Cellulitis in patients with chronic lower-limb lymphedema due to HIV-related Kaposi sarcoma

Objective Chronic Lower Limb Lymphedema (CL-LL) secondary to Kaposi sarcoma (KS) has not been recognized as a risk factor for cellulitis. The aim was to describe the clinical spectrum and use of antimicrobial prophylaxis in patients with cellulitis and CL-LL due to KS. Methods HIV patients with KS, CL-LL, and at least one episode of cellulitis seen at the AIDS Cancer Clinic at INCan in Mexico from 2004 to 2019 were included. Demographic and clinical data were obtained from medical records. Results Thirty-nine men all with CL-LL were included. Clinical factors associated with cellulitis were groin and/or lymph-node KS infiltration (69.2%), onychomycosis and/or tinea pedis (44.7%), ulcerated lesions (38.4%), and obesity (2.5%). Eighteen (46.1%) were hospitalized in the first episode and eight (20.5%) in recurrence. Six (25.3%) died, two of toxic shock syndrome (TSS), and one of septic shock. Fourteen (35.8%) had at least one recurrent episode of cellulitis. Twenty-five (64.1%) received prophylaxis. Patients without prophylaxis had significantly more unfavorable outcomes (hospitalization and recurrences) than those with prophylaxis. Conclusions CL-LL due to KS is a risk factor for cellulitis and severe complications in patients with a long life expectancy. Antimicrobial prophylaxis needs to be explored as it could prevent complications.

The design, implementation and evaluation of hybrid cancer clinic simulations: Escaping the norm

Introduction Simulation and gamification are two popular educational tools utilized to enhance student learning and engagement. This study aimed to evaluate the effectiveness of integrating a hybrid cancer clinic simulation into the curricula for third-year pharmacy (P3) students. Methods This prospective, single-arm pilot study incorporated a mixed-method learning activity involving patient simulation and escape room elements. Two cancer clinic simulations were developed by faculty members. For each clinic, students were randomly divided into 6 groups and tasked with completing a series of Pharmacist Patient Care Process (PPCP) activities involving patient actors. The PPCP activities were interwoven with engaging puzzles and games to simulate an escape room. Student learning and retention was measured by pre- and post-simulation quizzes and course level exams. A perceptions survey was administered after each simulation activity. Results Thirty-six students participated in both cancer clinic simulations, with 100% completing all aspects of the study. Mean student quiz scores improved from 61.4% to 81.7% (p < 0.0001) and 52.6% to 81.8% (p < 0.0001) following the first and second simulations, respectively. Exam performance improved for 16 out of 19 exam questions, with a significant increase in 4 questions (p < 0.05). Students overwhelmingly agreed that the cancer clinic simulations 1) reinforced knowledge, 2) facilitated PPCP, 3) improved their ability to make chemotherapeutic recommendations, 4) enhanced problem-solving skills, and 5) encouraged collaboration. Conclusion This innovative hybrid simulation enhanced oncology-related knowledge and supported an interactive environment that improved student confidence and teamwork. Students enjoyed the simulations and recommended continuation for all future cohorts.

Variability in the Histopathological Diagnosis of Nonmelanocytic Lesions Excised to Exclude Melanoma

Introduction. The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions. Objectives. We examined the variability between pathologists in diagnosing non-melanocytic lesions. Methods. As part of a larger study prospectively examining the diagnosis of lesions excised to exclude melanoma in 198 patients at a primary care skin cancer clinic in Newcastle, Australia, we compared diagnosis made by 5 experienced dermatopathologists, of 44 non-melanocytic lesions in 44 patients aged 22-90. Results. Forty-four lesions (out of 217 in total) were non-melanocytic. Among the 5 pathologists who examined each case there was marked variability in the terminology used to diagnose each case. The most common variability was found between seborrheic keratosis, large cell acanthoma, solar lentigo, and lichenoid keratosis. The diagnosis made by the majority of the pathologists was deemed to be the reference diagnosis. Versus majority diagnosis, 4% of benign lesions were considered malignant, and 7% of malignant diagnoses were considered as benign. Conclusions. The different terminology adopted and lack of consensus in the diagnosis of these non-melanocytic lesions in this setting suggests that training AI systems using gold standards may be problematic. We propose a new management classification scheme called MOLEM (Management of Lesions Excised to exclude Melanoma) which expands the previously described MPATH-dx to include non-melanocytic lesions.

1648 Is Telephone Triage Here to Stay? An Audit of The Impact of COVID 19 On A Head and Neck Cancer Clinic

Due to the COVID19 pandemic, NHS reported a 60% drop in suspected cancer referrals and a delay in treatment initiation. In a pandemic, cancer waiting time (WT) targets can prove difficult to achieve. ENT UK and NHS England recommended a senior-led telephone triage system to be put in place in response to the pandemic. Aim of this audit was to assess the impact of the pandemic and evaluate the efficacy of tele-consults on the Head & Neck Cancer (H&N) Service at a District General Hospital. A retrospective audit of patients referred to the H&N clinic from April - June 2020, comparing patients managed by teleconsultations to patients seen F2F. Medical records were analysed to assess compliance with NHS Cancer WT targets. 2020 saw a 1.4% drop in referrals compared to 2019. Of the 224 referrals received from April - June 2020, 96.9% were seen within 14 days. 98.7% were initially reviewed by telephone, 37% of which were triaged to a F2F appointment, 39% were followed up by telephone and 24% were discharged or given routine appointments. 11.2% were diagnosed with cancer. Comparing cancer patients managed by telephone to patients seen F2F, 80% v 57% received a diagnosis by 28 days from the referral, and 100% v 17% started treatment by 62 days. The department did not have a significant drop in referrals due to the COVID pandemic. Cancer patients managed by telephone were more likely to start treatment within 62 days. Telephone consults should be a permanent feature of cancer clinics beyond the pandemic.

Early Referral to Palliative Care for Advanced Oral Cancer Patients: A Quality Improvement Initiative in Oncology Center at All India Institute of Medical Sciences

Objectives: Oral cancers have high epidemiologic burden in India, and most oral cancer patients at the All India Institute of Medical Sciences present in advanced stages. Their symptomatic needs are often not adequately addressed and the referrals to palliative medicine clinic are for severe pain or terminal stages. Using quality improvement methods, we aimed to provide early referral to palliative care for advanced oral cancer patients. Materials and Methods: Duration (number of days) between registration at the head-and-neck cancer clinic and referral to palliative medicine clinic at baseline and postinterventions. Interventions: Understanding current perceptions of oncologists for referral to palliative medicine clinic, educating them through departmental meetings, fostering clinician and patient-family awareness through pamphlets, defining process and screening guidelines for referral, including symptom burden charts in head-and-neck cancer clinic notes, soliciting regular feedback from oncologists at review meetings. Results: The number of days for the referral to the palliative medicine clinic decreased from an average of 48 days to 13 days in 6 months. Conclusion: A multicomponent intervention included oncologists and patients and families, education, workflow modification, standardized assessment, documentation, and clinician feedback, and succeeded in improving the timeliness of palliative care referrals of advanced oral cancer patients.