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Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and International Clinical Guidelines (CoSMIC-G) 大肠癌同步肝转移的管理:国家和国际临床指南系统回顾 (CoSMIC-G)
IF 1.4 Q3 SURGERY Pub Date : 2024-10-31 DOI: 10.1016/j.sopen.2024.10.009
Anthony K.C. Chan PhD FRCS, Ajith K. Siriwardena MD FRCS

Introduction

The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. This study appraises the recommendations made by national/international guidelines for the diagnosis and management of patients with synchronous liver metastases from colorectal cancer.

Methods

A systematic review of national and international guidelines published between 2011 and 2024 was carried out using PubMed, OvidSP and Guidelines International Network databases. The quality of guidelines was evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidelines were assessed for the quality of advice for specific scenarios. The protocol was registered with PROSPERO (CRD42021243744).

Results

The search strategy returned ninety unique articles with 11 guidelines eligible for inclusion. Of these, one (9 %) guideline defined ‘synchronous disease’ at outset, eight (73 %) recommended neoadjuvant chemotherapy as first intervention. Seven (64 %) guidelines supported synchronous hepatic resection with colectomy. One (9 %) recommended against synchronous surgery.

Conclusions

This study demonstrates important variations between international clinical guidelines on diagnostic workup and management of synchronous liver metastases in colorectal cancer. [167 words].
导言当代结直肠癌同步肝转移患者的管理非常复杂。本研究评估了国家/国际指南对结直肠癌同步肝转移患者的诊断和管理提出的建议。方法利用PubMed、OvidSP和指南国际网络数据库对2011年至2024年间发布的国家和国际指南进行了系统性回顾。使用研究与amp; 评估指南鉴定 II (AGREE II) 工具对指南质量进行评估。对指南进行了评估,以确定针对特定情况提出的建议的质量。该方案已在 PROSPERO(CRD42021243744)上注册。其中,1 份(9%)指南从一开始就定义了 "同步疾病",8 份(73%)指南建议将新辅助化疗作为首次干预。七份(64%)指南支持同步肝切除和结肠切除术。结论这项研究表明,国际临床指南在结直肠癌同步肝转移的诊断和管理方面存在重大差异。[167字]。
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引用次数: 0
Primary delayed gastric emptying after pylorus-resecting pancreatoduodenectomy: A matched-pair comparison of Roux-en-Y vs. Billroth-II reconstruction 幽门切除胰十二指肠术后原发性胃排空延迟:Roux-en-Y重建与Billroth-II重建的配对比较
IF 1.4 Q3 SURGERY Pub Date : 2024-10-31 DOI: 10.1016/j.sopen.2024.10.005
Felix O. Hofmann , Victoria S. Engelstädter , Ughur Aghamaliyev , Mathilda M. Knoblauch , Elise Pretzsch , Maximilian Weniger , Jan G. D'Haese , Bernhard W. Renz , Jens Werner , Matthias Ilmer

Background

After pylorus-resecting pancreatoduodenectomy (PrPD), delayed gastric emptying (DGE) might partially be attributed to biliary reflux. We investigated whether the incidence of primary DGE is reduced after Roux-en-Y instead of Billroth-II reconstruction.

Methods

Patients undergoing PrPD from 2016 to 2019 at a high-volume center were identified. Excluding causes of secondary DGE, we matched patients with Roux-en-Y and Billroth-II reconstruction in a 1:2 ratio and compared primary DGE.

Results

In 24 vs. 48 (Roux-en-Y vs. Billroth-II) patients, DGE (grade B/C) incidence (20.8 % vs. 18.8 %; P = 1.000), nasogastric tube requirement (median 2 vs. 2 days; P = 0.844) and time to solid food intake (7 vs. 7 days; P = 0.933) were comparable. Univariable logistic regression showed no association between DGE and Roux-en-Y reconstruction (OR 1.47; P = 0.524), in contrast to age (1.08; P = 0.030) and pancreatic biochemical leak (4.98; P = 0.007).

Conclusions

Primary DGE did not differ between Roux-en-Y and Billroth-II reconstruction after PrPD. Instead, age and postoperative pancreatic biochemical leak were associated with higher DGE risk.
背景幽门切除胰十二指肠切除术(PrPD)后,胃排空延迟(DGE)可能部分归因于胆汁反流。我们研究了 Roux-en-Y 代替 Billroth-II 重建后是否会降低原发性 DGE 的发生率。结果 在24例与48例(Roux-en-Y与Billroth-II)患者中,DGE(B/C级)发生率(20.8% vs. 18.8%;P = 1.000)、鼻胃管需求(中位2天 vs. 2天;P = 0.844)和固体食物摄入时间(7天 vs. 7天;P = 0.933)相当。单变量逻辑回归显示,DGE与Roux-en-Y重建(OR 1.47;P = 0.524)之间没有关联,而与年龄(1.08;P = 0.030)和胰腺生化漏(4.98;P = 0.007)之间有关联。相反,年龄和术后胰腺生化漏与较高的 DGE 风险相关。
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引用次数: 0
Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study 用于胸外科研究生病例教学的沉浸式协作虚拟现实技术:试点研究
IF 1.4 Q3 SURGERY Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.008
Philipp Feodorovici , Nils Sommer , Philipp Bergedieck , Philipp Lingohr , Jörg C. Kalff , Joachim Schmidt , Jan C. Arensmeyer

Background

In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.
This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.

Methods

A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.

Results

Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.
A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.

Conclusion

The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.
背景在医学教育中,有多种非数字化教学方法。然而,研究证明,虚拟现实(VR)应用的身临其境特性对空间关系的理解有积极影响。本研究概述了一种新型系统的开发和试点测试,该系统用于协作式、基于病例的 VR 教学,利用实时容积渲染的计算机断层扫描(CT)数据对研究生进行胸外科病例教学。结果70名学生通过问卷对课程进行了评估。绝大多数学生(98.57%)认为,与传统方法相比,VR 提高了他们对解剖学的理解,大多数学生认为学习更有效(88.57%)和更快乐。(绝大多数学生(98.57%)认为,与传统方法相比,虚拟现实技术提高了他们对解剖学的理解,大多数学生认为学习更有效(88.57%),参与过程中的愉悦程度很高(97.14%)。大多数学生(61.43 %)认为 VR 可以部分取代传统方法。他们支持将虚拟现实融入临床前教学(81.43 %)和临床教学(94.29 %),以及在家学习虚拟现实课程(78.57 %)。大多数参与者(90.72%)鼓励扩大 VR 基础设施。结论医学研究生教学中基于 VR 的协作式实时教育计划的概念已证明其技术可行性,并得到了积极的认可,人们希望在外科课程中融入更多的 VR 技术。随着 VR 教学环境的不断扩展,我们将开展一项双臂研究,以评估其客观影响。
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引用次数: 0
Engagement and learning approaches among medical students in an online surgical teaching programme: A cross-sectional study 在线外科教学计划中医科学生的参与度和学习方法:横断面研究
IF 1.4 Q3 SURGERY Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.010
Sumayyah Ebrahim MMED Surgery (UKZN), MSc Epidemiology (Columbia University) , Jacqueline Marina Van Wyk PhD (UKZN)

Background

The COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively.

Methods

A cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (n = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha.

Results

The survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, p < 0.001). Both the OSE and R-SPQ-2F tools showed an acceptable level of internal consistency of 0.893 and 0.806 respectively.

Conclusions

Student engagement was associated with deep learning approaches. The OSE and R-SPQ-2F tools were reliable tools to measure student engagement and learning approaches among medical students.
背景COVID-19大流行促使普外科毕业班学生的所有教学和学习过渡到在线平台。尽管在线教学方法很有用,但也存在一些挑战,如学习缺乏人情味、学生参与度低等。学生对课程内容的参与对于深度学习非常重要。我们使用在线学生参与度量表(OSE)和修订版比格斯双因素学习过程问卷(R-SPQ-2F)来分别评估学生的参与度和学习方法。OSE和R-SPQ-2F在线调查工具的使用对象是所有参加外科在线模块学习的毕业班学生(n = 325)。收集了定量数据,并使用 R-Statistical 计算软件对数据进行了统计分析。结果以描述性和推论性统计的形式呈现。调查回复率为 35.4%(115/325)。学生的参与度很高,OSE 工具的中位数(IQR)为 71.0(63.0-78.0)。总体而言,学生采用了深度学习法(DA),R-SPQ-2F 工具的中位数(IQR)为 34.0(30.0-39.0)分。OSE 总分与 "深度学习 "之间存在中度正相关(0.53,p < 0.001)。OSE和R-SPQ-2F工具的内部一致性分别为0.893和0.806,都达到了可接受的水平。OSE和R-SPQ-2F工具是测量医学生参与度和学习方法的可靠工具。
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引用次数: 0
Gender and age specific dynamics of health-related postoperative outcome measures following the laparoscopic sleeve gastrectomy 腹腔镜袖带胃切除术后与健康相关的术后结果测量的性别和年龄特征动态变化
IF 1.4 Q3 SURGERY Pub Date : 2024-10-30 DOI: 10.1016/j.sopen.2024.10.007
Sevak Shahbazyan , Mushegh Mirijanyan , Zhorzheta Badalova , Zareh Ter-Avetikyan

Background

A variety of bariatric surgical techniques have been implemented to manage obesity, including the laparoscopic sleeve gastrectomy (LSG).
The aim of the study was to compare the pre and postoperative features of patients undergoing LSG, analyze the dynamics of BMI and BAROS indices and to assess the impact of body appearance concern on the postoperative outcomes.

Methods

A total of 591 participants were divided into 3 age groups (20–39, 40–59 and over 60 years of age). The Charlson Comorbidity Index was used to assess comorbidity in patient groups. The rate of complications, assessment of psychological well-being and number of hospital days for patients were used to compare the features of postoperative recovery in different age groups.

Results

In the young and middle-aged groups, the BMI reduction speed was similar, and significantly higher than in the elder group with a faster rate of BMI reduction in female participants. Higher scores of BAROS were revealed in the young and middle-aged groups for the 0–1 and 1–6 month periods. The 12-month assessment revealed much higher BAROS scores for male subgroups, compared to female participants. The BAROS scores decreased gradually in female groups within the assessment periods and was the lowest in the third assessment.

Conclusions

The pattern of BAROS reduction can be the result of lower psychological and social well-being scores in female participants who reported significant weight reduction in 6–12 month period with paradoxically decreased quality of life scores explained by the impact of body appearance concern on the postoperative outcomes.
研究目的是比较接受腹腔镜袖带胃切除术(LSG)的患者的术前和术后特征,分析 BMI 和 BAROS 指数的动态变化,并评估对身体外观的关注对术后结果的影响。研究方法将 591 名参与者分为 3 个年龄组(20-39 岁、40-59 岁和 60 岁以上)。采用夏尔森合并症指数(Charlson Comorbidity Index)评估各组患者的合并症。结果 在青年组和中年组中,BMI 下降速度相似,且明显高于老年组,女性参与者的 BMI 下降速度更快。年轻组和中年组在 0-1 个月和 1-6 个月期间的 BAROS 分数较高。在 12 个月的评估中,与女性参与者相比,男性亚组的 BAROS 分数要高得多。结论 BAROS 分数降低的模式可能是女性参与者的心理和社会幸福感分数降低的结果,她们在 6 至 12 个月期间体重明显减轻,但生活质量分数却下降,这是因为对身体外观的担忧影响了术后效果。
{"title":"Gender and age specific dynamics of health-related postoperative outcome measures following the laparoscopic sleeve gastrectomy","authors":"Sevak Shahbazyan ,&nbsp;Mushegh Mirijanyan ,&nbsp;Zhorzheta Badalova ,&nbsp;Zareh Ter-Avetikyan","doi":"10.1016/j.sopen.2024.10.007","DOIUrl":"10.1016/j.sopen.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>A variety of bariatric surgical techniques have been implemented to manage obesity, including the laparoscopic sleeve gastrectomy (LSG).</div><div>The aim of the study was to compare the pre and postoperative features of patients undergoing LSG, analyze the dynamics of BMI and BAROS indices and to assess the impact of body appearance concern on the postoperative outcomes.</div></div><div><h3>Methods</h3><div>A total of 591 participants were divided into 3 age groups (20–39, 40–59 and over 60 years of age). The Charlson Comorbidity Index was used to assess comorbidity in patient groups. The rate of complications, assessment of psychological well-being and number of hospital days for patients were used to compare the features of postoperative recovery in different age groups.</div></div><div><h3>Results</h3><div>In the young and middle-aged groups, the BMI reduction speed was similar, and significantly higher than in the elder group with a faster rate of BMI reduction in female participants. Higher scores of BAROS were revealed in the young and middle-aged groups for the 0–1 and 1–6 month periods. The 12-month assessment revealed much higher BAROS scores for male subgroups, compared to female participants. The BAROS scores decreased gradually in female groups within the assessment periods and was the lowest in the third assessment.</div></div><div><h3>Conclusions</h3><div>The pattern of BAROS reduction can be the result of lower psychological and social well-being scores in female participants who reported significant weight reduction in 6–12 month period with paradoxically decreased quality of life scores explained by the impact of body appearance concern on the postoperative outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 67-73"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rapid liver graft implantation in canine: A preliminary study 犬类快速肝脏移植手术:初步研究
IF 1.4 Q3 SURGERY Pub Date : 2024-10-29 DOI: 10.1016/j.sopen.2024.10.006
Jie Hao , Jia-Wei Yu , Jing-Wen Xiao , Lin-Biao Xiang , Rong Peng , Jia-Qi Quan , Ya-Xu Dong , En-Hui Li , Juan-Juan Wang , Lu Ren , Yong Wan , Hong-Ke Zhang , Yi Lv , Qiang Lu

Background

The current method for liver graft implantation during the anhepatic phase is complex. Therefore, this study aimed to introduce a modified orthotopic liver transplantation (OLT) technique with major vascular reconstruction using cuff technique to simplify the process of liver graft implantation during the anhepatic phase.

Methods

Twenty-four canines were randomly assigned to two groups: the modified orthotopic liver transplantation group (M-OLT, n = 12) and the control group (n = 12). All animals were randomly assigned to the donor or recipient groups. The recipients received orthotopic liver transplantation using a modified technique in the M-OLT group, and OLT using traditional implantation technique without venovenous bypass was performed in the control group. The donor and recipient characteristics were compared between the two groups. Vascular anastomotic patency was evaluated using angiography immediately and one week after surgery.

Results

All recipients underwent successful liver transplantation. There were no significant differences between the two groups in terms of sex, body weight, or cold ischemia time of the donor liver. However, recipients in the M-OLT group had a shorter operation time, less intraoperative blood loss, shorter anhepatic phase, shorter vascular occlusion time, and shorter warm ischemia time than that in the control group (all p < 0.05). No anastomotic leakage or stenosis was detected in either group after liver transplantation. One recipient in the M-OLT group and three in the control group died within one week of transplantation.

Conclusions

This modified technique is safe and feasible for canine liver transplantation and can significantly simplify liver graft implantation procedures during the anhepatic period.
背景目前在无肝期植入肝脏移植物的方法较为复杂。方法将 24 只犬随机分为两组:改良正位肝移植组(M-OLT,n = 12)和对照组(n = 12)。所有动物都被随机分配到供体组或受体组。在M-OLT组中,受体接受改良技术的正位肝移植;在对照组中,受体接受不经静脉旁路的传统植入技术的OLT。比较了两组供体和受体的特征。结果 所有受者都成功接受了肝移植手术。两组受者在性别、体重和供肝冷缺血时间方面没有明显差异。然而,与对照组相比,M-OLT 组受者的手术时间更短、术中失血量更少、无肝期更短、血管闭塞时间更短以及热缺血时间更短(均为 p <0.05)。两组肝移植术后均未发现吻合口漏或狭窄。结论这种改良技术在犬肝移植中安全可行,可大大简化无肝期的肝移植植入手术。
{"title":"Rapid liver graft implantation in canine: A preliminary study","authors":"Jie Hao ,&nbsp;Jia-Wei Yu ,&nbsp;Jing-Wen Xiao ,&nbsp;Lin-Biao Xiang ,&nbsp;Rong Peng ,&nbsp;Jia-Qi Quan ,&nbsp;Ya-Xu Dong ,&nbsp;En-Hui Li ,&nbsp;Juan-Juan Wang ,&nbsp;Lu Ren ,&nbsp;Yong Wan ,&nbsp;Hong-Ke Zhang ,&nbsp;Yi Lv ,&nbsp;Qiang Lu","doi":"10.1016/j.sopen.2024.10.006","DOIUrl":"10.1016/j.sopen.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>The current method for liver graft implantation during the anhepatic phase is complex. Therefore, this study aimed to introduce a modified orthotopic liver transplantation (OLT) technique with major vascular reconstruction using cuff technique to simplify the process of liver graft implantation during the anhepatic phase.</div></div><div><h3>Methods</h3><div>Twenty-four canines were randomly assigned to two groups: the modified orthotopic liver transplantation group (M-OLT, <em>n</em> = 12) and the control group (n = 12). All animals were randomly assigned to the donor or recipient groups. The recipients received orthotopic liver transplantation using a modified technique in the M-OLT group, and OLT using traditional implantation technique without venovenous bypass was performed in the control group. The donor and recipient characteristics were compared between the two groups. Vascular anastomotic patency was evaluated using angiography immediately and one week after surgery.</div></div><div><h3>Results</h3><div>All recipients underwent successful liver transplantation. There were no significant differences between the two groups in terms of sex, body weight, or cold ischemia time of the donor liver. However, recipients in the M-OLT group had a shorter operation time, less intraoperative blood loss, shorter anhepatic phase, shorter vascular occlusion time, and shorter warm ischemia time than that in the control group (all <em>p</em> &lt; 0.05). No anastomotic leakage or stenosis was detected in either group after liver transplantation. One recipient in the M-OLT group and three in the control group died within one week of transplantation.</div></div><div><h3>Conclusions</h3><div>This modified technique is safe and feasible for canine liver transplantation and can significantly simplify liver graft implantation procedures during the anhepatic period.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 34-39"},"PeriodicalIF":1.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A nomogram for cancer-specific survival of lung adenocarcinoma patients: A SEER based analysis 肺腺癌患者癌症特异性生存期提名图:基于 SEER 的分析
IF 1.4 Q3 SURGERY Pub Date : 2024-10-18 DOI: 10.1016/j.sopen.2024.10.003
Hong Guo Doctor of Medicine (M.D.) , Guole Nie Doctor of Medicine (M.D.) , Xin Zhao Master of Medicine (M.M.) , Jialu Liu Master of Medicine (M.M.) , Kaihua Yu Master of Medicine (M.M.) , Yulan Li Doctor of Medicine (M.D.)

Background

Non-small cell lung cancer (NSCLC) accounts for 85 % of lung cancer cases. Among NSCLC subtypes, lung adenocarcinoma (LUAD) stands as the most prevalent. Regrettably, LUAD continues to exhibit a notably unfavorable overall prognosis. This study's primary aim was to develop and validate prognostic tools capable of predicting the likelihood of cancer-specific survival (CSS) in patients with LUAD.

Methods

We retrospectively collected 21,099 patients diagnosed with LUAD between 2010 and 2015, and 8290 patients diagnosed between 2004 and 2009 from SEER database. The cohort of 21,099 patients served as the prognostic group for the exploration of LUAD-related prognostic risk factors. The cohort of 8290 patients was designated for external validation. We created a training set and an internal validation set in the prognostic group for the development and internal validation of CSS nomograms. CSS predictors were identified through the least absolute shrinkage and selection operator (Lasso) regression analysis. Prognostic model was constructed via Cox hazard regression analysis, presented in the form of both static and dynamic network-based nomograms.

Results

Several independent prognostic factors were incorporated into the construction of nomogram. The nomogram accurately predicted CSS at 1, 3, and 5 years, with respective AUC values of 0.769, 0.761, and 0.748 for the training group, and 0.741, 0.752, and 0.740 for the testing group. The study demonstrated a strong agreement between anticipated and actual CSS values, supported by decision curve analysis (DCA) and time-dependent calibrated curves. High-risk patients based on the nomogram exhibiting significantly lower survival rates compared to their low-risk counterparts according to Kaplan-Meier (K-M) curves. The nomogram demonstrates excellent predictive power in the external validation cohort.

Conclusions

A dependable and user-friendly nomogram has been developed, available in both static and online dynamic calculator formats, to facilitate healthcare professionals in accurately estimating the likelihood of CSS for patients diagnosed LUAD.
背景非小细胞肺癌(NSCLC)占肺癌病例的 85%。在 NSCLC 亚型中,肺腺癌(LUAD)最为常见。令人遗憾的是,肺腺癌的总体预后仍然不容乐观。本研究的主要目的是开发并验证能够预测LUAD患者癌症特异性生存(CSS)可能性的预后工具。方法我们从SEER数据库中回顾性地收集了2010年至2015年间确诊的21099例LUAD患者,以及2004年至2009年间确诊的8290例患者。21,099例患者作为预后组,探讨与LUAD相关的预后风险因素。8290例患者队列被指定为外部验证组。我们在预后组中创建了一个训练集和一个内部验证集,用于开发和内部验证 CSS 直方图。通过最小绝对收缩和选择算子(Lasso)回归分析确定了 CSS 预测因子。通过 Cox 危险回归分析建立了预后模型,并以基于静态和动态网络的提名图形式呈现。提名图能准确预测 1、3 和 5 年后的 CSS,训练组的 AUC 值分别为 0.769、0.761 和 0.748,测试组的 AUC 值分别为 0.741、0.752 和 0.740。研究结果表明,预期 CSS 值与实际 CSS 值之间具有很高的一致性,决策曲线分析 (DCA) 和随时间变化的校准曲线也证明了这一点。根据 Kaplan-Meier (K-M) 曲线,基于提名图的高风险患者的生存率明显低于低风险患者。结论 我们开发出了一种可靠且用户友好的提名图,它既有静态计算器格式,也有在线动态计算器格式,可帮助医护人员准确估计确诊为 LUAD 患者的 CSS 可能性。
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引用次数: 0
Investigation and self-assessment of liver transplantation training physicians at Shanghai Renji Hospital: A preliminary study 上海仁济医院肝移植培训医师的调查与自我评估:初步研究
IF 1.4 Q3 SURGERY Pub Date : 2024-10-17 DOI: 10.1016/j.sopen.2024.10.004
Xiaochen Bo, Feng Xue, Qiang Xia, Kang He

Background

Continuing medical education in liver transplantation is pivotal in enhancing the proficiency of liver surgeons. The goal of this study is to obtain information on all aspects of the training, enable us to pinpoint the training's strengths, and address any shortcomings or challenges.

Method

We conducted an online questionnaire survey, which was comprised of 33 questions, offering response options in the form of “yes/no”, single choice, or multiple choice.

Results

A total of 59 liver surgeons actively participated in the questionnaire survey. The majority of them exhibited a comprehensive understanding of the liver transplant training program, encompassing its structure, content, and assessment format. It is noteworthy that all respondents expressed keen interest in novel course components such as medical humanities, interpersonal communication, full-process patient management, and scientific research and academic activities. The overall satisfaction with the diverse specialized training courses was notably high. Furthermore, there was a significant improvement in self-confidence among participants for performing relevant clinical practices post-training, signifying the effectiveness of the program. Notably, key determinants influencing physicians' confidence levels before and after training included accumulated clinical practice time, basic operation cases, and educational background.

Conclusion

This survey reveals that trainees possess a commendable grasp of the program, maintain a positive outlook, and gain substantial benefits from the training. Importantly, it underscores the need to enhance the pedagogical skills of professional training instructors, continually refine the curriculum, and serve as a foundation for informed decisions in the ongoing training of liver transplant physicians.
背景肝移植的继续医学教育对提高肝脏外科医生的水平至关重要。本研究的目的是获取有关培训各个方面的信息,使我们能够明确培训的优势,并解决任何不足或挑战。方法我们进行了在线问卷调查,其中包括 33 个问题,回答方式有 "是/否"、单选或多选。他们中的大多数人都对肝移植培训项目有了全面的了解,包括其结构、内容和评估形式。值得注意的是,所有受访者都对医学人文、人际沟通、全程患者管理、科研和学术活动等新颖的课程内容表现出浓厚的兴趣。对各种专业培训课程的总体满意度明显较高。此外,学员们在培训后开展相关临床实践的自信心也有了显著提高,这表明该项目卓有成效。值得注意的是,影响医生培训前后自信水平的主要决定因素包括累计临床实践时间、基本操作病例和教育背景。重要的是,它强调了提高专业培训导师的教学技能、不断完善课程设置的必要性,并为肝移植医生的持续培训提供了明智决策的基础。
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引用次数: 0
Optimizing the role of scrub nurses during robotic surgery console time 优化机器人手术控制台时间内擦洗护士的作用
IF 1.4 Q3 SURGERY Pub Date : 2024-10-11 DOI: 10.1016/j.sopen.2024.10.001
Kenro Chikazawa , Hiroyoshi Ko , Hiroshi Noda , Ken Imai , Tomoyuki Kuwata
At our institution, scrub nurses leave the surgical field during the console time for robotic surgeries to attend to other duties. The first assistant then assumes their responsibilities, allowing for efficient use of staff time and resources. This practice improves teamwork and can be presented as a cost-saving measure for hospital administrations.
在我院,擦洗护士会在机器人手术的控制台时间离开手术区,去处理其他工作。然后由第一助手承担其职责,从而有效利用员工的时间和资源。这种做法提高了团队协作能力,并可作为医院管理部门的一项节约成本措施。
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引用次数: 0
Woman or surgeon – Not both: Perceptions of support, enablers and barriers in general surgery 妇女或外科医生 - 两者不可兼得:对普外科支持、促进因素和障碍的看法
IF 1.4 Q3 SURGERY Pub Date : 2024-10-11 DOI: 10.1016/j.sopen.2024.10.002
Kelda M.O. Sheridan, Naomi D. Quinton

Introduction

The General Surgery (GS) educational community of practice faces crisis. Recruitment is challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility (UK Shape of Training Steering Group, 2017; Kennedy, 2021) [1,45]. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum (Brown et al., 2019) [26]. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.

Methods

Qualitative methodology within a constructivist research paradigm was utilised. Recruitment included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. Individual semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified.

Results and discussion

Foundation, specialty doctors, core and higher surgical trainees were included (60 % men, 40 % women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.

Conclusions

The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.
导言普通外科(GS)教育实践社区面临危机。招聘面临着推迟基础培训后的文化规范的挑战;留住人才则面临着精英主义、歧视和缺乏灵活性的看法(英国培训形态指导小组,2017 年;肯尼迪,2021 年)[1,45]。外科教学法已通过技能学习进行了研究,但隐性课程的情况如何(Brown 等人,2019 年)[26]。我们提出了三个研究目标:谁是普通外科医生,从事这一职业的有利因素或障碍是什么,以及我们目前的英国培训体系是否符合目的。招募对象包括具有代表性的初级医生,包括男性、女性和来自不同种族背景的人。个人半结构式访谈探讨了参与者对培训、招聘和工作与生活平衡的看法。对数据进行了转录、熟悉、解构和生成。潜在数据分析、编码和发展保持了反思性。将 "数据集 "转化为主题图,并确定关键主题。结果与讨论包括基础、专科医生、核心和高级外科受训人员(男性占 60%,女性占 40%)。确定了支持、态度和牺牲等基本主题,这些主题相互作用,影响着教育叙事。支持包括个人、机构、学术和文化形式。精英主义的态度、隐性和显性的性别偏见、微观诽谤和公开歧视掩盖了外科手术的传统。该研究探讨了 GS 中的表型、动机、智力和理念。教育是一种强有力的工具,可用于挑战观念和改善培训。
{"title":"Woman or surgeon – Not both: Perceptions of support, enablers and barriers in general surgery","authors":"Kelda M.O. Sheridan,&nbsp;Naomi D. Quinton","doi":"10.1016/j.sopen.2024.10.002","DOIUrl":"10.1016/j.sopen.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The General Surgery (GS) educational community of practice faces crisis. Recruitment is challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility (UK Shape of Training Steering Group, 2017; Kennedy, 2021) [<span><span>1</span></span>,<span><span>45</span></span>]. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum (Brown et al., 2019) [<span><span>26</span></span>]. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.</div></div><div><h3>Methods</h3><div>Qualitative methodology within a constructivist research paradigm was utilised. Recruitment included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. Individual semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified.</div></div><div><h3>Results and discussion</h3><div>Foundation, specialty doctors, core and higher surgical trainees were included (60 % men, 40 % women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.</div></div><div><h3>Conclusions</h3><div>The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 3-12"},"PeriodicalIF":1.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Surgery open science
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