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BACKGROUND: The detection of a stenotic celiac artery (CA) typically mandates intraoperative revascularization during pancreaticoduodenectomy (PD) to preserve liver perfusion. The impact of CA stenosis on postoperative outcomes is unclear. This study evaluates whether CA stenosis (CAS) is associated with increased postoperative complications. METHODS: We conducted a retrospective analysis of PD patients from February 2014 to February 2022. Preoperative imaging assessed the CA lumen, categorizing it as patent, <50%, or ≥50% stenosis. Patients with narrowed SMA were excluded. Complications were categorized using the Clavien-Dindo system, and statistical analyses identified outcome differences. RESULTS: We included 427 patients in the study. Of these, 52 had CAS, and 311 had no-vessel stenosis (NVS). The median age of the CAS and NVS groups was 68 and 65 years, respectively. Postoperatively, 17.6% of patients with CAS exhibited delayed gastric emptying (DGE) versus 25.3% in the NVS group. Postoperative pancreatic fistula (POPF) was found in 13.5% of patients with CAS, compared with 23.7% without stenosis. The median length of hospital stay was shorter for patients with CAS (9 days) than for those with CAS (12 days). Severity-based classifications indicated higher complications in the no stenosis group and a 33.0% readmission rate within 30 days compared with 21.2% in CAS patients. However, none of these differences were statistically significant. CONCLUSIONS: Critical stenosis of the CA does not significantly affect postoperative outcomes following PD, suggesting preoperative correction of the narrowed CA may not be necessary. Further research is needed to confirm these findings.

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OBJECTIVES: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. METHODS: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status. RESULTS: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). CONCLUSIONS: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

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Pressure injuries are a common chronic wound in the older adult. Care of pressure injuries is an interprofessional effort and involves physicians, nurses, registered dieticians, rehabilitation therapists, and surgical subspecialties. Numerous treatment modalities exist but have varying evidence to substantiate their efficacy. All primary and other care providers, particularly geriatricians, need to be aware of current evidence-based prevention and treatment standards. When healing is not expected, palliative care should be considered to avoid futile procedures and preserve dignity and quality of life.

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The treatment, maintenance, and suppression of infection in chronic wounds remain a challenge to all practitioners. From an infectious disease standpoint, knowing when a chronic wound has progressed from colonized to infected, when to use systemic antimicrobial therapy and when and how to culture such wounds can be daunting. With few standardized clinical guidelines for infections in chronic wounds, caring for them is an art form. However, there have been notable advances in the diagnosis, treatment, and management of infected wounds. This article will discuss the pathophysiology of infection in older adults, including specific infections such as cutaneous candidiasis, necrotizing soft tissue infection, osteomyelitis, and infections involving hardware.

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GENERAL PURPOSE: To review the management of a patient with a chemical burn from wet cement. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Recognize the clinical presentation of a patient with a chemical burn from contact with wet cement.2. Describe features related to the pathophysiology of alkali burns from wet cement.3. Select the proper decontamination procedure after exposure to wet cement.4. Identify steps in the treatment of a patient with a chemical burn from contact with wet cement.

Alkali burn from wet cement is an often unrecognized and completely preventable chemical injury. The prevalence of cement burns is likely underestimated because of a lack of awareness and knowledge among both individuals who work with cement and healthcare providers. Chemical injuries have important differences compared with thermal burns: they are usually produced by longer exposure to noxious agents as opposed to short-term exposure that is quickly stopped. As a result, first aid approaches are different. Chemical burns from cement can be avoided with adequate skin and eye protection as well as immediate first aid if contact occurs. Manufacturers of bagged cement place warning notices on packaging, but these can be small and go unnoticed by consumers. Construction workers and amateur do-it-yourselfers should avoid direct contact with cement for any prolonged amount of time. Watertight boots, gloves, and clothing will prevent contact, and any accidental splash on exposed skin should be immediately washed away. Education and awareness of the consequences of cement burns are the best prevention.

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BACKGROUND AND OBJECTIVES: The aim of this study was to examine experiences of New Jersey family medicine residents and preceptors with the etonogestrel subdermal contraceptive implant and to explore barriers to and facilitators of training. METHODS: In this qualitative study, we conducted semistructured individual interviews to explore residents' and preceptors' experiences with contraceptive implant procedural training. We invited residents and preceptors from programs with high (5.2-10.9) and low (0.0-0.1) implant procedures per resident to participate. Participants discussed factors that supported or inhibited implant training and provision. We transcribed, coded, and analyzed interviews on a rolling basis. We used memoing to reflect on the data and identify saturation. We developed and refined our codebook using a collaborative, iterative process. We analyzed interviews using deductive and inductive techniques to identify themes. RESULTS: We interviewed 25 subjects: 14 residents and 11 preceptors from four family medicine residency programs with the highest and lowest implant training numbers. Common barriers included lack of hands-on experience with the procedure, lack of teaching with the procedure, and difficulty scheduling patients. Facilitators included formal training and inclusion of contraception in residency curricula, preceptors' comfort with the procedure, office sessions dedicated to procedures or gynecology visits, and patient familiarity with the implant. CONCLUSIONS: Family medicine residencies provide unique opportunities to impact provision of long-acting reversible contraception (LARC). We identified potential interventions, including formal implant training sessions, dedicated procedure office sessions, stocking of devices in the office, and staff focused on reproductive health that can aid in scheduling, obtaining devices, and setup.

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