Articles: surgery.
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The guidelines provided by US professional surgical organizations for involvement of trainees in global surgery are limited. The aim of this consensus statement is to provide surgical trainees with official recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group (GSWG) regarding professional, practical, and ethical guidelines for participation in global surgery endeavors. ⋯ This consensus statement from the Resident and Associate Society of the American College of Surgeons GSWG outlines the official recommendations for guidelines for involvement of trainees in global surgery, with an aim to support equitable, sustainable collaborations that center on improving access to safe, timely, and affordable surgical care for the global community at large. Future processes seek to involve representation and perspectives from a larger body of low- to middle-income country surgical trainees.
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There is wide variation in treatment planning strategy for central nervous system (CNS) stereotactic radiosurgery. We sought to understand what relationships exist between intratumor maximum dose and local control (LC) or CNS toxicity, and dosimetric effects of constraining hotspots on plan quality of multiple metastases volumetric modulated arc therapy radiosurgery plans. ⋯ The prescription isodose line had no impact on local tumor control or CNS toxicity. Penalizing radiosurgery hotspots resulted in worse radiosurgery plans with poorer gradient. Limiting maximum dose in gross tumor causes increased collateral exposure to surrounding tissue and should be avoided.
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Observational Study
Feasibility and Safety of a "Shared Care" Model in Complex Hepatopancreatobiliary Surgery: A 5-Year Observational Study of Outcomes in Pancreaticoduodenectomy.
To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy. ⋯ SCMs are feasible in complex elective surgery without compromising patient outcomes, and wider adoption may be encouraged.
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Spinal cord compression caused by spinal tumors is measured using the epidural spinal cord compression scale, also known as the Bilsky score. Whether Bilsky score predicts short-/long-term outcomes remains unknown. The objectives were to determine the correlation of Bilsky score 0-1 vs 2-3 with regards to (1) preoperative presentation, (2) perioperative variables, and (3) long-term outcomes. ⋯ Bilsky 2-3 lesions were associated with longer length of stay, more nonhome discharge, worse postoperative KPS/modified McCormick scale score, shorter OS, and reduced survival at 1 year. Higher-grade Bilsky score lesions appear to be at a higher risk for worse outcomes. Efforts should be made to identify metastatic spine patients before they reach the point of severe spinal cord compression..
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Retrospective cohort. ⋯ The use of raw MRIs in an artificial intelligence model improved the accuracy of PJK prediction compared with raw scoliosis radiographs and traditional clinical/radiographic measurements. The improved predictive accuracy using MRI may indicate that PJK is best predicted by soft tissue degeneration and muscle atrophy.