Fire corals (Millepora spp) are the second most common reef-forming organisms and are frequently found in tropical and subtropical waters. Fire corals are not true corals but rather hydrozoans more closely related to jellyfish and sea nettles. Rigidly affixed to the reef and with a branching structure, each fire coral is a colony of numerous individual hydrozoans forming a collective symbiotic organism. It is common for divers to accidentally make contact with fire corals. Fire coral contact is characterized by the immediate onset of burning pain caused by venom discharge from numerous tiny nematocysts located externally on the creature. Treatment consists of saltwater irrigation of the wound, nematocyst removal, and supportive care of the associated symptoms of pain, dermatitis, and pruritus. Rarely, fire coral can cause systemic toxicity. We present a case report of a 30-y-old recreational diver who experienced a fire coral sting of her left anterior thigh and review the recommended prevention and management of fire coral stings.
(CAHPS) survey questions, were collected at each on-treatment visit. Additionally, physicians completed the NCI CTCAE v4.0 toxicity score and collected UTEs from the patients' medical records. Propensity score weighting and regression methods were used to quantify associations between PNREs and patient experience. Results: 20/24 patients (pts) who enrolled with 2 months f/u during RT comprise our study cohort. Mean age was 64.5AE2.1 year (SEM); 60% male. Overall, 80 encounters occurred, median of 4 (range: 3-5). In 39% of encounters, at least one PNRE was reported yielding 40 total PNREs from 75% of the pts. 32.5% of PNREs were safety related while the remaining were related to pts' care experience. In encounters when pts did not report PNREs, the GHS and DT measurements were 70.8AE3.0 and 2.5AE0.4, respectively. In cases where pts reported at least one PNRE, GHS decreased to 63.9AE4.4 (pZ0.182) and distress increased to 3.7AE0.6 (pZ0.088). The GHS was even lower (56.4AE6.9) and distress higher (4.6AE0.9) in pts who experienced safety-related PNREs. Three study pts each had one UTE (15% of participants), including a hospital readmission for surgical complications. 15.4% of the adult safety-related PNREs related to these UTEs. The 5 pts who never reported a PNRE experienced no UTEs. Encounters in which PNREs were reported were associated with lower CAHPS composite scores e no PNRE: 58% top-box ratings; !1 PNRE: 19% top-box ratings (p<0.001). Conclusion: This pilot study demonstrates the feasibility of collecting PNREs to identify potential systems safety risks in a radiation oncology clinic. Future efforts will include a large phase II trial to validate these findings, and to assess the value of PNREs in improving cancer care processes and patients' outcomes.
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