A multi-institutional analysis of Textbook Outcomes among patients undergoing cytoreductive surgery for peritoneal surface malignancies

BackgroundWhile recent studies have introduced the composite measure of a textbook outcome (TO) for measuring postoperative outcomes, the incidence of a TO has not been characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM).Study designAll patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999 and 2017 from 12 institutions were included. A TO was defined as the absence of any of the following criteria: completeness of cytoreduction >1, reoperation within 90-days, readmission within 90-days, mortality within 90-days, any grade ≥2 complication, hospital stay >75th percentile, and non-home discharge.ResultsAmong 1904 patients who underwent CRS, only 30.9% achieved a TO while 69.1% failed to achieve a TO most commonly because of postoperative complications. On multivariable analysis, factors associated with achieving a TO were age <65 years (OR: 1.5), albumin ≥3.5 g/dl (OR: 5.7), receipt of HIPEC (OR: 4.5), PCI ≤14 (OR: 2.2), intravenous fluid volume ≤10,000 ml (OR: 2.1), blood loss ≤1000 ml (OR: 4.2) and operative time <7 h (OR: 1.9); while receipt of neoadjuvant therapy (OR: 0.7) and liver resection (OR: 0.4) were associated with not achieving a TO (all p < 0.05). TO was associated with improved overall survival (median 159 months vs 56 months, p < 0.01) even after controlling for confounders on Cox regression (hazard ratio: 2.5, p < 0.01).ConclusionAmong patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and independently associated with worse overall survival.     

浅谈《中医诊断学》案例版教材的编写

《中医诊断学》案例版教材是普通高等教育“十一五”国家级规划教材,它的编写是在中医诊断学案例教学的基础上所进行的创新和尝试,是以启发式教学为总的指导思想,以临床辨证思维能力培养为宗旨。本教材突破了传统教材的编写体例和书写格式,使传统教材中的中医诊断学理论知识在案例中得到了阐述和深化,通过案例训练了学生的辨证思维能力和临证应变能力。     

英文经典医学教科书采访前评价

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Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis

BackgroundThe concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival.MethodAll patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014–December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups.ResultsIn total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, “macroscopically complete resection” had the highest compliance (96.5%) while “no serious complications” had the lowest compliance (63.7%). Age (OR 0.53 for the 65–74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34–0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08–0.70), multivisceral resection (OR 0.55, 95%CI 0.33–0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46–0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55–0.83).ConclusionTO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.     

Textbook outcome,chemotherapy compliance,and prognosis after radical gastrectomy for gastric cancer: A large sample analysis

BackgroundThis study aims to analyze the effect of textbook outcome (TO) on the long-term prognosis and adjuvant chemotherapy (AC) compliance of patients with gastric cancer (GC) in a single institute.Materials and methodsConsecutive patients who underwent radical gastrectomy with pathological stage I-III at Union Hospital of Fujian Medical University from January 2010 to June 2017 were included. TO was defined as receiving a complete-potentially curative status, ≥15 lymph nodes examined, hospital stay ≤21 days, and freedom from intraoperative and postoperative complications, re-intervention in 30 days, 30-day readmission to the hospital or intensive care unit, and 30-day postoperative mortality.ResultsTotally 3993 patients were included, of which 3361 (84.2%) patients achieved TO. The overall, disease-specific, and recurrence-free survival of patients achieving TO were significantly better than those of patients without achieving TO (all P < 0.05). The total number of AC cycles was greater and the interval from surgery to first AC was shorter in the TO group compared with the Non-TO group. Age >65 years old, open surgery, pT3-4 stage, and total radical gastrectomy (TG) were identified as related high-risk factors for failure to achieve TO. Laparoscopic surgery facilitated TO achievement in high-risk groups.ConclusionTO is a reliable indicator of favorable prognosis of patients with GC and contributes to postoperative chemotherapy compliance. Age ≤65 years old, non-TG, pT1-2 stage, and laparoscopic surgery may promote the achievement of TO.     

传承发展与时俱进——预防医学《流行病学》规划教材建设40年回顾

预防医学类专业本科生《流行病学》规划教材从1980年面世至今,走过了40年的历程,在几代流行病学工作者的共同努力下,已经更新到第8版,成为流行病学立体化教材体系的核心,在学科建设和人才培养中发挥了重要的作用。本文回顾了此套教材的编撰过程,对比分析了各版教材的内容,为不断完善本科生教材建设提供参考。     

国内卫生信息管理教材建设现状及思考

基于CNKI中194篇相关领域文献的摘要信息,分析21世纪以来我国卫生信息管理教材建设的总体发展趋势、主要分支领域、成熟研究主题,揭示目前其存在的问题,提出现阶段教材建设的基本方向和思路。     

Textbook outcome en cirugía gástrica oncológica, ¿qué implicaciones tiene sobre la supervivencia?

IntroductionThe textbook outcome (TO) is a multidimensional measure to assess the quality of healthcare practice. This is reflected as the “ideal” surgical result, attending to a series of indicators or established reference points that are adapted depending on the surgical disease that we want to analyze. There are few references and series published about TO, all of them very recent.ObjectiveWe present a series of gastric surgery from the TO perspective and we analyze its impact on survival.MethodRetrospective observational study of all gastric neoplasms operated on in our center. Period: January 2015 - December 2020. The criteria for TO were: margins R0, > 15 lymph nodes in the histological study, no Clavien-Dindo complications > IIIa, hospital stay < 21 days, no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between the TO group versus the non-TO group.Results91 patients were operated on. We reached the TO in 34.1% of the patients. The variable > 15 lymph nodes was the one that most affected to achieve a TO. When performing the survival analysis, we obtained that the group in which the TO was obtained had a greater survival (p < 0.008).ConclusionIn our series, obtaining the TO has an impact on survival which 34,1% of degree of compliance.     

试论“以器官系统为中心”的医学基础课程教材建设

建立“以器官系统为中心”的医学教育模式是国际医学教育改革的趋势.本文介绍了由世界著名医药卫生出版集团爱思唯尔公司出版的一套“以器官系统为中心”的医学基础课程教材,期望其编写中的一些特色和经验给中文教材的编写带来启示.     

药物生物信息学课程教学探讨

探讨了药物生物信息学本科教学中教材的选择、教学方式的改革及如何在教学当中培养学生的实践能力和创新能力等问题。