Diagnostic peritoneal lavage (DPL) remains an accurate diagnostic test for intra-abdominal injury. This study examined the safety and efficacy of DPL performed by supervised residents in an urban trauma centre. A retrospective chart review was carried out of a one year experience (July 1994-June 1995). Junior surgical and senior emergency medicine residents rotating on the Trauma Service performed an open DPL by protocol under the direct supervision of senior surgical residents. Standard criteria were used for diagnosis. During this study, 1349 injured patients were admitted to the Trauma Service. Of these 525 patients underwent DPL. Complete records were available on 516 patients. The average age of the patients was 33 years and injury was primarily blunt (95%). There were 72 true positives, 428 true negatives, two false positive and seven false negative DPLs; for a sensitivity of 91.1%, specificity of 99.5% and accuracy of 96.9%. Complications occurred in 12 patients (2.3%): non-diagnostic DPL—7 (1.3%); intra-abdominal injury—4 (0.8%); wound complication—1 (0.2%). Seven patients underwent nontherapeutic laparotomy for a positive DPL. Thirty-four patients (6.6%) died, none from the DPL. DPL obviated the need for computed tomography scan of the abdomen and /or pelvis in 464 patients resulting in a cost saving of approximately $250 000. DPL performed by supervised junior surgical and senior emergency medicine residents is a safe and cost-effective method of evaluating patients with potential intra-abdominal injury.
Pancreatic ductal adenocarcinoma (PDAC) is a solid tumor mass that grows and metastasizes rapidly. There are no definitivemethods for early detection and most patients are diagnosed at a late stage. Those diagnosed at an early stage are eligible for tumorresection. However, many of these patients are soon burdened with tumor recurrence. The tumor grows back aggressively andwith resistance to the original chemotherapy. Gemcitabine has been the treatment of choice, but provides only minimal survivalprolongation. Researchers are trying to improve the current standard of care by finding different methods to improve treatmentefficacy and reduce side effects. This review emphasizes recent data on targeting the tumor using antifibrotic, nanotargeted, anddendritic cell therapies. Antifibrotic therapy aims to reduce tumor fibrosis, which prevents adequate chemotherapy penetration.Nanotargeted therapy offers precise targeting of cancer cells and chemotherapy delivery. Dendritic cell vaccines stimulate thebody’s immune system to target PDAC cells. These three treatment methods or a combination of them might improve the lifespanand quality of life for PDAC patients.
Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations.Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort ( n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program.The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities.The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.
