Warring, Simrit K.

Endometrial cancer (EC) patients make up the second largest group of female cancer survivors. Patient-reported outcomes (PROs) including quality of life (QOL) and sexual function and satisfaction (SF and S) are critical facets of survivorship. This prospective, longitudinal study assesses associations between baseline characteristics and PROs after treatment. Herein, we report the baseline clinical characteristics and PROs prior to treatment initiation. Outcomes post-treatment over time will be reported separately. Patients with planned surgery for EC were prospectively enrolled in 2019–2021 and administered the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ-C30), EORTC QLQ EC Module (EN24), Patient-Reported Outcomes Measurement Information System (PROMIS), and the Mayo Clinic lower extremity lymphedema (LEL) questionnaire. This study enrolled 198 patients with a mean (SD) age of 63.6 (9.8) years and body mass index of 35.5 (8.3) kg/m2. No significant differences in the PROs for the QOL were seen when compared to the reference means (SD) except for the lower interest in sexual activity (31.9 (9.8) vs. 47.5 (SE0.70)) and lower fatigue (21.3 (19.8) vs. 31.7 (25.9)). Increased obesity was associated with an increased likelihood of LEL (p < 0.01) and multiple QOL scales, including poorer global health status (p < 0.01) and physical functioning (p < 0.01). Prior to treatment initiation for EC, the patients had a similar QOL compared to that of the general population. The patients with increasing obesity, a known risk factor for EC, had worse overall global health status and physical functioning. A better understanding of these QOL measures is imperative for earlier identification and intervention of patients at risk of chronic impairments from EC treatment.

Objective: Using a triage algorithm for primary cytoreductive surgery (PCS) reduces perioperative mortality, however, nonlethal complications are common. This study identified procedures associated with postoperative complications in triage-appropriate women, with the aim of guiding the next steps to foster surgical quality improvement. Materials and Methods: Consecutive triage-appropriate women with stage IIIC/IV ovarian cancer undergoing PCS, from January 2012 to April 2018, were included. The expanded Accordion scale was used to grade complications. Adjusted risk ratios ( RRs ) were calculated to quantify the association between concomitant procedures and risk of 30-day grade 3+ (G3+) complications by fitting Poisson regression models adjusted for performance status and age. Population-attributable risk (PAR) was calculated based on the adjusted RR s and prevalence of each procedure. Results: Of 214 women, 82.7% had intermediate- or high-complexity surgery, 68.7% had complete gross resection, 3.7% had residual disease >1 cm, and 18.7% experienced G3+ complications. In univariate analysis, operative time, surgical complexity, splenectomy, and bowel resection (any and extent of) were associated with G3+ complications. Operative time, bowel resection (any, extent of, and large) were associated with G4+ complications. In the adjusted analysis for G4+ complications, bowel resection (any, extent of, and large) had statistically significant PAR values of 60.7%, 54.7%, and 50.8%, respectively. PAR values associated with G3+ complications were 27.4% and 26.8% for any and multiple bowel resections, respectively. Conclusions: Bowel resection, upper abdominal procedures, and longer operative times are essential for PCS, but each contributes to the relatively constant rates of postoperative morbidity despite triage to prevent frail patients from undergoing PCS. Surgical-improvement research should focus on improving the safety of these procedures. (J GYNECOL SURG 39:123)

Ultrasound education continues to be integrated into gross anatomy courses in the United States. The team based design of the anatomy course at Mayo Clinic School of Medicine incorporates team‐based ultrasound oriented activities that are formalized through defined course objectives and assessed in the final examination. Providing personal handheld ultrasound devices to first‐year medical students during the gross anatomy course has been the mainstay of ultrasound education for the past three years. Handheld ultrasound devices have been provided to students for limited periods in some medical schools within the United States, but unique to this curriculum, students are assigned devices that can be utilized outside formal class time. This provides unlimited opportunity to apply their understanding of three‐dimensional, living anatomy, while simultaneously promoting student comfort and engagement with advancing ultrasound technology. Student perception related to the use of ultrasound outside of formal curricular time was evaluated on a five point Likert scale. Both quantitative and qualitative analyses were used to interpret the data obtained from this study. A total of three surveys were sent to medical students over a period of twelve months with an average response rate of 58.9%. Students indicated that (1) ultrasound devices at personal disposal during the anatomy course improved understanding of anatomical structures imaged ( mean 3.9, SD=+/− 1.01 ), (2) the handheld ultrasound device was easy to use ( mean 3.9, SD = +/− 0.8), and (3) it would be beneficial if ultrasound was implemented as part of the longitudinal learning experience in medical school ( mean 4.1, SD = +/ − 0.7 ). Students were not convinced that (1) having a personal ultrasound device influenced future choice of medical specialty ( mean 2.8, SD = +/− 1.0 ) and (2) the opportunity augmented coursework in the past three months of medical school at time of taking the survey ( mean 2.7, SD =+/ − 1.25 ). Results of the study indicated that access to personal handheld devices motivated students to use ultrasound devices and that they did so with increasing frequency outside of class time. In addition, students were able to apply and reinforce anatomical concepts by using landmarks to first locate and orientate the anatomic field and then interpret images of underlying structures. The fact that students did not see the value of ultrasound in determining future career choices or relate their learning of ultrasound to subsequent courses should not deter prospective opportunity for use of ultrasound in clinical practice. Basic ultrasound proficiency and an ability to effectively interpret scans are skills that in the long term will significantly decrease the learning curve in the use of technology as a diagnostic tool in future clinical settings. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Near‐peer teachers continue to be a significant driving force behind curricular changes that provide anatomy instruction to meet the needs of students in the current learning environment. Near‐peer teaching assistants (TAs) are important contributors in the facilitation of Mayo Clinic School of Medicine, anatomy course. The team‐based design of this course incorporates various approaches to team oriented activities, including introduction to radiology and ultrasound education and whole body dissections. TAs are equally involved in delivery of briefing sessions, prosections, guidance of student dissections, and review sessions. While students acknowledge educational benefits of learning anatomy through dissection, many still experience challenges in effectively using combined classical resources such as dissection manuals, textbooks, atlases, and various computer‐assisted tools. To enhance student competency in dissection as well as to maintain curricular alignment between clinically oriented course content and dissection goals often different than what is presented in dissection manuals or commercially available videos, TAs dissected a cadaver and created short videos. Videos outlined necessary steps for the assigned dissection, identified challenging aspects of dissection procedure, and provided review of clinically relevant anatomic structures. Videos were filmed daily by TAs using commercially available iPads or iPhones and edited using iMovie software. All videos were uploaded to Blackboard curriculum management system the day before dissection and remained accessible to students throughout the course. The objective of this study was to determine medical student satisfaction and utilization of near‐peer created teaching videos for preparation and guidance of laboratory dissection. A total of 28 videos were created that ran from approximately 2 to 13 min in duration. Viewing data for the videos was tracked on the server and a survey was distributed to the students after the final examination (IRB protocol #17‐009090). Response rate was 91% (48 of 53 students responded to the survey). The survey used a five‐point Likert scale in which 1 = strongly disagree and 5 = strongly agree. In general, students found the videos useful in their preparation for laboratory dissection. They agreed that they frequently used the videos to prepare for the assigned dissection (4.74) and they felt that videos improved their efficiency (4.73) and confidence (4.45) in the laboratory. Additionally, 47% of students ranked the videos as their primary resource for dissection preparation. Near‐peer created videos provide an inexpensive and effective alternative to commercially available products. In addition, these videos allow facilitators to relate course specific material with dissection goals, advance self‐directed learning, and help students overcome the challenge of potential cognitive overload from the need to consult too many references within a short timeframe of the dissection laboratory. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .