Training and teaching of vagus nerve stimulation surgery: Worldwide survey and future perspectives

ObjectiveVagus nerve stimulation (VNS) therapy has been used for more than two decades to treat drug resistant epilepsy and depression and most recently received FDA approval for stroke rehabilitation. Expanding indications will renew the interest in the technique and increase the number of surgeons to be trained. The aim of this study was to survey surgeons with substantial expertise on optimal teaching and training approaches.MethodsAnonymous forms comprising 16 questions were sent by e-mail to surgeons with substantial expertise. Statistical analyses were used to compare the answers of the most experienced surgeons (>5 years) with the less experienced ones (<5 years).ResultsFully-completed forms were collected from 57 experts from 20 countries. The placement of the helical coils was deemed to be the most difficult step by 36 (63.2%) experts, and the use of optical magnification during this step was deemed necessary by 39 (68.4%) experts. Vocal cord palsy should be largely avoidable with proper surgical technique according to 44 (77.2%) experts. The teaching tool considered the most useful was mentoring (38, 66.7%). The future of VNS surgery teaching was deemed to be in anatomical workshops (29, 50.9%) and surgical simulation (26, 45.6%). Overall, answers did not vary significantly according to experience.ConclusionsVNS surgery should be mastered by actively participating in dedicated practical training courses and by individual mentoring during actual surgery, which is still the best way to learn. This study highlights the need for a formal training course and possible specific accreditation.     

Radiotherapy-specific interprofessional learning through simulation

IntroductionInterprofessional learning (IPL) is a vital aspect of training in radiation oncology professions, yet is rarely delivered to those professionals who work most closely together in clinical practice. Scenario-based learning using simulation facilities provides a unique opportunity to facilitate this learning and this project aimed to determine the impact and value of this initiative.MethodsSmall groups comprising post-graduate diploma pre-registration therapeutic radiographers, medical physics trainees and radiation oncology registrars were challenged with 4 plausible and challenging radiotherapy scenarios within an academic simulation centre. Pre- and post-event completion of the “Readiness for Interprofessional Learning Scale” measured impact and a Likert-style survey gathered feedback from participants.ResultsThe session increased participants' teamwork and collaboration skills as well as strengthening professional identities. Participants reported high levels of enjoyment related to collaborative working, communication and observing other professionals deploying their technical skills and specialist knowledge.ConclusionAlthough beneficial, simulated scenarios offering equal opportunities for engagement across the professions are challenging to plan and timetabling issues between the 3 groups present significant difficulties. The safe environment and unique opportunity for these groups to learn together was particularly well received and future oncology-specific simulated scenario sessions are planned with larger cohorts.Implications for practiceSimulated scenario training can be used to improve team working across the radiotherapy interprofessional team and may have wider use in other specialist interdisciplinary team development.     

Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients.MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups.ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001).ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.     

我国三级医疗机构营养科专业人才队伍情况调查

目的调查分析我国三级医疗机构营养科专业人才队伍情况，提出针对性建议。方法从国家医疗质量管理与控制信息网选取1 283家三级医疗机构调研临床营养专业技术人员数据，应用频数、构成比等进行描述性统计分析。 结果三级医疗机构营养科专业技术人员数量不足且分布不均衡，高层次人才比例偏低。医床比1:556.91，技床比1:841.30，医技比1.51:1，护床比1:1 031.31，均未达到文件标准，营养科医师严重缺编。结论应加强营养科专业人员教育和高层次人才培养，建立规范化培养体系，明确营养科职称评定和岗位技能考核制度，不断扩增专业人才数量，提升临床营养诊疗能力。     

«Omepralith»: un modelo de simulación novedoso para el entrenamiento en sialoendoscopia

IntroductionThere are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy.Materials and methodsA simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model.ResultsTwenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey.ConclusionWe describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.     

数据之美——聚焦全球器官捐献发展趋势

器官移植术是20世纪出现的针对器官功能衰竭的最有效治疗方法，每年拯救全球超过12万例患者。但供器官短缺的现状，与器官移植技术和辅助药物的发展不匹配，制约了器官移植事业的发展。我国自2015年起已成为全球器官捐献和移植大国之一，2017年公民逝世后器官捐献数量超过5 000例，占全球捐献总量的15%以上。黄洁夫教授总结的器官捐献与移植"中国模式"得到了世界卫生组织、国际移植界的高度重视和充分肯定。本文通过整理全球及各国的器官捐献与移植数据，剖析全球现状与发展趋势，进一步探索我国公民器官捐献的影响因素并提出针对性的应对策略，以期实现我国器官捐献和移植的"自给自足"。