Autoinflammatory keratinization diseases

Publication date: Available online 28 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Masashi Akiyama, Takuya Takeichi, John A. McGrath, Kazumitsu Sugiura




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Pediatric toxic polycystic thyroid

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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At Home Preresidency Preparation for General Surgery Internship: A Pilot Study

Publication date: Available online 27 June 2017
Source:Journal of Surgical Education
Author(s): T.K. Pandian, Eeeln H. Buckarma, Monali Mohan, Becca L. Gas, Nimesh D. Naik, Eduardo F. Abbott, Apram Jyot, Muhammad H. Zeb, Stephanie F. Heller, David R. Farley
ObjectiveTo create a novel "at-home" preresidency preparatory adjunct for medical students entering surgical residency.DesignPreparatory resources were mailed to match medical students before residency matriculation in 2015. This included "how-to" videos, low-cost models, and surgical instruments for 5 "stations" (arterial blood gas analysis, anatomy and imaging knowledge, knot tying ability, and suturing dexterity) of our program's biannual general surgery intern objective assessment activity (Surgical Olympics: total 13 stations, 10 points each). Scores from 2015 were compared with 2014 historical controls in a retrospective manner using the Student's t-test.SettingAcademic, tertiary care referral center with a large general surgery training program.ParticipantsPostgraduate year 1 general surgery trainees (interns) from the years 2014 and 2015.ResultsTwenty-six interns participated in the 2015 assessment and were compared to thirty-two 2014 interns. Overall mean scores were low, but higher (19.7 vs. 15.4, p = 0.04) in the 2015 class. The largest increase was noted in the anatomy knowledge station (mean = 5.0 vs. 1.9, p < 0.01). Scores in stations assessing technical competence were similar to controls. The number of perfect scores among the 5 stations was higher (10 vs. 5) in the 2015 group. Mean scores from the other 8 stations, for which no resources were mailed, showed no difference (29.3 vs. 28.3, p = 0.75).ConclusionsEnacting a simple, home-based curriculum for medical students before surgical residency, improved performance on early knowledge assessments.



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A Multicenter Prospective Comparison of the Accreditation Council for Graduate Medical Education Milestones: Clinical Competency Committee vs. Resident Self-Assessment

Publication date: Available online 27 June 2017
Source:Journal of Surgical Education
Author(s): Ryan S. Watson, Andrew J. Borgert, Colette T. O׳Heron, Kara J. Kallies, Richard A. Sidwell, John D. Mellinger, Amit R. Joshi, Joseph M. Galante, Lowell W. Chambers, Jon B. Morris, Robert K. Josloff, Marc L. Melcher, George M. Fuhrman, Kyla P. Terhune, Lily Chang, Elizabeth M. Ferguson, Edward D. Auyang, Kevin R. Patel, Benjamin T. Jarman
ObjectiveThe Accreditation Council for Graduate Medical Education requires accredited residency programs to implement competency-based assessments of medical trainees based upon nationally established Milestones. Clinical competency committees (CCC) are required to prepare biannual reports using the Milestones and ensure reporting to the Accreditation Council for Graduate Medical Education. Previous research demonstrated a strong correlation between CCC and resident scores on the Milestones at 1 institution. We sought to evaluate a national sampling of general surgery residency programs and hypothesized that CCC and resident assessments are similar.DesignDetails regarding the makeup and process of each CCC were obtained. Major disparities were defined as an absolute mean difference of ≥0.5 on the 4-point scale. A negative assessment disparity indicated that the residents evaluated themselves at a lower level than did the CCC. Statistical analysis included Wilcoxon rank sum and Sign tests.SettingCCCs and categorical general surgery residents from 15 residency programs completed the Milestones document independently during the spring of 2016.ResultsOverall, 334 residents were included; 44 (13%) and 43 (13%) residents scored themselves ≥0.5 points higher and lower than the CCC, respectively. Female residents scored themselves a mean of 0.08 points lower, and male residents scored themselves a mean of 0.03 points higher than the CCC. Median assessment differences for postgraduate year (PGY) 1-5 were 0.03 (range: −0.94 to 1.28), −0.11 (range: −1.22 to 1.22), −0.08 (range: −1.28 to 0.81), 0.02 (range: −0.91 to 1.00), and −0.19 (range: −1.16 to 0.50), respectively. Residents in university vs. independent programs had higher rates of negative assessment differences in medical knowledge (15% vs. 6%; P = 0.015), patient care (17% vs. 5%; P = 0.002), professionalism (23% vs. 14%; P = 0.013), and system-based practice (18% vs. 9%; P = 0.031) competencies. Major assessment disparities by sex or PGY were similar among individual competencies.ConclusionsSurgery residents in this national cohort demonstrated self-awareness when compared to assessments by their respective CCCs. This was independent of program type, sex, or level of training. PGY 5 residents, female residents, and those from university programs consistently rated themselves lower than the CCC, but these were not major disparities and the significance of this is unclear.



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Design and Implementation of a Robotic Surgery Training Experience Logging System

Publication date: Available online 28 June 2017
Source:Journal of Surgical Education
Author(s): Kristin G. Baldea, Ryan Thorwarth, Petar Bajic, Marcus L. Quek, Gopal N. Gupta
PurposeResidents currently log robotic cases in the ACGME system as a "surgeon" if they performed any critical step of the procedure on the surgeon console. There is no standardization as to which steps or how much of the procedure should be performed by the resident. It was our objective to establish a tool for logging the true operative experience in robotic surgery to aid in assessing surgical competency as well as curriculum development.Materials and MethodsWe propose a tool to log surgical skill progression, experience, and feedback for robotic cases. A web-based robotic experience logging system (RoboLog) was developed with procedures deconstructed to their major steps. Trainees may request the supervising attending review their performance. RoboLog provides automated summary reports to both residents and attendings.ResultsRoboLog was successfully developed and piloted with a total of 310 cases logged over 1 year. A reporting structure was developed where residents could view statistics on several data points such as step-specific involvement and feedback from attending staff. Detailed data on resident experience were obtained. For instance, 82% of the 151 robotic prostatectomies were logged as "surgeon", yet urethral transection had <35% resident involvement.ConclusionsOur current system for logging robotic experience is lacking given the fact that resident involvement on the surgical console is variable. Widespread usage of a logging system with more insight into step-specific involvement is needed. RoboLog fills this need and can be used to track robotic training progress and aid in development of a standardized curriculum.



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A Case of Keloids Complicated by Castleman’s Disease: Interleukin-6 as a Keloid Risk Factor

Summary: Keloids are a manifestation of a fibroproliferative scarring disorder of the skin and develop in response to dermal injury in patients with a susceptible background. Local, systemic, and genetic factors contribute to keloid susceptibility. These factors include tension on the edges of the wound, hormonal influences, and ethnicity, respectively. Castleman's disease is a rare lymphoproliferative disorder that is characterized by the unregulated overproduction of interleukin-6, which leads to systemic lymphadenopathy and constitutional inflammatory symptoms. This case report shows that the bilateral auricular keloids of an adult woman were greatly exacerbated by the onset of Castleman's disease. We present our multimodal management algorithm for auricular keloids, which involves core excision and radiation therapy and achieves excellent aesthetic outcomes. The current treatment pathway for auricular keloids and the possible relationship between interleukin-6 and keloid progression will be discussed.

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Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer

Publication date: Available online 28 June 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Daniel Kverneng Hultberg, Eva Angenete, Marie-Louise Lydrup, Jörgen Rutegård, Peter Matthiessen, Martin Rutegård
BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used in colorectal surgery due to their opioid-sparing effect. However, several studies have indicated an increased risk of anastomotic leakage following NSAID treatment, although conflicting results exist. The primary goal of this study was to further examine whether postoperative NSAIDs are independently associated with anastomotic leakage after anterior resection for rectal cancer.MethodsPatients who underwent anterior resection for rectal cancer during 2007-2013 in 15 different hospitals in three healthcare regions in Sweden were included in the study. Registry data and information from patient records were retrieved. The association between NSAID treatment (for at least two days in the first postoperative week) and symptomatic anastomotic leakage (within 90 days) was evaluated with multiple logistic regression, with adjustment for pertinent confounding factors.ResultsSome 1495 patients were included in the study. Of these, 27% received postoperative NSAIDs for at least two days in the first postoperative week. Symptomatic anastomotic leakage occurred in 11% and 14% in the NSAID and non-NSAID group, respectively. With adjustment for confounders, the odds ratio for leakage among patients who received NSAIDs compared with those who did not was 0.88 (95% CI 0.65-1.20). No differences were seen between non-selective and COX-2-selective NSAIDs.ConclusionPostoperative NSAID treatment does not seem to increase the risk of symptomatic anastomotic leakage after anterior resection for rectal cancer. NSAID use appears to be safe, but a well-powered randomized clinical trial is warranted.



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