International journal of surgery
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To compare the clinical efficacy of platelet-rich plasma (PRP) injections with that of corticosteroids in patients with lateral epicondylitis (LE). ⋯ Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months.
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Comparative Study
Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis.
Thymectomy is increasingly being performed via minimally invasive approaches. The present study aimed to assess the safety and feasibility of the subxiphoid approach to video-assisted thoracic surgery (VATS) compared with the lateral intercostal approach VATS. ⋯ Our data suggest that subxiphoid and subcostal arch thoracoscopic radical thymectomy is a less invasive procedure for the treatment of non-myasthenic early-stage thymoma and provides a satisfactory cosmetic effect. Owing to the limitation ofour retrospective study, further prospective studies are needed to evaluate long-term and oncologic outcomes of subxiphoid approach VATS thymectomy.
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For complete removal of intrahepatic cholangiocarcinoma (ICC), extended resection is often necessary. Information on the influence of visceral or vascular extension, extended resection, or postoperative morbidity on survival is scarce. The aim of this study was to show the impact of an aggressive surgical attitude on morbidity, mortality, and long-term outcome. ⋯ Extended resection results in worse OS in patients with ICC than major or minor liver resection. Minor and major resection with visceral or vascular extension should be classified as extended resection. Despite worse OS, extended resection offers a chance for long-term survival and performs significantly better than the exploration group with manageable accompanied risks.
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Surgical training is evolving, and simulation is becoming more important as a way to expedite the early learning curve and augment surgical techniques. With novel technology, and innovation, major changes are possible in how surgeons are trained. The integration of these concepts into the surgical curriculum may drive up educational standards and enhance patient safety. This survey sought to determine surgical trainees views on the current place of simulation in surgical training and explore their vision for the future. ⋯ This study highlights the importance of simulation to trainees. Delivery and accessibility of simulation training varies widely. We highlight areas for improvement and best practice. In a culture of accountability, where patient safety is our highest priority, a "see one, do one, teach one" approach to training is no longer appropriate; instead we must utilise available simulation tools to augment learning.
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Surgical trainees in the UK and Ireland undergo rigorous formative and summative assessments throughout each placement, and appraisal at an Annual Review of Competence Progression (ARCP). The ARCP evaluates performance during each training year and determines progression to the next year of training. It is critical that the ARCP is a robust and fair process. The Association of Surgeons in Training (ASiT) sought to evaluate surgical trainees' experiences of the ARCP process in order to identify areas for improvement. ⋯ 600 trainees from all deaneries, grades and specialities participated. The survey demonstrated difficulties in preparing for ARCP: insufficient notice (24%), inadequate communication (22%) and lack of engagement of seniors (30-39%). 47% considered the process and standards inconsistent. 82% of trainees considered a face-to-face ARCP advantageous. Such a meeting provided a means of raising concerns regarding training posts (29%), bullying (18%) and patient safety (17%) that would not otherwise have been reported in writing. During qualitative analysis, the following themes emerged: The conflict between potential value and real experience; concerns regarding the quality of assessment and the need for improvement (in process, individual performance and surgical training.) CONCLUSION: This survey demonstrates that trainees appreciate the potential educational value of the ARCP process. However, there is a gap between this potential and trainees experience. Particular concerns include inconsistency, the timing of decision-making and the need to retain a face-to-face meeting. This feedback from trainees can be used to improve the assessment process in relation to procedural developments at the national level and engagement of supervisors and trainers locally. These changes will ensure that the ARCP becomes a higher quality assessment and more constructive for training in future.