Transitioning from a Doctor of Nursing Practice clinical role to academic scholar.

Nursing faculty prepared with a Doctor of Nursing Practice (DNP) degree have unique needs as they transition from their clinical roles into full-time academia. As expert clinicians they share a wealth of knowledge that contributes to quality improvement and implementation of evidence-based practice in healthcare. However, they may lack the preparation needed for scholarship, a requirement for promotion, as well as retention, in many academic organizations. Traditional promotional processes are more in tune with the nursing faculty who have received a Doctor of Philosophy (PhD) degree, in which scholarship and research are a core component of their education and practice. As the number of DNP-prepared faculty increases, supporting successful transition to academia including scholarly productivity is essential to retention especially as nurse faculty shortages persist. Further research and resources are needed to help prepare and support DNP-prepared faculty to develop their scholarship with an increasing need to recognize the additional means of dissemination that these clinical scholars can utilize to meet the requirements of promotion.

Does race influence the attainment of the principles of oncologic surgical resection in colon adenocarcinoma? A retrospective cohort analysis from the national cancer database.

The standard operation for colon cancer resection should follow certain principles to ensure appropriate oncologic resection, such as retrieving 12 or more nodes with the specimen and adequate surgical margins. Although these principles are well documented, there is little evidence regarding the association of race and the attainment of an adequate oncologic resection. Methods: The authors performed a retrospective cohort study of all cases of resectable colon adenocarcinoma who underwent surgical resection in the National Cancer Database between 2004 and 2018. The postoperative lymph node count and margins were grouped as 'principles of oncologic surgical resection'. A multivariate logistic regression analysis was performed to assess race and other demographic variables as independent factors influencing the attainment of the principles of oncologic resection. Results: A total of 456 746 cases were included. From this cohort, 377 344 (82.6%) achieved an adequate oncologic resection and 79 402 (17.4%) did not. On logistic regression, African American and Native American patients were less likely to attain an adequate oncologic resection. Similarly, patients with an elevated Charlson-Deyo score (2 or above), stage I cancer, and patients who underwent extended resection were less likely to achieve adequate oncologic resection. Resections performed in metropolitan areas, patients with private insurance, high-income quartiles, and patients diagnosed in more recent years were more likely to achieve adequate oncologic resection. Conclusions: There are significant racial disparities regarding the attainment of the principles of oncologic resection in colon cancer, which could be explained by unconscious biases, social discrepancies, and inadequate healthcare access. Early introduction and conscientization of unconscious biases are required in surgical training.

Metastatic colon adenocarcinoma presenting as a giant inguinal hernia: A case report.

INTRODUCTION AND IMPORTANCE: Giant inguinoscrotal hernias (GIH) are a rare form of inguinal hernia. There have been few reported cases of GIH containing colon adenocarcinoma. CASE PRESENTATION: This case describes a 72-year-old male with a right GIH containing the right colon, terminal ileum, and associated mesentery with a large heterogenous, irregular mass with necrosis involving the cecum and ascending colon measuring 14 × 8 × 9 cm. The patient initially presented with pain and evidence of partial large bowel obstruction. Due to suspected extensive local invasion of tumor, the patient was scheduled for evaluation for possible neoadjuvant chemotherapy. Unfortunately, the patient re-presented with a large bowel obstruction and was subsequently taken for an exploratory laparotomy with trans-scrotal incision for en bloc resection of cecal adenocarcinoma and involved hernia contents. CLINICAL DISCUSSION: Due to the rarity of this pathology, there is not a standard approach to management or optimal surgical technique described. In this case, a trans-scrotal incision paired with an exploratory laparotomy allowed for superior access to the adhered cancer containing bowel as well as skin excision, following standard oncologic principle of high ileocolic mesenteric excision. CONCLUSION: The complexity of management of GIH containing colon cancer has been documented, however a standard oncologic approach has not been described. This case report presents exploratory laparotomy with trans-scrotal incision as an approach.

Implementation of educational escape rooms in a nurse practitioner doctoral curriculum.

Escape rooms have gained popularity as a means for team building while working to accurately complete challenging puzzles to 'escape' the room. The use of escape rooms is starting to emerge in healthcare education, including nursing, medicine, dentistry, pharmacology, and psychology. An escape room intensive was created and piloted using the Educational Escape Room Development Guide during the second year of the DNP program. The objective was to challenge their clinical judgment and critical thinking as they solved a series of puzzles created to provide hints for resolving a complex patient scenario. All faculty (n = 7) and most students (96 %, n = 26/27) felt the activity contributed to students' learning process while all students and the majority of faculty (86 %, 6/7) strongly agreed that content was relevant to develop decision making skills. Educational escape rooms can provide engaging, innovative learning to support development of critical thinking and clinical judgment.

Metastatic pancreatic adenocarcinoma presenting as large bowel obstruction: A case report.

INTRODUCTION AND IMPORTANCE: The incidence of pancreatic cancer has gradually increased over the past decades. Metastatic pancreatic cancer to the colon is rare with only seven cases reported. Symptomatic metastasis to the colon as the initial presentation of pancreatic adenocarcinoma has only been reported in two occasions prior to this report. CASE PRESENTATION: In this report, the diagnosis and operative management of a 78-year-old male who presented with three days of obstipation and computed tomography evidence of an annular obstructing mass in the sigmoid colon in addition to a pancreatic body and lesser sac mass involving the gastric antral region. The patient underwent a laparoscopic sigmoidectomy with end colostomy. Pathology revealed metastatic adenocarcinoma of pancreatic origin. The postoperative period was unremarkable, and the patient was referred to medical oncology to pursue further treatment. CLINICAL DISCUSSION: Symptomatic metastasis to the colon as the initial presentation of pancreatic adenocarcinoma is exceedingly rare. To our knowledge, this is the 3rd case to be reported and the second that was located in the sigmoid colon. CONCLUSION: The presentation of metastatic pancreatic cancer to the colon causing a colonic obstruction is rare but should be considered in cases of atypical synchronic masses in cross-sectional imaging. When metastatic disease is suspected in the sigmoid colon, it is advisable to perform a colostomy instead of an anastomosis to avoid the potential risk of anastomotic leak that could delay the immediate need for systemic therapy.

Emergent carotid endarterectomy and mechanical thrombectomy in tandem occlusion.

Background: Acute tandem occlusions, or occlusions of the extracranial portion of the internal carotid artery (ICA) with concurrent thromboembolism of the intracranial ICA or middle cerebral artery, poses a major clinical challenge, with patients suffering worse outcomes compared to those with single occlusions. Management of these lesions generally includes a combination of mechanical thrombectomy (MT) of the intracranial occlusion and stenting of the extracranial carotid lesion. In this manuscript, we describe a successful surgical method for achieving revascularization of tandem occlusions in the rare circumstance that the proximal lesion cannot be crossed endovascularly to gain intracranial access. Methods: Despite using our institution's standard protocol for achieving revascularization of such lesions, the extracranial occlusion could not be crossed endovascularly, and the case was converted to an emergent carotid endarterectomy (CEA) in the operating room. Once the endarterectomy was complete, intraoperative MT was performed before cervical incision closure to revascularization. Results: The patient recovered well postoperatively and was discharged with NIHSS of 2 due to minor facial palsy and minor dysarthria. Thirty-day follow-up revealed resolution of the prior neurologic deficits and an mRS of 1. Conclusion: Emergent CEA should be considered in the rare circumstance of being unable to cross the cervical occlusion during management of acute ischemic stroke with tandem occlusion.

Demographic Barriers for Genetic Testing in High-Risk Breast Cancer Patients in the Northern Michigan Area.

INTRODUCTION: The National Comprehensive Cancer Network (NCCN) has outlined guidelines for criteria regarding genetic testing for high-penetrance breast and/or ovarian cancer susceptibility genes. Due to the lack of availability of genetic counseling services in Northern Michigan prior to COVID-19, the utilization of genetic testing falls well below recommended guidelines. METHODS: Patients diagnosed with breast cancer in 2019 were randomly selected from Ascension Michigan's Northern Ministries Tumor Registry. A retrospective chart review was conducted. For patients who met NCCN criteria, their medical records were used to determine if genetic testing was recommended and if genetic testing was completed. Univariate (Crosstabs and t-tests) and multivariate tests with logistic regression were used to identify significant associations between the variables of interest. RESULTS: One hundred and two (102) patient charts were reviewed in this group; 55 (52.4%) were eligible by the NCCN guidelines for genetic testing. From this eligible subset of patients, only 29 were offered genetic testing, and only 21 were tested. The mean age of the patients offered genetic counseling was 56.2 years compared and 67.6 years in the group not offered counseling (p < 0.001). The patient's insurance type was an independent factor for obtaining genetic testing, specifically, the subgroup who had Medicare (OR = 0.73, CI = 0.01-0.54; p = 0.02). Patients insured through Medicare were less likely to obtain genetic testing after referral to a genetic counselor (p = 0.01). CONCLUSION: Genetic counseling for high-risk breast cancer patients is below average in Northern Michigan, likely related to lack of physician referral, poor availability of counseling services, low socioeconomic status as well as a lower level of concern in older ages.

Insights and Recommendations From Parents Receiving a Diagnosis of Pediatric Multiple Sclerosis for Their Child.

Forty-two parents of 41 children reported on their experiences receiving a diagnosis of pediatric-onset multiple sclerosis for their child through semistructured phone interviews. Time to diagnosis ranged from 8 hours to 16 years, with the mean age at diagnosis of 13.7 years. The most common initial symptoms included visual disturbances and numbness. The mean number of medical visits to receive a diagnosis was 3.6. Parents reported feeling frustrated and overwhelmed during the diagnosis process, as well as shocked when told their child had multiple sclerosis. Parents emphasized the need for more awareness of pediatric-onset multiple sclerosis. Numerous parents reported encountering physicians who believed multiple sclerosis did not occur in childhood, contributing to a longer time to diagnosis. Parents preferred physicians first share the diagnosis with the parents without the child present. Finally, parents appreciated when physicians provided a variety of resources to help them cope with the diagnosis.