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Background: Percutaneous ablation therapy as a treatment for non-small cell lung cancer (NSCLC) has been increasingly utilized. There is little data on long term efficacy. Because of this we reviewed the rate of recurrence of all ablation procedures done at our institution for the last 6 years. Methods: A total of 36 patients underwent 43 percutaneous procedures from July 2008 until January 2014 at our institution. There were 9 patients treated with radiofrequency ablation (RFA) and 27 treated withmicrowave ablation (MWA) for Stage I NSCLC. Each patient was reviewed to determine if there was a recurrence, the time to recurrence and the characteristics of the original cancer possibly predisposing the procedure to failure. Results: There were 8 recurrences in 9 patients undergoing RFA occurring at a median time of 842 days (range 425 - 1568) after their procedure. MWA was utilized in 27 patients for 34 procedures with 11 patients experiencing recurrences at a median time of 487 days (range 168 - 845). The median follow up time for the RFA patients was 1631 days (4.46 years) and for the MWA patients 751 days (2.06 years). Of the RFA recurrences, 5 involved systemic spread of their cancer and 3 were limited to site recurrences only. Of the MWA recurrences, 5 involved systemic spread of their cancer, 2 had chest wall recurrences and 4 were limited to site recurrences only.
Objective: Admissions to
acute care hospitals represent a significant portion of healthcare utilization.
Little is known regarding hospitalization in the first postpartum year beyond
the traditional 6 weeks of the puerperium. We sought to investigate whether
there are identifiable risk factors for hospital readmission during this time
period. Study Design: We conducted a retrospective population-based study using
all California birth records between 1999 and 2003. These records were linked
with hospital discharge data for all admissions to California hospitals in the
first 365 days after delivery. For women with a first birth during the study period,
we assessed the likelihood of readmission to an acute care hospital between 42
and 365 days post-delivery. Univariate and multivariable logistic regression
were used to determine risk factors for these “late postpartum” admissions.
Results: Of 951,570 maternal birth admissions during the time period, 15,727
(1.7%) women were admitted in the late postpartum period. Women with an early
postpartum readmission, antepartum admission, extremes of maternal age, black
race, diabetes, hypertension, early preterm delivery and cesarean delivery had
higher rates of late postpartum readmission. Of women with an antepartum
admission for gestational diabetes or pre-existing diabetes, 6.6% and 18.5% of
these women experienced a late postpartum admission for a diabetes-related
diagnosis. Conclusion: Hospital readmission rates in the first year postpartum,
remote from delivery, are significant. Women are at a higher risk of requiring
hospital admission in the first year postpartum with select demographics and
Objective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Support Group (PDSG) programs. Methods: 32 OB/GYN residents participated in this IRB approved pilot study. Twenty residents were assessed with the Barry Challenges to Professionalism Questionnaire (Barry), the Jefferson Scale of Empathy-Physician Version (JSE), and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAT) in August 2010, as controls. Five Narrative Medicine sessions and four PDSG sessions were then used from August 2010-May 2011, for resident physician professionalism education. Seventeen residents then underwent post-testing with the Barry, JSE, and JSAT in May 2011. Results: The pre-test/post-test Barry comparison showed an improvement in scores after introduction of the new Narrative Medicine and PDSG curriculum (7.6 +/- 2.1 versus 8.4 +/- 1.6; p = 0.10) though this was not statistically significant. Pre-test/post-test comparison of JSAT scores showed a statistically significant decline in collaboration (52.3 +/- 4.1 versus 49.7 +/- 3.7; p = 0.028) while JSE scores showed a downward trend in empathy (109.3 +/- 10.0 versus 104.8 +/- 9.2; p = 0.086). Conclusion: Narrative Medicine and PDSG small group sessions could be an effective component of OB/GYN resident physician Professionalism curriculum. This pilot project was underpowered, due to limited resources.