71 research outputs found
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
No full textBackground: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January?December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien?Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/ 2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives
Job satisfaction among young board-certified surgeons at academic centers in Europe and North America
No full textOBJECTIVES:
To identify independent factors influencing job satisfaction of academic surgeons within their first 10 years after board certification.
BACKGROUND DATA:
Job satisfaction is increasingly recognized as a crucial factor for high performance of individuals and teams in most organizations. Sophisticated tools are now available to assess job satisfaction in medicine.
METHODS:
A survey among 439 faculty surgeons from 16 European countries, United States, and Canada was conducted in 2011. Satisfaction at work was analyzed using the validated Global Job Satisfaction (GJS) instrument (score range, -36 to +36), modified to an extended version (eGJS) (score range, -87 to +87) covering additional personal and environmental factors. Independent factors were identified with multiple logistic regression analysis.
RESULTS:
Response rate was high at 59% (439/744). Median age of responders was 39 years, with 17% women. North American surgeons scored higher on the eGJS when compared with Europeans (median: 21 vs. 33, respectively, P < 0.001). The surgical specialty with the highest median eGJS score was colorectal, whereas general surgery scored lowest (median: 33 vs 7, respectively, P = 0.002). On multivariate analysis, independent factors of high job satisfaction included protected time for research (odds ratio [OR]: 9), good team relationship (OR: 7), female sex (OR: 5), having a partner (OR: 4), feeling enthusiastic about work (OR: 4), being pleased with life accomplishments (OR: 4), having the standard of living one deserves (OR: 3), and clinical autonomy (OR: 3). In contrast, independent predictors of poor job satisfaction were feeling frustrated by work (ie, a burnout item) (OR: 37), worrying about personal life at work (OR: 3), and having to work too many weekends (OR: 3).
CONCLUSIONS:
Satisfaction in young faculty members mostly relates to research opportunities, clinical autonomy, burnout, and lifestyle. Understanding satisfaction factors may improve productivity and competence
Calf and forearm compression garments incorporating “AF pads” significantly increases reaction times for esports
No full textAims: Video gaming (e-gaming|) is a wide-spread pastime with over 3 billion regular gamers, which continues to grow. Esports (competitive e-gaming) is very lucrative for top players with one competition recently topping $40 million in the prize pool. Anything that might improve a gamer’s performance would have wide appeal. We studied the effects of arm and calf compression sleeves lined with patented ‘AF pads’ (Anatomic Focus, West Sussex, UK) on e-gamers.
Methods: 38 gamers (M:F 31:7, age range 16-18 years) played the same video game for 6 hours continuously, on two separate occasions, at least 48 hours apart. For the first session, the gamer wore their normal clothing, without any compression on their limbs. During the second session, the gamers wore fitted compression sleeves lined with AF pads, on both arms and legs. The gamers measured their reaction times before they started to play, and then after each hour of play up until 6 hours.
Results: Before the game was started, as would be expected, there was no significant difference in reaction times. However, after 1, 2, 3, 5, and 6 hours of gaming, there was a significant improvement in reaction times when the gamer was wearing the compression sleeves lined with AF pads. Improvement in reaction times failed to reach statistical significance at only one time period, at 4 hours, for no apparent reason.
Conclusion: Compression sleeves lined with AF pads worn on the arms and legs during esports significantly improves reaction times in e-gamers. We suggest that this improvement may be due to the improved venous return (and hence, circulatory enhancement) from the limbs during these games when the gamer is largely sedentary for hours at a time
Right Hepatectomy in Patients over 70 Years of Age: An Analysis of Liver Function and Outcome
Get PDFBackground: As a consequence of the increase in life expectancy, hepatobiliary surgeons have to deal with an emerging aged population. We aimed to analyze the liver function and outcome after right hepatectomy (RH) in patients over 70years of age. Methods: From January 2006 to December 2009, we prospectively collected data of 207 consecutive elective hepatectomies. In patients who had RH, cardiac risk was assessed by a dedicated preoperative workup. Liver failure (LF) was defined by the "fifty-fifty” criteria at postoperative day 5 (POD) and morbidity by the Clavien-Dindo classification. Liver function tests (LFTs) and short-term outcome were retrospectively analyzed in patients over (elderly group, EG) and younger (young group, YG) than 70years of age. Results: Eighty-seven consecutive RH were performed during the study period. Indication for surgery included 90% malignancy in 47% of patients requiring preoperative chemotherapy. ASA grade>2 (44 vs. 16%, p=0.027), ischemic heart disease (17 vs. 5%, p=0.076), and preoperative cardiac failure (26 vs. 2%, p<0.001) were more frequent in the EG (n=23) than in the YG (n=64). Both groups were similar regarding rates of normal liver parenchyma, chemotherapy and intraoperative parameters. The overall morbidity rates were comparable, but the serious complication (grades III-V) rate was relatively higher in the EG (39 vs. 25%, p=0.199), particularly in patients with diabetes mellitus (100 vs. 29%, p=0.04) and those who had additional nonhepatic surgery (67 vs. 35%, p=0.110) and transfusions (44 vs. 30%, p=0.523). The 90-day mortality rate was similar (9% in the EG vs. 3% in the YG, p=0.28) and was related to heart failure in the EG. LFTs showed a similar trend from POD 1 to 8, and patients ≥70years of age had no liver failure. Conclusions: Age ≥70years alone is not a contraindication to RH. However, major morbidity is particularly higher in the elderly with diabetes. This high-risk group should be closely monitored in the postoperative course. Liver function is not altered in the elderly patient after R
Sewed revascularization for arterialized liver transplantation in mice
No full textBACKGROUND: Mouse models of liver transplantation are powerful tools for biomedical research. The cuff method is currently the most popular approach for revascularization of mouse liver grafts, as it is relatively easy to perform hence reducing the anhepatic time. However, the use of cuffs may induce a tissue reaction, causing chronic obstruction of anastomosed vessels, leading to portal hypertension. Here, we applied the suture technique for arterialized liver transplantation in mice. MATERIALS AND METHODS: Liver transplantation was performed on 14 pairs of C57BL/6 mice. All hepatic vessels were anastomosed by sewing. The bile duct was connected with a stent. The liver grafts were harvested for histology on day 30 after surgery. Serum aspartate transaminase, alkaline phosphatase and bilirubin were measured at d 3, 7, and 30 after implantation. RESULTS: With a mean anhepatic time of 25.78 ± 3 min, the survival rate was 86% (n = 14) at 30 d following surgery. During this period, no significant liver injury was observed as assessed by serum markers and histology. Survival remained stable when grafts were exposed to 6 h cold ischemia prior to implantation. Vessel examination at the end of the studied period revealed an intact patency and a lack of collateral vessel growth. CONCLUSION: Arterialized liver transplantation with sewed revascularization in mice is technically feasible. Both sewing and arterialization seem to be important factors promoting the survival of mouse recipients. The mouse model of suture arterialized orthotopic liver transplantation provides a novel tool for modern transplantation research and might be particularly suited for studies requiring longer-term survival of recipients
Are Library and Information Science Journals Becoming More Internationalized? A Longitudinal Study of Authors' Geographical Affiliations in 20 LIS Journals from 1981 to 2003
Get PDFThis paper examines journal publications in the field of library and information science (LIS) to assess the level of
internationalization in their publications authorship pattern. The international production and communication of
scholarly knowledge is crucial to the growth of a discipline. Recent advancement in communication technology and the rise of globalization have led to the hope of a more balanced flow of scientific knowledge. Nevertheless, scholars also cautioned the possibility of a global digital divide and a widening knowledge gap. This study analyzed the geographical affiliations of authors in 20 international LIS journals to track the longitudinal changes in LIS authorship pattern. Findings suggest an increase in the internationalization of LIS authorships over the years. However, the LIS authorship distribution was still highly uneven in 2003 (Gini coefficient = 0.95). Economic power is still found to be a moderate predictor of publication performance. The findings of this study suggest that, at the moment of the writing, there is still room for the LIS field to be more internationalized. Further research is needed to identify the barriers in international scholarly communication and to explore the implications of such a communication pattern on scientific development and global equality
FA01.02: The effect of postoperative complications after mie on long-term survival: a retrospective, multi-center cohort study
No full textBackground Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated.
Methods Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses.
Results A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29–2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32–2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38–5.35, p 0.004). For all other complications, no significant influence on long-term survival was found
Influence on ICU course, outcome and costs for lung transplantation after implementation of the new Swiss transplantation law
Get PDFBACKGROUND The Swiss organ allocation system for donor lungs was implemented on 1 July 2007. The effects of this implementation on patient selection, intensive care unit course, outcomes and intensive care costs are unknown. METHODS The first 37 consecutive lung transplant recipients following the implementation of the new act were compared with the previous 42 lung transplant recipients. RESULTS Following implementation of the new law, baseline characteristics and cumulative one-year patient survival were comparable in both groups (88.1% vs 83.8%, P = 0.58). The costs for each case increased by 35,000 euros after adoption of the new law. Stratifying patients after implementation of the law according to urgency status shows that urgent patients required longer mechanical ventilation (P = 0.04), a longer ICU stay (P = 0.045) and a longer hospital stay (P = 0.04) and ICU costs (median 64,050 euros) were higher compared to regular patients. CONCLUSION The new transplantation law has increased ICU costs with the implementation of the Swiss organ allocation system. Patients listed as 'urgent' contribute significantly to the increase in ICU costs
Which preoperative assessment modalities best identify patients who are suitable for enhanced recovery after liver transplantation? A systematic review of the literature and expert panel recommendations
Get PDFBACKGROUND
To implement Enhanced Recovery After Surgery (ERAS) protocols for liver transplant (LT) candidates, it is essential to identify tools that can help risk stratify patients by their risk of early adverse post-LT outcomes.
OBJECTIVE
We aimed to identify pre-LT tools that assess functional capacity, frailty, and muscle mass that can best risk stratify patients by their risk of adverse post-LT outcomes.
METHODS
We first conducted a systematic review following PRISMA guidelines, expert panel review and recommendations using the GRADE approach (PROSPERO ID CRD42021237434). After confirming there are no studies evaluating assessment modalities for ERAS protocols for LT recipients specifically, the approach of the review focused on pre-LT modalities that identify LT recipients at higher risk of worse early post-LT outcomes (≤90 days), considering that this is particularly pertinent when evaluating candidates for ERAS.
RESULTS
Twenty-two studies were included in the review, encompassing three different types of pre-LT modalities: evaluation of physical function (including frailty and general physical scores like the Karnofsky Performance Status (KPS), assessment of cardiopulmonary capacity, and estimation of muscle mass and composition. The majority of studies evaluated frailty assessment and muscle mass. Most studies, except for liver frailty index (LFI), were retrospective and single-center. All assessment modalities could identify, in different grade, LT recipients with higher risk of early post-LT mortality, length of stay or postoperative complications.
CONCLUSIONS
We identified 4 pre-LT assessment tools that could be used to identify patients who are suitable for ERAS protocols: 1) KPS (quality of evidence moderate, grade of recommendation strong), 2) LFI (quality of evidence moderate, grade of recommendation strong), 3) abdominal muscle mass by CT (quality of evidence moderate, grade of recommendation strong), and 4) cardiopulmonary exercise testing (CPET) (quality of evidence moderate, grade of recommendation weak). We recommend that selection of the appropriate tool depends on the specific clinical setting and available resources to administer the tool, and that use of a tool be incorporated into the routine pre-operative assessment when considering implementation of ERAS protocols for LT. This article is protected by copyright. All rights reserved
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