The results of our survey provide insights into current transfusion practice and decision making in liver resection, including a comparison between anesthesiologist and surgeon transfusion behavior. Management of preoperative anemia, increased use of intraoperative blood conservation techniques, and improved communication between providers were identified as targets for quality improvement.
Introduction: As the online environment has evolved, the use of social networking sites (SNSs) has been integrated into the methods of teaching. Students across the world are currently using SNSs to enhance their learning. Objective: This study sought to explore the students' use of social media, in particular that of Facebook groups in medical education at the University of Ottawa. Methods: Pre-clerkship medical students (n = 160) were surveyed regarding the trends of use of SNSs in their learning. The survey consisted of 23 questions (Likert-style, multiple choice, yes/no, and short answer questions). Results: 94% of respondents use SNSs to facilitate their learning with Facebook (n = 98, 97%). Students mostly use Facebook groups for histology (30%), physiology (21%), etc. They mostly use SNSs for these particular subjects because the material posted is engaging. Sixty percent (60%) of students use SNSs to communicate with their colleagues and 59.8% stated that they prefer Facebook groups over pages. They prefer sample tests/quizzes and study guides (65.6%), followed by explanatory comments and an answer to a question (54.2%), etc. The downside of the use of social media in education is distraction and privacy issues. Conclusion: SNSs are used by the majority of students to enhance their learning, but to use them to their fullest; the material posted has to be concise, engaging and aligned with the learning objectives. Social media are contemporary and efficient communication tools that educators cannot overlook; the challenge is to choose the right platform, the amount and quality of the information shared to ensure optimal benefit and collaboration of the students.
Objective: Trans-arterial chemoembolization (TACE) is the recommended treatment for intermediate-stage hepatocellular carcinoma (HCC) according to American Association for the Study of Liver Disease (AASLD) guidelines. In an era of healthcare regionalization, it is unclear whether hospital volume is associated with post-TACE outcomes. Methods: The 2012 linkage of Surveillance, Epidemiology, and End Results (SEER)-Medicare database was utilized. A multivariable Cox proportional hazards model was utilized to evaluate the association between post-TACE survival and patient factors, hospital characteristics, and TACE volume. Results: 4258 patients with HCC treated with TACE comprised the study cohort. The mean age was 70, patients were 69.7% male, 60.6% Caucasian, 58.8% had HCV, 40.0% had multifocal disease, and median tumor size was 4.5 cm. Teaching hospitals, large hospitals and hospital performing >100 TACE treated 59.0%, 47.5%, and 35.8% of patients respectively. Median survival was 24.5 months. Unadjusted KM survival analysis demonstrated improved survival in hospitals performing >100 TACE annually (p < 0.001, figure). After controlling for sociodemographic, oncologic, and hospital characteristics, there was no significant association with TACE volume and survival. Significant survival predictors were household income, HBV status, extrahepatic disease, Charlson score, tumor size, AJCC stage, concordance with AASLD guidelines, and receiving additional oncologic treatments. Conclusion: Neither hospital size, teaching status, nor TACE volume predicted survival in the Medicare patient population. These data encourage widespread utilization of TACE.
Background: Telangiectasia macularis eruptiva perstans (TMEP) is a rare form of cutaneous mastocytosis which usually presents as ill-defined reddish brown telangiectatic macules. Although cutaneous mastocytosis rarely presents with systemic involvement, almost half of patients with TMEP demonstrate systemic mastocytosis. Currently, there is no guidance surrounding systemic testing in patients with TMEP. Case presentation: A 50-year-old Caucasian male was referred to the Clinical Immunology and Allergy clinic with a history of a rash. He initially presented to hospital 12 years prior with group A beta hemolytic streptococcus bacteremia treated with multiple different antibiotics. One week following discharge, he developed erythematous brown spots on his right leg which were flat, non-pruritic and not painful. The rash later expanded to his trunk and extremities. A skin biopsy performed two years prior to referral to our clinic demonstrated telangiectasia macularis eruptiva perstans. The CD117 immunohistochemical stain showed increased perivascular and interstitial mast cells in the superficial dermis. Darier’s sign was negative on physical examination, and venom testing was also negative. Although he had no symptoms of systemic involvement, a serum tryptase was elevated at 47.6 ng/mL in the context of normal kidney and liver function. A skeletal survey was normal and an abdominal ultrasound ruled-out splenomegaly. Bone marrow biopsy demonstrated a mild increase in paratrabecular and perivascular atypical mast cells, in keeping with systemic mastocytosis.Conclusions: Unlike other forms of cutaneous mastocytosis, patients with TMEP have a high likelihood of an underlying systemic mast cell disorder. Therefore, any patient presenting with characteristic skin findings should be investigated as having a cutaneous manifestation of systemic mastocytosis. This case demonstrates the utility of serum tryptase, and its role in triggering additional investigations and guiding appropriate therapy.
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