Transfusion Camp Rwanda: A prospective feasibility study evaluating the delivery of Transfusion Camp to a multidisciplinary group of postgraduate medical trainees in Rwanda.

BACKGROUND: Safe blood transfusion is an increasing priority in global health equity. The Global Health 2030 commission lists access to a safe blood supply as essential for all surgical and nonoperative patients. The objective of this study was to determine if Transfusion Camp, when modified through a collaborative partnership between experts in Canada and Rwanda, results in improved knowledge and confidence among trainees in a resource-limited setting in sub-Saharan Africa. METHODS: This prospective study took place at The University Teaching Hospital of Kigali in Rwanda. Participants were postgraduate medical trainees from departments where blood transfusion is frequent. Participants watched five prerecorded lectures and then attended a 5-hour team-based learning seminar to consolidate learning. Pre- and post-data were analyzed on transfusion knowledge and trainee confidence. A Rasch analysis investigated the performance of individual questions in assessing respondent knowledge. RESULTS: Of 31 trainees from surgery, anesthesia, internal medicine, and pediatrics invited to the course, 27 trainees attended the in-person team-based learning and 24 trainees completed the pre- and post-course analysis. Trainee knowledge assessment improved from (mean ± SD) 7.7/20 ± 1.95 to 10.4/20 ± 2.4 (p < .0001) and this knowledge was maintained by 12 trainees on a 3-month follow-up with a mean score of 9.3/20 ± 2.3. Trainees reported increased confidence in managing transfusion medicine-related patient issues. CONCLUSION: This pilot study demonstrated that Transfusion Camp education content modified to the local context can result in increased knowledge and confidence in managing transfusion-related issues. These results will inform future planning of Transfusion Camp in resource-limited settings.

Transfusion medicine education delivery in Rwanda: Adapting Transfusion Camp to a resource-limited setting.

BACKGROUND: Due to few teaching faculty, resource-limited settings may lack the education curricula providers need for safe practice. As safe surgery becomes an increasing priority worldwide, it is essential to improve access to critical education content including in transfusion medicine. Transfusion Camp is a longitudinal curriculum, shown to increase knowledge in postgraduate trainees. The objective was to develop a sustainable bilateral partnership between Rwanda and Canada, and to integrate Transfusion Camp into the existing curriculum of the School of Medicine and Pharmacy at University of Rwanda. METHODS: A Transfusion Camp pilot course was initiated through collaboration of experts in Rwanda and Canada. Planning occurred over 6 months via online and in-person meetings. Canadian teaching faculty adapted course content via iterative discussion with Rwandan faculty. Final content was delivered through online pre-recorded lectures by Canadian Faculty, and in-person small-group seminars by Rwandan Faculty. Project feasibility was assessed through structured evaluation and informal debriefing. RESULTS: Twenty-seven postgraduate trainees were present for the pilot course, of whom 21 (78%) submitted evaluation forms. While the structure and content of the adapted Transfusion Camp curriculum were well-received, the majority of respondents indicated a preference for in-person rather than pre-recorded lectures. Debriefing determined that future courses should focus on continuing education initiatives aimed at physicians entering or already in independent practice. CONCLUSION: A partnership between universities and blood operators in high-resource and resource-limited countries results in a transfusion medicine curriculum that is locally applicable, multidisciplinary, and supportive of learning benefitting the learners and educators alike.

Efficiency and Safety of Balloon-Assisted Gastrostomy.

PURPOSE: To examine the safety and efficiency of balloon-assisted gastrostomy for insertion of large bore feeding tubes compared to conventional techniques using dilators. MATERIALS AND METHODS: Retrospective review of all fluoroscopically guided percutaneous gastrostomy tube insertions between July 2017 and September 2019 was performed. Collected data points included patient demographics, initial pathology, type of gastrostomy tube (G tube) inserted [(Avanos standard balloon retained (Mic-G), or low-profile balloon retained (Mic-Key)], type of insertion technique (balloon-assisted or -nested dilator technique), fluoroscopy time, amount of sedation required, technical success, and complications. The focus of the study was method of tract dilatation - either balloon-assisted gastrostomy (BAG group) versus nested or sequential dilators (dilator group). Two hundred patients were included in this study; 100 patients were evaluated in each group. RESULTS: There were no significant differences between the two groups. The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (11%, compared to 7% in the BAG group) but did not reach statistical significance. Males were associated with lower risk of minor complications (OR 0.19, 95% CI (0.07, 0.53)), while age did not present a significant association. Patients in the BAG group received a significantly lower amount of fentanyl (p < 0.001) and midazolam (p < 0.001) than patients in the dilator group. CONCLUSION: Balloon-assisted gastrostomy is a safe and effective technique for large bore gastrostomy placement. Patients required less sedation, allowing for faster recovery and discharge time in outpatients at our institution.

Evolving role of minimally invasive techniques in the management of symptomatic bone metastases.

PURPOSE OF REVIEW: Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities. RECENT FINDINGS: Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting. SUMMARY: Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.

Locoregional options in the management of cholangiocarcinoma: single center experience.

BACKGROUND: The purpose of this case series is to assess the safety and efficacy, as well as the overall survival (OS) and progression free survival (PFS) of patients with intrahepatic cholangiocarcinoma (ICC) treated with percutaneous ablation, transarterial arterial chemoembolization (TACE) or a combination of both at our institution. METHODS: Ten patients with pathological diagnosis of adenocarcinoma treated at out institution between January 1st 2013 and January 1st 2019 were reviewed. Three patients received a combined TACE and ablation treatment, three patients received TACE without ablation and four patients were treated with ablation only. Ablation technical success was determined by absence of residual tumor in the ablation zone on follow-up imaging one-month post-ablation. TACE response was assessed using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Technical success was defined as injection of chemoembolic material in the involved liver lobes. PFS and OS were calculated from the date of diagnosis. RESULTS: In the TACE and radiofrequency ablation (RFA) group, OS was 12, 55 and 56 months; PFS was 5, 6 and 32 months, one patient died and two others remain alive. In the TACE group, OS was 29, 10 and 5 months; PFS was 15, 10 and 4 months. All three patients remain alive. In the ablation group, OS and PFS were 16, 31, 30 and 40 months. All patients remain alive. Overall, 9 of 10 patients are alive, with a Median OS and PFS of 29.5 and 15.5 months, respectively, with some patients remain alive over four years following initial presentation. CONCLUSIONS: Our study shows that ablation and TACE in combination with more traditional modalities such as chemoradiation and surgical resection can extend survival in patients with ICC significantly. Locoregional therapy is well tolerated with only minor adverse events. The use of stereotactic body radiation therapy (SBRT) with ablation demonstrated the synergistic nature of using multiple lines of interventions.

It's a matter of time: The effect of depletion on communal action in romantic relationships is moderated by relationship length.

Researchers have only begun to turn their attention to the role of self-control in communal action (rather than communal restraint) in relationships. Conflicting results from early studies indicate that the association between self-control and communal action may be quite complex, and potentially moderated by many variables. Here we investigate how relationship length may moderate the extent to which communal actions require self-control resources. In 5 studies, we investigated the role of self-control resources in implementing (Studies 1 and 2) and in choosing (Studies 3-5) communal actions for a romantic partner, as a function of the length of time partners had been together. The data supported the hypothesis that as relationships mature over time, communal actions may require less self-control to implement and may become a decisional default. These findings suggest that communal actions may be a more deliberative response in newer romantic relationships but a more reflexive response in more established relationships.