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.     

Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study

IntroductionTextbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.MethodsThis was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.Results2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.ConclusionTO differs between indications for liver resection and can be used to assess between hospital and network differences.     

神经生物学教学改革初探

神经生物学是一门新兴的前沿学科,西安交通大学医学院从2010年起,为八年制医学生开设了神经生物学课程,在教学内容安排、教材选择、教学模式、教学语言以及综合考评方面进行了改革和尝试.结合“区段整合式”教学改革的需要以及我校神经科学研究工作基础,对教学内容进行调整;打破以课本为主的传统教学模式,不指定教材;教学活动为理论课...     

基于培养创新性人才的《中药鉴定学》教材建设思考

为培养创新性中药人才,在总结前几版《中药鉴定学》教材编写的成功经验基础上,根据当前《中药鉴定学》教学所面临的新情况,探讨在《中药鉴定学》教材编写过程中的创新问题。提出组成老、中、青相结合和产、学、研相结合的编写队伍,采用书本、光盘和网页相结合的开放性立体教材形式,整合基础知识、应用技能和创新能力培养的培养目标,改进知识呈现的方式,促进特色教材和统编教材共同发展。     

Textbook outcomes in hepatobiliary and pancreatic surgery

The concept of textbook outcome (TO) has recently gained popularity in surgical research and has been used to evaluate the quality or success of different surgical procedures, including hepatopancreatobiliary (HPB) operations. TO consists of individual outcome parameters that each reflect different domains of care including structure, process, and individual outcomes; in turn, the composite TO metric represents the optimal course after a surgical episode. TO can be used to assess patient-level outcomes, hospital performance, center designation and quality metrics. In addition to being an outcome measurement, TO may also be linked to healthcare costs. Future efforts should be directed towards establishing a universal definition of TO in HPB surgery so that surgeons and hospitals can assess and compare outcomes, identify shortcomings and improve real world patient outcomes.     

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。     

英文经典医学教科书采访前评价

对英文经典医学教科书采访前评价进行探讨,指出内容上需具有权威性、先进性、易理解和实用性等特点,形式上应体现在出版社、版本、作者及其学协会、译本等方面,采访馆员在英文经典医学教科书的采访前需要进行合理评估和综合评价。     

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

IntroductionTextbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival.Methods269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models.ResultsPatients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p = 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters.ConclusionMinimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.     

评《医学信息检索》双语教材

<医学信息检索>双语教材一书选题具有重大意义,体例科学完整,内涵丰富;业界影响较大,应用广泛;继承与创新相结合,特色鲜明.     

《基础护理学》中浪纹线的应用问题探讨

本文指出了《基础护理学》中浪纹线应用存在的一些问题,对其中的语病分为成分赘余、表意不明和不合逻辑三类,并进行了深入分析,提出了具体的修改意见。对于浪纹线应用中存在的争议进行了深入的探讨,力求引起教科书编者和编辑的高度重视,从而提高医学教材编写水平和教科书质量。