Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Effect of pulse mode in reactive magnetron sputtering on structure and properties of titanium dioxide films

The state of the art to obtain crystalline TiO2 layers by vacuum deposition methods is the use of elevated substrate temperature during deposition or annealing after deposition above 250 °C. Therefore these processes are limited to temperature resistant substrates like glass. On the other hand there is a call for photocatalytic and hydrophilic layers on temperature sensitive materials. An innovative reactive pulse magnetron sputtering (PMS) system allowing to change the pulse mode (unipolar pulse, bipolar pulse or pulse packet) has been used for the sputter deposition of transparent TiO2 films. Investigations were carried out to determine the influence of the pulse mode on the substrate peak temperature during deposition for different substrate materials, on the film structure and on different film properties (hardness, Young's modulus, refractive index and surface roughness). The experimental results show that it is possible to achieve crystalline TiO2 films by pulse sputtering without heating the substrate prior to or annealing the substrate after the coating procedure. Bipolar powering as well as pulse packet powering tend to affect the structure of the layers towards rutile. On thermal sensitive polycarbonate substrates we deposited 500 nm thick amorphous TiO2 films by unipolar pulse sputtering. To deposit crystalline TiO2 layers on these substrates is still a challenge

Grundsaetzliche Einfluesse der Herstell- und Verbindungstechnik auf konfektionierte Hochleistungsdiodenlaser Schlussbericht

The aim of this project was to investigate materials matched with its thermal expansion to gallium arsenide and to use it for mounting high power laser diodes. Submounts and n-contact foils based on the Cu-Mo-Cu layered system as well as CuMo and CuW composit materials and diamond layered systems were analyzed. The semiconductor dies were mounted on these materials using indium or eutectic gold tin solder. The inner coating of the water cooled hent sinks were improved to obtain over 10.000 hours operating time under normal working conditions, proving their reliability. New semiconductor laser bars were tested under different operating conditions. (orig.)SIGLEAvailable from TIB Hannover: DtF QN1(67,5) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Untersuchung von Halbleiterlaser-Diodenarrays hoher Pumpleistung Abschlussbericht

SIGLEAvailable from TIB Hannover: F95B223+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Untersuchungen von Halbleiterlaser-Lichtquellen hoher Ausgangsleistung Abschlussbericht

Available from TIB Hannover: F98B1184+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Patient screening tool as input to the survivorship summary of care plan appointment

140 Background: A review of the literature failed to identify a screening tool specific to the unique needs of cancer survivors. The Coleman Supportive Oncology Collaborative (CSOC) developed a tool to evaluate psychosocial, physical and practical concerns, and emotional distress for concurrent use during the cancer survivorship visit. Based on pilot results of the tool, minor modifications were made and tested. Methods: The CSOC (v.3) survivorship tool was used in patients (n = 49) who had completed their adjuvant therapy at one of two safety net hospitals in Chicago, IL. The CSOC v.3 screening tool items (n = 44) include: PHQ4, fear of another cancer or recurrence, financial, social and religious concerns, nutritional concerns, physical concerns, lifestyle risk factors, and treatment/care concerns. Results: The most common patient concerns included: fear of another cancer 53% (26/49), tingling in my hands/feet 53% (26/49), concerns about diet 51% (25/49), pain 51% (25/49), sleep 51% (25/49), dry skin 47% (23/49); endorsement of these concerns were not significantly associated. Of the 44 items, 16 were reported by at least 30% of patients, and 3 items were reported by less than 10% of patients. There was an average of 15 items/concerns noted by patients with a maximum of 27 items and a minimum of 5 items. Clinicians (n = 7) reported the use of the screening tool results aided the survivorship appointment discussion, directing the focus to reported patient’s concerns. Conclusions: Survivors continue to experience multiple concerns and distress, thus they may benefit from a comprehensive tool that is tailored to capture their unique survivorship needs. Administration of the tool at the beginning of the survivorship appointment provided the framework for the patient’s appointment narrative. An additional study is planned to compare use of the tool versus current practice at a large academic center