Louis Flint, M.D., curated by FACS, ACS overview Editorial Board.
Impact of surgical and non-surgical treatment of malignant bowel obstruction on patient QoL and survival
Ayabe R, Mendoza T, Yennu S et al Symptom burden in patients with malignant bowel obstruction treated with or without surgery. Jay Am Call Thurg2022, in print.
Malignant intestinal obstruction is the most common indication for palliative surgical consultation. This study sought to determine the impact of surgical or non-surgical treatment of malignant bowel obstruction on patient quality of life and survival using patient-reported outcomes and mortality data. This prospective cohort study (n = 125) was conducted at a single cancer center.
Researchers used an approved symptom inventory (MD Anderson Symptom Inventory – Gastrointestinal Obstruction (MDASI-GIO)) to quantify symptom severity (pain) and degree of symptom interference with activities of daily living. Used. In the study cohort, 37 patients underwent surgery and 88 did not. Data analysis showed that patients who underwent surgery had improved overall survival (median 15 months vs. 3 months) but experienced significantly more disability in areas such as work, activity and walking . Ability to undergo surgical treatment followed by chemotherapy was a predictor of survival, whereas palliative care visits and gastrostomy use were statistically associated with an increased risk of death.
The authors concluded that these data, derived from real patient experiences, are of potential value in improving the conversation about palliative care for patients with advanced cancer and gastrointestinal obstruction.
Surgical Clerkship Director Suggests COVID-19 Pandemic Has Significant Impact on Medical Students’ Education
Spanknebel K, Ellison EC, Nagler A, et al. Surgical clerkship directors’ perceptions of the impact of the COVID-19 pandemic on medical student education. J Am Cole Surgeon2022, in print.
The authors conducted a survey of 164 surgical directors in the spring of 2020 and 2021 to solicit their views on the impact of the COVID-19 pandemic on the education of medical students. The response rate for the 2020 survey was 44.5% and for the 2021 survey was 50.6%.
Survey data showed that over 95% of programs have adopted virtual education platforms in 2020, and 46% have returned to their pre-pandemic educational activities by 2021. Delayed student progress was observed in his 12% of clerkships and reported by his 43% of clerkship directors. Negative effects of the 2020 pandemic. However, this figure has improved significantly in the 2021 survey. A promising observation is that the proportion of students interested in pursuing surgical training did not decrease during the study period. An important positive aspect of the pandemic experience was the development of virtual patient encounters. Improvements in teaching methods, student test performance, continued personal learning, and involvement in clerical work were also recorded.
Although the authors concluded that the pandemic had a significant negative impact on aspects of student surgical education, some positive pandemic experiences were also uncovered. Further investigation may confirm the long-term value of these approaches.
editorial
Freischlag JA. What has COVID-19 brought to you recently? Jay Am Call Thurg2022, in print.
In an editorial that accompanied the article, former ACS President Julie A. Freischlag, M.D., FACS, DFSVS, noted that there were multiple hallmarks of the pandemic that harmed patients (e.g., delays in cancer diagnosis and treatment). However, it is worth noting that surgeons have adapted to the crisis by developing informative and innovative clinical and educational solutions to the challenges presented.
AAST Publishes Consensus Document on Prevention of Alcohol Withdrawal Syndrome in Surgical ICU
Seshadri A, Appelbaum R, Carmichael SP, 2nd, et al. Prevention of Alcohol Withdrawal Syndrome in the Surgical ICU: A Clinical Consensus Document of the American Trauma Surgery and Emergency Care Board. Trauma Surg Acute Care Open2022;7(1).
Alcohol withdrawal syndrome is defined as a set of symptoms including nausea, vomiting, tremors, sweating, agitation, and disorientation that appear in patients after they stop drinking alcohol. This condition is observed in up to 40% of at-risk patients admitted to surgical ICU care. In this report, the authors presented the recommendations contained in the clinical consensus document produced by the Society of Surgeons of the American Board of Trauma and Critical Care Medicine.
The consensus document recommends using standard instruments such as the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol Withdrawal Severity Prediction Scale (PAWSS) to assess the risk of developing an alcohol withdrawal syndrome in individuals with a history of alcohol use. Patient screening is recommended. The characteristics of the evaluation instruments are clearly stated in the report. Monitoring of at-risk patients using the Minnesota Detoxification Scale was recommended. Patients judged to be at high risk may be treated empirically with benzodiazepines or phenobarbital.
The consensus document provided a useful discussion of alternative medications and discussed the history of intravenous alcohol use. A consensus panel recommended against intravenous alcohol use. Other useful agents such as micronutrients were also discussed. Surgeons are strongly encouraged to review the entire document.
