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Despite subtle differences between the laparoscopic and open approaches to inguinal hernia repairs in octogenarians, both procedures are safe with similar outcomes.

Purpose To analyze a multidisciplinary community experience with oncoplastic breast surgery (OBS) and postoperative radiation therapy (RT). Methods The records of 79 patients with localized breast cancer who underwent OBS + RT were reviewed. OBS included immediate reconstruction and contralateral mammoreduction. All patients had negative surgical margins. Whole breast RT was delivered without boost. A subset of 44 patients agreed to complete a validated quality of life survey pre-RT, post-RT, 6 months after RT, and at final follow-up assessing cosmesis and treatment satisfaction. Results Sixty seven patients (85%) were Caucasian. Median age was 62. Median interval between OBS and RT start was 9.6 weeks. Median RT dose was 46 Gy. Fourteen patients (18%) developed surgical toxicities prior to RT. Five patients (6%) developed RT toxicities. Physician rating of cosmesis post-RT was: 3% excellent, 94% good, and 4% fair. Cosmesis was rated as excellent or good by 87% of patients pre-RT, 82% post-RT, 75% at 6 months, and 88% at the final follow-up. Treatment satisfaction was rated as “total” or “somewhat” by 97% of patients pre-RT, 93% post-RT, 75% at 6 months, and 96% at final follow-up. No significant relation was found between patient or treatment-related factors and toxicity. Local control is 100% at median follow-up of 2.9 years. Conclusions OBS followed by RT resulted in acceptable toxicity and favorable physician-rated cosmesis in this large community series. Patients’ ratings of cosmesis and treatment satisfaction were initially high, decreasing at 6 months, returning near baseline at final follow-up.

Introduction The purpose of this evaluation was to determine the effectiveness of the clinical nurse transition program (CNTP) for newly commissioned Army nurses. This is one of the first evaluations conducted to document the outcomes of the Army Nurse Corps (ANC) transition-to practice residency program. Materials and Methods This project was a prospective pre-test/post-test design evaluation of newly licensed registered nurses (RNs) entering the military health system from Fall 2017 to Fall 2018 using Casey-Fink Readiness for Practice Survey and the New Graduate RN Transition Program Competency Assessment Tool. Data were analyzed using SAS 9.4. All tests were two-tailed as applicable and p-values less than 0.05 were considered significant. Missing data were treated as missing for individual items; their values were not imputed. No participant was excluded due to missing items. This evaluation was determined to be exempt from human subject protection regulations by the Human Protections Administrator at Womack Army Medical Center. Results A total of 92 pre-test surveys were sent to the nine CNTP training sites which actively trained RNs during the study timeframe. Due to a shipping error, 6 of the 92 completed pre-test surveys from one CNTP site were not received, for an overall response rate of 93.4% (86/92), from eight CNTP sites. Of the 86 participants from whom pre-tests were received, all 86 successfully returned their post-test survey, for a 100% response rate pre- to post- survey. The participants were predominately white (73.3%) and female (70.9%) with a median age of 23 years (IQR: 22–24 years) and an undergraduate GPA of 3.5 (IQR: 3.4–3.7, Table II). Quantitative data analysis revealed that after the training, all participants reported a significant improvement in providing safe (p < 0.0001) and quality care (p < 0.0001) for an average workload of in-patient patients. It also showed a significant improvement in team leading (p < 0.0001), effective decision making (p < 0.0001), incorporating evidence into practice (p < 0.0001), and demonstrated professionalism (p < 0.0001). The overall clinical competence and readiness to practice (p < 0.0001) also improved. Data shows that participants perceive significant improvement in all the objectives set by the ANC for the transition program. Conclusion The results of this program evaluation provide evidence that the CNTP has been a success in meeting the intended objectives. Participants showed a significant improvement in their perceived readiness and level of competency in clinical, technical, and leadership skills performance at the end of the program, as well as improved communication and teamwork. The CNTP experience provides an effective means to facilitate the development of newly licensed Army nurses’ clinical competence and confidence in practice. The study limitation includes the Casey-Fink Readiness for Practice Survey had relatively low reliability, but it was chosen as it was better aligned to the specified CNTP objectives. And also, with any self-reported evaluation, there is potential bias regarding the accuracy of participants’ self-perception. Follow-up study may include examining the demographics of the incoming nurses, such as their source of commission. To determine if and how the comfort and confidence self-reported by the new graduate nurses is reflective of actual ability, nurse preceptors may be asked to complete skills assessments or simulations with objective measurements may be used.