Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jhep.2001.22172

A model to predict survival in patients with end‐stage liver disease

https://globalhealth.duke.edu/sites/default/files/event-attachments/2.18_meara.pdf

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

Background The technical skill of surgical trainees is not well assessed. This study aimed (1) to compare the reliability of three scoring systems, (2) to compare live and bench formats and (3) to assess construct validity of a test of operative skill.

Methods Parallel examinations of operative skill, one using live animals and one using simulations, were developed. Performance was graded using operation-specific checklists, detailed global rating forms and pass/fail judgements. Twenty surgical residents each took both formats.

Results Disattenuated correlations between live and bench scores were high (0.69–0.72). Mean inter-rater reliability across stations ranged from 0.64 to 0.72. Internal consistency was moderate to high (α: 0.61–0.74) for the live format using the checklist and for live and bench formats using global ratings. Global ratings discriminated between resident levels for both formats (bench: F(2,17) = 4.45, P < 0.05; live: F(2,17) = 3.5, P < 0.05), checklists did not.

Conclusion This preliminary study suggests that the Objective Structured Assessment of Technical Skill can reliably and validly assess surgical skills. Global ratings are a better method of assessment than task-specific checklists. Bench model simulation gives equivalent results to use of live animals for this test format.

Objective structured assessment of technical skill (OSATS) for surgical residents.

Consensus statement on the pathology of IgG4-related disease

Hepatocellular carcinoma is one of the commonest causes of death worldwide from malignant disease. Although a variety of initiating and promoting causes have been identified, infection with hepatitis B virus (HBV) currently appears to be the leading etiological agent [1]. There is a striking relationship between the prevalence of the HBV carrier state and the incidence of HCC, and prospective studies have shown that in certain populations where infections occurred early in life and the chronic carrier state exists, the risk of developing hepatocellular carcinoma later in life approaches 50% [2]. The recognition of the sequence of events beginning with HBV infection, development of a chronic carrier state (with or without chronic liver disease), incorporation of viral DNA into liver cells, and the eventual development of HCC [3] has generated increased efforts toward earlier diagnosis, including massive screening programs. Studies have focused on those areas of the world where HBV infection is most prevalent (subequatorial Africa, China, and Japan, where HBV carrier rates are 5–20%), but also in areas with a moderate incidence (southern and eastern Europe — carrier rates of 2–8%) and in those with low a incidence (western Europe, North America — carrier rates 0.2–0.5%) [4].

Surgical resection and transplantation for hepatocellular carcinoma

Carcinoma of the head of the pancreas is a lethal condition because it presents clinically late in the disease and because of its unfavourable biologic course. Surgical approaches have become progressively more aggressive in recent years, without a significant increase in long-term survival. Controversy persists as to the appropiate surgical procedure for this disease, nonoperative or operative palliation, and future prospects for management. This review considers questions often posed by clinicians and offers answers based on a literature review and the experience of the hepatobiliary service at the Toronto Hospital, Toronto General Division.

1995 Roussel Lecture. Management of adenocarcinoma of the head of the pancreas: 10 questions for the 1990s

Antilymphoblast globulin (ALG) as initial prophylaxis against rejection following liver transplantation.

Subsequent correspondence and articles in this journal 3‐5 have addressed numerous issues both central and peripheral to the debate. Everyone seems to understand the complex issues, but what we really need now is to collectively work toward a viable solution. Our ultimate objective should be to attract the best and brightest into surgery, train and educate these young people effectively and humanely, and create a product that improves the surgical care of Canadians — but how do we get there with all today’s conflicting forces at work? Our focus should be on those changes to current surgical training that will best serve the public interest; this “public” includes not only patients, but also residents, practising surgeons and other health care workers with whom surgeons interact. A competent but overworked surgeon too fatigued to function safely and effectively is as undesirable as a surgeon who is inadequately prepared to meet the standards of contemporary surgical practice. We submit that negotiations between residents and an association of hospital administrators (as is the situation in Ontario) excludes key groups who should be major participants. Those responsible for residency programs, provincial medical associations, licensing bodies, ministries of health and representatives of the public should all be at the table. Collective bargaining is appropriate to deal with matters such as salary, benefits, adequacy of call rooms, access to hospital cafeterias and libraries at night, and so on, but is it reasonable for them to discuss work schedules or distribution of time between service and education, items more suitable for accrediting bodies? Furthermore, the fundamentals of surgical education become buried in a one-for-all agreement that may be appropriate for some specialties such as psychiatry, anesthesia or internal medicine, but quite inadequate for the technical specialties.

http://canjsurg.ca/wp-content/uploads/2014/03/44-5-327.pdf

Residency education in surgery.

In two patients who had peritoneovenous shunts inserted for the treatment of intractable ascites, the shunt became infected following dental procedures that were carried out without antibiotic prophylaxis. The organisms grown were alpha-hemolytic streptococcus in one patient, and alpha-hemolytic streptococcus and Klebsiella pneumoniae in the other. Alpha hemolytic streptococcus is commonly found in the oral cavity and has also been found, related to dental manipulations, in hematogenous infections at other sites. In both patients the infections were successfully managed by antibiotic treatment with removal of the infected shunt. Physicians caring for patients with peritoneovenous shunts should be aware of this potential complication; antibiotics should always be given prophylactically at the time of dental procedures.

Bryce R. Taylor

Papers

Surgical resection and transplantation for hepatocellular carcinoma

1995 Roussel Lecture. Management of adenocarcinoma of the head of the pancreas: 10 questions for the 1990s

Antilymphoblast globulin (ALG) as initial prophylaxis against rejection following liver transplantation.

Residency education in surgery.

Hematogenous infection of peritoneovenous shunts after dental procedures.