Length of intraabdominal measurement of bowel (LIMB).

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries. The steep associated learning curve is dependent on the training facility, laparoscopic experience, and overall procedural volume. William Beaumont Army Medical Center (WBAMC) has been accredited as a bariatric center of excellence and trains resident surgeons in the performance of RYGB. Objective: This study aimed to investigate the accuracy and precision of a bariatric center of excellence's training of surgical residents in terms of laparoscopic measurements of simulated small bowel. This will act as a surrogate for how well surgical residents learn to run the small bowel during bariatric procedures and how their accuracy and precision change over time in training. Setting: This study took place at William Beaumont Army Medical Center, a bariatric center of excellence and training institution. Methods: Participants included surgical residents from WBAMC. Participants used a laparoscopic trainer and two bowel graspers to measure both a collapsing garden hose (simulated bowel) and a nylon rope (control material) to 75 cm (cm) and 125 cm (cm), three times each, with recordings of time required to do so, actual distance measured, and technique used. Results: Fifteen residents participated in the study. Residents displayed accuracy of 21.6 %. 33%of residents were precise for the 75 cm measurement, and 53 % of residents were precise for the 125-cm measurement. PGY-4 residents were the most accurate while PGY-3 residents were the most precise. There were no statistical differences between junior (PGY 1-4) and senior residents (PGY 5-6) in accuracy or precision in the measurement of 75-cm or 125-cm. No statistical differences were found measuring the hose versus rope in accuracy nor precision. PGY-4 residents completed the task in the least amount of time while PGY-2 residents took the longest to complete each task. Conclusions: In general, residents are neither precise nor accurate in measurements of simulated bowel lengths, and experience does not contribute to either. Time in residency correlates with laparoscopic speed but not with accuracy nor precision. Extrapolating this data to attending surgeons suggests that estimated lengths of small bowel that are 'run' or measured during laparoscopic cases are neither accurate nor precise. More investigation must be performed in this area.

Declining Military Surgical Cases and the Impact on Military Surgical Graduate Medical Education.

BACKGROUND: Several studies have indicated a decline in the number, types, and complexity of surgical procedures within military treatment facilities (MTFs). This study aims to determine what effect, if any, these downward trends have had on the relationship between the military health system (MHS) and surgical graduate medical education. METHODS: Graduating chief resident final ACGME case logs from 4 of thirteen military general surgery programs were evaluated from 2015 to 2020. The proportion of total cases performed by residents at military institutions were compared on a year over year basis. RESULTS: The proportion of cases performed within the military hospitals declined 3.27% each year between 2015 and 2020 (P < .0001) in 4 MTFs. All individual hospitals had significant declines in case volume except one (William Beaumont Army Medical Center) which increased 6.05% with each year, but also increased the number of MTF partnerships within its program (P < .0001). CONCLUSIONS: There has been a statistically significant decline over time in the proportion of cases logged by residents within the studied military treatment facilities. Investment into military hospitals to increase case numbers, case diversity, and complexity and/or acceptance of this gradual decline with greater shifting of educational workload onto civilian hospitals is required.

Response and remission in adolescent mania: signal detection analyses of the young mania rating scale.

OBJECTIVE: The purpose of this study was to determine optimal criteria for defining response and remission in adolescents with acute mania. METHOD: Data were analyzed from three treatment studies of adolescents with acute mania (N = 99). Trained raters completed the Young Mania Rating Scale (YMRS), and clinicians completed the Clinical Global Impressions Scale for Bipolar Disorder (CGI-BP) independent of YMRS ratings. For response, the percentages of reduction in YMRS scores from baseline to endpoint were compared with CGI-BP Mania Improvement scores. For remission, endpoint YMRS scores were compared with CGI-BP Mania Severity scores. Signal detection analyses were conducted to evaluate the efficiency of selected cutoffs associated with response and remission. RESULTS: A > or =55% reduction in YMRS scores from baseline to endpoint was the optimal cutoff defining response. An absolute endpoint YMRS score < or =12 was the optimal cutoff defining remission. CONCLUSIONS: The results of this signal detection analysis in adolescent mania suggest that current commonly used cutoffs to define response (> or =50% reduction) and remission (< or =12) may be appropriate with regard to efficiency. Studies with methods specifically tailored to evaluate and compare these rating scales and larger patient samples from multiple sites are needed to confirm these preliminary findings.