March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovas...

Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association

Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Standards for educational and psychological testing

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascul...

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.

Laparoscopic Colorectal Surgical Training: A Curricular Approach

The last 100 years have witnessed great advances in medicine with respect to antibiotic therapy, blood transfusion, organ transplantation, and more recently stem cell therapies and fetal surgery. Certainly this rate of progress has served society well with regard to life expectancy and quality of life. However, the past 25 years have noticed a new cause of illness—that of medical harm. Current estimates suggest that one in ten patients are harmed through their healthcare journey [1]. This has led to an emerging field of patient safety, whereby we can and must do better. Surgery has been in the limelight, as up to two-thirds of medical harm affects surgical patients [2]. In this issue of the journal, Kurmann et al. [3] describe a retrospective analysis of 117 patients undergoing elective open abdominal surgery at a single university-hospital center. At this hospital, senior and junior surgeons work together in 6-month blocks under a fellowship system. The intention was to study clinical outcomes for patients operated upon during month 1 versus month 6 for each pair of surgeons. Of the surgeries, 59 of them were conducted in month 1 of a 6-month block, and 58 during month 6. Baseline characteristics of patients were similar between the two time points, as were operation duration and blood loss. Notably, there were 36 % fewer complications during month 6 than during month 1, with an absolute reduction in complication rate of almost 20 %; the main decrease in complication rates was seen for those with Clavien–Dindo grades \3, i.e. not requiring re-intervention beyond additional medication, blood transfusion, or parenteral nutrition. Senior surgeons reported their concentration scores to reside above the overall mean from 37.5 % of the time at month 1, to almost 90 % of the time during month 6. Interestingly, they did not note an improvement in team collaboration scores between the two time periods. Of note, this study is retrospective in nature, from a single center and included only five senior surgeons leading a total of 16 fellowship teams over a 2.5-year period. Thus, the results are preliminary at best, and warrant further investigation. The self-report data from senior surgeons and operative members was only collected for 26 of 117 procedures, and thus it is difficult to draw any meaningful conclusions. For the 26 selected procedures, the authors also measured sound levels above baseline, and report a significant reduction of 1.7 dB at month 6; whilst this is of statistical interest, the clinical impact is likely irrelevant. Two similar studies were published in the surgical literature just last year, considering the impact of surgeon-tosurgeon familiarity in the operating room (OR) [4, 5]. The first considered coronary artery bypass graft (CABG) procedures, during which time on cardiopulmonary bypass (CBP) and cross-clamp time were measured [4]. CABG patients (n = 4,068) were operated upon by 11 attending surgeons and 73 cardiothoracic surgery fellows, over a 9-year period. The mean number of cases between unique attending–fellow dyads was 10 (range 1–62). Whilst an additional year of attending experience only served to reduce CBP and cross-clamp times by about 20 seconds, each additional case performed by an attending–fellow dyad had a threefold effect in time reduction, up to the point where the 50th case performed by an attending–fellow dyad led to a 44 % reduction in CBP time. A second study by the same group considered 754 bilateral reduction mammoplasty procedures, performed by eight attending R. Aggarwal (&) Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, D6.136, Montreal, QC, Canada e-mail: rajesh.aggarwal@mcgill.ca

/pdf/better-care-in-the-operating-room-1f3lv85rgs.pdf

Rajesh Aggarwal

Papers

Laparoscopic Colorectal Surgical Training: A Curricular Approach

Better care in the operating room.

Deliberate practice on virtual reality laparoscopic simulator improves quality of surgical skills

Bariatric Surgery in the Elderly: Single Center Medium-term Outcomes

A dedicated one-month laparoscopic and endoscopic skills rotation significantly improves surgical residents' technical skill and reduces error scores