WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe

The Effect of Early Detection and Treatment of Early-Stage Lung Cancer on the Thoracic Navigator Role.

Background: With preventive screening, increased focus on early detection, and advances in treatment in lung cancer, the multidisciplinary approach at Lehigh Valley Health Network Cancer Institute (LVHN-CI) continues to evolve, providing innovative care to this patient population. According to US Preventive Services Task Force, low-dose computed tomography has shown high sensitivity and acceptable specificity for the detection of lung cancer in high-risk persons. 1 Also, the number and proportion of patients diagnosed with early-stage disease are anticipated to increase. 2 The thoracic multidisciplinary clinic (T-MDC) has experienced changes leading to continuous evolution of the role of the thoracic-oncology nurse navigator (TONN). Oncology nurse navigators play a critical role in cancer screening and coordination of services. 3 Objectives: Identify the multiple roles of the T-ONN. Demonstrate the impact of the increase in early detection on the T-MDC and on the T-ONN role. Methods: Prior to the emphasis on low-dose CT (LDCT) screening, the T-MDC predominantly saw patients with stage IIIA-III-B disease. Since the increased focus on LDCT, more patients with stage 1 thoracic cancer with high-risk comorbidities are referred to the MDC for team evaluation and discussion of treatment options, including stereotactic body radiation therapy and robotic surgical options. The LDCT program LungRads 4 cases (L-RADS4) are reviewed in T-MDC for team recommendations. In 2018, an increase in the amount of LDCTs led to a higher number of L-RADS4 cases reviewed, contributing to early-stage diagnosis. The T-ONN has a dual role as T-MDC Clinic Coordinator and also as navigator for patients throughout treatment. The T-ONN prepares cases for review and moderates at pulmonary tumor board. A radiologist focusing on LDCT has joined the thoracic team. The T-ONN is point of contact for the radiologist and primary care physician, and is responsible to track data and outcomes for L-RADS4 cases, ensuring follow-up. Results: The total number of lung cancers at LVHN-CI increased from 408 in 2016 to 522 in 2017, and an annualized number of 430 for 2018. The number of visits to T-MDC was 359 from 2016 to 2018, with an average of 120 per year. The number of LDCT L-RADS4 has increased each year: 2016-12; 2017-17; 2018-35. Conclusions: The T-MDC\u27s increase in volume and complexity contributed to the hiring of 1 additional fulltime employee (FTE) for a total of 2 FTE T-ONNs plus cross-training of additional ONNs to cover the T-MDC, to allow for increased patient visits per clinic. The workload of the T-ONN has increased with added responsibilities, including increased preparation time, additional coordination of patient visits, ensuring appropriate imaging and testing are completed, and increased caseloads for ongoing navigation services. The T-ONNs participated in Lung Disease Management Team meetings in order to develop a workflow for the L-RADS4 population. An LVHN Network goal of increasing lung screenings ensures continued referrals to the T-MDC. This goal includes development of a comprehensive lung health program, including adding a nurse practitioner and support staff to follow all high-risk patients and ensure referrals to appropriate multidisciplinary care