Articles: cations.
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Define recommendations for work-life integration and wellness and provide a pathway for supporting, teaching, and strengthening the skills needed to live as an authentic, empathic, compassionate, emotionally intelligent surgeon who provides the best care to patients. ⋯ Creating a culture of belonging by focusing on program culture through accountability, safety, and collaboration can lead surgical training programs to train highly successful surgeons.
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The National Cancer Database (NCDB) collects data from approximately 1,500 Commission on Cancer (CoC) facilities and represent 73.7% of newly diagnosed cancers nationwide. The American College of Surgeons Cancer Program developed it first annual report from the NCDB 2021 participant user file reporting new observations and recent trends of cancer diagnoses, patient demographics, and treatments as well as an in-depth report on treatment and outcomes in breast, pancreas, and colon cancers. Of the 1,328,131 cancers diagnosed in 2021 at 1,281 reporting CoC hospitals, one-fifth continue to be female breast cancer. ⋯ Pancreatic cancer presents with stage IV disease in nearly half, although an increase in stage I disease is seen. The most common location is pancreatic head. Survival is relatively low and most dependent on stage.
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Anesthesia and analgesia · Jan 2025
A Cognitive Load Theory Perspective of the Undergraduate Anesthesia Curricula in South Africa.
Safe anesthesia is indispensable to achieve global safe surgery and equitable health care access. The disease burden and lack of specialists in South Africa (SA) require junior, nonspecialist doctors to be fit-for-purpose from day 1 when they provide anesthetic services in peripheral hospitals with limited supervision. Graduating students report low self-perceived preparedness for administering anesthesia, but it is not known how their curricular experiences influence their learning. Cognitive load theory defines intrinsic, extraneous, and germane cognitive loads (subtypes). Intrinsic load relates to learning tasks, extraneous load to distractions, and germane load to students' learning processes. This study used a cognitive load theory lens to explore SA students' experiences of their undergraduate anesthesia training. ⋯ Cognitive load theory provided a useful theoretical basis for understanding students' curricular experiences. The COLOAD framework suggests a microlevel interrelatedness of the constituting elements of the 3 cognitive load subtypes. This has implications for curriculum design, pedagogy, and student support. Learning outcomes development and curriculum mapping are important to ensure a lean curriculum, but measures to enhance germane cognitive load might be equally important to achieve competence. Attention to the hidden curriculum and active promotion of reflective practice might reduce cognitive load in complex learning environments such as anesthesia training.
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No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. ⋯ For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.
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Although stereotactic radiosurgery (SRS) has well defined outcomes in the management of smaller-volume arteriovenous malformations (AVM), this report evaluates the outcomes when SRS is used for large-volume (≥10 cc) lobar AVMs. ⋯ These outcomes underscore both the potential effectiveness and the limitations of multistage SRS procedures for complex high-risk large volume AVMs in critical brain lobar locations. Most patients retained either stable or improved long-term mRS scores. During the latency interval from the first SRS until obliteration, achieved after two or more procedures, the risk of hemorrhage and treatment-related complications persists.