A PATH TO RESUME AESTHETIC CARE EXECUTIVE SUMMARY OF PROJECT AesCert™ GUIDANCE SUPPLEMENT: PRACTICAL CONSIDERATIONS FOR AESTHETIC MEDICINE PROFESSIONALS SUPPORTING CLINIC PREPAREDNESS IN RESPONSE TO THE SARS-CoV-2 OUTBREAK.

This Project AesCert™ Guidance Supplement ("Guidance Supplement") was developed in partnership with a multi-disciplinary panel of board-certified physician and doctoral experts in the fields of Infectious Disease, Immunology, Public Health Policy, Dermatology, Facial Plastic Surgery and Plastic Surgery. The Guidance Supplement is intended to provide aesthetic medicine physicians and their staffs with a practical guide to safety considerations to support clinic preparedness for patients seeking non-surgical aesthetic treatments and procedures following the return-to-work phase of the COVID-19 pandemic, once such activity is permitted by applicable law. Many federal, state and local governmental authorities, public health agencies and professional medical societies have promulgated COVID-19 orders and advisories applicable to health care practitioners. The Guidance Supplement is intended to provide aesthetic physicians and their staffs with an additional set of practical considerations for delivering aesthetic care safely and generally conducting business responsibly in the new world of COVID-19. Aesthetic providers will face new and unique challenges as government stay-at-home orders and related commercial limitations are eased, and the U.S. economy reopens and healthcare systems transition from providing only urgent and other essential treatment to resuming routine care and elective procedures and services. The medical aesthetic specialties will therefore wish to resume practice in order to ensure high quality, expert care is available, and importantly to help promote patients' positive self-image and sense of well-being following a lengthy and stressful period of quarantine. In a number of areas, this Guidance Supplement exceeds traditional aesthetic office safety precautions, recognizing reduced tolerance in an elective treatment environment for any risk associated with COVID-19's highly variable presentation and unpredictable course. The disease has placed a disturbing number of young, otherwise healthy patients in extremis with severe respiratory and renal failure, stroke, pericarditis, neurologic deficits and other suddenly life-threatening complications, in addition to its pernicious effects on those with pre-existing morbidities and advanced age. Accordingly, the Guidance Supplement seeks to establish an elevated safety profile for providing patient care while reducing, to the greatest extent reasonably possible, the risk of infectious processes to both patients and providers. While the Guidance Supplement cannot foreclose the risk of infection, nor serve to establish or modify any standards of care, it does offer actionable risk-mitigation considerations for general office comportment and for certain non-surgical procedures typically performed in aesthetic medical settings. It is axiomatic that all such considerations are necessarily subject to the ultimate judgment of each individual healthcare professional based on patient situation, procedure details, office environment, staffing constraints, equipment and testing availability, and local legal status and public health conditions.

A Project-based Curriculum for Driving Organization-wide Continuous Improvement.

BACKGROUND: Creating the capacity and capability for meaningful improvement in healthcare quality is a challenge many organizations face. Before 2012, Children's Mercy sponsored 20 leaders to obtain advanced improvement training from peer organizations. Recognizing an opportunity to build upon this momentum, we developed an organization-wide curriculum for teaching continuous improvement. METHODS: A steering committee was created in 2011 to define, advise, and oversee education in improvement science. We agreed upon a framework for improvement, a program name [Continuous Quality and Practice Improvement (CQPI)], and a phased curriculum development approach, beginning with a project/experiential learning based course (Team CQPI). Course evaluation for Team CQPI consisted of a standard evaluation of objectives, pre- and post-course assessment, qualitative feedback, and serial assessment of project progress using the Team Assessment Score (TAS). The curriculum committee monitored improvement. RESULTS: From 2012 to 2017, 297 people participated in the project-based course, completing a total of 83 projects. TAS improved throughout the 4-month project-based course, from an average starting score of 1 ("forming a team") to 2.7 ("changes tested"). The average TAS at 12 months following completion of the Team CQPI course was 3.5 ("improvement") out of 5. CONCLUSIONS: Development of a comprehensive curriculum for driving continuous improvement has resulted in a measurable change in TAS scores representative of local improvement efforts.

[Cystic duplication of the esophagus, a rare etiology of dysphagia. Apropos of a case]. / La duplication kystique de l'oesophage, étiologie rare d'une dysphagie. A propos d'une observation.

A case of an upper oesophageal duplication in a 44 year old man was reported. Dysphagia was the only clinical signs and further examinations CT Scan, MRI performed for diagnosis. Surgical treatment (thoracotomy) was performed and postoperative complication was underlined. Cysts with oesophageal structure are unusual anomaly and surgery is difficult and dangerous.

Teamwork and leadership: the development of the National Psoriasis Tissue Bank.

The National Psoriasis Tissue Bank is the first tissue bank of its kind for psoriasis, providing cell lines and DNA samples to researchers worldwide who are actively seeking to locate the genes that cause psoriasis. Developed by a multidisciplinary, multi-institutional team, the tissue bank is also an interesting study in teamwork and leadership, as well as an excellent example of the expanding roles and opportunities for nurses.

Gene for familial psoriasis susceptibility mapped to the distal end of human chromosome 17q.

A gene involved in psoriasis susceptibility was localized to the distal region of human chromosome 17q as a result of a genome-wide linkage analysis with polymorphic microsatellites and eight multiply affected psoriasis kindreds. In the family which showed the strongest evidence for linkage, the recombination fraction between a psoriasis susceptibility locus and D17S784 was 0.04 with a maximum two-point lod score of 5.33. There was also evidence for genetic heterogeneity and although none of the linked families showed any association with HLA-Cw6, two unlinked families showed weak levels of association. This study demonstrates that in some families, psoriasis susceptibility is due to variation at a single major genetic locus other than the human lymphocyte antigen locus.

[Atypical cylindroma of the ethmoid]. / A propos d'un cylindrome de l'ethmoïde à expression atypique.

The authors relate an ethmoidal cylindroma, whose extension includes the orbital apex, without any ocular symptomatology. They wonder about the possibility of an early diagnosis of such tumors.

[Blast injuries of the ear. Current status and study of 200 cases]. / Les lésions auriculaires par blast. Aspects actuels et étude de 200 cas.

Clinical case-reports of 200 patients with blast-induced lesions are used as a basis for a review of physical and physiopathologic factors. Otologic aspects of injuries due to high-intensity shock waves are discussed and clinical and histopathologic features described. The place of post-traumatic pressure induced injuries to ear in catastrophy medicine is emphasized.

[Complications of decompression of the internal ear during diving]. / Les accidents de décompression de l'oreille interne lors de la plongée sous-marine.

Inner ear decompression sickness belongs inner ear barotrauma. It occurs after a dive with factors of risk. The diagnostic needs an accurate history and physical examination which allows emergency treatment: therapeutic recompression, then hyperbaric oxygen and perfusions of vasodilators + corticoids. The symptomatology is mainly vestibular and the discussion between peripheric and/or central lesions is still open.