Jackson-Madison County General Hospital

Background/Objectives: Surgical ablation for atrial fibrillation (AF) during cardiac surgery decreases perioperative morbidity and mortality and improves long-term patient outcomes. Because of these benefits, it has been designated a Class I surgical society recommendation. As surgical ablation techniques have evolved, so too have ablation tools such as radiofrequency and cryothermal devices. In this study, we evaluated real-world evidence (RWE) of concomitant surgical ablation featuring an epicardial left atrial encircling lesion created by a novel bipolar radiofrequency clamp. Methods: Thirteen centers in the observational Tracking Results of Ablation to Combat AF (TRAC-AF) Registry (NCT05111015) contributed data used in this analysis. Included patients had AF and received the epicardial encircling lesion during cardiac surgery. Additional ablation and follow-up were per institutional standard of care. Freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) and survival were evaluated using the Kaplan-Meier method. Safety was evaluated within 30 days of the procedure. Results: Among 327 patients, 70% were male with a median age of 69 years. Sixty-nine percent had paroxysmal AF. Median left atrial diameter was 4.1 cm, and CHA2DS2-VASc score was 3. Isolated coronary artery bypass graft and aortic valve surgery were performed in 51% and 11% of patients, respectively. One- and two-year survival rates were 95.3% (95% CI, 91.7-97.3%) and 88.1% (95% CI, 81.5-92.5%). Through 12- and 24-months freedom from AF/AT/AFL was 87.4% (95% CI, 81.3-91.6%) and 79.9% (95% CI 72.0-85.8%). Mortality within 30 days of the index procedure was 1.5%. No serious adverse events were related to the epicardial cardiac ablation procedure or device. Conclusions: RWE from the TRAC-AF Registry demonstrates surgical ablation including an epicardial left atrial encircling lesion made by a novel bipolar RF clamp was safe and resulted in favorable long-term rhythm outcomes.

Bronchocutaneous Fistula Secondary to TuberculosisFIG. 1.(a) The blue arrow in the first two frames shows an expansile area during inspiration.The yellow arrow shows the collapse of the same region during expiration.(b) Chest X-ray: the red arrow shows a cavitary lesion in the right upper lobe of the lung.(c) A chest CT revealed an apical cavitary lesion (orange arrows) and a communicating lesion in the subcutaneous plane (blue arrow).CT, computed tomography.

The primary objective of this study was to evaluate the effectiveness of an autonomous oncology boot camp on Advanced Pharmacy Practice Experience (APPE) student knowledge. Secondary objectives included assessing student perception of the virtual learning experience and overall comfort level with the material. APPE students rotating through our institution between November 2019 and March 2020 were voluntarily enrolled in a 4-hour oncology-focused boot camp, which included five PlayPosit (Denver, CO, USA) interactive video lectures embedded with case-based application questions followed by one comprehensive web-based Quandary (Victoria, BC, Canada) action-maze case. Student learning was measured by a pre- and post-intervention exam. A web survey tool (Qualtrics, Provo, UT, USA) collected student perceptions evaluating their comfort with oncology-specific drug knowledge and APPE rotations tasks. Fifty students enrolled in the oncology boot camp, with 100% completing the pre- and post-intervention assessments. Overall, pre-intervention exam scores (mean: 55.4%, SD: 21.8%) improved by 23.2% following the boot camp (mean: 78.6%, SD: 19.2%; p < 0.001). Students performed better on all 10 exam questions, with 6 questions showing a statistically significant improvement (p < 0.05). Forty-five students (90%) completed the perception surveys. Of those, 93% agreed that it effectively reinforced important oncology knowledge, 91% supported the autonomous design, and 82% would recommend the oncology boot camp for future students. The boot camp proved to be a beneficial educational tool that enhanced student knowledge and confidence in navigating common oncology concepts. Students valued the ability to independently complete the activities and supported its continuation.

From the Madison General Hospital, Madison, Wisconsin. Reprint requests to Dr. George L. Lucas, 2704 Marshall Court, Madison, WI 53705. Received: January 14, 1980.

An open dislocation of the shoulder is a very uncommon and serious injury. The sequelae of open glenohumeral dislocation include infection, avascular necrosis, and limited motion. The patient with such complications will have serious compromise in shoulder function, as illustrated in this case report and reference to another report in the literature.

A RULE, reports of milkborne outbreaks I/ of shigellosis which have appeared in the literature traced the infection to known raw milk supplies.Milk contaminated after pas- teurization or improperly pasteurized may also carry infections to the consumer.Without ade- quate milk sanitation and the enforcement of laws and ordinances dealing with milk sanitation, the danger of the transmission of patho- genic organisms through milk is always present.An outbreak of shigellosis traceable to milk occurred in Madison County, Tenn., in October 1952.It was the first milkborne outbreak of shigellosis reported in the State. Features of the OutbreakOn the evening of October 14, 1952, a sudden outbreak of an illness occurred among school children and teachers in 3 Jackson grammar schools and in 1 Madison County school located approximately 5 miles from Jackson.In addition, there were a few scattered cases occurring Dr. Tucker is the director of the division of prevent- able diseases, and Mr. Fulkerson is sanitation con- sultant in charge of milk sanitation, both with the Tennessee Department of Public Health.Dr.