Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients

Background Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost

The Rising Tide of Revisional Surgery: Tracking Changes in Index Cases Among Bariatric-Accredited Fellowships

BACKGROUND: The field of bariatric surgery has seen peaks and troughs in the types of metabolic procedures performed. Our primary aim was to evaluate bariatric case volumes among fellows enrolled in bariatric Fellowship Council (FC)-accredited programs. Our secondary aim was to assess trends in revisional case volumes. METHODS: We reviewed de-identified FC case logs for all bariatric surgery-accredited programs from 2010 through 2019. The number of primary sleeve gastrectomy, gastric band, gastric bypass, biliopancreatic diversion, and major revisional bariatric surgical procedures (defined as a revision with creation of a new anastomosis) were graphed for each academic year. Fellows were stratified into quartiles based on the number of revisional operations per year and graphed over ten years. Volumes of primary gastric bypass, major revisions, and total anastomotic cases were compared over time using ANOVA with p \u3c 0.05 considered significant. RESULTS: Case volumes for 822 fellows were evaluated. Sleeve gastrectomy had a significant surge in 2010 and plateaued in 2016. The fellows\u27 number of primary gastric bypasses had a non-significant decrease from 84 to 75 cases/fellow from 2010 to 2019. This decrease was offset by a significant increase in major revisional surgery from 8 to 19 cases/fellow. As a result, the number of anastomotic cases did not change significantly over the study time period. Interestingly, as revisional volume has grown, the gap between quartiles of fellowship programs has widened with the 95th percentile growing at a much faster rate than lower quartiles. CONCLUSION: The volume of bariatric procedures performed in the last decade among FC fellows follows similar trends to national data. Major revisional cases have doubled with the most robust growth isolated to a small number of programs. As revisional surgery continues to increase, applicants interested in a comprehensive bariatric practice should seek out training programs that offer strong revisional experience

High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass

PURPOSE: Given that smoking is known to contribute to gastrojejunal anastomotic (GJA) ulcers, cessation is recommended prior to laparoscopic Roux-en-Y gastric bypass (LRYGB). However, smoking relapse rates and the exact ulcer risk remain unknown. This study aimed to define smoking relapse, risk of GJA ulceration, and complications after LRYGB. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent primary LRYGB during 2011-2015. Initially, three patient categories were identified: lifetime non-smokers, patients who were smoking during the initial visit at the bariatric clinic or within the prior year (recent smokers), and patients who had ceased smoking more than a year prior to their initial clinic visit (former smokers). Smoking relapse, GJA ulcer occurrences, reinterventions, and reoperations were recorded and compared. RESULTS: A total of 766 patients were included in the analysis. After surgery, 53 (64.6%) recent smokers had resumed smoking. Out of these relapsed smokers, 51% developed GJA ulcers compared with 14.8% in non-relapsed recent smokers, 16.1% in former smokers, and 6% in lifetime nonsmokers (p < 0.001). Furthermore, relapsed smokers required more frequently endoscopic reinterventions (60.4%) compared with non-relapsed smokers (20.8%, p < 0.001), former smokers (20.7%, p < 0.001), and lifetime non-smokers (15.4%, p < 0.001). Additionally, relapsed smokers required a reoperation (18.9%) more often than non-relapsed recent smokers (5.7%, p < 0.001) and lifetime non-smokers (1.3%, p < 0.001). CONCLUSION: Smokers relapse frequently after LRYGB, and the majority experience GJA complications. They should be counseled about this risk preoperatively and directed towards less ulcerogenic procedures when possible. Alternatively, longer periods of preoperative smoking abstinence might be needed

What delays your case start? Exploring operating room inefficiencies

Introduction Improving operating room (OR) inefficiencies benefits the OR team, hospital, and patients alike but the available literature is limited. Our goal was, using a novel surgical application, to identify any OR incidents that cause delays from the time the patient enters the OR till procedure start (preparatory phase). Materials and methods We conducted an IRB approved, prospective, observational study between July 2018 and January 2019. Using a novel surgical application (ExplORer Surgical) three observers recorded disrupting incidents and their duration during the preparatory phase of a variety of general surgery cases. Specifically, the number and duration of anesthesia delays, unnecessary/distracting conversations, missing items, and other delays were recorded from the moment they started until they stopped affecting the normal workflow. Results Ninety-six OR cases were assessed. 20 incidents occurred in 18 (19%) of those cases. The average preparatory duration for all the cases was 20.7 ± 8.6 min. Cases without incidents lasted 19.5 ± 7.4 min while cases with incidents lasted 25.9 ± 11.2 min, p = 0.03. The average incident lasted 3.7 min, approximately 18% of the preparatory phase duration. Conclusion The use of the ExplORer Surgical app allowed us to accurately record the incidents happening during the preparatory phase of various general surgery operations. Such incidents significantly prolonged the preparatory duration. The identification of those inefficiencies is the first step to targeted interventions that may eventually optimize the efficiency of preoperative preparation

Exploring SMEFT Couplings Using the Forward-Backward Asymmetry in Neutral Current Drell-Yan Production at the LHC

Neutral current Drell-Yan (DY) lepton-pair production is considered in the framework of the Standard Model Effective Field Theory (SMEFT). Using the open-source fit platform xFitter, we investigate the impact of high-statistics measurements of the neutral current DY (NCDY) forward-backward asymmetry $A_{\rm{FB}}$ near the weak boson mass scale in the present and forthcoming stages of the Large Hadron Collider (LHC). Besides recovering earlier results on the $A_{\rm{FB}}$ sensitivity to parton distribution functions, we analyze the precision determination of $Z$-boson couplings to left-handed and right-handed $u$-quarks and $d$-quarks, and explore Beyond-Standard-Model contributions using the SMEFT framework. We comment on the role of the $A_{\rm{FB}}$ asymmetry for the electroweak SMEFT fit and precision $Z$-boson physics at the LHC and high-luminosity HL-LHC

A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents’ Operative Performance and Decreases Skill Variability: Cohort Study

Objective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill. Summary of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability. Methods: PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group’s performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant. Results: Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance (P = 0.04). Conclusions: Completion of a CBE rotation led to significant improvements in PGY-2 residents’ LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training

Comparison of CMS measurements with predictions at NLO applying the Parton Branching Method and PYTHIA

In August 2023, more than 30 students joined the Special Remote DESY summer-school to work on projects of importance for LHC experiments. In a dedicated initiative, analyses that had not been incorporated into the RIVET package were implemented and verified. Here, a brief description of the accomplished work is given, and a comparison of the measurements with predictions obtained from matched standard parton shower Monte Carlo event generators as well as with those obtained from Parton-Branching TMDs with corresponding parton showers are presented

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs).&nbsp;Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings.&nbsp;Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran.&nbsp;Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p&lt;0.001).&nbsp;Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions