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Multidimensional impact involving COVID-19 widespread in India-Challenges and upcoming route.
RESULTS At a mean follow-up of 46±17 months, mean subjective IKDC was 67.8±23; KOOS scores were symptoms, 78±22; pain, 78±23; function, 85±20; sports, 66±27; and activities of daily living, 59±25. selleck MRI MOCART score revealed incomplete scaffold healing in 21.4% of cases, with variable signal intensity within regenerated tissue. Functional scores did not correlate with reconstruction aspect on MRI. DISCUSSION/CONCLUSION 3D collagen scaffolds yield good medium-term clinical outcomes in large osteochondral defects of the knee. There is, however, a discrepancy between MRI features of the recipient site and objective and subjective clinical scores. These scaffolds may be a good option for treating large focal osteochondral defects in knees of young patients, but MRI does not provide satisfactory medium-term assessment. PURPOSE The Prosigna-PAM50 risk of recurrence (ROR) score has documented clinical utility for the prediction of 10-year distant recurrence (DR). The present study investigated the value of Prosigna-PAM50 for predicting 10-year DR and overall survival after 5 years of endocrine treatment for postmenopausal patients with invasive lobular carcinoma. PATIENTS AND METHODS Using the Danish Breast Cancer Group database, we identified patients with a diagnosis from 2000 to 2003 of estrogen receptor-positive, human epidermal growth factor receptor 2-negative invasive ductal (n = 1570) or lobular (n = 341) cancer > 20 mm or 1 to 3 positive lymph nodes and applied multivariate Cox models. RESULTS The median follow-up for DR was 9.3 years and for overall survival 15.2 years. Of the 341 lobular and 1570 ductal cases, 140 (41%) and 349 (22%) were classified as low ROR, with a 10-year DR rate of 7.7% (95% confidence interval [CI], 3.7%-13.6%) and 3.5% (95% CI, 1.8%-6.2%), respectively. The 10-year DR rate for the intermediate ROR group for those with lobular cancer was 18% (95% CI, 10.1%-27.9%) compared with 9.7% (95% CI, 6.7%-13.4%) for those with ductal cancer. Luminal B tumors had a significantly worse outcome than luminal A tumors in both lobular (hazard ratio, 1.89; 95% CI, 1.03%-3.45%; P = .04) and ductal (hazard ratio, 3.18; 95% CI, 2.29%-4.43%; P less then .0001) cancer. CONCLUSION Prosigna PAM-50 provides significant prognostic information beyond the clinicopathologic factors in patients with invasive lobular breast cancer. Those with lobular cancer had worse 10-year DR rates compared with those with ductal cancer in the same ROR category. Our results could have an effect on the treatment decisions regarding the addition of chemotherapy for those in the intermediate ROR group. BACKGROUND The COVID-19 pandemic presents a unique challenge to surgical residency programs. Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations, the educational landscape for surgical residents is rapidly changing. In addition, the time course of these changes is undefined. METHODS We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents, educators, and patients. Within the basic framework of limiting in-person gatherings, postponing or canceling elective operations in hospitals, and limiting rotations between sites, we propose innovative solutions to maintain rigorous education. RESULTS We propose several innovative solutions including the flipped classroom model, online practice questions, teleconferencing in place of in-person lectures, involving residents in telemedicine clinics, procedural simulation, and the facilitated use of surgical videos. Although there is no substitute for hands-on learning through operative experience and direct patient care, these may be ways to mitigate the loss of learning exposure during this time. CONCLUSIONS These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance. The support of national organizations may be beneficial in maintaining rigorous surgical education. Published by Elsevier Inc.BACKGROUND Emergency nurses work consecutive, rotating shift patterns. However, how their occupational physical activity levels are associated between these shifts is unknown. This study aimed to examine the associations between emergency nurses' time spent in different activity levels across one shift and the following day's shift. METHODS Fifty emergency nurses (45 female, five male) wore an ActiGraph accelerometer and completed work and sleep diaries across four weeks in 2018. A sub-sample (n = 42) also wore an activPAL inclinometer. Time spent sedentary, physically active, and in postural positions was determined. Multi-level analyses examined associations between one shift and the following day's shift. RESULTS Additional time spent sedentary and in light-intensity physical activity during the first shift was associated with more time spent being physically active in the following day's shift for all rotations except back-to-back night shifts. However, additional time spent engaged in moderate- to vigorous-intensity physical activity during the first shift was associated with less time spent physically active in the following day's shift for afternoon-morning and morning-afternoon rotations. CONCLUSION These findings demonstrate that shift sequences may impact emergency nurses' physical activity across shifts. Future research should identify the strategies emergency nurses use to maintain activity levels between shifts. BACKGROUND Blood culture collection remains the gold standard to diagnose bacteraemia. Current evidence suggests that the emergency department (ED) often has blood culture contamination (BCC) rates above the recommended 3%, contributing to increased hospital length of stay, unnecessary or inappropriate antimicrobial treatment, and increased economic burden. The aim of this review is to identify effective strategies to improve blood culture collection in EDs to decrease contamination rates and improve patient safety. METHODS An integrative literature review methodology was utilised to conduct a structured search of contemporary literature using CINAHL, Embase, Medline, Pubmed and Scopus databases. All eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool. RESULTS Eleven reports were included in the final review, which identified bundled approaches, education and feedback, equipment and technique, and stakeholder engagement as strategies that improve BCC rates in the ED.
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