Brazil

Very little of cosmetic surgery procedures were done hitherto in most of the plastic surgery training institutions in Nigeria. The reasons for this are many. The practice and training is tilted significantly in favor of reconstructive surgery compared to aesthetic surgery with a ratio as high as 9:1 in the major teaching and training institutions in the country. As a result, experience is limited in cosmetic surgery and the trainees rarely participate in significant number of cosmetic procedures throughout their training. With the progressive increase in demand for cosmetic surgery locally, concerted efforts must be made to build the capacity of plastic surgeons to meet this growing demand. This article documents the experience of the author during a cosmetic surgery fellowship at the Ivo Pitanguy Institute, Rio de Janeiro, Brazil, and drew perspectives from the experience for the building of capacity for cosmetic surgery in Nigeria.

Auckland cataract study 2: clinical outcomes of phacoemulsification cataract surgery in a public teaching hospital.

A contemporary benchmark for the most common ophthalmic surgery. To assess patient characteristics and outcomes of contemporary phacoemulsification cataract surgery in a New Zealand public teaching hospital setting. Prospective observational study. Consecutive cases (n=500) of phacoemulsification surgery between April and June 2015. An independent observer assessed clinical and surgical data preoperatively and 4-6weeks postoperatively. Visual acuity, intraoperative and postoperative complications. Mean age was 72.3±11.9years and 57% female. Mean preoperative best-measured visual acuity was 6/30. Ocular comorbidity was present in 45.8% of eyes, most commonly glaucoma (10%), age-related macular degeneration (8%) and diabetic retinopathy (8%). Systemically, hypertension (59%) and diabetes mellitus (31%) were prevalent. Mean contralateral best-measured visual acuity was 6/12 (n=495) with 62% being phakic. The rate of posterior capsular tear was 2.6% and cystoid macular oedema 3.5%. Intraoperative complication rates were not significantly different between surgeon levels (P=0.234). However, registrars had fewer postoperative complications than fellows (2.2% vs. 11.9%, P=0.012). Postoperatively, mean unaided and best-measured visual acuity were 6/12 and 6/9. This study reports current phacoemulsification surgery outcomes in a major public teaching institution. A large proportion of patients exhibited systemic and ocular comorbidities, relatively dense cataracts and poor presenting visual acuity. However, visual outcomes and intraoperative complication rates were not statistically different between trainees and senior surgeons. Generally, outcomes reflect international standards and have improved since the last comparable study in this region.

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program

There are paradoxical associations among hospitals participating in the Hospital-Acquired Condition Reduction Program (HACRP) such that hospitals with more quality accreditations, those that offer advance services, major teaching institutions and those with better performance on other quality process and outcome measures are penalized more often in the HACRP.

Incidence and Demographics of Post-Operative Naloxone Administration: A 13-Year Experience at a Major Tertiary Teaching Institution

Background: Perioperative use of opioids is associated with the risk of opioid-induced respiratory depression. Naloxone is a competitive opioid antagonist typically administered to reverse opioidinduced respiratory depression. Postoperative administration of naloxone may be considered a proxy for significant postoperative opioid-induced respiratory depression and data regarding its use may be utilized as a quality measure. Few large studies have been done to characterize the population and define an incidence of naloxone recipients in the postoperative inpatient setting. Objectives: We aimed to characterize the demographics of patients receiving postoperative naloxone, as well as the incidence of administration in the first 72 post-operative hours at a large urban academic medical center in the United States. Study Design: This is a retrospective cohort study. Setting: Major urban tertiary teaching institution. Methods: The robust electronic record database of The Department of Anesthesiology at The Icahn School of Medicine at Mount Sinai, as well as the institution’s data warehouse were instrumental in allowing almost 450,000 surgical cases performed between 2001 and 2014 to be screened for naloxone administration within the first 72 postoperative hours. Organ harvests, outside of OR intubations, cancelled cases, and patients age less than or equal to 18 were excluded from the total case count. Results: Naloxone was administered 433 times in a total of 442,699 postoperative cases. This yielded an incidence of 0.1%. Additionally, the demographics of the group receiving naloxone were described. The mean age was 60, mean body mass index (BMI) was 27, 60% were women, and the mean American Society of Anesthesiologists (ASA) status was 3. Average time to naloxone administration was 21 hours (standard deviation 7) after surgery. Thirteen percent of the cases were emergent. Breakdown of anesthetic technique revealed that 81% of the cases were performed under general anesthesia, 7% with monitored anesthesia care (MAC), and 12% under neuraxial anesthesia. This study lays the groundwork for further elucidating risk factors for postoperative administration of naloxone. Limitations: This is a retrospective study. Conclusion: The overall incidence of postoperative naloxone administration over a 13 year period in approximately 450,000 patients was 0.1%. Demographics of this group were older, ASA 3 women, qualifying as overweight, but not obese, undergoing elective surgery with a general anesthetic technique. Average time to administration was 21 hours postoperatively. Key words: Post-operative, naloxone, respiratory depression, incidence

Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.

In fiscal year (FY) 2015, the Centers for Medicare & Medicaid Services (CMS) instituted the Hospital-Acquired Condition (HAC) Reduction Program, which reduces payments to the lowest-performing hospitals. However, it is uncertain whether this program accurately measures quality and fairly penalizes hospitals. To examine the characteristics of hospitals penalized by the HAC Reduction Program and to evaluate the association of a summary score of hospital characteristics related to quality with penalization in the HAC program. Data for hospitals participating in the FY2015 HAC Reduction Program were obtained from CMS' Hospital Compare and merged with the 2014 American Hospital Association Annual Survey and FY2015 Medicare Impact File. Logistic regression models were developed to examine the association between hospital characteristics and HAC program penalization. An 8-point hospital quality summary score was created using hospital characteristics related to volume, accreditations, and offering of advanced care services. The relationship between the hospital quality summary score and HAC program penalization was examined. Publicly reported process-of-care and outcome measures were examined from 4 clinical areas (surgery, acute myocardial infarction, heart failure, pneumonia), and their association with the hospital quality summary score was evaluated. Penalization in the HAC Reduction Program. Hospital characteristics associated with penalization. Of the 3284 hospitals participating in the HAC program, 721 (22.0%) were penalized. Hospitals were more likely to be penalized if they were accredited by the Joint Commission (24.0% accredited, 14.4% not accredited; odds ratio [OR], 1.33; 95% CI, 1.04-1.70); they were major teaching hospitals (42.3%; OR, 1.58; 95% CI, 1.09-2.29) or very major teaching hospitals (62.2%; OR, 2.61; 95% CI, 1.55-4.39; vs nonteaching hospitals, 17.0%); they cared for more complex patient populations based on case mix index (quartile 4 vs quartile 1: 32.8% vs 12.1%; OR, 1.98; 95% CI, 1.44-2.71); or they were safety-net hospitals vs non-safety-net hospitals (28.3% vs 19.9%; OR, 1.36; 95% CI, 1.11-1.68). Hospitals with higher hospital quality summary scores had significantly better performance on 9 of 10 publicly reported process and outcomes measures compared with hospitals that had lower quality scores (all P ≤ .01 for trend). However, hospitals with the highest quality score of 8 were penalized significantly more frequently than hospitals with the lowest quality score of 0 (67.3% [37/55] vs 12.6% [53/422]; P < .001 for trend). Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.

Pilot Validation Study of the European Association of Urology Robotic Training Curriculum

BackgroundThe development of structured and validated training curricula is one of the current priorities in robot-assisted urological surgery. ObjectiveTo establish the feasibility, acceptability, face validity, and educational impact of a structured training curriculum for robot-assisted radical prostatectomy (RARP), and to assess improvements in performance and ability to perform RARP after completion of the curriculum. Design, setting, and participantsA 12-wk training curriculum was developed based on an expert panel discussion and used to train ten fellows from major European teaching institutions. The curriculum included: (1) e-learning, (2) 1 wk of structured simulation-based training (virtual reality synthetic, animal, and cadaveric platforms), and (3) supervised modular training for RARP. Outcome measurements and statistical analysisThe feasibility, acceptability, face validity, and educational impact were assessed using quantitative surveys. Improvement in the technical skills of participants over the training period was evaluated using the inbuilt validated assessment metrics on the da Vinci surgical simulator (dVSS). A final RARP performed by fellows on completion of their training was assessed using the Global Evaluative Assessment of Robotic Skills (GEARS) score and generic and procedure-specific scoring criteria. Results and limitationsThe median baseline experience of participants as console surgeon was 4 mo (interquartile range [IQR] 0–6.5 mo). All participants completed the curriculum and were involved in a median of 18 RARPs (IQR 14–36) during modular training. The overall score for dVSS tasks significantly increased over the training period (p<0.001-0.005). At the end of the curriculum, eight fellows (80%) were deemed able by their mentors to perform a RARP independently, safely, and effectively. At assessment of the final RARP, the participants achieved an average score ≥4 (scale 1–5) for all domains using the GEARS scale and an average score >10 (scale 4–16) for all procedural steps using a generic dedicated scoring tool. In performance comparison using this scoring tool, the experts significantly outperformed the fellows (mean score for all steps 13.6 vs 11). ConclusionsThe European robot-assisted urologic training curriculum is acceptable, valid, and effective for training in RARP. Patient summaryThis study shows that a 12-wk structured training program including simulation-based training and mentored training in the operating room allows surgeons with limited robotic experience to increase their robotic skills and their ability to perform the surgical steps of robot-assisted radical prostatectomy.

Cost discrepancies for common acute care surgery diagnoses in Ohio: Influences of hospital characteristics on charge and payment differences

Charge and payment discrepancies exist between hospitals, although such variation is understood incompletely. We hypothesized that hospital characteristics may account for such differences. The 2011 Medicare Inpatient Prospective Payment System for Ohio hospitals was queried for discharge diagnoses of gastrointestinal bleed (GIB), GI obstruction (GIO), and laparoscopic cholecystectomy (LC). Analyses were performed to assess the association of hospital variables with charges and payments. For all three diagnoses, urban hospitals had greater median charges than rural hospitals; payments were not significantly different. Consequently, urban centers had lesser cost to charge ratios than rural centers for GIB, GIO, and LC: 0.29 versus 0.32 (P=.004), 0.27 versus 0.47 (P=.0007), and 0.26 versus 0.40 (P=.04), respectively. Centers with the greatest bed size had higher median charges and payments. Other discrepancies for all three diagnoses were greater payments at verified Level 1 centers and major teaching institutions (P value range <.0001 to .03). On multivariate analysis, excess charges were greater at urban centers for both GIB ($4,482, P=.02) and GIO ($5,700, P<.01). Hospital characteristics are associated with differences in charges and payments for acute care surgery diagnoses. Further study should investigate whether these cost discrepancies are associated with outcomes.

MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 2014MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM Alessandro Volpe, Kamran Ahmed, Prokar Dasgupta, Vincenzo Ficarra, Henk Van der Poel, Alexandre Mottrie, and ERUS board members Alessandro VolpeAlessandro Volpe More articles by this author , Kamran AhmedKamran Ahmed More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Henk Van der PoelHenk Van der Poel More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and ERUS board members ERUS board members More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The criteria set for surgeon’s competence before starting robotic surgery are neither structured nor evidence based. The development of structured and validated training curricula represents one of the current priorities in the robotic urologic field. METHODS A 12-weeks structured training program/curriculum was developed based on a focused group expert panel discussion and used to train 10 fellows from major teaching institutions across Europe. The key components of the curriculum were e-learning, an intensive week of structured simulation laboratory training (virtual reality simulator and dry/wet lab simulation platforms) and modular training in robot-assisted radical prostatectomy (RARP) at each institutions under supervision of the mentors. The technical and non- technical skills of the fellows were assessed by the mentors at the end of the program using previously validated GEARS (score 1- 5) and NOTTS (score 1-4) scales. At the end of the training, a full RARP performed by the fellows was video-recorded and blindly assessed by two independent expert robotic surgeons using a dedicated assessment scale. The scores of the fellows were compared with those of two expert robotic surgeons. The educational impact was evaluated with a dedicated questionnaire. RESULTS The fellows had limited previous console exposure (4 mos, IQR 0-6.5). At the end of the training, the fellows received an average score >4 (4.1-4.7) from their mentors for all the technical skills domains of the GEARS scale, with no negative scores (≤2). An average score ≥3.5 was also achieved for the 4 non-technical skills domains of the NOTTS scale, with no negative scores (≤2). Eight fellows were deemed able to perform a RARP alone by their mentors. At the assessment of the video-recorded RARP, 6 fellows received a sufficient score by the reviewers for all steps of the surgical procedure and 8 reached an average overall sufficient score. The robotic experts significantly outperformed the fellows for all surgical steps. At the final questionnaire, all fellows considered the program effective in improving their robotic skills and ability to perform the surgical steps of RARP with a mean score of 4.7 on a Likert-type scale (1=strongly disagree to 5=strongly agree). CONCLUSIONS This 12-weeks structured training program was successful to improve the robotic skills of fellows and their ability to perform the surgical steps of RARP. Further studies are needed to define the ideal length and schedule of these programs. This pilot study represents a step towards the definition of validated curricula for RARP and other robotic procedures. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e658 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alessandro Volpe More articles by this author Kamran Ahmed More articles by this author Prokar Dasgupta More articles by this author Vincenzo Ficarra More articles by this author Henk Van der Poel More articles by this author Alexandre Mottrie More articles by this author ERUS board members More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Medical Students' Conceptualizations of Quality of Life Associated With Children With IBD

The aim of the present study was to investigate second-year medical students' understanding of quality of life associated with childhood inflammatory bowel disease (IBD). A cross-sectional study in a major teaching institution in San Francisco was carried out. A questionnaire was administered following an hour-long gastroenterology lecture, which featured 2 young patients with pediatric-onset IBD who addressed everyday life with the disease. Analyses of numerate responses to the questionnaire were paired with a content and thematic analysis of audiotape recordings of the patients' commentaries. Medical students' responses to the patient interviews were extremely positive. Medical students gained a new awareness of the psychosocial complexities associated with living with a pediatric chronic illness and a new way of thinking about the meaning of "healthy." Despite listening to 2 healthy young patients, however, the medical students still conceptualized pediatric IBD in mostly, although not exclusively, negative terms. Medical students' perceptions of pediatric IBD improved as a result of listening to the patient interviews. Although this teaching modality effectively introduced students to a complex condition, it did not overcome their unfavorable impression of the effect of IBD on children's lives. The symptoms associated with IBD have stigma attached to them, and these stereotypes influence how medical students perceive those living with this chronic illness. More research and training in this area is necessary.

Redefining the Standardized Infection Ratio to Aid in Consumer Value Purchasing

The derivations of the standardized infection ratio (SIR) are reviewed in this report. To be most understandable to the consumer, the SIR National Benchmark of 1.0 should reflect what is obtainable.The SIR is a tool intended to be used by consumers in value purchasing to compare differences between facilities and thus should not adjust for these differences. Ideally, factors used in risk adjustment should solely be based upon patient characteristics. Thus, facility-specific adjustments (i.e., medical school affiliation, major teaching institution and unit bed size) should be used with caution in calculating the SIR and their use made clearly transparent to health-care consumers.Using data downloaded from the US Department of Health and Human Services' website, Hospital Compare, we observed an average SIR for central line blood stream infections of 0.568 and an SIR at the peak of the distribution curve approximating 0.35. A suggested methodology to calculate an obtainable SIR is to set the National Benchmark of 1.0 at the location of the distribution curve's peak. The curve's peak is more reflective of higher performing facilities. The SIR needs to reflect the expected performance of facilities, which are using up-to-date methods of infection control. The remainder of the facility SIRs can then be adjusted accordingly.It is recommended that the obtainable SIR be calculated every other year using data from the most recent 3 years. This enables the SIR to be reset as the control of health care-associated infections progressively improves.

Continuous Quality Improvement in Radiation Oncology is Feasible at a Major Tertiary Teaching Institution

Continuous Quality Improvement in Radiation Oncology is Feasible at a Major Tertiary Teaching Institution

Reasons Given By Trainees for Avoiding the Use of Acetaminophen and Non-Steroid Anti-Inflammatory Drugs In Patients With Chronic Liver Disease

Purpose: A survey by Rossi et al. (Drug Safety 2008;31:261-70) revealed that a majority of primary care physicians would recommend non-steroidal anti-inflammatory drugs (NSAIDs) over acetaminophen (APAP) for patients with chronic liver disease (CLD) while gastroenterologists (GIs) were more likely to recommend APAP at lower doses rather than NSAIDs. However, their study did not address the reasons behind these physicians' recommendations. We are unaware of any information on this topic amongst physicians in training. Therefore, as part of a survey to assess preferences for NSAIDs and APAP in CLD patients by trainees, we inquired about the specific reasons why senior medical students (MS4), internal medicine (IM) residents (PGY1-3), and GI fellows would avoid NSAIDS or APAP in this important patient population. Methods: A 21-question web-based survey was distributed using SurveyMonkey via email to MS4s, residents and GI fellows at several of the major teaching institutions in Washington, DC to determine what recommendations they would make regarding NSAID and APAP use in patients with chronic hepatitis of any cause (group I), compensated cirrhosis (group II), and decompensated cirrhosis (group III). Results: A total of 543 trainees were sent the survey with 174 (32%) responding. The results in Table 1 show that a majority of MS4s and IM residents were concerned about NSAIDs causing ulcers/GI bleeds in patients with CLD, whereas GI fellows were more concerned about NSAIDs precipitating renal failure in these patients. Table 2 shows that a majority of upper level residents and GI fellows were most concerned about APAP worsening underlying CLD as opposed to MS4s and interns. MS4s were the only group to suggest that the perceived lack of evidence-based literature for the safe use of APAP in CLD was their main concern against using APAP.Table 1: Primary reasons for not using NSAIDs in patients with CLDTable: [389] Table 2. Primary reasons for not using APAP in patients with CLDConclusion: The variable responses suggest that more education regarding the adverse effects of NSAIDs in CLD patients is warranted, especially at the student and resident levels. Further studies examining the safety of APAP in CLD are warranted to obtain recommendations that are beyond expert opinion.

Referral liability and interdisciplinary craniofacial or dentofacial anomaly care

Referral liability and interdisciplinary craniofacial or dentofacial anomaly care

The validity of the MSKCC nomogram in predicting overall survival of black patients with uterine cancer.

e15570 Background: To test the validity of a MSKCC nomogram for predicting overall survival in black women with uterine cancer. Methods: Retrospective review of a uterine cancer database at two major teaching institutions identified 636 eligible black patients with uterine cancer who underwent surgery between 1984 and 2009. We compared actual survival at the time of analysis to that predicted by the MSKCC nomogram based on age at diagnosis, grade, stage, histologic subtype, and number of negative lymph nodes. Subjects were divided into quartiles based on their model-based survival probability; Kaplan-Meier (KM) analysis was then applied to generate an independent estimate of survival probability for each quartile, along with a 95% confidence interval (CI). Results: The median age was 64 years (range; 28-100). Final grade included: G1 (n=253), G2 (n=187), G3 (n=391) and missing (4). Stage included: IA (n=149), IB (n=244), IC (n=76), IIA (n=28), IIB (n=62), IIIA (n=32), IIIB (16), IIIC (n=97), IVA (n=16), and IVB (n=115). Histology included: adenocarcinoma (561), carcinosarcoma (158), serous (93) and clear cell carcinoma (23). Median follow-up for survivors was 54 months (range; 1–274 months). For women in the upper two quartiles, the model-based probability of survival at 3 years was 0.976 and 0.924, and the KM for our patient population was 0.983 (95% CI 0.024) and 0.857 (95% CI 0.061), respectively. For women in the lower two quartiles the model-based probability of survival at 3 years was 0.761 and 0.331, and the KM estimate for our patient population was 0.700 (95% CI 0.080) and 0.174 (95% CI 0.063), respectively. Results regarding five-year survival for the upper two quartiles was 0.958 and 0.879, the KM estimate for our patients was 0.938 (95% CI 0.023) and 0.786 (95% CI 0.037) respectively. For patients in the lower two quartiles, the model-based probability was 0.645 and 0.183, and the KM estimates were 0.498 (95% CI 0.044) and 0.183 (95% CI 0.028) respectively. Conclusions: The nomogram is a good predictor of survival in black patients who are young and with early stages of disease. In contrast, the nomogram performed poorly in predicting survival in black patients who were elderly or had advanced stage disease.

National Football League Teams and Pregame Hyperhydration With Intravenous Fluid—Some Considerations

National Football League Teams and Pregame Hyperhydration With Intravenous Fluid—Some Considerations

University of Arizona College of Medicine: Tucson and Phoenix

University of Arizona College of Medicine: Tucson and Phoenix

Creating Effective Undergraduate Research Programmes in Science: The Transformation from Student to Scientist

This collection of papers analyses the effects and effectiveness of exposing undergraduate science students to research. The background is the growing US movement for major teaching institutions to...