The educational and practical value of clinical audit in Greece: a pilot study by surgical interns. Is it time to adapt a structured way to improve quality in healthcare?

Objectives: Clinical audit is a great way of facilitating quality improvement in health services. Our aim is to describe the concept, clinical and educational benefits of clinical audit, as well as present a simple example that can be used as a guide for interns and medical students in Greece. We hope to raise awareness on the subject of quality improvement in our financially challenged healthcare system. Methods: The potential educational benefits of the clinical audit were defined and were set as the objectives of this study. It was assigned to a team of surgical interns to select a topic of their choice, conduct a clinical audit, under the necessary supervision, and present their findings. Finally a discussion between the professors and the interns took place in order to assess whether the objectives were actually achieved. Results: The interns completed the audit successfully. It was obvious that they managed to improve the initial area of weakness significantly and identify opportunities for further improvement. At the same time this kind of project help them acquire important educational competencies. Conclusions: Incorporating clinical audits in medical education proves helpful for interns and for the quality of healthcare offered. This is especially important as it underscores the need and provides the methodology for structural changes that are critical in health care systems facing the global financial crisis

THE EVOLUTION OF CRITERIA FOR LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA: FROM MILAN TO SAN FRANCISCO AND ALL AROUND THE WORLD!

Introduction: Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third most common cancerrelated cause of death in the world. According to the stage of the disease, each patient is allocated to a different treatment option. Liver transplantation, along with surgical resection, is the only totally therapeutic option and is primarily indicated in HCC patients with underlying cirrhosis. However, the restricted number of liver grafts imposes difficulties in selecting the most suitable patients to receive those limited grafts and therefore certain criteria have been proposed. The Milan criteria are currently the most widely accepted and utilized criteria around the world, despite their restrictiveness. In an attempt to assist HCC patients exceeding them, but with a potential to display acceptable survival outcomes, undergo liver transplantation, research teams worldwide suggest expanded criteria based on their findings. Some of the most broadly known are the University of California, San Francisco (UCSF), Kyoto, Tokyo, Hangzhou and up-to-7 criteria. On the other hand, in order to expand the liver donor pool, grafts may be accepted from living, non-heart beating, elderly, steatotic, or even HCV-infected donors, in addition to the use of split livers with both advantages and disadvantages. The aim of this review is to thoroughly present the current situation of liver transplantation for HCC patients, with a focus on the criteria used and emerging challenges presented. Core tip: Hepatocellular carcinoma (HCC) is the third most common malignancy worldwide and liver transplantation represents the treatment of choice, particularly in the setting of cirrhosis. Lack of grafts led to the utilization of certain criteria in order to determine the eligibility of an HCC patient to access the waiting list. The most widely accepted are the Milan criteria, even though they are thought off as too restrictive. Consequently, transplant research groups all over the world published their own criteria, which showed acceptable outcomes. Living donor liver transplantation and other extended-criteria grafts have been proposed as an alternative to reduced donations. Ziogas IA, Tsoulfas G. The evolution of criteria for liver transplantation for hepatocellular carcinoma: from Milan to San Francisco and all around the world! DOI: https://doi.org/10.25176/RFMH.v17.n3.119

Making clinical skills education real - Transition from simulation to ward

Transition from classical clinical skills teaching to simulation-based training has contributed to better medical education. However, a gap still exists between Clinical Skills Lab (CSL) training and the clinical setting. In response, the Transition Programme from CSL to Clinical Reality Setting was designed and implemented in the Medical School of AUTH

Damage Control Surgery for Liver Trauma

The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the “lethal triad” (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place, along with permanent closure of the abdominal wall

Machine Perfusion Strategies in Liver and Renal Transplantation

Transplantation is the only treatment for patients with end-stage renal and hepatic disease but unfortunately, it is limited worldwide due to the organ shortage. The need to expand the donor pool with the use of donors after cardiac death (DCD) and extended criteria donors (ECD) has led to major improvements in organ preservation. From cold static storage and preservation solutions to different types of machine perfusion, the possibility of successfully transplanting a marginal organ becomes reality. In this chapter, we examine the machine perfusion methods and the advantages of new technology in minimizing ischemic injury and improving the transplant outcome. Τhe establishment of protocols with the use of biomarkers in order to assess the transplant suitability of the graft will eventually provide the ideal opportunity to intervene and improve the quality of the organ