An on-call escape room: Escaping the monotony of a didactic induction for doctors.

AIMS: To establish an on-call escape room as a novel educational tool for Foundation Year 1 (FY1) doctors' induction at Epsom and St Helier University Hospitals Trust. The escape room simulates common on-call scenarios for newly qualified doctors, with a view to facilitating communication and teamwork with unfamiliar peers and establishing a safe environment to develop practical skills. Ultimately aiming to reduce anxiety and improve confidence amongst our FY1 cohort. METHODS: A pilot escape room, as a simulated on-call shift with nine clinical scenarios, was designed for groups of 4-5 doctors. Following feedback, a 70-minute escape room with 17 clinical scenarios was established. Sequential completion of tasks would 'unlock' the door to handover with a senior colleague, thereby finishing the 'shift'. Questionnaires utilised a 10-point Likert scale to assess confidence and anxiety levels with regards to on-call shifts. Statistical analysis was performed using the Student's t-test. RESULTS: Pilot: Nineteen participants trialled the pilot escape room. Perceived levels of confidence increased from a mean of 5.0 to 7.1 (p < 0.05).Final: Forty-one participants underwent the final version of the escape room with perceived levels of on-call confidence increasing from a mean of 4.2 to 6.5 (p < 0.05), prescribing confidence from 5.3 to 6.6 (p < 0.05), using apps from 6.3 to 7.5 (p < 0.05), consulting trust guidelines from 5.0 to 7.0 (p < 0.05) and handing over from 5.8 to 6.8 (p < 0.05). Anxiety levels also decreased from 7.2 to 6.3 (p < 0.05) with an overall mean score of 9/10 for 'enjoyability' of the session. CONCLUSION: Incorporating an on-call escape room scenario into induction has demonstrably increased confidence levels and reduced anxiety levels amongst new FY1 doctors. This novel teaching method maximises participant engagement with the view to an enhanced learning experience.

Robustness of virus removal by protein A chromatography is independent of media lifetime.

The robustness of virus clearance with respect to protein A media reuse was demonstrated using media with four matrix chemistries: Protein A immobilized ProSep A, Poros A50, Protein A ceramic Hyper DF and MabSelect SuRe, an alkali resistant protein A ligand. Endogenous retrovirus clearance, step yield, impurity clearance and other performance parameters were evaluated periodically in media cycled up to 300 times. Media lifetime was generally limited by either declining step yield or media fouling. However, clearance of endogenous retrovirus remained in an acceptable range, either increasing or remaining constant. Multiply cycled media were tested for clearance of three viruses (SV40, X-MuLV, and MMV); clearance was comparable to naïve media. Overall, virus clearance by protein A chromatography appears to be extremely robust with respect to media age.

Conditional survival in gastric cancer: a SEER database analysis.

BACKGROUND: Gastric cancer survival is typically reported in terms of survival from the time of diagnosis. Conditional survival is a more relevant measure of prognosis for patients who have already survived 1 or more years since diagnosis. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER 17) database from the National Cancer Institute, we analyzed data from 20 018 gastric cancer patients diagnosed between 1988 and 1998. Using the life-table method, we computed 5-year relative conditional survival, grouped by summary stage, age, sex, and ethnicity, for patients who had already survived up to 5 years from diagnosis. RESULTS: Relative conditional survival improves over time for all groups of gastric cancer patients who survive a period of time after diagnosis. The largest gains in conditional survival were seen in patients with advanced stage disease. In general, females showed better survival than males. When grouped by ethnicity, Asians continued to have improved survival compared to other ethnic categories, even at 5 years out from diagnosis. CONCLUSION: For gastric cancer patients who survive a period of time after diagnosis, the largest increases in conditional survival are seen for patients with advanced stage disease and for those less than 65 years old. Conditional survival can provide more relevant prognostic information than survival from the time of diagnosis for gastric cancer patients who survive a period of time after diagnosis.

Sentinel node staging of primary melanoma by the "10% rule": pathology and clinical outcomes.

BACKGROUND: Surgical staging of clinically node-negative primary melanoma involves identification and removal of "sentinel" lymph nodes (SLNs). Although some suggest removal of only the "hottest" SLN, the "10% rule" dictates that nodes are removed until the background count is 10% or less of the count of the "hottest" node. METHODS: To determine the utility of the 10% rule, a university database of clinically node-negative melanomas surgically staged by using this rule was examined. RESULTS: Twenty-two of 177 cases (12.5%; 15% of T2 and T3 lesions) were SLN positive. Among the SLN-positive cases, use of the rule resulted in removal of 21 additional nodes, 7 of which contained tumor. In 3 cases (14%), the positive SLN was not the "hottest" node. At 49 months of mean follow-up time, overall survival was 63% for SLN-positive patients versus 92% for SLN-negative patients (P = .01). CONCLUSIONS: Sentinel node staging of melanoma by the 10% rule provides significant prognostic information and a modest increase in tumor detection compared with removal of only the "hottest" node.

Conditional Survival in Rectal Cancer: A SEER Database Analysis.

PURPOSE: To provide an analysis of conditional survival (CS) in rectal cancer patients. Cancer survival is typically reported in terms of survival from time of diagnosis. CS can provide improved prognostic information for patients surviving a given period after diagnosis. METHODS: Data from 36,321 rectal cancer patients diagnosed between 1988 and 1998 were analyzed using the Surveillance, Epidemiology, and End Results (SEER 17) database. Observed 5-year CS rates according to disease stage, age, sex, and race were calculated using the life-table method. RESULTS: As survival from diagnosis increased from 0 to 5 years, the 5-year observed CS changed from 73% to 74% for stage I disease, 56% to 66% for stage II, 47% to 65% for stage III, and 6% to 48% for stage IV. Patients aged 65 years and over at diagnosis had lower CS than those under 65 years, both at diagnosis (45% vs. 61%) and at 5 years from diagnosis (59% vs. 81%). Men had slightly lower 5-year survival than women, both at diagnosis (50% vs. 53%) and after 5 years (68% vs. 71%). Black patients had slightly lower survival than white patients for nearly all time points and stages. CONCLUSION: For rectal cancer patients who survive a given period of time after diagnosis, the largest increases in CS are in patients with advanced stage disease and for those under 65 years of age. CS can provide more accurate prognostic information for rectal cancer patients who survive a given period after diagnosis.

Impact of multiple re-use of anion-exchange chromatography media on virus removal.

We evaluated viral clearance in multiply-cycled anion-exchange media run in flow-through mode. We found that anion-exchange columns do not lose viral clearance capacity after extensive re-use, if they are cleaned with recommended buffers that do not chemically degrade the media. In contrast, anion-exchange (AEX) columns that are not cleaned or are cleaned with buffers that chemically degrade the media lost viral clearance capacity after extended use. In these cases, other performance attributes that changed at the same time were increased band spreading, decreased DNA clearance and accumulating backpressure that prevented re-use past 80-120 cycles. Thus, our data suggests that flow through mode anion-exchange columns that are cleaned with recommended cleaning buffers, and periodically monitored for band spreading, DNA clearance and/or backpressure need not be re-evaluated for viral clearance at the end of the validated media lifetime.