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Quality assurance in the vascular laboratory 血管实验室的质量保证
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100094
Drena K. Root BS, RVT
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引用次数: 0
The use of artificial intelligence in three-dimensional imaging modalities and diabetic foot disease: A systematic review 人工智能在三维成像模式和糖尿病足病中的应用--系统综述
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100057
Manal Ahmad MBBCh BAO, MRCS, MMedSc, PGCMedEd, MAcadMEd , Matthew Tan MBBS, BSc (Hon), MRCS, AFHEA , Henry Bergman MBBS, MRCS , Joseph Shalhoub BSc, MBBS, FHEA, PhD, Med, FRCS, FEBVS , Alun Davies MA (Oxon & Cantab), BM, BCh (Oxon), DM (Oxon), DSC (Oxon)

Background

Diabetic foot disease (DFD) is serious complication of diabetes with a multifactorial etiology and carries a significant risk of lower limb amputations. The prevalence of DFD continues to grow globally. Artificial intelligence has been proposed in aiding early detection and risk stratification for ulceration and other major complications, including sepsis, minor or major lower limb amputation, and death. We systematically reviewed the literature available on the use of artificial intelligence in three-dimensional imaging modalities in DFD.

Methods

A literature review was conducted in accordance with PRISMA guidelines. Embase and Medline (via the Ovid interface), CINAHL (via Ebsco Host), Web of Science, and Scopus databases were searched. The gray literature was also reviewed on ClinicalTrials.gov and the National Institute for Health Research journals library. The medical subject headings terms “diabetes” AND “diabetic foot disease” AND “artificial intelligence” and various permutations of three-dimensional imaging modalities, including “computed tomography,” “magnetic resonance imaging” and “positron emission tomography” were used in the primary search string. The articles were independently screened and reviewed by two reviewers.

Results

We identified 4865 studies and removed 102 duplicates. We excluded 4721 during title and abstract screening. Overall, 42 articles underwent full text review and 1 article was included in the final review, which used computed tomography scanning in patients with DFD to create a risk prediction model.

Conclusions

The use of machine learning and deep learning models is still being explored and evaluated in this context. Current methodologies focus on wound imaging classification, plantar thermography and plantar pressures. Specialized models that evaluate three-dimensional imaging are currently primitive and limited in their use; however, they have potential for the generation of suprahuman insights into existing imaging, extraction of novel metadata features, and prediction using integration of multidimensional patient characteristics.

背景糖尿病足病（DFD）是糖尿病的一种严重并发症，其病因是多因素的，并具有下肢截肢的重大风险。糖尿病足的发病率在全球范围内持续增长。人工智能已被提出用于帮助早期检测溃疡和其他主要并发症（包括败血症、轻度或重度下肢截肢和死亡）并对其进行风险分层。我们系统地回顾了有关人工智能在 DFD 三维成像模式中应用的现有文献。我们检索了 Embase 和 Medline（通过 Ovid 界面）、CINAHL（通过 Ebsco Host）、Web of Science 和 Scopus 数据库。此外，还查阅了 ClinicalTrials.gov 和国家健康研究所期刊图书馆的灰色文献。在主要检索字符串中使用了医学主题词 "糖尿病"、"糖尿病足病 "和 "人工智能 "以及三维成像模式的各种排列组合，包括 "计算机断层扫描"、"磁共振成像 "和 "正电子发射断层扫描"。这些文章由两名审稿人独立筛选和审阅。结果我们确定了 4865 项研究，删除了 102 项重复研究。我们在筛选标题和摘要时排除了 4721 篇文章。总体而言，42 篇文章进行了全文审阅，1 篇文章被纳入最终审阅，这篇文章利用 DFD 患者的计算机断层扫描创建了一个风险预测模型。目前的方法侧重于伤口成像分类、足底热成像和足底压力。评估三维成像的专业模型目前还很原始，使用也很有限；不过，这些模型有潜力为现有成像提供超人的见解，提取新的元数据特征，并通过整合多维患者特征进行预测。
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引用次数: 0
Development of a surgical skills course for preclinical medical students 为医学预科生开设外科技能课程
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100067
Jerry Zhu BS, Andrew Min BS, Susan Lerner MD, John Phair MD, Ageliki Vouyouka MD, Christopher Smolock MD, Michael Marin MD, Peter Faries MD, Daniel Han MD, Ajit Rao MD

Background

Preclinical students have limited exposure and training in surgical skills. As a result, many students report negative experiences during their surgery clerkship from a lack of confidence in their technical abilities and, thus, lower participation in cases. Moreover, in fields such as vascular surgery, where a shortage of physicians persists, the absence of surgery and field-specific exposure for medical students could limit recruitment. To address these gaps, we designed a surgical skills curriculum for preclinical medical students using surgical simulators to develop fundamental surgical skills, introduce students to vascular surgery early, and provide training on vascular surgery-specific procedures. We hypothesize that a surgical skills course can significantly enhance preclinical students' surgical abilities before they enter their surgical clerkship and increase interest in pursuing a surgical specialty.

Methods

A total of 26 students took part in a structured surgical skills curriculum comprising three sections: fundamental surgical skills, application of skills in a clinical context, and a surgical skills competition. During the course of six workshops, the students received formative feedback from proctors using task-specific standardized rubrics and assessments through the Objective Standardized Assessment of Technical Skills. Additionally, students' attitudes and perceptions toward surgical training and vascular surgery were evaluated using the modified Vascular Surgery Interest Forum. The summative performance of the preclinical students enrolled in the surgical skills course was compared with their initial performance after the skills workshop and with that of third-year medical students who had completed surgical rotations. Differences in responses and attitudes were analyzed at the beginning and conclusion of the course using bivariate analysis.

Results

Of the 26 students, most were women (61.5%) and in their second year of medical school (76.9%). Also, 23.1% identified as underrepresented minorities in medicine, 7.7% had physician family members, and 19.2% reported they had decided on a specialty. Following the knot-tying and suturing workshops, students reported a statistically significant increase in their self-rated understanding, comfort, and knowledge of tasks. Third-year medical students outperformed the preclinical students in knot-tying and instrument-tying tasks. However, no difference was found in the performance of these tasks between the third-year medical students and the top three preclinical students who completed the course. Both groups performed similarly on the anastomosis challenge (29.25 vs 28.42; P = .9) and the vascular simulation challenge (27.25 vs 26.83; P = .6). At the program's conclusion, the students demonstrated an increased mean interest in vascular surgery (from 2.3 ± 1.1 to 2.9 ± 1.2; P = .39), a

背景临床实习学生在外科技能方面的接触和培训有限。因此，许多学生表示在外科实习期间，由于对自己的技术能力缺乏信心而产生了负面体验，从而降低了对病例的参与度。此外，在血管外科等医生短缺的领域，医学生缺乏外科手术和特定领域的接触可能会限制招募。为了弥补这些不足，我们为临床前医科学生设计了外科技能课程，使用手术模拟器培养基本外科技能，让学生尽早接触血管外科，并提供血管外科特定手术的培训。我们假设，外科技能课程能在临床前医学生进入外科实习前显著提高他们的外科能力，并增加他们对外科专业的兴趣。方法共有 26 名学生参加了结构化外科技能课程，包括三个部分：基本外科技能、临床背景下的技能应用和外科技能竞赛。在六次研讨会期间，学生们通过任务特定的标准化评分标准和技术技能客观标准化评估获得了监考人员的形成性反馈。此外，还使用修改后的 "血管外科兴趣论坛 "评估了学生对外科培训和血管外科的态度和看法。参加外科技能课程的临床前学生的总结性表现与他们在技能讲习班后的初始表现以及已完成外科轮转的三年级医学生的表现进行了比较。结果 在 26 名学生中，大多数为女性（61.5%），且就读于医学院二年级（76.9%）。此外，23.1%的学生认为自己是医学界代表性不足的少数群体，7.7%的学生有医生家庭成员，19.2%的学生表示自己已经确定了专业。在参加了打结和缝合工作坊后，学生们表示他们对任务的自我评价在理解、舒适度和知识方面都有了显著提高。三年级医学生在打结和器械绑扎任务中的表现优于临床前学生。然而，三年级医学生和完成课程的前三名临床前学生在这些任务的表现上没有差异。两组学生在吻合术挑战（29.25 vs 28.42；P = .9）和血管模拟挑战（27.25 vs 26.83；P = .6）中的表现相似。项目结束时，学生们对血管外科手术的平均兴趣有所提高（从 2.3 ± 1.1 到 2.9 ± 1.2；P = .39），对外科手术的动手兴趣也有所提高（从 4.5 ± 0.8 到 4.7 ± 0.6; P = .06），在教授基本技能时更倾向于模拟手术（从 3.7 ± 1.0 到 3.9 ± 0.8; P = .31），并提高了对手术实践中辐射暴露的认识（从 2.5 ± 1.0 到 3.0 ± 1.3; P = .11）。学生们认为，性格契合度、医学院期间的接触以及导师的认同是影响他们从事外科职业的最大因素。结论 为临床前医科学生开设的结构化外科技能课程提高了学生的技术技能，并培养了学生对外科手术的实践性和技术性的更高评价。此外，过早接触血管外科可增强他们对该领域的兴趣和了解。值得注意的是，学生们认为医学院没有为他们在外科轮转中取得成功做好充分准备，并强调在考虑从事外科职业时，个性匹配、早期接触和导师指导非常重要。
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引用次数: 0
Vascular surgery experience for major vascular injuries in the Beirut Blast: Lessons learned 贝鲁特爆炸中重大血管损伤的血管外科经验：经验教训
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100104
Makram Abou Ghaida MD , Naji Abou Ali MD , Mazen Basbous MD , Kaissar Yammine MD , Chahine Assi MD , Fadi Hayek MD

Background

The Beirut Port Blast on August 4, 2020, was the largest non-nuclear blast in history. It heavily affected the fragile population already facing an ongoing political and socioeconomic crisis, and the coronavirus diease 2019 pandemic. This article is a review of major vascular injury patterns and mechanism, strategies of treatment, and physician experience.

Methods

This retrospective review was performed on all patients who presented to the Lebanese American University Medical Center—Rizk Hospital after the Beirut Blast owing to vascular injuries. All patients presenting with major vascular injuries requiring admission, operations, or who were deceased owing to vascular injuries were included. Basic identification and medical history data were extracted. The surgical procedures and postoperative care and outcomes were also recorded.

Results

Eigtheen patients who presented to our institution during the day of the blast were included. Two patients passed away in the emergency room. The remaining 16 patients required surgeries. Most vascular injuries were caused by debris and shattered standard glass. The location of the vascular injuries were diverse; six patients (33.3%) had neck injuries, nine patients (50%) had upper extremity injuries, and three patients (16.6%) had lower extremity injuries. Furthermore, all patients had venous injuries (100%), and nine patients (50%) had arterial injuries.

Conclusions

After the Beirut Blast, the major vascular injury seen was in the upper extremity, followed by the neck and lower extremity, mostly owing to shattered nonlaminated glass. Laminated or tempered glass should be considered superior to standard nonlaminated glass during Beirut renovation and areas at high risk for bombing, wars, and natural disasters like earthquakes. Awareness and knowledge of bleeding control is a must for people living in such risky environments. Venous injuries were more common and managed safely by ligation. Arterial injuries required a more extensive approach based on the location and extent of injury, but damage control surgery remains the mainstay strategy in disastrous situations.

背景2020 年 8 月 4 日发生的贝鲁特港口爆炸是历史上最大的非核爆炸。它严重影响了已经面临持续的政治和社会经济危机以及 2019 年冠状病毒大流行的脆弱人群。本文对主要血管损伤的模式和机制、治疗策略以及医生的经验进行了回顾性分析。所有因严重血管损伤而需要入院治疗、手术或因血管损伤死亡的患者均被纳入其中。提取了患者的基本身份和病史资料。结果纳入了爆炸当天到我院就诊的八十名患者。两名患者在急诊室去世。其余 16 名患者需要进行手术。大多数血管损伤是由碎片和标准玻璃碎片造成的。血管损伤的部位多种多样：6 名患者（33.3%）颈部受伤，9 名患者（50%）上肢受伤，3 名患者（16.6%）下肢受伤。结论贝鲁特爆炸事件后，主要的血管损伤发生在上肢，其次是颈部和下肢，这主要是由于非夹层玻璃破碎造成的。在贝鲁特翻修期间，以及在爆炸、战争和地震等自然灾害高发地区，夹层玻璃或钢化玻璃应被视为优于标准非夹层玻璃。生活在这种高危环境中的人们必须具备止血意识和知识。静脉损伤较为常见，可通过结扎手术安全处理。动脉损伤需要根据损伤的部位和程度采取更广泛的方法，但损伤控制手术仍是灾难性情况下的主要策略。
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引用次数: 0
Specialty acuity should be a consideration while assessing operating room block time metrics 评估手术室间隔时间指标时应考虑专科急诊情况
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100080
Aakanksha Gupta MD, Joseph V. Lombardi MD, MBA, Mikael Fadoul MD,, Bruce L. Tjaden MD, Philip Batista MD, Jeffery Carpenter MD, Katherine McMackin MD

Objective

Operating room (OR) utilization is a key metric of productivity for surgeons and surgical services. It is defined as total hours of elective surgery performed within OR block time, including turnover time, divided by the hours of allocated block time. To maximize this metric, hospitals have OR release times built in, which often trigger 72 hours prior to the start of the day. Vascular surgery is among several disciplines that carry a high number of urgent case bookings that require last minute OR availability. The purpose of this study was to examine OR release policy within our own institution in the context of the number of cases booked after the release period by vascular surgery and other surgical services.

Methods

A single-center retrospective review of all cases done by the Department of Surgery between October 2021 and October 2022 at a tertiary care university hospital was performed. Urgent cases were defined as those booked within 48 hours of the procedure. Total cases, inpatient vs outpatient/preadmit designation, number of urgent cases booked, OR utilization, and surgeon division were collated. included divisions were vascular (5 surgeons), colorectal (3 surgeons), bariatrics (2 surgeons), breast (7 surgeons), acute care (10 surgeons), general (8 surgeons), plastics (8 surgeons), otolaryngology (5 surgeons), and urology (6 surgeons). Additionally, we propose a novel method to calculate OR utilization based on the number of urgent cases performed by each specialty.

Results

A total of 9295 surgeries were performed by 54 surgeons. Of the surgeries, 1849 were performed on inpatients. Vascular surgeons accounted for 9% of surgeons in the study and booked 372 urgent cases (26%), representing the highest of all divisions including acute care surgery, who booked 180 urgent cases (13%). In addition, vascular surgery performed 26% (n = 476) of all inpatient surgeries during the study period, which made up over one-half (55%) of the total vascular volume of 865 cases. This was the highest percentage of inpatients throughout the surgical service line. Despite this, vascular surgery had one of the lowest OR utilizations at 65% during this time period. However, after accounting for number of urgent cases using the proposed formula, vascular surgery's adjusted OR utilization was found to be 115.7%.

Conclusions

Ensuring OR availability for services that have high urgency and substantial inpatient volume may allow greater system throughput, patient satisfaction, decreased length of stay, and lower surgeon stress burden. Vascular surgeons had the highest urgent and inpatient case volume of all examined surgical specialties. Hybrid OR availability and allocation of block time for vascular services should be reflected in the need to accommodate this operative climate.

目标手术室（OR）利用率是衡量外科医生和手术服务效率的关键指标。它的定义是在手术室分块时间内完成的择期手术总时数（包括周转时间）除以分配的分块时间时数。为了最大限度地提高这一指标，医院规定了手术室释放时间，通常在一天开始前 72 小时触发。血管外科是紧急病例预约较多的几个学科之一，需要在最后一分钟提供手术室。本研究的目的是根据血管外科和其他外科手术服务在手术室开放期后预约的病例数量，研究本院的手术室开放政策。方法对一家三级医疗大学医院外科在 2021 年 10 月至 2022 年 10 月期间完成的所有病例进行单中心回顾性审查。急诊病例是指在手术后 48 小时内预约的病例。我们整理了总病例数、住院病人与门诊病人/分科指定、预订的紧急病例数、手术室使用率和外科医生分科。包括的分科有血管科（5 名外科医生）、结直肠科（3 名外科医生）、减肥科（2 名外科医生）、乳腺科（7 名外科医生）、急症护理科（10 名外科医生）、普通科（8 名外科医生）、整形外科（8 名外科医生）、耳鼻喉科（5 名外科医生）和泌尿科（6 名外科医生）。此外，我们还提出了一种新方法，根据各专科急诊病例的数量来计算手术室的利用率。其中，1849 例手术是为住院病人实施的。研究中，血管外科医生占外科医生总数的 9%，预订了 372 例急诊病例（26%），在所有科室中占比最高，其中急诊外科预订了 180 例急诊病例（13%）。此外，在研究期间，血管外科实施的手术占所有住院手术的 26%（476 例），在 865 例血管手术中占二分之一以上（55%）。这是整个外科服务项目中住院患者比例最高的。尽管如此，血管外科在这一时期的手术室使用率却最低，仅为 65%。然而，在使用建议的公式计算出急诊病例数量后，血管外科的调整后手术室利用率为 115.7%。结论确保高急诊率和大量住院病人的手术室可用性，可以提高系统吞吐量、患者满意度、缩短住院时间并减轻外科医生的压力负担。在所有接受检查的外科专科中，血管外科医生的急诊和住院病例量最高。混合手术室的可用性和血管服务的分块时间分配应反映出适应这种手术环境的需要。
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引用次数: 0
Running a quality-focused office-based laboratory 运行以质量为中心的办公室实验室
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100076
Krishna Jain MD, FACS
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引用次数: 0
Challenges and potential solutions to enrollment in a clinical trial of arteriovenous fistula vs arteriovenous graft vascular access strategy 注册 AVF 与 AVG 血管通路策略临床试验的挑战和潜在解决方案
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100108
Matthew P. Goldman MD , Dipal M. Patel MD , Kevin Z. Chang MD , Ross P. Davis MD , Matthew S. Edwards MD , Justin B. Hurie MD , Ashlee Sutsrim MD , Gabriela Velazquez-Ramirez MD , Timothy K. Williams MD , Oscar H. Grandas MD , Michael B. Freeman MD , Michael M. McNally MD , Scott L. Stevens MD , Kyla M. Bennett MD , Karen Woo MD , Christopher G. Carsten MD , Mark P. Androes MD , Joseph-Vincent V. Blas MD , Brian Jones MD , R. Michael Patton MD , Sherry Leung

This article presents the rationale, challenges, and adaptive strategies employed during the initiation and execution of the arteriovenous (AV) access trial—a multicenter randomized controlled trial (RCT) comparing AV fistulas and AV grafts for hemodialysis in older adults with major comorbidities. Motivated by shifts in epidemiologic landscapes and evolving guidelines moving away from a fistula-first approach and to more patient-centric approaches, the objective of this randomized controlled trial was to fill critical knowledge gaps in determining the optimal vascular access for this complex patient population. We outline the challenges encountered in patient recruitment along with measures employed to overcome these obstacles in recruitment. We emphasize the pivotal role of continuous research in overcoming these challenges, underscoring its necessity to achieve a thorough comprehension of optimal vascular access strategies for this complex patient population.

本文介绍了动静脉（AV）通路试验（多中心随机对照试验，RCT）的启动和执行过程中采用的原理、挑战和适应策略，该试验比较了动静脉瘘和动静脉移植物在患有重大合并症的老年人血液透析中的应用。由于流行病学的变化和不断发展的指南从瘘管优先的方法转向更加以患者为中心的方法，这项随机对照试验的目的是填补在确定这一复杂患者群体的最佳血管通路方面的知识空白。我们概述了在招募患者时遇到的挑战，以及为克服这些招募障碍而采取的措施。我们强调了持续研究在克服这些挑战中的关键作用，并强调了彻底了解这一复杂患者群体最佳血管通路策略的必要性。
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引用次数: 0
Morphologic characteristics of painful varicose veins in women: possible role of disordered collagen and endothelial cells 女性静脉曲张疼痛的形态特征：紊乱的胶原蛋白和内皮细胞的可能作用
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100105
Shivani Thakur BA , Jasmin Dominguez Cervantes BS , Ahmed Zabiba BS

Objective

This study examines to what extent vein wall thickness, collagen arrangements, muscular layers distribution, immunohistochemical presentation of endothelial cell arrangement, and adventitia layer placement differed in patients with small painful veins vs large painful symptomatic varicose veins (VVs).

Methods

This study was conducted from June 2022 to September 2022 at Valley Vein Health Center, a rural phlebology outpatient clinic. Ten samples from each of the three subjects were collected (n = 3): five were small symptomatic veins, and five were large symptomatic veins. All tissue blocks were cut transversely, perpendicular to the vessel axis, into 5-μm-thick sections. Three stains were chosen: Masson trichrome, hematoxylin and eosin, and a cluster of differentiation 31 (CD31). Statistical analysis was performed with the GraphPad statistical program. Comparisons between vein wall thicknesses were made using Student’s t test.

Results

The average thickness of small veins was less than that of large veins (426 μm ± 26.1 μm vs 480 μm ± 19.2 μm, respectively; P < .001). Histologic and immunohistochemical (CD31) analysis of small symptomatic VVs by hematoxylin and eosin and trichrome stain showed an endothelial layer overlying the media, mostly of elastic tissue fibers, and smooth muscle bundles. CD31 expression analysis demonstrated more endothelial channels in the tunica media of the enlarged veins compared with smaller vessels. The larger vein’s microscopic structure was variable with irregular collagen arrangement, clumped elastin layer appearance, feathered muscular layer distribution, and thickened adventitia layer placement.

Conclusions

The morphological distinctions in VVs highlighted in this study need to be considered to develop potential drug therapies tailored to women.

本研究旨在探讨小静脉疼痛患者与大静脉疼痛症状性静脉曲张（VVs）患者的静脉壁厚度、胶原排列、肌肉层分布、内皮细胞排列的免疫组化表现以及静脉外膜层位置的差异程度。方法本研究于 2022 年 6 月至 2022 年 9 月在农村静脉科门诊诊所 Valley Vein Health Center 进行。从三名受试者中各采集了 10 个样本（n = 3）：其中 5 个是症状较轻的小静脉，5 个是症状较重的大静脉。所有组织块都被横向切割成 5 微米厚的切片，垂直于血管轴线。选择了三种染色方法：马森三色染色法、苏木精和伊红染色法以及分化簇 31（CD31）染色法。使用 GraphPad 统计程序进行统计分析。结果小静脉的平均厚度小于大静脉（分别为 426 μm ± 26.1 μm vs 480 μm ± 19.2 μm；P <.001）。用苏木精、伊红和三色染色法对无症状的小静脉进行组织学和免疫组化（CD31）分析，结果显示内皮层覆盖在介质上，大部分是弹性组织纤维和平滑肌束。CD31 表达分析显示，与较小的血管相比，增大的静脉中膜有更多的内皮通道。大静脉的显微结构多变，胶原排列不规则，弹性蛋白层呈团块状，肌肉层呈羽毛状分布，血管外膜层增厚。
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引用次数: 0
Simulation and industry partnership in vascular surgery education 血管外科教育中的模拟与行业合作
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100082

Objective

Simulation training improves resident open and endovascular technique and increases efficiency in the operating room, meeting costs and allocating time to curriculum development are obstacles for the leadership of surgical residencies. In this paper, we provide a narrative review of the types of simulation and the role industry has in simulation. We also explain how our institution utilized medical device sponsorship in a cost-efficient, non-biased way.

Methods

Vascular surgery trainees and surgeons were invited to two local, in-person simulation events, focusing on the management of aortic aneurysms and peripheral vascular disease. Pre- and post-surveys were sent to participants, and the results were analyzed with descriptive statistics. Survey score means were compared via paired t-test with significance set at P < .05.

Results

Benchtop anastomotic models, animal/cadaveric models, and virtual reality have been adopted in many surgical programs and can each provide practice to different levels of skill. Although industry is supportive of simulation curriculums, little is published regarding the role it plays and ways to reduce conflict of interest. At our local simulation events, trainees showed significant improvement in confidence ratings.

Conclusions

Industry sponsorship has been able to support many educational endeavors. In our experience, we attempted to reduce conflict of interest by focusing on device company participation and nonpartisan, physician-lead didactics. There is a great need for future research in surgical education and industry partnership.

目的模拟训练可提高住院医生的开放手术和血管内手术技术，并提高手术室的效率，但成本和课程开发时间的分配是外科住院医生领导层面临的障碍。在本文中，我们将对模拟培训的类型和行业在模拟培训中的作用进行叙述性回顾。我们还解释了本机构如何以一种具有成本效益、无偏见的方式利用医疗设备赞助。方法 邀请血管外科学员和外科医生参加两次当地的现场模拟活动，重点是主动脉瘤和外周血管疾病的管理。对参与者进行了事前和事后调查，并对调查结果进行了描述性统计分析。通过配对 t 检验比较调查得分平均值，显著性设定为 P < .05。结果 许多外科课程都采用了台式吻合器模型、动物/穴位模型和虚拟现实技术，每种技术都能提供不同水平的技能练习。虽然业界支持模拟课程，但有关其所扮演的角色以及如何减少利益冲突的报道却很少。在我们当地的模拟活动中，受训者的信心评分有了显著提高。根据我们的经验，我们试图通过器械公司的参与和非党派、医生主导的教学来减少利益冲突。未来在外科教育和行业合作方面有很大的研究需求。
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引用次数: 0
Impact of hospitalist comanagement on vascular surgery inpatient outcomes 住院医师共同管理对血管外科住院病人疗效的影响
JVS-vascular insights
Pub Date : 2024-01-01 DOI: 10.1016/j.jvsvi.2024.100120

Objective

In recent years, hospitalists have been increasingly involved in the medical management of hospitalized surgical patients. This trend has been impacted by the goal of offloading inpatient care from the primary care provider in addition to the presence of an increasing burden of inpatient comorbidities and broader trends in multidisciplinary team-based care of the surgical patient. Multiple studies have demonstrated the clinical benefits associated with the implementation of a hospitalist comanagement service for surgical patients, whereas others have highlighted increases in cost and strain on understaffed medical teams. We aimed to assess the impact of the implementation of a dedicated hospitalist comanagement agreement on outcomes in an academic medical center vascular surgery inpatient service.

Methods

Institutional review board approval was obtained before data collection. The inpatient database was queried for all admissions to the vascular surgery service between January 1, 2007, and December 31, 2017. Given that a hospitalist comanagement agreement was established in 2014, we collected data and compared cohorts admitted to the vascular surgery service before and after January 1, 2014. Patients admitted to the intensive care unit during their hospital stay were excluded, as the hospitalist team was not involved in intensive care unit patient care. We collected data on patient demographics, admission diagnosis, comorbid diseases, and clinical outcomes including hospital length of stay, cardiac morbidity, and mortality. Data were assessed via logistic regression models to investigate the impact on clinical outcomes after the start date of the hospitalist comanagement program.

Results

A total of 1438 patients were included in the analysis, including 866 pre- and 572 posthospitalist comanagement agreement. The mean age was 66.1 (standard deviation 14.0) years, similar in both groups. Overall, 822 (57.2%) patients were male, and 616 (42.8%) were female, similar in both groups. Overall, 67.5% were White, 25.6% Black, and 6.9% were classified as other race. The mean length of stay was 8.2 days overall and was lower in the comanagement group at 7.6 vs 8.6 days in the non-comanagement group (P = .0022). Overall 30-day mortality was 2.5%, similar in both groups (P = .36). The incidence of myocardial infarction was lower in the comanagement group at 2.6% vs 6.0% in the non-comanagement group (P = .0001). Logistic regression modeling controlling for comorbidities demonstrated a 61% odds reduction rate for cardiac events in patients who were comanaged by the hospitalist medicine team (P < .01). Linear regression modeling showed an overall reduced length of stay in the comanagement group by 1.45 days (P < .01) with benefits shown specifically for patients undergoing major amputation, thromboembolectomy, and those with infected va

目标近年来，住院医生越来越多地参与住院手术患者的医疗管理。除了住院病人的合并症负担日益加重以及外科病人多学科团队护理的大趋势之外，从初级保健提供者手中卸下住院病人护理工作这一目标也对这一趋势产生了影响。多项研究表明，对手术患者实施住院医师联合管理服务可带来临床益处，而其他研究则强调了成本的增加和对人手不足的医疗团队造成的压力。我们旨在评估在学术医疗中心血管外科住院病人服务中实施专门的住院医师共同管理协议对疗效的影响。我们在住院患者数据库中查询了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间血管外科的所有住院患者。鉴于住院医师共同管理协议于2014年签订，我们收集了数据，并对2014年1月1日前后入住血管外科服务的队列进行了比较。住院期间入住重症监护室的患者不包括在内，因为住院医师团队不参与重症监护室的患者护理。我们收集了患者的人口统计学数据、入院诊断、合并疾病以及临床结果（包括住院时间、心脏疾病发病率和死亡率）。数据通过逻辑回归模型进行评估，以研究住院医师联合管理项目启动后对临床结果的影响。结果 共有 1438 名患者纳入分析，其中包括住院医师联合管理协议签署前的 866 人和签署后的 572 人。两组患者的平均年龄为 66.1 岁（标准差为 14.0），年龄相仿。总体而言，822 名（57.2%）患者为男性，616 名（42.8%）患者为女性，两组情况相似。总体而言，67.5%为白人，25.6%为黑人，6.9%为其他种族。平均住院时间为 8.2 天，联合管理组为 7.6 天，非管理组为 8.6 天（P = .0022）。30 天总死亡率为 2.5%，两组相似（P = .36）。联合管理组的心肌梗死发生率较低，为 2.6%，而非管理组为 6.0%（P = .0001）。控制合并症的逻辑回归模型显示，接受住院医师医疗团队联合管理的患者发生心脏事件的几率降低了 61%（P < .01）。线性回归模型显示，联合管理组患者的住院时间总体缩短了 1.45 天（P <.01），尤其是接受大截肢手术、血栓栓塞切除术和血管移植物感染的患者（分别缩短了 3.8 天、7.4 天和 8.4 天）。这些发现鼓励人们在未来研究住院医师联合管理对血管外科住院病人的其他临床益处和财务影响。
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