Background:The COVID-19 pandemic has disrupted clinician education. To address this challenge, our divisional difficult airway program (AirEquip) designed and implemented small-group educational workshops for experienced clinicians. Our primary aim was to test the feasibility and acceptability of a small-group, flexible-curriculum skills workshop conducted during the clinical workday. Secondary objectives were to evaluate whether our workshop increased confidence in performing relevant skills and to assess the work-effort required for the new program. Methods:We implemented a 1:1 and 2:1 (participant to facilitator ratio) airway skills workshop for experienced clinicians during the workday. A member of the AirEquip team temporarily relieved the attendee of clinical duties to facilitate participation.Attendance was encouraged but not required. Feasibility was assessed by clinician attendance, and acceptability was assessed using three Likert scale questions and derived from free-response feedback. Participants completed pre and postworkshop surveys to assess familiarity and comfort with various aspects of airway management.A work-effort analysis was conducted and compared to the effort to run a previously held larger-format difficult airway conference.Results: Fifteen workshops were conducted over 7 weeks; members of AirEquip were able to temporarily assume participants' clinical duties. Forty-seven attending anesthesiologists and 17 CRNAs attended the workshops, compared with six attending anesthesiologists and five CRNAs who attended the most recent larger-format conference. There was no change in confidence after workshop participation, but participants overwhelmingly expressed enthusiasm and satisfaction with the workshops.The number of facilitator person-hours required to operate the workshops (105 h) was similar to that required to run a single all-day larger-format conference (104.5 h). Conclusion:It is feasible and acceptable to incorporate expert-led skills training into the clinical workday. Alongside conferences and large-format instruction, this modality enhances the way we are able to share knowledge with our colleagues. This concept can likely be applied to other skills in various clinical settings.

Purpose/Objective(s) Managing pediatric patients (pts) requiring daily general anesthesia (GA) for radiation (RT) in the setting of COVID-19 is complex, due to both the aerosolizing nature of GA procedures and the risk of cardiopulmonary complications for infected pts. We hypothesized that deliberate management of pts requiring GA for RO during COVID-19 would allow safe operations to continue. Materials/Methods Pediatric pts treated under GA at our tertiary hospital from 3/1/2020 to 1/29/2021 were identified; development of COVID-19 precautions began on 3/1/2020. Pts underwent COVID testing prior to their first treatment and thrice weekly (MWF) during treatment. Pts were accompanied by only one designated adult caregiver through the entire RT course; caregivers were verbally screened; and staff personal protective equipment (PPE) included surgical mask and eye protection. For COVID+ pts, RT was delivered at the end of day; a negative pressure room was used for GA induction and recovery; staff PPE included N-95 masks or powered air purifying respirators (PAPRs); and separate physician/nurse teams were designated for in-room vs. out-of-room pt management. Results 78 pediatric pts received RT under GA (vs. 69 pts over the same prior-year timeframe). From 3/1/2020-1/29/2021, mean age was 4.9 y (range 5.5 m - 19.0 y), 41/78 (52.6%) were male, and 2/78 (2.6%) received 2 courses of RT under GA, for a total of 80 courses. 24/80 (30.0%) courses were delivered to the chest, abdomen, and/or pelvis, 21/80 (26.3%) craniospinal axis, 17/80 (21.3%) brain, 9/80 (11.3%) total body irradiation, 5/80 (6.3%) head/neck, and 4/80 (5%) other. 64/80 (80%) of courses were delivered with curative intent. 39/80 (48.8%) used proton therapy, 18/80 (22.5%) photons, and 23/80 (28.8%) both modalities. Mean number of treatment fractions was 22.2 (range 1-40). 2/78 pts (2.6%) tested positive for COVID-19, both asymptomatic. Early in the pandemic (4/2020), pt 1 (a 3 yo female with neuroblastoma) had simulation delay for known household contact; after 5 weeks, COVID testing returned positive after the first day of RT. A 2 d treatment interruption was required to finalize institutional COVID guidelines, and treatment continued without incident. Because eye protection was not yet routinely used early in the pandemic, 17 staff were quarantined, but no further staff exposures occurred after precautions for the positive test were implemented. Later in the pandemic (1/2021), pt 2 (a 3 yo male with relapsed medulloblastoma) tested positive on initial COVID testing, requiring 10 d of COVID precautions for treatment; no staff exposures occurred. No caregivers screened positive, and no children presented for treatment without the designated parent. Conclusion With careful multidisciplinary planning to mitigate COVID-19 risk, pediatric RT with GA was carried out for a large pt volume without widespread infection, and without increased toxicities from eithe...

2016-12-24T18:18:19

Thyroglobulin (Tg) provides the peptide backbone for synthesis for thyroid hormones. Because previous studies by various techniques have raised the possibility of heterogeneity in Tg's message and translated protein, we have applied a highly sensitive ribonuclease protection assay (RPA) to examine the mRNA species translating part of Tg's C-terminal region, an area containing three of Tg's hormonogenic sites. Tissue samples were obtained from 18 normal and diseased human thyroids at surgery. Three probes spanning part or all of the nucleotide segment containing bases 7808-8086 in the cDNA sequence, detected full-length mRNAs as the dominant transcripts but also showed the consistent presence of at least seven discrete smaller mRNA species in the thyroid samples. The amounts of these smaller mRNAs varied among tissue samples without a discernible relationship to the underlying clinical thyroid condition. We conclude that the mRNA for this region of Tg is quite heterogeneous and offers potential opportunities for translation of different peptide sequences that might affect hormonogenesis in the C-terminal region of the protein.

No abstract