Measuring Impact of Simulation-Based Informed Consent Training on Surgical Intern's Long-Term Confidence.

OBJECTIVE: Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians. DESIGN: In this prospective cohort study, general surgery interns underwent a training program on informed consent that involved didactics, standardized patient encounters, and supplemental procedure specific guides at the start of the academic year. At the end of the academic year, we surveyed interns from the classes of 2020 (trained) and 2019 (untrained) about their experience and confidence in obtaining an informed consent. Further, we queried attending physicians on their experience and confidence in the interns at the end of each academic year. SETTING: Single academic general surgery residency program based at 2 urban tertiary hospitals. PARTICIPANTS: General surgery interns including unmatched preliminary residents and categorical interns from general surgery, interventional radiology, and urology. RESULTS: Twenty-four incoming interns participated in the training program. Intern confidence discussing operation benefits improved from a median score of 4 to 5 (p = 0.03), and total confidence improved from a median score of 15 to 17.5 (p = 0.08). There was no difference in median total confidence scores (15 vs. 17.5; p = 0.21) between classes. Attending physicians had similar median total confidence scores following intervention (10 vs. 11; p = 0.87). Intern satisfaction was 80% with the didactic session, and 90% with standardized patient encounters. Twenty percent of learners used the supplemental procedure specific guides. CONCLUSIONS: Implementation of an intern targeted program on informed consent that incorporated didactics and standardized patient encounters was viewed as useful and may contribute to long-term improvements in confidence.

Incidental Diagnosis of Metastatic Prostate Cancer Post-Inguinal Hernia Repair.

This report discusses the case of an 83-year-old male who was incidentally found to have a diagnosis of metastatic prostate cancer on pathology from elective inguinal hernia repair. The medical record, radiology, operative reports, and pathology of the patient were reviewed and a literature search was subsequently performed. A new cancer diagnosis is a very rare finding during routine hernia surgery. Moreover, the decision of whether to send a hernia sac for routine pathology is often dependent on individual surgeon practices and institutional guidelines. However, this case demonstrates the potential for an unexpected finding on routine pathology to significantly alter the clinical course of a patient's care as the patient subsequently underwent both medical and palliative surgical treatment for prostate cancer.

Improving HCV cure rates in HIV-coinfected patients - a real-world perspective.

OBJECTIVES: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure. METHODS: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015. RESULTS: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure. CONCLUSIONS: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.