Annals of surgery
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Review
Objective structured assessment of debriefing: bringing science to the art of debriefing in surgery.
: To identify the features of effective debriefing and to use this to develop and validate a tool for assessing such debriefings. ⋯ : OSAD provides an evidence-based, end-user informed approach to debriefing in surgery. By quantifying the quality of a debriefing, OSAD has the potential to identify areas for improving practice and to optimize learning during simulation-based training.
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We conducted a systematic review of published literature to gain a better understanding of the impact of advanced fellowships on surgical resident training and education. ⋯ The overall impact of advanced surgical fellowships on surgical resident education and training remains unclear, as most studies rely on limited data of questionable generalizability. A careful study of the national database of surgery resident case logs is essential to better understand how early surgical specialization and fellowships will impact the future of general surgery education.
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Meta Analysis
A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas.
Several randomized control trials (RCTs) have compared somatostatin and its analogues versus a control group in patients with enterocutaneous fistulas (ECF). This study meta-analyzes the literature and establishes whether it shows a beneficial effect on ECF closure. ⋯ Somatostatin and octreotide increase the likelihood of fistula closure. Both are beneficial in reducing the time to fistula closure. Neither has an effect on mortality. The risk ratio (RR) for somatostatin was higher than the RR for analogues. This may suggest that somatostatin could be better than analogues in relation to the number of fistulas closed and time to closure. Further studies are required to corroborate these apparent findings.
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Randomized Controlled Trial Comparative Study
Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial.
: We report a multicentered randomized controlled trial across Australia and New Zealand comparing laparoscopic-assisted colon resection (LCR) with open colon resection (OCR) for colon cancer. ⋯ : In spite of some differences in short-term surrogate oncological markers, LCR was not inferior to OCR in direct measures of survival and disease recurrence. These findings emphasize the importance of long-term data in formulating evidence-based practice guidelines.
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We sought to investigate whether a volume-outcome relationship exists for lower extremity arterial bypass (LEAB) surgery. ⋯ A positive volume-outcome relationship exists for LEAB procedures even after employing multilevel risk adjustment models. There are benefits in terms of mortality and limb salvage both in the short-term and at 1 year postsurgery.