Sagittal spinal alignment deviation in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry

BACKGROUND CONTEXT

It is widely recognized that sagittal spinal alignment changes with age. However, there are presently no clear benchmarks for such values or those for the cervical spine in the general population. Quality epidemiological studies are needed to establish standards for spinal alignment deviation.

教学督导会诊在超声医学科住院医师规范化培训中的应用

目的总结住院医师规范化培训阶段的会诊需求概况，评价教学督导会诊在住院医师规范化培训阶段的作用。 方法回顾性收集2015年8月至2017年8月间于北京协和医院超声医学科参加北京市住院医师规范化培训的住院医师43名及其于2017年11月至2018年8月申请教学督导会诊的病例，随访申请教学督导会诊的病例，总结会诊原因和部位，参照病理或临床诊断，对会诊医师作出教学评价（技术操作、定位、定性）。采用χ²检验比较不同年资、不同学历住院医师申请会诊原因和部位的差异，并采用t检验比较应用教学督导会诊前、后3年以下住院医师客观结构化临床考试（OSCE）阶段考核平均成绩的差异。 结果43名住院医师共随访1727份会诊病例。第一、二、三年住院医师申请会诊次数占比分别为53.0%（915/1727）、42.9%（741/1727）、4.1%（71/1727）。住院医师申请会诊原因：定性70.9%（1224/1727）、技术操作22.7%（392/1727）、定位6.4%（111/1727）。第一、二、三年住院医师因技术操作原因申请会诊比例分别为26.9%（246/915）、18.6%（138/741）、11.3%（8/71）；因定位原因申请会诊比例分别为7.8%（71/915）、4.5%（33/741）、9.8%（7/71）；因定性原因申请会诊比例分别为65.3%（598/915）、76.9%（570/741）、78.9%（56/71），不同年资住院医师申请会诊的原因不同，差异具有统计学意义（χ²=33.293，P＜0.001）。申请会诊的检查部位前三位为妇科27.9%（482/1727）、浅表器官23.3%（402/1727）和腹部20.1%（347/1727），共占71.3%，不同年资住院医师申请会诊的部位不同，差异具有统计学意义（χ²=167.583，P＜0.001）。第一、二年住院医师申请会诊主要为腹盆腔脏器技术操作和定性，第三年住院医师申请会诊集中在浅表器官病变的定性。不同学历住院医师申请会诊部位分布不同，差异具有统计学意义（χ²=64.942，P＜0.001），申请会诊原因分布差异无统计学意义（χ²=8.131，P=0.087），平均申请会诊次数相近。97.7%（383/392）的技术操作问题通过教学督导会诊得到解决；教学督导会诊定位正确率73.0%（81/111）；定性正确率92.7%（1135/1224）。应用教学督导会诊后的住院医师OSCE成绩高于应用前［（85.7±6.6）分vs（75.7±7.5）分］，差异具有统计学意义（t=-2.426，P=0.036）。 结论随着住院医师年资增加，申请会诊次数减少。不同年资住院医师申请会诊的部位和原因不同。住院医师因技术操作原因申请会诊次数逐年下降，定性需求逐年增加。教学督导会诊能有效帮助住院医师解决技术操作难点、定位和定性，提升住院医师临床胜任力。     

A survey of robotic surgery training curricula in general surgery residency programs: How close are we to a standardized curriculum?

Background

Robotic surgery is increasingly adopted into surgical practice, but it remains unclear what level of robotic training general surgery residents receive. The purpose of our study was to assess the variation in robotic surgery training amongst general surgery residency programs in the United States.

Can Energy Drinks Increase the Desire for More Alcohol?

Energy drinks, the fastest growing segment in the beverage market, have become popular mixers with alcohol. The emerging research examining the use of alcohol mixed with energy drinks (AmEDs) indicates that the combination of caffeine-containing energy drinks with alcohol may be riskier than the use of alcohol alone. The public health concerns arising from AmED use are documented in different research domains. Epidemiologic studies reveal that the consumption of AmEDs is frequent among young and underage drinkers, demographic groups that are more likely to experience the harms and hazards associated with alcohol use. In addition, for all consumers, elevated rates of binge drinking and risk of alcohol dependence have been associated with AmED use when compared to alcohol alone. Results from laboratory studies help explain why AmED use is associated with excessive intake of alcohol. When an energy drink (or caffeine) is combined with alcohol, the desire (or urge) to drink more alcohol is more pronounced in both humans and animals than with the same dose of alcohol alone. The experience of drinking alcohol appears to be more rewarding when combined with energy drinks. Given that caffeine in other foods and beverages increases preference for those products, further research on AmEDs may elucidate the underlying mechanisms that contribute to alcohol dependence.     

Senior surgical resident autonomy and teaching assistant cases: A prospective observational study

IntroductionTeaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.MethodsProspective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision.ResultsCase mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS).DiscussionCarefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.     

Resident experience in brachytherapy: An analysis of Accreditation Council for Graduate Medical Education case logs for intracavitary and interstitial brachytherapy from 2007 to 2018

PurposeWe sought to characterize temporal trends of radiation oncology resident–reported case experience with intracavitary brachytherapy (ICBT) and interstitial brachytherapy (ISBT).Methods and MaterialsSummarized, deidentified case logs for graduating radiation oncology residents (GRORs) between 2007 and 2018 were obtained from the Accreditation Council for Graduate Medical Education national summary data report. Cases were subdivided based on the site of treatment. Analysis of variance was used to determine differences, and strength of association was evaluated using the Pearson correlation.ResultsThe number of GRORs increased by 66% from 114 in 2007 to 189 in 2018 (p < 0.001). Average number of gynecologic ICBT cases per GROR increased, from 39.6 in 2007 to 48.7 in 2018 (p < 0.005). Average number of ISBT cases per GROR decreased, from 34.5 to 20.6 (p < 0.001), due to decreasing prostate volume, from 21.5 to 12 (p < 0.001). Experience with gynecologic ISBT cases remained low at an average of 4.5 cases per year.ConclusionsThe average number of ICBT cases per GROR has increased, although this does not differentiate between cylinder and tandem-based insertions currently. There has been a steady decline in ISBT experience. These findings may have implications for the development of Accreditation Council for Graduate Medical Education case minimums for residency programs.     

Who are the women who enrolled in the POSITIVE trial: A global study to support young hormone receptor positive breast cancer survivors desiring pregnancy

BackgroundPremenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5–10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy.MethodsPOSITIVE enrolled women with stage I-III HR + early breast cancer, ≤42 years, who had received 18–30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration.FindingsFrom 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were <35 years at enrolment (42.7 %), had mastectomy (59.0 %) and received tamoxifen alone (59.8 %). More Asian women were nulliparous (81.0 %), had node-negative disease (76.2%) and received tamoxifen + OFS (56.0 %). More European women had received chemotherapy (69.3 %).InterpretationThe characteristics of participants in the POSITIVE study provide insights to which patients and doctors considered it acceptable to interrupt ET to pursue pregnancy. Similarities and variations from a regional, sociodemographic, disease and treatment standpoint suggest specific sociocultural attitudes across the world.