International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery.

BACKGROUND: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. OBJECTIVE: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. STUDY DESIGN: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. RESULTS: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90-0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82-0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. CONCLUSION: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.

Probing the amyloid-beta(1-40) fibril environment with substituted tryptophan residues.

A signature feature of Alzheimer's disease is the accumulation of plaques, composed of fibrillar amyloid-beta protein (Abeta), in the brain parenchyma. Structural models of Abeta fibrils reveal an extensive beta-sheet network with a hydrophobic core extending throughout the fibril axis. In this study, phenylalanines in the Abeta(1-40) sequence were substituted with tryptophan residues at either position 4 (F4W) or 19 (F19W) to probe the fibril environment. The F4W substitution did not alter self-assembly kinetics, while the F19W change slightly lengthened the lag phase without hindering fibril formation. The tryptophan fluorescence of Abeta(1-40) F19W, but not Abeta(1-40) F4W, underwent a marked blue shift during fibril formation and this shift was temporally correlated with thioflavin T binding. Isolated Abeta(1-40) F19W fibrils exhibited the largest fluorescence blue shifts consistent with W19 insertion into the Abeta(1-40) fibril inner core and direct probing of the substantially hydrophobic environment therein.

Predicting baccalaureate nursing students' first-semester outcomes: HESI Admission Assessment.

As a means of promoting evidence-based admission selection decisions in a baccalaureate school of nursing, the faculty at a college of nursing in the southeastern part of the United States investigated the value of including preadmission exam scores as one criterion in the admission protocol. The purpose of this study was to evaluate the use of Elsevier's HESI Admission Assessment (A(2)) exam as a predictor of student success. Four A(2) exams were administered to baccalaureate nursing students: reading comprehension, vocabulary & general knowledge, math, and anatomy & physiology. The mean of reading comprehension scores and vocabulary & general knowledge scores constituted the students' English scores, and the mean of all 4 exam scores constituted the students' A(2) composite scores. A(2) scores were correlated with final course grades in the 3 first-semester nursing courses (N = 184). There was a significantly positive (P ≤ .01) relationship between A(2) scores and final course grades for the 3 first-semester nursing courses-as A(2) scores increased, so did final course grades. Faculty concluded that A(2) scores provided a valuable measure of students' ability to succeed within the nursing program and, as such, they enabled faculty to make evidence-based decisions regarding applicant selection.

Pica for foam rubber in patients with sickle cell disease.

We report three cases of pica for foam rubber among sickle cell disease patients. All three were African-American males, and at the times of initial presentation for the pica, two of them were 11 years of age and one was 15 years of age. In all cases, the pica reportedly had been occurring for at least several years. The foam rubber was most often obtained from furniture and mattresses, as well as from ironing-board pads, stereo speakers, and padded hair rollers. Reports from other researchers also suggest that this is not an uncommon type of pica. We discuss this problem from biologic, psychologic, and social perspectives.

Test-retest reliability of a student self-assessment of professional behaviors.

The test-retest reliability of the University of Indianapolis School of Occupational Therapy Student Self-Assessment for Professional Behaviors was investigated. Twenty-seven first year and 31 second year students participated in the study. Results indicated that 31 (83.78%) of 37 academic questions answered by first year students were significant for test-retest reliability and 6 (16.22%) of 37 questions were not significant at alpha level 0.05. Of the 74 combined academic and clinical questions answered by second year students, 56 (75.68%) were significant for test-rest reliability and 18 (24.32%) were not significant at alpha level 0.05. To further examine results, 5 second year students participated in a focus group. Focus group results revealed themes regarding tool impressions, individual differences, and question display. Findings emphasized areas for revision to enhance test-retest reliability of the self-assessment tool.