Attrition Rate in Military General Surgery GME and Effect on Quality of Military Programs

AbstractTo address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

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Appraising the Quality of Reporting of American College of Surgeons NSQIP Emergency General Surgery Studies

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.01.012 ◽

2021 ◽

Vol 232 (5) ◽

pp. 671-680 ◽

Cited By ~ 1

Author(s):

Mohamad El Moheb ◽

Hadi Sabbagh ◽

Daniel Badin ◽

Tala Mahmoud ◽

Basil Karam ◽

...

Keyword(s):

General Surgery ◽

Emergency General Surgery ◽

Quality Of Reporting ◽

American College Of Surgeons

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The effect of gender dyads on the quality of narrative assessments of general surgery trainees

The American Journal of Surgery ◽

10.1016/j.amjsurg.2021.12.001 ◽

2021 ◽

Author(s):

A. Roshan ◽

A. Farooq ◽

A. Acai ◽

N. Wagner ◽

R.R. Sonnadara ◽

...

Keyword(s):

General Surgery ◽

Gender Dyads

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Comparative Efficacy and Safety of Sertraline Versus Nortriptyline in Major Depression in Patients 70 and Older

International Psychogeriatrics ◽

10.1017/s104161029900561x ◽

1999 ◽

Vol 11 (1) ◽

pp. 85-99 ◽

Cited By ~ 41

Author(s):

Sanford I. Finkel ◽

Ellen M. Richter ◽

Cathryn M. Clary

Keyword(s):

Major Depression ◽

Rating Scale ◽

Antidepressant Treatment ◽

Change Score ◽

Attrition Rate ◽

Double Blind ◽

Almost All ◽

Positive Effect ◽

Population Segment

Background. Few randomized, double-blind studies that examine antidepressant treatment in patients 70 years and older are available. To provide additional data on the safety and efficacy of antidepressants in this rapidly growing population segment, a subgroup analysis of a larger sertraline vs. nortriptyline elderly depression treatment study was performed. Methods. Outpatients (N = 76) who met DSM-III-R criteria for major depression with a minimum Hamilton Depression Rating Scale (HAM-D) severity score of 18 were randomized to 12 weeks of flexible dose treatment with sertraline (50–150 mg) or nortriptyline (25–100 mg). Results. Both treatments significantly improved depression as measured by the HAM-D and Clinical Global Impression scales. At Weeks 10, 12, and endpoint, sertraline demonstrated a significantly greater reduction in depression severity compared to nortriptyline as measured by improvement on the 24-item HAM-D (mean adjusted change score of 14.8 vs. 7.6, respectively, at Week 12; p = .001). Sixty-five percent of sertraline-treated patients were responders by Week 12 (50% or greater reduction from baseline in 24-item HAM-D score) compared to 26% of nortriptyline-treated patients (p < .05). Sertraline treatment had a significantly more positive effect, when compared to nortriptyline, across almost all associated measures of cognitive function, energy, anxiety, and quality of life and was better tolerated than nortriptyline, with a lower attrition rate/side effect burden. Conclusion. The efficacy advantage of sertraline appeared to be even greater in this subgroup of older patients drawn from a larger treatment study of depression that included elderly individuals over the age of 60.

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Factors associated with general surgery residents’ decisions regarding fellowship and subspecialty stratified by burnout and quality of life

The American Journal of Surgery ◽

10.1016/j.amjsurg.2019.08.003 ◽

2019 ◽

Vol 218 (6) ◽

pp. 1090-1095

Author(s):

Natalie C. McClintock ◽

Kelsey E. Gray ◽

Angela L. Neville ◽

Amy H. Kaji ◽

Mary M. Wolfe ◽

...

Keyword(s):

Quality Of Life ◽

General Surgery ◽

Factors Associated

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An Effectiveness Study of a Digital Mindfulness-Based Program for Upper Secondary Education Students

Mindfulness ◽

10.1007/s12671-020-01462-y ◽

2020 ◽

Vol 11 (11) ◽

pp. 2494-2505

Author(s):

Oskari Lahtinen ◽

Christina Salmivalli

Keyword(s):

Controlled Trial ◽

Attrition Rate ◽

Education Students ◽

Online Questionnaire ◽

Face To Face ◽

Upper Secondary Education ◽

Randomized Controlled ◽

Upper Secondary

Abstract Objectives Mindfulness-based programs/interventions (MBPs) are emerging as treatments for anxiety and stress for adults and adolescents. MBPs can also be helpful as universal interventions for healthy subjects. Few studies have looked at how beneficial MBP effects transfer to digital MBPs. Methods The study was a randomized controlled trial with 1349 participants aged mostly 16–19. We compared a digital MBP vs. a waitlist condition. Online questionnaire data were collected pre-program, post-program, and at 3-month follow-up. Results Completing the MBP resulted in a small-to-moderate reduction in anxiety (F1,681 = 13.71, p < .01, d = .26), a small reduction in depression (F1,686 = 8.54, p < .01, d = .15), and a small increase in psychological quality of life (F1,708 = 3.94, p = .05, d = .16). Attrition rate for the MBP was 41.5%. Conclusions The results suggest that digital MBPs can be successful in delivering at least some of the benefits characteristic of face-to-face MBPs.

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Variation in Quality of Care after Emergency General Surgery Procedures in the Elderly

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2011.03.001 ◽

2011 ◽

Vol 212 (6) ◽

pp. 1039-1048 ◽

Cited By ~ 43

Author(s):

Angela M. Ingraham ◽

Mark E. Cohen ◽

Mehul V. Raval ◽

Clifford Y. Ko ◽

Avery B. Nathens

Keyword(s):

Quality Of Care ◽

General Surgery ◽

The Elderly ◽

Emergency General Surgery

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Histopathological Aspects Described in Patients with Hepatic Hydatidosis

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0005 ◽

2016 ◽

Vol 54 (1) ◽

pp. 47-53

Author(s):

Daniela E. Mihăilă ◽

M.C. Niţu ◽

T.D. Potecă

Keyword(s):

General Surgery ◽

Liver Parenchyma ◽

Cystic Mass ◽

Cytokeratin 19 ◽

Hepatic Hydatidosis ◽

Benign Pathology ◽

Before And After ◽

Immunohistochemical Techniques ◽

Surgery Department

Introduction. Hydatidosis is a parasitic disease with tumour-like development of a cystic mass. This has specific endemic areas, Romania being amongst them. Our hospital has national addressability and the collaboration between the Departments of Parasitology, General Surgery and Pathology ensures optimal multidisciplinary approach to cases of therapeutic and diagnostic standpoint. The study aims to test the hypothesis that the gallbladder is a hydatid reservoir, to identify signs of biliary fistulas in the pericyst and liver parenchyma; to identify inflammation elements in the pericyst and the gallbladder. Material and methods. The study is a retrospective observational one, carried out between 2011-2014, on a total of 35 patients operated for hepatic hydatidosis in the General Surgery Department of “Colentina” Clinical Hospital. All the selected patients had sent to the Pathology Department: gallbladder, cyst and pericyst. Statistical analysis of the data was performed using SPSS package Statistics 19. Results. The main results of the study revealed no evidence to confirm the hypothesis that the gallbladder is a hydatid reservoir. Out of the 35 cases, in 16 we observed the tendency to include hepatic biliary ducts in the pericyst or the formation of new canals which lead to the formation of biliary fistulas. Using immunohistochemical techniques with mark of CK19 (cytokeratin 19), have been observed the pattern of fistulization and modification of local architecture through the formation of the pericyst, in 16/35 (45.7%) of cases. Conclusion. Although it is a benign pathology, the evolution of hepatic hydatidosis can lead to severe complications and a low quality of life for the patient, both before and after surgery. Better knowledge of the pathology behind the local evolution of the disease can influence the therapeutic approach.

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SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

British Journal of Surgery ◽

10.1093/bjs/znab361.071 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Edward Hardy ◽

Thomas Smart ◽

Jacob Hatt ◽

Jon Lund

Keyword(s):

Length Of Stay ◽

Perceived Stress ◽

General Surgery ◽

Surgical Care ◽

Emergency General Surgery ◽

Quality Of Patient Care ◽

Stress Levels ◽

General Surgeons ◽

The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, >4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, > 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

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