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Monitoring neoadjuvant treatment-induced surgical benefit in GIST patients using CT-based radiological criteria 利用基于 CT 的放射学标准监测新辅助治疗对 GIST 患者的手术治疗效果
IF 1.4 Q3 SURGERY Pub Date : 2024-07-14 DOI: 10.1016/j.sopen.2024.07.002

Objective

This single-centre retrospective study aims to determine the incidence of therapy-induced surgical benefit in patients with non-metastatic gastrointestinal stromal tumour (GIST) treated with neoadjuvant tyrosine kinase inhibitors (TKI) and evaluate whether this can be predicted by radiological response criteria.

Methods

Thirty-nine non-metastatic GIST patients were treated with neoadjuvant TKI treatment, followed by curative-intended surgery, and monitored using contrast-enhanced computed tomography (CE-CT). Surgical benefit was independently assessed by two surgical oncologists and was defined by de-escalation of surgical strategy or reduced surgical complexity. Radiological response between baseline and the last preoperative scan was determined through RECIST 1.1, Choi and volumetric criteria.

Results

In this patient cohort, median neoadjuvant treatment interval was 8.3 (IQR, 3.9–10.6) months. Surgical benefit was gained in 22/39 patients. When comparing radiological criteria to findings on surgical benefit, accuracy, sensitivity, and specificity for RECIST 1.1 (90 %, 100.0 % and 82 %), Choi (64 %, 24 %, and 96 %) and volumetry (95 %, 100.0 %, and 91 %) were calculated. In 30/39 patients, temporal changes in tumour size over the course of treatment was assessed. Tumour volume reduced significantly in the surgical-benefit group compared to the non-benefit group (72 % vs. 25 %, p < 0.01) within three months. 14/19 surgical-benefit patients had an initial volume reduction above 66 %, after which volume reduced slightly with a median 3.1 % (IQR, 2.1–7.8 %) reduction.

Conclusion

Surgical benefit after neoadjuvant treatment was achieved in 56 % of patients and was most accurately reflected by size-based response criteria. In patients with therapy-induced surgical benefit, nearly all treatment-induced volume reductions were achieved within three months.

目的这项单中心回顾性研究旨在确定接受新辅助酪氨酸激酶抑制剂(TKI)治疗的非转移性胃肠道间质瘤(GIST)患者因治疗引起的手术获益的发生率,并评估是否可以通过放射学反应标准来预测。方法39例非转移性GIST患者接受了新辅助TKI治疗,随后进行了治愈性手术,并使用造影剂增强计算机断层扫描(CE-CT)进行监测。手术获益由两名肿瘤外科专家独立评估,其定义是手术策略降级或手术复杂性降低。基线与最后一次术前扫描之间的放射学反应根据 RECIST 1.1、Choi 和容积标准确定。22/39例患者从手术中获益。在将放射学标准与手术获益结果进行比较时,计算了RECIST 1.1(90%、100.0%和82%)、Choi(64%、24%和96%)和容积测量(95%、100.0%和91%)的准确性、敏感性和特异性。对 30/39 例患者的肿瘤大小在治疗过程中的时间变化进行了评估。与非获益组相比,手术获益组的肿瘤体积在三个月内明显缩小(72 % vs. 25 %,p < 0.01)。14/19例手术获益患者的初始体积缩小率超过66%,之后体积略有缩小,中位缩小率为3.1%(IQR,2.1-7.8%)。在治疗诱导手术获益的患者中,几乎所有治疗诱导的体积缩小都是在三个月内实现的。
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引用次数: 0
Satisfaction and wellbeing of general surgery trainees in the Saudi Arabian residency educational environment: A mixed-methods study 沙特阿拉伯住院医师教育环境中普外科学员的满意度和幸福感:混合方法研究
IF 1.4 Q3 SURGERY Pub Date : 2024-07-05 DOI: 10.1016/j.sopen.2024.06.011

Background

Surgical residency training is prominently demanding and stressful. This can affect the residents' wellbeing, work-life balance and increase the rates of burnout. We aimed to assess rates of satisfaction and burn-out among GS residents in the national training programs and provide a subsequent in-depth analysis of the potential reasons.

Method

A sequential explanatory mixed-methods study was conducted using an online survey and virtual interviews. The validated abbreviated Maslach Burnout Inventory (aMBI) was used to assess burnout while satisfaction was assessed via 5-points Likert scale.

Results

After excluding incomplete responses from the total 74 received, 53 were analyzed. The average participant age was 27.4 ± 2 years, with females comprising 52 % of the sample. Junior residents made up 58.5 %, and nearly half −45 %- considered quitting GS training. Moderate to high burnout rates were noted on each aMBI subscale, ranging from 41.7 % to 62.5 %. The majority of residents expressed dissatisfaction with the level of research engagement (81.1 %), supervision, and mentorship. However, operative exposure was a source of satisfaction. Dissatisfaction rates with intra-operative learning, academia, teaching, and clinical exposure were 62.3 %, 52.8 %, 50.9 %, and 35.8 %, respectively. Interviews revealed surgical case flow and a friendly work environment as major satisfaction sources. Conversely, lack of academic supervision and suboptimal hands-on training were major dissatisfaction sources.

Conclusion

Dissatisfaction and burn-out is prevalent among national GS training programs. Sub-optimal educational delivery and low-quality hands-on operative exposure -rather than lack of exposure to cases- seem to be the culprit.

背景外科住院医师培训要求高、压力大。这会影响住院医师的身心健康、工作与生活的平衡,并增加倦怠率。我们的目的是评估国家培训项目中外科学住院医师的满意度和倦怠率,并对潜在原因进行深入分析。结果从收到的 74 份问卷中剔除不完整的回答后,对 53 份问卷进行了分析。参与者的平均年龄为 27.4 ± 2 岁,女性占样本的 52%。初级住院医师占 58.5%,近一半(45%)考虑退出 GS 培训。在 aMBI 各分量表中,倦怠率从中度到高度不等,从 41.7% 到 62.5%。大多数住院医师对研究参与度(81.1%)、督导和导师表示不满。然而,对手术的接触则表示满意。对术中学习、学术、教学和临床接触不满意的比例分别为 62.3%、52.8%、50.9% 和 35.8%。访谈显示,手术病例流程和友好的工作环境是满意度的主要来源。结论 在国家一般事务培训项目中,普遍存在不满意和倦怠的情况。次优的教学方式和低质量的动手操作--而不是缺乏病例--似乎是罪魁祸首。
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引用次数: 0
Effect of noise on the performance of arthroscopic simulator 噪音对关节镜模拟器性能的影响
IF 1.4 Q3 SURGERY Pub Date : 2024-07-05 DOI: 10.1016/j.sopen.2024.06.006
Alexandre Czerwiec , Margot Vannier , Olivier Courage

Background

Noise is omnipresent in the operating room. The average noise in the operating room generally ranges between 60 and 65 dB and can sometimes exceed 100 dB, despite the ARS (Agence Régionale de Santé) and WHO (World Health Organization) recommending levels of 35 dB(A). This study aimed to evaluate the effect of different kinds of background auditory stimuli on the performance of surgeons during an arthroscopic simulation task.

Methods

Forty-seven surgeons with varying experience in arthroscopic surgery undertook different exercises under four different conditions: quiet, classical music, hard rock, and sustained chatter. All background auditory stimuli were set at 65 dB(A). Each participant underwent double randomization for the four sound stimuli and the four exercises to be performed. A musical questionnaire was also completed by each participant. Data related to each exercise included operating time in seconds, distance from the camera or instruments in centimeters, and an overall score automatically calculated by the simulator based on safety, economy of movement, and speed (scale: 0–20 points).

Results

Operative time in an environment with classical music was significantly lower than in an environment with hard rock (95.9 s vs. 128.7 s, p = 0.0003). The overall rating in an environment with chatter was significantly lower than in a silent environment (11.7 vs. 15.7, p < 0.0001). The overall rating in an environment with hard rock was significantly lower than in an environment with classical music (14.3 vs. 17.5, p = 0.0008).

Surgeons who preferred listening to music in the operating room performed differently than those who did not. The mean operative time for surgeons who preferred music was 99.52 s (SD = 47.20), compared to 117.16 s (SD = 61.06) for those who did not prefer music, though this difference was not statistically significant (p = 0.082). The mean overall score for surgeons who preferred music was significantly higher at 17.46 (SD = 2.29) compared to 15.57 (SD = 3.49) for those who did not prefer music (p = 0.001).

Conclusions

Our study suggests that exposure to classical music and silence may confer greater benefits to the surgeon compared to the impact of hard rock and chatter. These conclusions are grounded in significant differences observed in operative time and overall evaluations, highlighting the potential advantages of an environment characterized by acoustic tranquility for surgical professionals. Preferences for music in the operating room also play a role, with those who prefer music demonstrating better performance scores.

背景噪声在手术室中无处不在。手术室的平均噪音一般在 60 到 65 分贝之间,有时甚至会超过 100 分贝,尽管 ARS(法国区域卫生机构)和 WHO(世界卫生组织)建议噪音水平为 35 分贝(A)。本研究旨在评估不同种类的背景听觉刺激对外科医生在关节镜模拟任务中的表现的影响。方法47名具有不同关节镜手术经验的外科医生在四种不同的条件下进行了不同的练习:安静、古典音乐、硬摇滚乐和持续的喋喋不休。所有背景听觉刺激均设置为 65 dB(A)。每位受试者在四种声音刺激和四种练习之间进行双重随机分配。每位参与者还填写了一份音乐问卷。每项练习的相关数据包括以秒为单位的操作时间、以厘米为单位的与摄像头或仪器的距离,以及模拟器根据安全性、动作经济性和速度自动计算出的总分(评分标准:0-20 分)。结果在古典音乐环境中的操作时间明显低于硬摇滚环境(95.9 秒 vs. 128.7 秒,p = 0.0003)。嘈杂环境中的总体评分明显低于安静环境(11.7 对 15.7,p = 0.0001)。喜欢在手术室听音乐的外科医生与不喜欢听音乐的外科医生的表现不同。喜欢听音乐的外科医生的平均手术时间为 99.52 秒(SD = 47.20),而不喜欢听音乐的外科医生的平均手术时间为 117.16 秒(SD = 61.06),但这一差异在统计学上并不显著(p = 0.082)。我们的研究表明,与硬摇滚乐和喋喋不休的影响相比,接触古典音乐和安静可能会给外科医生带来更大的益处。这些结论的依据是在手术时间和总体评价方面观察到的显著差异,凸显了以声音宁静为特点的环境对外科专业人员的潜在优势。对手术室音乐的偏好也有影响,喜欢音乐的人表现得分更高。
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引用次数: 0
Endoscopic techniques for management of large colorectal polyps, strictures and leaks 治疗大肠息肉、狭窄和渗漏的内窥镜技术
IF 1.4 Q3 SURGERY Pub Date : 2024-07-04 DOI: 10.1016/j.sopen.2024.06.012
Stuart R. Gordon, Lauren S. Eichenwald, Hannah K. Systrom

The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (<10 mm), recent evidence favors cold snare polypectomy due to its superior safety profile and comparable complete resection rates. Large polyps (>10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection.

This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.

实施切除息肉的结肠镜筛查后,与结直肠癌(CRC)相关的死亡率明显下降,但它仍然是全球癌症相关死亡的主要原因。结直肠癌通常源于腺瘤性息肉,增加息肉切除可降低结直肠癌的发病率和死亡率。在这一过程中,内窥镜息肉切除术(包括热和冷套管息肉切除术)发挥了关键作用。虽然这两种方法对小息肉(10 毫米)都有效,但最近的证据表明,冷镜息肉切除术因其更高的安全性和可比的完全切除率而更受青睐。大息肉(<10 mm),尤其是那些具有晚期特征的息肉,会增加患癌风险,通常需要细致的评估和先进的内镜技术,包括内镜下粘膜切除术(EMR)和内镜下粘膜下剥离术(ESD),才能进行切除。本章还对处理结肠梗阻和结肠周围积液的内窥镜技术进行了实用性概述,详细介绍了这些技术的适应症、优点、缺点和并发症,目的是提高临床实践中的理解和应用。此外,我们还总结了内窥镜闭合技术,这些技术彻底改变了穿孔和瘘管的治疗方法,为手术提供了安全有效的替代方案。
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引用次数: 0
Revolutionizing medical education: Surgery takes the lead in virtual reality research 医学教育的革命:外科率先开展虚拟现实研究
IF 1.4 Q3 SURGERY Pub Date : 2024-07-03 DOI: 10.1016/j.sopen.2024.06.013
M.A. Wolf , M. Mergen , P. Winter , S. Landgraeber , P. Orth

Objectives

Advancements in technology have spurred a transformative shift in medical education, with virtual reality (VR) emerging as a powerful tool for enhancing the learning experience. This study analyses the publications of VR in medical education, focusing on differences within different medical specialties.

Design

Using specific search terms, all studies published on VR in medical education listed in the Web of Science databases were included. All identified publications were analysed in order to draw comparative conclusions regarding their qualitative and quantitative scientific merit.

Results

Since the first publication in 1993 and until the year 2022, there have been 1534 publications on VR in medical education. Over the years, the annual publication rate has increased almost exponentially. The studies have in total been cited 42,655 times (average 27.64 citations/publication). The leading medical field was surgery (415 publications), followed by internal medicine (117 publications), neurology (77 publications) and radiology and nuclear medicine (75 publications). Internationally, the United States (560 publications), the United Kingdom (179 publications), Canada (156 publications), Germany (139 publications) and China (100 publications) are the leading countries in this field. 37.1 % of the publications reported having received funding. Among the 100 organizations with the highest number of grants, only 8 were private companies.

Conclusion

During the last 30 years, there has been a consistent rise in publications, with a notable surge observed in 2016 and 2020. The majority of the studies centered on surgical concerns. However, only a small proportion received financial support, which was particularly evident for funding originating from the private sector.

目标技术的进步推动了医学教育的变革,虚拟现实(VR)成为增强学习体验的有力工具。本研究分析了有关医学教育中虚拟现实技术的出版物,重点关注不同医学专业中的差异。设计使用特定的搜索条件,纳入了科学网数据库中列出的所有有关医学教育中虚拟现实技术的研究。结果自 1993 年首次发表至 2022 年,共有 1534 篇关于医学教育中的虚拟现实技术的论文发表。多年来,每年的发表率几乎呈指数增长。这些研究总共被引用了 42,655 次(平均 27.64 次/篇)。最主要的医学领域是外科(415 篇),其次是内科(117 篇)、神经内科(77 篇)以及放射学和核医学(75 篇)。在国际上,美国(560 篇)、英国(179 篇)、加拿大(156 篇)、德国(139 篇)和中国(100 篇)是该领域的主要国家。37.1%的出版物报告说获得了资助。在获得资助最多的 100 家机构中,只有 8 家是私营公司。大多数研究以外科问题为中心。然而,只有一小部分获得了资金支持,这一点在来自私营部门的资金中尤为明显。
{"title":"Revolutionizing medical education: Surgery takes the lead in virtual reality research","authors":"M.A. Wolf ,&nbsp;M. Mergen ,&nbsp;P. Winter ,&nbsp;S. Landgraeber ,&nbsp;P. Orth","doi":"10.1016/j.sopen.2024.06.013","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.06.013","url":null,"abstract":"<div><h3>Objectives</h3><p>Advancements in technology have spurred a transformative shift in medical education, with virtual reality (VR) emerging as a powerful tool for enhancing the learning experience. This study analyses the publications of VR in medical education, focusing on differences within different medical specialties.</p></div><div><h3>Design</h3><p>Using specific search terms, all studies published on VR in medical education listed in the Web of Science databases were included. All identified publications were analysed in order to draw comparative conclusions regarding their qualitative and quantitative scientific merit.</p></div><div><h3>Results</h3><p>Since the first publication in 1993 and until the year 2022, there have been 1534 publications on VR in medical education. Over the years, the annual publication rate has increased almost exponentially. The studies have in total been cited 42,655 times (average 27.64 citations/publication). The leading medical field was surgery (415 publications), followed by internal medicine (117 publications), neurology (77 publications) and radiology and nuclear medicine (75 publications). Internationally, the United States (560 publications), the United Kingdom (179 publications), Canada (156 publications), Germany (139 publications) and China (100 publications) are the leading countries in this field. 37.1 % of the publications reported having received funding. Among the 100 organizations with the highest number of grants, only 8 were private companies.</p></div><div><h3>Conclusion</h3><p>During the last 30 years, there has been a consistent rise in publications, with a notable surge observed in 2016 and 2020. The majority of the studies centered on surgical concerns. However, only a small proportion received financial support, which was particularly evident for funding originating from the private sector.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000964/pdfft?md5=11cfc4d45510616796c8b9476af8b7a7&pid=1-s2.0-S2589845024000964-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141583370","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
COVID-19: A national rise in penetrating trauma cared for by a prepared trauma system COVID-19:全国由准备就绪的创伤系统护理的穿透性创伤增加
IF 1.4 Q3 SURGERY Pub Date : 2024-07-03 DOI: 10.1016/j.sopen.2024.06.007
Mallory Jebbia, Jeffry Nahmias, Matthew Dolich, Sebastian Schubl, Michael Lekawa, Lourdes Swentek, Areg Grigorian

Background

The COVID-19 pandemic negatively impacted the collective American psyche. Socioeconomic hardships including social isolation led to an increase in firearm sales. Previous regional studies demonstrated increased penetrating trauma during the pandemic but it is unclear if trauma systems were prepared for this influx of penetrating injuries. This study aimed to confirm this increased penetrating trauma trend nationally and hypothesized penetrating trauma patients treated during the pandemic had a higher risk of complications and death, compared to pre-pandemic patients.

Methods

The 2017–2020 Trauma Quality Improvement Program database was divided into pre-pandemic (2017–2019) and pandemic years (2020). Bivariate analyses and a multivariable logistic regression analyses were performed controlling for age, comorbidities, injuries, and vitals on arrival.

Results

From 3,525,132 patients, 936,890 (26.6 %) presented during the pandemic. The pandemic patients had a higher rate of stab-wounds (4.8 % vs. 4.5 %, p > 0.001) and gunshot wounds (5.8 % vs. 4.6 %, p < 0.001) compared to pre-pandemic patients. Among penetrating trauma patients, the rate and associated risk of in-hospital complications (5.0 % vs. 5.1 %, p = 0.38) (OR 0.98, CI 0.94–1.02, p = 0.26) was similar between pre-pandemic and pandemic cohorts but adjusted risk of mortality decreased during the pandemic (8.3 % vs. 8.3 %, p = 0.45) (OR 0.92, CI 0.89–0.96, p < 0.001).

Conclusion

This national analysis confirms an increased rate of penetrating trauma during the COVID-19 pandemic, with a higher rate of gunshot injuries. However, this did not result in an increased risk of death or complications suggesting that trauma systems across the country were prepared to handle a dual pandemic of COVID and firearm violence.

背景COVID-19 大流行对美国人的集体心理产生了负面影响。包括社会隔离在内的社会经济困难导致枪支销售增加。先前的地区性研究表明,大流行期间穿透性创伤增加,但目前尚不清楚创伤系统是否为穿透性创伤的涌入做好了准备。本研究旨在证实全国穿透性创伤增加的趋势,并假设与大流行前相比,在大流行期间接受治疗的穿透性创伤患者有更高的并发症和死亡风险。方法将 2017-2020 年创伤质量改进计划数据库分为大流行前(2017-2019 年)和大流行年(2020 年)。结果在3525132名患者中,有936890人(26.6%)在大流行期间就诊。与大流行前的病人相比,大流行期间病人的刀伤率(4.8% 对 4.5%,P> 0.001)和枪伤率(5.8% 对 4.6%,P< 0.001)较高。在穿透性创伤患者中,大流行前和大流行期间的住院并发症发生率和相关风险(5.0 % vs. 5.1 %,p = 0.38)(OR 0.98,CI 0.94-1.02,p = 0.26)相似,但在大流行期间,调整后的死亡风险下降(8.结论这项全国性分析证实,在 COVID-19 大流行期间,穿透性创伤的发生率有所上升,枪伤的发生率更高。然而,这并没有导致死亡或并发症风险的增加,这表明全国各地的创伤系统已经做好了应对 COVID 和枪支暴力双重流行的准备。
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引用次数: 0
The development of Logix – An application for component-based case logging and surgical trainee assessment 开发 Logix - 基于组件的病例记录和外科学员评估应用程序
IF 1.4 Q3 SURGERY Pub Date : 2024-07-03 DOI: 10.1016/j.sopen.2024.06.008
Benjamin D. Seadler MD , Nathan J. Smith MD , Adhitya Ramamurthi MD , James Zelten MS , Karina Alagoa BS , Lyle D. Joyce MD PhD , David L. Joyce MD MBA

Background

The optimal training program to transform a new resident into a competent and capable surgeon is constantly evolving. Competency-based evaluation represents a change in mindset from quantitative or chronologic metrics for graduate readiness. As surgery becomes more specialized, more dependent on technology, and more public, we must continue to improve our ability to pass on technical skills. Approaching surgery in a component-based fashion enables even the most complex operation to be broken down into smaller sets of steps that range the entire spectrum of complexity. Treating an operation through the lens of its components, emphasizing stepwise forward progression in a trainee's experience, may provide a way to train competent surgeons more efficiently. Current case-logging products do not provide adequate granularity to apply this methodology.

Methods

Application design relied on the involvement of local surgeons from all specialties and subspecialties related to general surgical training. Individual interviews with multiple experts in each field were used to generate a list of most commonly performed operations. Once a consensus was reached, the same surgeons were queried on what they felt were the core steps that make up each operation. This information was utilized to create a novel mobile application which enables the user to record cases by date, attending surgeon, specific operation, and which portions of the operation they were able/allowed to perform.

Conclusion

Component-based case logging through the Logix application may be a useful adjunct as we continue to implement competency-based surgical training. Future investigation will assess user experience and compare subjective and objective metrics of training progression between the Logix application and currently utilized products. The information provided by the application stands to benefit not just trainees, but educators, training programs, and regulatory bodies.

Key message

Component-based case logging via a novel mobile application stands to increase the efficiency of surgical training and more effectively assess trainee competency.

背景将新住院医师转变为称职和有能力的外科医生的最佳培训计划在不断演变。以能力为基础的评估代表了一种思维方式的改变,即不再以数量或时间为标准来衡量毕业生的准备程度。随着外科手术越来越专业化、越来越依赖技术、越来越大众化,我们必须不断提高传授技术技能的能力。以组件为基础的手术方式可以将最复杂的手术分解成更小的步骤,从而涵盖整个手术的复杂程度。通过组件的视角来处理手术,强调受训者经验的循序渐进,可以更高效地培训出合格的外科医生。目前的病例记录产品无法提供应用这种方法所需的足够精细度。方法应用设计依赖于与普通外科培训相关的所有专科和亚专科的当地外科医生的参与。对每个领域的多位专家进行个别访谈,以得出最常实施的手术清单。在达成共识后,又询问了这些外科医生他们认为每项手术的核心步骤是什么。这些信息被用来创建一个新颖的移动应用程序,使用户能够按照日期、主治外科医生、具体手术以及他们能够/允许执行的手术部分来记录病例。结论在我们继续实施基于能力的外科培训时,通过 Logix 应用程序进行基于组件的病例记录可能是一个有用的辅助工具。未来的调查将评估用户体验,并比较 Logix 应用程序和当前使用的产品在培训进展方面的主观和客观指标。该应用程序提供的信息不仅有利于学员,也有利于教育工作者、培训项目和监管机构。关键信息通过新颖的移动应用程序进行基于组件的病例记录可提高外科培训的效率,更有效地评估学员的能力。
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引用次数: 0
Predictors of emergency abdominal surgery for patients aged 90 years or older: A retrospective study 90 岁或以上患者接受紧急腹部手术的预测因素:回顾性研究
IF 1.4 Q3 SURGERY Pub Date : 2024-07-03 DOI: 10.1016/j.sopen.2024.06.010
Atsushi Horiuchi, Shun Akehi, Yuta Fujiwara, Sakura Kawaharada, Takayuki Anai

Background

With the aging of the population, more and more patients ≥90 years old are undergoing surgery. We retrospectively examined factors affecting morbidity and in-hospital mortality among patients ≥90 years old who underwent emergency abdominal operations.

Materials and methods

Forty-six cases of emergency abdominal surgery for patients ≥90 years old who underwent surgery at our hospital between 2011 and 2022 were included in this study. Factors affecting morbidity and in-hospital mortality were analyzed statistically. Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)-predicted morbidity and Portsmouth-POSSUM (P-POSSUM)-predicted mortality were calculated.

Results

Postoperative complications occurred in 30 patients (65.2 %) and 5 patients (10.8 %) died in the hospital. Factors affecting morbidity included American Society of Anesthesiologists physical status score, operative time and blood loss, and operative severity score. Multivariate analysis identified male sex, operative severity score, and length of hospital stay as factors affecting morbidity. Eastern Cooperative Oncology Group performance status and physiological score were identified as factors influencing mortality in hospital, and only physiological score was identified in the multivariate analysis. Area under the receiver operating characteristic (ROC) curve for POSSUM-predicted morbidity was 0.796 and area under the ROC curve for P-POSSUM-predicted mortality was 0.805, both of which were moderately accurate.

Conclusion

Risk of emergency abdominal surgery in patients ≥90 years old may be predictable to some extent, and we are able to provide convincing explanations to patients and families based on these data.

背景随着人口老龄化的加剧,越来越多的≥90岁患者接受手术治疗。我们对接受急诊腹部手术的≥90岁患者中影响发病率和院内死亡率的因素进行了回顾性研究。对影响发病率和院内死亡率的因素进行统计分析。结果 30 名患者(65.2%)出现术后并发症,5 名患者(10.8%)在医院死亡。影响发病率的因素包括美国麻醉医师协会身体状况评分、手术时间和失血量以及手术严重程度评分。多变量分析发现,男性性别、手术严重程度评分和住院时间是影响发病率的因素。东部合作肿瘤学组表现状态和生理评分被认为是影响住院死亡率的因素,而在多变量分析中只有生理评分被认为是影响住院死亡率的因素。POSSUM 预测发病率的接收者操作特征曲线下面积为 0.796,P-POSSUM 预测死亡率的接收者操作特征曲线下面积为 0.805,两者的准确度均为中等。
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引用次数: 0
Assessing the prevalence of workplace telepressure on resident and attending physicians: A validated scale 评估工作场所远程压力对住院医师和主治医师的影响:经过验证的量表
IF 1.4 Q3 SURGERY Pub Date : 2024-06-21 DOI: 10.1016/j.sopen.2024.06.004
Brittany E. Levy , Wesley A. Stephens , Gregory Charak , Alison N. Buckley , Cristina Ortega , Jitesh A. Patel

Background

Physician wellbeing and burnout are significant threats to the healthcare workforce. Mobile electronic medical record access and smartphones allow for efficient communication in healthcare but may lead to workplace telepressure (WPT).

Methods

An IRB-approved survey related to five domains of burnout [WPT, smartphone usage, boundary control, and psychologic detachment] was circulated. Internal medicine and general surgery faculty and residents were surveyed between 3/2021 and 6/2021. Survey results were analyzed for internal consistency with a Cronbach alpha coefficient and validation against a known physician burnout scale.

Results

The domains were internally valid with a Cronbach alpha of 0.888. Validation against the physician burnout scale was significantly correlated with WPT domains but was overall positively correlated across domains. Surgical trainees reported the highest burnout rate related to every domain.

Conclusion

Survey-based WPT burnout scales provide insight into the daily pressures on physicians. Targeted interventions to limit WPT are needed to improve physician wellbeing.

背景医生的健康和职业倦怠是医疗保健队伍面临的重大威胁。方法我们分发了一份经 IRB 批准的调查问卷,内容涉及职业倦怠的五个方面[WPT、智能手机使用、边界控制和心理疏离]。在 2021 年 3 月至 2021 年 6 月期间,对内科和普外科的教师和住院医师进行了调查。调查结果各领域的内部一致性良好,Cronbach alpha系数为0.888。与医师倦怠量表的验证结果显示,WPT领域与医师倦怠量表的验证结果呈显著正相关,但各领域之间总体呈正相关。结论基于调查的 WPT 职业倦怠量表可以帮助我们深入了解医生的日常压力。需要采取有针对性的干预措施来限制 WPT,以改善医生的健康状况。
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引用次数: 0
Development and validation of a mouse model to investigate post surgical pain after laparotomy 开发和验证小鼠模型以研究开腹手术后的疼痛
IF 1.4 Q3 Medicine Pub Date : 2024-06-18 DOI: 10.1016/j.sopen.2024.06.002
Juan Martinez , Thomas Maisey , Nicola Ingram , Nikil Kapur , Paul A. Beales , David G. Jayne

Background

Postoperative pain following abdominal surgery is a significant obstacle to patient recovery, often necessitating high analgesic doses associated with adverse effects like cognitive impairment and cardiorespiratory depression. Reliable animal models are crucial for understanding the pathophysiology of post surgical pain and developing more effective pain-relieving strategies.

Methods

We developed a mouse model to replicate peritoneal trauma induced by abdominal surgery. 30 C57BL/6 mice underwent laparotomy, with half undergoing standardised peritoneal abrasion and the rest serving as controls. Mouse recovery was assessed using two validated scoring systems of surgical recovery: Post surgery Severity Assessment (PSSA) and Mouse Grimace Score (MGS). Blood samples were taken for cytokine analysis. Adhesions were evaluated on day 6, and peritoneal tissue was examined for healing markers.

Results

After laparotomy, all mice exhibited expected pain profiles. Mice with peritoneal abrasion had significantly higher PSSA (7.2 ± 1.2 vs 4.68 ± 0.82, p ≤ 0.001) and MGS scores (3.62 ± 0.74 vs 0.82 ± 0.40, p ≤ 0.05) with slower recovery. Serum inflammatory cytokine levels were significantly elevated in the abraded group, and adhesion formation was higher in this group. Immunohistochemical analysis showed significantly increased expression of α-SMA, CD31, CD68, and F4/80 in peritoneal tissue in the abraded group.

Discussion

A mouse model involving laparotomy and standardised peritoneal abrasion replicates the expected pathophysiological changes following abdominal surgery. It will be a useful model for better understanding the mechanisms of post surgical pain and developing improved pain-relief strategies. It also has utility for the study of intra-abdominal adhesion formation.

Key message

To understand the intricate relationship between peritoneal trauma-induced pain, cytokine response, and post-operative adhesion formation in mouse models for advancing therapeutic interventions and enhancing post-operative recovery outcomes.

背景腹部手术后疼痛是患者康复的一大障碍,通常需要使用大剂量镇痛药,并伴有认知障碍和心肺功能抑制等不良反应。可靠的动物模型对于了解手术后疼痛的病理生理学和开发更有效的止痛策略至关重要。30 只 C57BL/6 小鼠接受了开腹手术,其中一半接受了标准化腹膜擦伤,其余作为对照组。小鼠的恢复情况采用两种经过验证的手术恢复评分系统进行评估:术后严重程度评估(PSSA)和小鼠痛苦评分(MGS)。采集血液样本用于细胞因子分析。第 6 天对粘连进行评估,并检查腹膜组织的愈合标记物。腹膜擦伤小鼠的 PSSA(7.2 ± 1.2 vs 4.68 ± 0.82,p ≤ 0.001)和 MGS 评分(3.62 ± 0.74 vs 0.82 ± 0.40,p ≤ 0.05)明显较高,且恢复较慢。擦伤组的血清炎症细胞因子水平明显升高,粘连形成也更高。免疫组化分析显示,磨损组腹膜组织中 α-SMA、CD31、CD68 和 F4/80 的表达明显增加。它将成为一种有用的模型,有助于更好地了解手术后疼痛的机制,并开发出更好的止痛策略。关键信息了解小鼠模型中腹膜创伤引起的疼痛、细胞因子反应和术后粘连形成之间错综复杂的关系,以促进治疗干预和提高术后恢复效果。
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引用次数: 0
期刊
Surgery open science
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