Botsford Hospital

To report the clinical characteristics and autonomic profiles of a single-center experience with Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome (CANVAS).

Cochlear implant manufacturers currently contraindicate the use of electroconvulsive therapy (ECT) in CI users, citing theoretical evidence of potential harm to the patient or the implant despite a lack of clinical data. We report two uncomplicated cases of ECT in CI users, including the first reported case of bilateral ECT in a patient with bilateral CIs. The first case involves a 66-year-old visually impaired male with bilateral CIs. He suffered from major depressive disorder complicated by refusal of oral intake despite maximal pharmacological therapy. He underwent 9 consecutive cycles of bilateral ECT, after which his psychiatric condition improved. Cochlear implant function remained unchanged following the procedure. The second case involved a 65-year-old female with a left-sided CI and a history of recurrent depressive disorder. Her condition deteriorated with the onset of auditory hallucinations and increased suicidality. She underwent 8 consecutive cycles of unilateral ECT with right-sided electrode placement. Her psychiatric condition improved, and there was no change in CI impedance following the procedure. We report 2 successful cases of ECT in CI users, including the first reported case of bilateral ECT in a patient with bilateral cochlear implants. Further investigation into the safety of ECT in CI users is warranted to ensure that this crucial treatment modality remains available to this vulnerable patient cohort.

Abstract Background and Objectives: Neoadjuvant chemo-radiotherapy improves survival compared with surgery alone in locally advanced oesophageal cancer. In the Chemo-Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) randomised controlled trial (RCT), the median age was 60. However, one third of patients diagnosed with oesophageal cancer are aged ≥70 years. The reported outcomes and toxicities from the CROSS RCT are therefore limited in their application to older adult patients. The proportion of older patients with oesophageal cancer is increasing globally due to prolonged life expectancy and an aging population. The aim of this study was to investigate the clinical outcomes and toxicity reported in older patients (≥70 years) treated with neoadjuvant chemo-radiation for oesophageal cancer compared with those aged < 70 years in a tertiary Irish cancer centre. Methods: A retrospective cohort of patients treated with neoadjuvant chemo-radiation for oesophageal cancer was identified between 1st January 2015 and 1st January 2021. Eligible patients with cT1-4aNxM0 oesophageal cancer were identified in the Beaumont RCSI Cancer Centre database. Baseline characteristics and haematological toxicities were reported. Pathological response was reported. Chemotherapy toxicity was reported using the CTCAE Version 5.0. Survival was estimated using the Kaplan-Meier method. Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS). Results: In total 105 patients with potentially curable oesophageal cancer were included. One third (n=35) of patients were ≥70 years (older cohort) and 70 (67%) aged <70 years (younger cohort). In the older cohort, the median age was 75 (range: 70-86) and the younger cohort median age was 60 (29-69). The majority in both cohorts were male (73%). In 5 (14%) of the older and 7 (10%) younger cohort, individuals experienced ≥ grade 3 neutropoenia. In total, 80% of the older and 86% of the younger cohort proceeded to surgery. There was no difference in OS between the cohorts. There was also no difference in disease free survival (DFS) between the cohorts. Conclusion: In conclusion, in patients aged ≥ 70 years compared to those aged < 70 years, we confirm that neoadjuvant chemoradiation is tolerable. There was no evidence to suggest any differences in OS and DFS between the cohorts. Neoadjuvant therapy in appropriately selected patients aged ≥ 70 years with oesophageal cancer is a reasonable treatment choice.

Abstract Introduction Despite the multitude of urology podcasts developed for both patients and providers, there is little research on the use of urology podcasts and the effects of these podcasts on listeners and their behaviors. Objective We sought to identify listener interests and satisfaction with urology podcasts and determine whether the podcasts influences the listeners’ behaviors or health-related decisions. Methods Qualtrics surveys were distributed to both patients and providers who listen to urology podcasts via social media. Survey information assessed self-reported demographics and podcast listening habits. Participants selected specific urology podcast(s) and answered questions about satisfaction with the selected podcasts and how the podcast influenced their behaviors. A subset of questions were administered to providers about the podcast appropriateness for their level of training and whether the podcast influenced their practice. Results There were 212 survey participants. Demographics and podcast listening habits are listed in Table 1. Of the participants, 81.13% agreed or strongly agreed that the podcast(s) improved their knowledge of topics covered and 82.08% agreed or strongly agreed that the podcast(s) were clear and easy to understand. 85.19% were likely or extremely likely to recommend the podcast(s) to a friend. After listening to the podcast(s), 84.66% reported changing their behavior (i.e., went to the doctor, changed their practice). The most valuable aspects of the podcasts were the ability to review materials at their own pace (33.33%) and at any time (24.56%). The preferred lengths for podcasts were 15-30 minutes (35.47%) and 30-45 minutes (30.23%). Once weekly was the ideal frequency of new episodes (51.18%) while solo lecture-style was the preferred format (40.35%). Half of the healthcare providers were attendings, 17.39% were fellows, 10.87% were residents, 13.04% were students, 6.52% were advanced practice providers, and 2.17% were physical therapists. 91.84% agreed or strongly agreed that the podcasts were appropriate for their training. After listening to the podcast(s) 81.63% changed or planned to change their practice. Conclusions Urology podcasts are effective forms of education for patients and providers. Majority of listeners would recommend the podcast(s) to a friend and endorsed changing their behavior after listening to the podcast(s). Disclosure No.

‘Shrimp nail’, a rarely described entity, refers to a pronounced vertical curvature of the nail plate that resembles the back of a shrimp. It is caused by sequential onychomadesis that occurs before sufficient regeneration of the new nail is completed.[1][1] Onychomadesis, related to spontaneous

Background Electrocardiogram (ECG) interpretation is a core skill required of all doctors. Despite this, ECG interpretation remains suboptimal among medical students and doctors in clinical practice. This study assessed the impact of a short period of ECG teaching provided to medical students on completion of their academic curriculum. The primary outcome was the impact on students’ knowledge. The secondary outcome was the impact on confidence in ECG interpretation. Methods and Results Prospective cohort study of the impact of 2 hours of ECG teaching delivered by Cardiology trainees to final year medical students. Standardised 10 question examinations were given before and after the session. Questionnaires were given to assess confidence in ECG interpretation. Of 150 students who received teaching, 141 completed the pre-course examination and 139 completed the post-course examination (mean age 25.1 years; 55.5% female; 81.1% undergraduate). There was a statistically significant improvement in results after the course (p <0.001). The improvement was most significant in the assessment of heart rate and STEMI identification. Thirty-nine students completed feedback questionnaires. There was a statistically significant improvement in confidence in ECG interpretation (p <0.001). Conclusions This study showed an improvement in both ECG knowledge and confidence in ECG interpretation following 2 hours of teaching. The assessment of simple concepts such as heart rate improved more significantly than complex concepts such as conduction abnormalities. Our findings suggest a benefit from dedicated ECG revision programmes to enhance ECG knowledge and confidence in ECG interpretation.