Surgery
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Surgeons in high-income countries increasingly are expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions. ⋯ A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of Médecins Sans Frontières's operative procedures provides valuable insight into the types of operations with which an aspiring volunteer surgeon should be familiar.
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Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. ⋯ Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives.
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Randomized Controlled Trial
Introduction of a comprehensive training curriculum in laparoscopic surgery for medical students: a randomized trial.
First- and second-year medical students have limited exposure to basic surgical skills. An introductory, comprehensive, simulation-based curriculum in basic laparoscopic skills may improve medical students' knowledge and technical and nontechnical skills and may raise their interest in a career in surgery. The purpose of this study was to (1) design a comprehensive, simulation-based training curriculum (STC) aimed to introduce junior medical students to basic laparoscopic skills and (2) compare structured and supervised learning and practice to a self-directed approach. ⋯ Participation in the STC resulted in significant gains in knowledge, technical skill, and attitudes toward nontechnical skills. Exposure of junior medical students to this curriculum before their clinical rotations is expected to enhance learning, maintain motivation, and increase interest in surgery as a future career.
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Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) leads to prolonged hospitalization and potentially fatal complications. We sought to determine whether estimated pancreatic parenchymal remnant volume (EPPRV) on preoperative computed tomography (CT) predicts clinically relevant POPF. ⋯ EPPRV from preoperative CT was highly predictive of POPF and may help in development of management for POPF after PD.
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With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. ⋯ Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future.