Esophageal adenocarcinoma: A dire need for early detection and treatment.

Esophageal cancer is the sixth most common cause of cancer-related death worldwide. Esophageal adenocarcinoma is the most common subtype of esophageal cancer in the United States, and its incidence has risen dramatically in the last few decades. Modern endoscopic and surgical techniques have significantly improved morbidity and mortality rates of patients undergoing treatment for esophageal cancer. However, most cases are diagnosed at a late stage when the prognosis is poor, emphasizing the need for an effective screening strategy. This clinical overview focuses on screening, multidisciplinary evaluation, and treatment of early esophageal adenocarcinoma.

Striking rural-urban disparities observed in acute stroke care capacity and services in the pacific northwest: implications and recommendations.

BACKGROUND AND PURPOSE: The age-adjusted stroke death rate in adults aged ≥45 years is significantly higher in the Northwest region than in the rest of the United States. Alaska, Idaho, Montana, Oregon, and Washington have substantial rural and frontier areas with unique characteristics and complexities that pose challenges to timely acute stroke care and ultimately affect the patient. METHODS: A regional needs assessment was conducted to assess acute stroke care capacity and services in the Northwest region. Hospitals with an emergency department were surveyed with a standardized online tool based on the Brain Attack Coalition recommendations and developed by stroke neurologists, emergency medical services leaders, state public health professionals, and American Stroke Association members. RESULTS: Approximately 76% of hospitals completed the questionnaire. Striking rural-urban differences were seen with rural hospitals having a much lower capacity to adequately care for patients with stroke. Two thirds lacked the necessary personnel, one third lacked necessary neuroimaging equipment, and one fourth were functioning without written emergency department and tissue plasminogen activator stroke protocols. CONCLUSIONS: This survey represents the first comprehensive regional assessment of stroke care capacity and services both in the Northwest region and the whole United States. The findings have confirmed the need to focus on strengthening stroke personnel, increasing access to care, and promoting written protocols, especially in rural settings. Additionally, promoting stroke center certification, increasing the number of stroke registries throughout the region, encouraging use of inpatient stroke care protocols in rural hospitals, and conducting ongoing stroke care capacity and services surveys is highly recommended.

Preventing needlestick injuries in obstetrics and gynecology: how can we improve the use of blunt tip needles in practice?

Surgical needlestick injuries are common in obstetrics and gynecology and can cause transmission of viral diseases including hepatitis and acquired immunodeficiency syndrome (AIDS). Strategies to reduce the rate of needlestick injuries include using instruments rather than fingers to retract tissue and grasp needles, double gloving, using surgical staplers for skin closure, and substituting blunt tip surgical needles for sharp tip needles where applicable. Studies have shown the use of blunt tip surgical needles to be remarkably effective in reducing needlestick injuries. Despite recommendations by the American College of Surgeons that blunt tip surgical needles be used routinely, at least for fascial closure, and by the Occupational Safety and Health Administration and the National Institute for Occupational Health and Safety that these devices be used whenever medically appropriate, use in obstetrics and gynecology appears to be limited. Potential barriers to use include availability, the "feel" of the needle as it penetrates tissue, and habit. We suggest that blunt tip surgical needles have the potential to replace traditional needles for many obstetric and gynecologic applications. If their use is to become more widespread, we must focus on availability, evaluation for specific applications, and physician education.