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

Simulating urban growth scenarios using GIS and multicriteria analysis techniques: a case study of the Madrid region, Spain

Over the last few years, urban expansion has occurred without much control or urban planning, causing both regional and global impacts on the natural ecosystems. This situation has spurred reflection on current planning policies and has also stimulated research into new tools and methodologies for the simulation of alternative territorial scenarios for the future. In this respect, the use of multicriteria evaluation techniques within a GIS environment has proved to be an efficient option for an optimal allocation of land uses. However, those techniques have not been explored thoroughly in the field of future scenario simulation. The aim of our research is to show and to reinforce the possibilities of these techniques in developing three different scenarios of urban growth (business as usual, crisis, and innovation and sustainability). All three scenarios discriminate between three land uses (residential, commercial, and industrial), and have been developed for the Madrid region. The base-line year of these scenarios is 2000 and the time horizon is 2020. In that process, fourteen spatial factors, which encompass environmental, economic, and social issues, have been considered. The results obtained show that some discrepancies exist between the business as usual scenario and European policies for transport and the environment. This situation has an impact on the territory and causes irreversible damage to the environment. The crisis scenario, in contrast, alleviates those pressures, if not because of the application of environmental policies to the planning process, at least because the situation of crisis causes the metropolitan model to change. Finally, innovation has been considered a driver of economic development and good planning practice, the positive effects of which have been highlighted in the third scenario.

Exploding Crime? Topic Management in Central American Newspapers

Huhn S, Oettler A, Peetz P. Exploding Crime? Topic Management in Central American Newspapers. GIGA Working Papers. Vol 33. Hamburg: GIGA; 2006.It has become common to state that criminal violence has superseded political violence in Central America. This paper presents the first results of a research project which analyses the social construction of violent realities in Costa Rica, El Salvador and Nicaragua. The authors describe the print media landscape in Central America and examine both the quality of leading newspapers and the main clusters of topics constituting the news discourse on violence. The analysis of the macro-structure of topic management in Central American newspapers allows to differentiate the “talk of crime”: it is more heterogeneous than often thought. There are signs that the problem of juvenile delinquency is emerging as the center of a cross-country discourse on “ordinary violence”. On the other hand, the talk of crime is centered around few topic clusters, with sexual violence and border-related discourse on violence being of key importance. Finally, the paper points to a heterogeneous array of discourse events that is connected to political developments and power-relations