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

Virtual Learning Communities - Theory and Practice: the Case of VirRAD

In this paper we discuss the development of virtual communities and especially virtual learning communities, taking into account basic community requirements as well as social factors of e-learning. This paper has been inspired by the VirRAD European project and presents the intermediate results that have raised form the definition of a virtual community for the vocational training of radiopharmacists. We therefore present the user requirements that form the functional specification of such an environment along with the role model that provides a mindful but solid distribution of the access level in the system

Building e-learning communities: The case of VirRAD

This paper discusses the development of virtual communities and especially e-learning communities. In particular, this paper is inspired by VirRAD European project, and presents the intermediate results that have raised from the definition of this virtual radiopharmacy community

Using VR Technology to Support e-Learning: The 3D Virtual Radiopharmacy Laboratory 1

In this paper, we present a virtual laboratory, which is designed and implemented in the framework of the VirRAD European project. This laboratory represents a 3D simulation of a radio-pharmacy laboratory, where learners, represented by 3D avatars, can experiment on radio-pharmacy equipment by carrying out specific learning scenarios. This paper describes the functionality provided by this laboratory, the motivation factors which led to its formation, the technological decisions that were made for the optimization of the system as well as the envisioned steps to be carried out

Delivering Interactive Enhanced Sports Content to Thin-Client DTV STBs

Digital Television (DTV) was the first major advance in the television industry since the establishment of color TV sets in the 50's. However, despite the ambitious anticipations, most DTV operators offering subscriber TV services are facing serious economic problems. Many believe that significantly increasing the DTV operator revenues is closely linked to the provision of advanced interactive TV applications which, on one-hand, based on content enhancements will attract more subscribers, and on the other hand will also generate indirect revenues through services like TV-commerce or on-line betting. In this paper an end-to-end interactive TV application is presented. The application has been developed for accompanying sport broadcasts, given that sports content is very attractive for the majority of subscribers. This application enhances sport broadcasts with relevant content (statistics, news, information) appearing on user-demand, as well as with an innovative interactive entertaining game of predictions challenging users to make predictions and to prove their anticipatory skills and sport knowledge. The application supports multiple types of forward and return channels and STB middleware systems. Furthermore, its components can be used in content distribution networks targeting multiple network-enabled information appliances

Multiple Myeloma Presenting as MPO-ANCA Associated Microscopic Polyangiitis

Reports on the association of multiple myeloma with systemic vasculitis are rare and concern, vasculitis due to crystalglobulin deposition in vessels or to polyarteritis nodosa PAN-like type necrotizing vasculitis. The association of multiple myeloma with MPO-ANCA positive microscopic polyangiitis has not yet been described. We report a case of a 72 year old man, who was referred to our clinic for evaluation of recent onset renal failure (serum creatinine 8mg/dl), proteinuria 2g/day, severe anemia (hematocrit 16%) and fever accompanied by malaise, anorexia, weigh loss, myalgia and arthralgia. These symptoms appeared 20 days prior to his admission. There was no evidence of any infection. The renal biopsy showed necrotizing crescentic glomerulonephritis. The MPO-ANCA were positive. Bone marrow biopsy revealed infiltration with IgG-lambda neoplastic plasma cells. The patient was treated with hemodialysis, plasma exchange, corticosteroids and cyclophosphamide. Even though his clinical situation and renal function improved gradually, two months after his admission, he developed acute respiratory insufficiency accompanied by heavy hemoptysis, patchy infiltration on chest X-rays, due to lung vasculitis and died. Multiple myeloma should be considered in the differential diagnosis of hematological neoplasms capable of causing paraneoplastic ANCA positive microscopic polyangiitis