Something has Fallen: Pelvic Organ Prolapse or Vaginal Cuff Dehiscence and Evisceration? A Case Report.

SOMETHING HAS FALLEN: PELVIC ORGAN PROLAPSE OR VAGINAL CUFF DEHISCENCE AND EVISCERATION? A CASE REPORT.Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral mastectomy, radiation, chemotherapy, and robotic-assisted prophylactic hysterectomy and BSO 6 months prior. Relevant social history includes tobacco use and first postoperative coitus 2 days prior. CT abdomen/pelvis findings included microscopic pneumoperitoneum, pelvic organ prolapse, prolapse of bowel loops into the vaginal vault, and localized small bowel obstruction. In the ED she was diagnosed with POP, which was reduced, leading to a reduction in her pain. Subsequent examination revealed an abdomen tender to palpation. Speculum exam displayed no pelvic organ prolapse. Bowel was visible at the vaginal cuff with clear yellow fluid pooling in the vaginal vault. Vesicovaginal fistula was ruled out and VCDE was suspected. During exploratory laparoscopy, a 4 cm vaginal cuff defect was found and transvaginal cuff closure was performed. Post-operative course was uncomplicated, and the patient was discharged on POD #2

Spirituality: Take Me to a Higher Place

Panel Chair: Marta Moore Papers Presented: The Acceptance of Fate from a Man of God by Alexandra Mendez Acceptance Is Peace by Kane Stanglin Hindu Beliefs in Bhagavad-Gita by Laura A Eads Analysis of \u27The Sovereignty of Goodness of God\u27 by Kyle Crossli

THE ACUTE EFFECTS OF A GRIP-CONSTRAINT TOOL ON UPPER BODY AND RACKET KINEMATICS DURING TENNIS FOREHANDS

The purpose of this study was to compare the acute effect of a grip-constraint tool on upper body and racket kinematics during tennis single-handed forehand strokes. Upper-body and racket kinematics for two grip conditions, Preferred (self-selected) and Grip-constraint tool (fixed semi-western forehand grip) were captured for eleven tennis players using a 22-camera Vicon motion capture system (240 Hz). Using a grip-constraint tool resulted in a more closed racket face tilt (~4°) at ball impact while having variations in joint rotations across the shoulder, elbow and wrist. This possibly demonstrates the participant’s ability to self-organise compensatory angular rotations across the upper limb to achieve similar impact orientations. Collectively, these data demonstrate the acute responses to modifying grip technique using a grip-constraint tool during single-handed down-the-line forehands

Risk of mature B-cell neoplasms and precursor conditions after joint replacement : a report from the Haematological Malignancy Research Network

Associations between previous joint replacement and B-cell lymphoid malignancies have been reported, but despite numerous reports, associations with the disease subtypes have received little attention. Using a UK-based register of haematological malignancies and a matched general population-based cohort, joint replacements from linked hospital inpatient records were examined. Cases diagnosed 2009-2015 who were aged 50 years or more were included; 8,013 mature B-cell neoplasms comprising myeloma (n=1,763), diffuse large B-cell lymphoma (DLBCL, n=1,676), chronic lymphocytic leukaemia (CLL, n=1,594), marginal zone lymphoma (MZL, n=957), follicular lymphoma (FL, n=725), and classical Hodgkin lymphoma (CHL, n=255), together with monoclonal gammopathy of uncertain significance (MGUS, n=2,138) and monoclonal B-cell lymphocytosis (MBL, n=632). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated relative to 10 age- and sex-matched controls using conditional logistic regression. Having had a joint replacement before diagnosis was associated with myeloma (OR=1.3, 95%CI 1.1-1.5, p=0.008) and MGUS (OR=1.3, 95%CI 1.1-1.5, p<0.001). Excluding replacements in the year before diagnosis, the MGUS risk remained, elevated where two or more joints were replaced (OR=1.5, 95%CI 1.2-2.0, p=0.001), with hip (OR=1.2, 95%CI 1.0-1.5, p=0.06) or knee replacements (OR=1.5, 95%CI 1.2-1.8, p<0.001). Associations with CHL and two or more replacements (OR=2.7, 95%CI 1.3-5.6, p=0.005) or hip replacements (OR=1.9, 95%CI 1.0-3.4, p=0.04); and between DLBCL and knee replacements (OR=1.3, 95%CI 1.0-1.6, p=0.04) were also observed. This study reports for the first time a relationship between joint replacements and MGUS; while absolute risks of disease are low and not of major public health concern, these findings warrant further investigation. This article is protected by copyright. All rights reserved

Perspectives and practices of accredited tennis coaches when developing stroke technique

The purpose of this study was to understand current international tennis coaching standards related to the development of specific grip positions in tennis and to explore tennis coaches’ opinions on using physically constraining training tools for effective skill development. Accredited tennis coaches (n = 237) from 33 countries completed an anonymous online survey about their perspectives on the importance of grip positions for effective stroke development, and opinions on using physically constraining training tools for skill development. In the early stages of a player’s technical development, training grip positions was ranked as the second most important aspect of foundational technique. This preliminary research indicates that while it is important for tennis players to develop a variety of grip techniques, the most commonly used are the Semi-Western (forehand), the combination of Continental/Eastern forehand (double-handed backhand), and Continental for the serve. It also demonstrated that 65.2 ± 23.7% of coaches would utilise a physically constraining tool to assist in developing tennis-specific skills. Using this information can guide future evidence-based biomechanical investigations to assess the effects of acute and longitudinal biomechanics of using physically constraining tools for tennis-specific skills

Hodgkin lymphoma detection and survival : findings from the Haematological Malignancy Research Network

Background Hodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes.Aim To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL).Design &amp; setting The study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths.Method All 971 patients with CHL newly diagnosed between 1 September 2004–31 August 2015 were followed until 18th December 2018.Results The median diagnostic age was 41.5 years (range 0–96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate–high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged &lt;25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P&lt;0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained.Conclusion These findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients

The Global Health and Care Worker Compact: Evidence Base and Policy Considerations

Background During the COVID-19 pandemic, and recognising the sacrifice of health and care workers alongside discrimination, violence, poor working conditions and other violations of their rights, health and safety, in 2021 the World Health Assembly requested WHO to develop a global health and care worker compact, building on existing normative documentation, to provide guidance to ‘protect health and care workers and safeguard their rights’. Methods A review of existing international law and other normative documents was conducted. We manually searched five main sets of international instruments: (1) International Labour Organization conventions and recommendations; (2) WHO documents; (3) United Nations (UN) human rights treaties and related documents; (4) UN Security Council and General Assembly resolutions and (5) the Geneva Conventions and Additional Protocols. We included only legal or other normative documents with a global or regional focus directly addressing or relevant to health and care workers or workers overall. Results More than 70 documents met our search criteria. Collectively, they fell into four domains, within which we identified 10 distinct areas: (1) preventing harm, encompassing (A) occupational hazards, (B) violence and harassment and (C) attacks in situations of fragility, conflict and violence; (2) inclusivity, encompassing (A) non-discrimination and equality; (3) providing support, encompassing (A) fair and equitable remuneration, (B) social protection and (C) enabling work environments and (4) safeguarding rights, encompassing (A) freedom of association and collective bargaining and (B) whistle-blower protections and freedom from retaliation. Discussion A robust legal and policy framework exists for supporting health and care workers and safeguarding their rights. Specific human rights, the right to health overall, and other binding and non-binding legal documents provide firm grounding for the compact. However, these existing commitments are not being fully met. Implementing the compact will require more effective governance mechanisms and new policies, in partnership with health and care workers themselves

Disease-related factors affecting timely lymphoma diagnosis : a qualitative study exploring patient experiences

Background Expediting cancer diagnosis is widely perceived as one way to improve patient outcomes. Evidence indicates that lymphoma diagnosis is often delayed, yet understanding of issues influencing this is incomplete. Aim To explore patients' and their relatives' perceptions of disease-related factors affecting time to diagnosis of Hodgkin and non-Hodgkin lymphoma. Design and setting Qualitative UK study involving patients with indolent and aggressive lymphomas, and their relatives, from an established population-based cohort in the north of England. Method Semi-structured interviews with 35 patients and 15 of their relatives. Interviews were audiorecorded and transcribed, and qualitative descriptive analysis was undertaken. Results Participant accounts suggest that certain features of lymphoma can impact on patients' and healthcare providers' (HCPs) responses to disease onset. Three characteristics stand out: disease occurrence (rare), manifestation (varied), and investigative options (often inconclusive). Interviewees described how they, and some HCPs, lacked familiarity with lymphoma, seldom considering it a likely explanation for their symptoms. Symptoms reported were highly variable, frequently non-specific, and often initially thought to be associated with various benign, self-limiting causes. Blood tests and other investigations, while frequently able to detect abnormalities, did not reliably indicate malignancy. Interviewees reported the potential for improvements among HCPs in information gathering, communication of uncertainty, and re-presentation advice for non-resolving/ progressive health changes. Conclusion This study demonstrates the complex characteristics of lymphoma, perceived by patients as prolonging time to diagnosis, often despite significant effort by themselves, their relatives, and HCPs to expedite this process. The findings also illustrate why simple solutions to delayed diagnosis of lymphoma are lacking