St. Elizabeth Healthcare

Abstract Background: While there are abundant data on the surgical management of BC after neoadjuvant chemotherapy (NAC), there is less guidance regarding surgical management of BC after NET, particularly with respect to lymph node (LN) surgery. While pathologic complete response (pCR) is common with NAC, it is a rare event with NET. In this analysis we assess the surgeons’ approach in the context of NET. Methods: The ALTERNATE trial is a phase III study that randomized postmenopausal patients (pts) with clinical stage II/III ER+ HER2- BC to receive neoadjuvant anastrozole (A), fulvestrant (F), or both for 6 mos. before surgery. The primary objective was to determine if neoadjuvant F or A+F increases the rate of pCR or ypT1-2N0/N1mic/Ki67 <2.7% residual disease over A alone. Breast surgery was per standard of care. Sentinel lymph node biopsy (SLNB) with or without axillary lymph node dissection (ALND) was required to determine preoperative endocrine prognostic index PEPI score and residual cancer burden (RCB). Surgeons were required to indicate if the patient would be eligible for breast- conserving surgery (BCS) prior to NET. Patient accrual occurred from 2014-2018. The surgical outcomes are reported for the entire group. Results: Among the 3 treatment arms, 933 patients completed 6 cycles of NET. The clinical T stage at diagnosis was 73.6% T2, 22.6% T3and 3.8% T4. Initial tumor size was assessed by mammogram and ultrasound. Primary tumor histology was ductal in 64.8% and lobular in 25.4%.568 pts (60.9%) were clinically node negative (cN0), 36.2% cN1, 2.6% cN2 with 0.3% cN3. LNs were palpable in 25.2%. 383 had LN needle biopsy pre NET, of which 80.9% were positive. The surgeons’ initial impression of the patient’s eligibility for BCS was 74% while 0.6% were considered inoperable.75.5% of pts had post-NET imaging performed. Of those with tumor size recorded, 52.9% were T1 or not visible. Overall, 69.9% of the 933 patients had BCS. Of those 330 pts without post-NET imaging or who had post-NET imaging without a size noted, 64.8% underwent BCS. For pts undergoing BCS, 80.2% required only one surgery for margin clearance. Of the 690 pts deemed eligible for BCS pre NET, 79% had BCS. Of the 240 pts deemed ineligible for BCS pre-NET, 43.8% had BCS. Of the pre-NET cT2 tumors, 79% had BCS while only 45.5% of T3 tumors and 37.1% of T4 tumors had BCS. On surgical pathology, 474 (50.8%) pts were LN+ compared to pre-NET cN+ 39.1% and needle biopsy-proven 33.2%. For pts with pN0, 93.3% had SLNB alone. 6.7 % of pN0 had ALND alone or SLNB+ALND. For those with pN1-3 , 36.3% had SLN only; 37.3% SLN+ ALND; 26.4% ALND alone. Only 0.8% of the patients had no ALND or SLNB performed. Pts undergoing BCS were more likely to have SLNB alone for a +SLN compared to mastectomy pts (62.9% vs. 37.6%; chi-square p<0.0001). For pts with pre-NET +LN on needle biopsy, only 26.8% underwent SLNB alone, while 37.4% underwent ALND alone. Of the 204 LN-positive pts having SLNB alone, 55.9% had only 1 + LN and 27% had only 2+ LNs. For pN+ pts who underwent SLNB +ALND, 42.1% had 1-2 + LNs. Conclusion: With NET, 69.9% of pts achieved BCS, including 43.8% deemed ineligible pre-NET. Given the low rate of pCR to NET, there should not be the expectation of pCR in +LNs. Based on the procedures performed in pts with +SLNs, it appears that surgeons were applying ACOSOG Z0011 criteria for pts having BCS, but were less likely to omit ALND for +LN in pts having mastectomy. The finding of only 1-2 +LNs in many of the LN+ pts suggests that omission of ALND may be a reasonable approach post-NET. Longer follow-up is required to assess local-regional recurrence. Support: U10CA180821, U10CA180882; https://acknowledgments.alliancefound.org. Clinical Trials.gov Identifier: NCT01953588 Citation Format: A. M. Leitch, T. Dockter, V. suman, A. Weiss, G. W. Unzeitig, J. Guenther, S. Sanati, K. Vij, J. Hoog, A. Caudle, A. Tiersten, M. Mita, W. Razaq, T. J. Hieken, Y. Wang, M. Rimawi, M. J. Ellis, E. Winer, K. K. Hunt, A. H. Partridge, L. A. Carey. Surgical outcomes in the ALTERNATE trial (Alliance A011106) -a randomized phase 3 neoadjuvant endocrine therapy (NET) trial in postmenopausal women with clinical stage II/III estrogen receptor positive (ER+) and HER2 negative (HER2-) breast cancer (BC) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr RF1-02.

Emergency departments (EDs) in the US treat large numbers of people with opioid use disorder (OUD), but most health systems do not equip EDs to provide OUD care. CA Bridge has supported the implementation of low-threshold, ED-initiated medications for OUD bundled with harm reduction and patient navigation in more than 80percent of California EDs. Using grant reporting and California controlled substances prescribing data, we assessed CA Bridge implementation from July2022 through December2023, as well as 2022 California statewide ED buprenorphine prescribing. There were 165,671 patient navigator encounters and 44,996 instances of buprenorphine treatment at CA Bridge hospitals; patient navigator and buprenorphine treatment rates at public hospitals were more than 50percent higher than at private hospitals. In 2022, across the entire state, 1,737 California emergency clinicians wrote 6,382 buprenorphine prescriptions; 36percent of the people who were given those prescriptions received a subsequent buprenorphine prescription within forty days. Our findings suggest that EDs can reach large numbers of people with OUD, and buprenorphine uptake is high.

Background: Patients with end-stage heart failure-related cardiogenic shock (HF-CS) are conclusively associated with a poor health-related quality of life (HRQL). Axillary mechanical circulatory support (aMCS), such as the Impella 5.5, is increasingly used in this population and may improve HRQL during hospitalization by providing enhanced left ventricular unloading. We aimed to assess changes in HRQL between admission and two weeks after Impella 5.5 placement in patients with HF-CS, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: We conducted a prospective longitudinal analysis on patients with the Impella 5.5 between May 2023 and July 2023. Participants completed the condensed KCCQ-12 at admission and again two weeks post-implantation. Changes in the scores were evaluated using the Wilcoxon signed-rank test. Results: Fifteen patients were enrolled. The median age was 59 years (50-63), and the median ejection fraction at implantation was 20% (15-30). On admission, most patients reported an overall HRQL of poor-to-fair (46.7%) according to the summary KCCQ-12 score. The median overall summary score increased significantly after Impella 5.5 support (50.52 vs. 28.13, p = 0.005). Symptom frequency (70.83 vs. 43.75, p = 0.009) and quality-of-life (50.00 vs. 12.50, p = 0.023) domains improved significantly, while physical limitation showed a positive trend and social limitation remained unchanged. These HRQL improvements occurred alongside a significant shift toward lower SCAI shock stages, marked increases in cardiac output and cardiac index, and no escalation in vasoactive-inotropic requirements. Conclusions: Impella 5.5 support in HF-CS patients was associated with early and clinically meaningful improvements in HRQL, particularly in symptom frequency and quality of life, during the critical pre-transplant or recovery period. These findings suggest that the Impella 5.5 may provide both physiological and patient-perceived benefits in this high-risk population.

Medical records are comprehensive documents that provide detailed information throughout a patient’s hospitalization. The quality of a medical record is determined by its accuracy, completeness, validity, and timeliness. This study aimed to evaluate the completeness of electronic medical records for fracture patients at Santa Elisabeth Hospital, Medan. Samples were selected using simple random sampling and Slovin’s formula. Data analysis focused on patient identity sheets, anamnesis, informed consent forms, and medical resumes. The review of medical record completeness from January to December 2024 revealed 100% completeness for patient identity sheets, 90.8% for anamnesis, and 98.7% for medical resumes. In contrast, informed consent forms had a notably low completeness rate of only 19.7%, particularly in sections requiring patient or family signatures and administrative authorization. These findings highlight the need for targeted improvements, especially in completing informed consent forms, to meet the standards for optimal medical record quality.

Abstract Craniosynostosis involves early fusion of cranial sutures, resulting in an abnormal head shape and functional issues such as elevated intracranial pressure. Treatment involves surgery to correct the head shape and to allow unrestricted brain growth. This work aims to overcome the restrictions of current instruments by developing a novel articulated bone cutting tool for minimally invasive craniosynostosis surgery. A handheld tendon-driven tool with a bending section was developed to enhance reachability along the skull. The tool comprises a driving unit, a bending section attached to an end-effector, and a flexible endoscope. The prototype was developed and characterized to validate its accuracy, stiffness, bone-cutting capability, and reachability. A prototype was developed with a high reachability of 72.2%, 71.6%, 78.4% (length of the osteotomy/total planned path) using sagittal, metopic, and unicoronal craniosynostosis skull models, respectively. The tool demonstrated low deflection (≤5 mm for all configurations except for 0 deg bending) under 5 N external force and is capable of cutting bone-like materials with varying bending angles (range from 45 deg to 90 deg). These results indicate the potential of the bone-cutting tool to provide a paradigm shift in the treatment of craniosynostosis, expanding the benefits of minimally invasive approach to more patients.

The modern era of hepatic resection began with the first published report on "formal" right hemi-hepatectomy by Jean Louis Lortat-Jacob in France in 1952.1 Advanced imaging has enabled improved patient selection for potentially curative resection.2 Dramatic clinical and technical innovations over the last several decades have resulted in >50% five-year survival for patients undergoing resection; however, only about 25% patients with colorectal hepatic metastases (CRHM) will be candidates for operation.3 Given this modest rate of resectability, most patients will require a combination of systemic and local non-surgical therapies In this patient population, besides systemic chemotherapy, treatment modalities collectively termed "regional hepatic therapies (RHT)" may be employed. RHT include trans-arterial chemotherapy, hepatic artery infusion (HAI) pumps, trans-arterial radio-embolization (TARE) with Yttrium-90 (Y-90) and thermal tumor ablation using radiofrequency ablation (RFA) or microwave ablation (MWA). 4 In this review, we introduce RHT and discuss their utility in the modern day.