Complicaciones de la esofagectomía por cáncer de esófago / Complications of Esophagectomy for Esophageal Cancer

Introducción: La esofagectomía es uno de los procedimientos con más alta morbilidad posoperatoria en cirugía oncológica digestiva. Objetivo: Describir las complicaciones relacionadas con la esofagectomía subtotal programada según variables de interés. Métodos: Se realizó un estudio descriptivo y transversal en los Servicios de Cirugía General de los hospitales "Saturnino Lora" y "Juan Bruno Zayas" de Santiago de Cuba, desde 2010 hasta 2019. La población estuvo conformada por 81 pacientes, de la cual se reclutó una muestra aleatoria de 68 enfermos sometidos a esofagectomía subtotal programada por cáncer de esófago. Fueron investigadas las siguientes variables: presencia de complicaciones posoperatorias y tipo de técnica quirúrgica utilizada. Además, se clasificaron en grados según Dindo Clavien. Resultados: Todos los enfermos fueron operados por técnica abierta mediante esofagectomía subtotal programada, donde la resección mediante la técnica de Ivor-Lewis se realizó en el 69,2 por ciento. Para todas las técnicas quirúrgicas empleadas predominó la atelectasia (39,7 por ciento) como complicación posquirúrgica, y entre las infecciosas la neumonía en 30 enfermos (44,1 por ciento), mientras que para las complicaciones quirúrgicas no infecciosas el neumotórax fue mayormente incidente, para el 25,0 por ciento. El mayor número de complicaciones se ubicó en el grado II de Dindo Clavien. Conclusiones: La presencia de complicaciones posquirúrgicas de la enfermedad es notable, en correspondencia a lo reflejado por la literatura médica. Existió relación significativa entre la presencia del hábito de fumar, de enfermedad pulmonar obstructiva crónica y la de toracotomía con algunas de las complicaciones encontradas(AU)

Introduction: Esophagectomy is one of the procedures with the highest postoperative morbidity in digestive cancer surgery. Objective: To describe the complications related to scheduled subtotal esophagectomy according to variables of interest. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Services at Saturnino Lora and Juan Bruno Zayas hospitals in Santiago de Cuba, from 2010 to 2019. The population consisted of 81 patients, out of which a random sample of 68 patients undergoing elective subtotal esophagectomy for esophageal cancer was selected. The variables investigated were presence of postoperative complications and type of surgical technique used. In addition, they were classified in grades according to Clavien-Dindo. Results: All the patients were operated by open technique by programmed subtotal esophagectomy, the resection by the Ivor-Lewis technique was performed in 69.2 percent. For all the surgical techniques used, atelectasis (39.7 percent) prevailed as a postsurgical complication, and among the infectious complications, pneumonia prevailed in 30 patients (44.1 percent), while for non-infectious surgical complications, pneumothorax was mostly incidental for 25.0 percent. The highest number of complications was in Clavien-Dindo grade II. Conclusions: The presence of post-surgical complications of the disease is notable, corresponding to what is reflected in the medical literature. There was significant relationship between the presence of smoking, chronic obstructive pulmonary disease and thoracotomy with some of the complications found(AU)

Ruptura de aguja dental con migración al espacio pterigomaxilar. Resolución mediante abordaje intrabucal laterofaríngeo / Rupture of dental needle with migration to the pterygomaxillary space. Resolution by intraoral lateropharyngeal approach

Introducción: La ruptura de una aguja dental es una complicación infrecuente y sucede generalmente por el movimiento repentino y/o cierre bucal inesperado del paciente, por doblar la aguja en forma inadecuada, por insertarla completamente o moverla dentro del tejido blando, por elegir agujas de calibre y longitud inadecuados y al realizar técnicas anestésicas inapropiadas. Cuando la aguja no puede ser recuperada al instante, debe establecerse su ubicación imagenológica tridimensional y decidir el manejo. Ante tal situación, su eliminación quirúrgica es la propuesta más recomendable por la posibilidad de que migre y lesione estructuras anatómicas importantes. Objetivo: Realizar una revisión de la literatura y presentar un caso clínico de ruptura de aguja dental localizada en el espacio pterigomaxilar, resuelto con un abordaje intrabucal laterofaríngeo. Presentación de caso: Paciente masculino de 8 años de edad, que acude a consulta por presentar ruptura de una aguja dental. Para obtener su ubicación se utilizó una tomografía computarizada de haz cónico con reconstrucción tridimensional a boca cerrada y abierta. Esta prueba ofreció mayor precisión y correspondencia anatómica, considerando que la eliminación quirúrgica podría realizarse mediante un abordaje intrabucal. Así fue hecho y durante la intervención quirúrgica se advirtió que la aguja había migrado a una ubicación superior y posterior, al espacio pterigomaxilar. Ante tal situación, resultó de mayor complejidad su recuperación, que ya presentaba riesgos por el procedimiento complejo al que se sometió. Conclusiones: La anestesia local intrabucal no está exenta de complicaciones propias como la ruptura de la aguja dental. Cuando este evento se presenta, el resultado puede ser de muy difícil manejo(AU)

Introduction: The rupture of a dental needle is an uncommon complication and usually happens due to the sudden movement and / or unexpected oral closure of the patient, by bending the needle improperly, by inserting it completely or moving it into the soft tissue, by choosing needles of inadequate caliber and length and by performing inappropriate anesthetic techniques. When the needle cannot be recovered instantly, its three-dimensional imaging location must be established and handling decided. In such a situation, its surgical elimination is the most recommended proposal due to the possibility of migrating and injuring important anatomical structures. Objective: Conduct a literature review and present a clinical case of dental needle rupture located in the pterygomaxillary space, resolved with a lateropharyngeal intraoral approach. Case presentation: An 8-year-old male patient, who comes to the consultation for a ruptured dental needle. To obtain its location, a cone-beam computed tomography with three-dimensional reconstruction was used at closed and open mouth. This test offered greater precision and anatomical correspondence, considering that surgical removal could be performed by an intraoral approach. This was done and during the surgical intervention it was noticed that the needle had migrated to an upper and posterior location, to the pterygomaxillary space. Faced with this situation, his recovery was more complex, in addition to the one that this procedure represents by itself. Conclusions: Intraoral local anesthesia is not exempt from its own complications such as the rupture of the dental needle. When this event occurs, the result can be very difficult to manage(AU)

Validación por expertos del contenido del diagnóstico enfermero de NANDA-I Fatiga (00093) / Expert Validation of the Content for the NANDA-I Nursing Diagnosis of Fatigue

Introducción: La fatiga constituye un importante problema de salud que precisa de una adecuada valoración, diagnóstico y planificación de cuidados enfermeros centrados en quienes la sufren. Objetivo: Validar el contenido del diagnóstico enfermero NANDA-I Fatiga (00093) en la versión incluida en una base de datos clínica. Métodos: Estudio descriptivo y exploratorio de validación de contenido diagnóstico mediante expertos siguiendo la propuesta de Fehring. El ámbito de estudio fue España. La recogida de datos se realizó entre los meses de junio 2019-marzo 2020. Los expertos participantes disponían de experiencia y formación en el uso de lenguajes estandarizados enfermeros. Resultados: De las 13 Características Definitorias con las que cuenta el diagnóstico incluido en la base de datos, siete fueron validadas como mayores, cinco como menores y una no fue validada. Los 16 Factores Relacionados del diagnóstico fueron validados. El Índice de Validez de Contenido del diagnóstico fue de 0,81. Conclusiones: El diagnóstico obtuvo un Índice de Validez de Contenido elevado. Los componentes del diagnóstico NANDA-I Fatiga (00093) en la versión de la base de datos clínica guardan correspondencia con los presentes en el diagnóstico NANDA-I Fatiga (00093) en la Clasificación NANDA-I 2018-2020. Se considera que la investigación actual contribuye a incrementar la precisión diagnóstica al identificar Características Definitorias claves de la presencia del diagnóstico. Al tiempo valida Factores Relacionados influyentes en el diagnóstico no incorporados en los componentes del diagnóstico NANDA-I Fatiga (00093) en la edición de la Clasificación NANDA-I 2018-2020(AU)

Introduction: Fatigue is an important health concern that requiring appropriate assessment, diagnosis and nursing care planning focused on those who suffer from it. Objective: To validate the content of NANDA-I nursing diagnosis of fatigue (00093) in the version included in a clinical database. Methods: Descriptive and exploratory study of diagnostic content validation by experts following Fehring's proposal. The setting of the study was Spain. Data collection was carried out between June 2019 and March 2020. The participating experts had experience and training in the use of standardized nursing languages. Results: Of the thirteen characteristics that define the diagnosis included in the database, seven were validated as major, five as minor and one was not validated. All sixteen related factors of the diagnosis were validated. The content validity index of the diagnosis was 0.81. Conclusions: The diagnosis obtained a high content validity index. The components of the NANDA-I diagnosis of fatigue (00093) in the clinical database version correspond with those present in the NANDA-I diagnosis of fatigue (00093) in the NANDA-I Classification 2018-2020. The current research is considered to contribute with an increase in diagnostic accuracy by identifying key defining characteristics for the diagnosis. At the same time, it validates related factors that have an influence on the diagnosis but are not incorporated among the components of the NANDA-I diagnosis of fatigue (00093) in the 2018-2020 edition of the NANDA-I Classification(AU)

A elaboração da experiência nos escritos e na correspondência do jesuíta Diego de Torres Bollo(1551-1638) / The elaboration of experience in the writings and correspondence of the Jesuit Diego de Torres Bollo(1551-1638)

O objetivo da pesquisa é evidenciar, nos escritos e na correspondência epistolar de Diego de Torres Bollo (1551-1638), missionário jesuíta espanhol no Paraguai nas primeiras décadas do século XVII, a elaboração da experiência acercados primeiros anos de vida missionária junto às populações indígenas, nos espaços territoriais chamados de Reduções. O método é abordar a tópica da experiência relatada nos documentos pelo autor e entendida conforme as categorias interpretativas próprias da cultura jesuítica da época. No âmbito da experiência narrada, serão evidenciados os saberes psicológicos elaborados na tradição cultural da Companhia de Jesus, especialmente os saberes referentes aos afetos.

The aim of this paperis to evidence, in the writings and epistolary correspondence of Diego de Torres Bollo (1551-1638), Spanish Jesuit missionary in Paraguay in the first decades of the 17th century, the elaboration of the experience of the first years of missionary life with the indigenous populations, in the territorial spaces called Reductions. The method is to approach the topic of the experience reported in the documents by the author and understood according to the interpretative categories of the Jesuit culture of the time. In the scope of the narrated experience, the psychological knowledge elaboratedin the cultural tradition of the Society of Jesus will be evidenced, especially the knowledge related to affections.

Respondências: análises (online) em confinamento / Responses: (online) analysis during social distancing / Correspondencias: análisis (en línea) durante el confinamiento / Réponses: analyse (en ligne) pendant la distanciation sociale

Resumo Este artigo compreende oito cartas trocadas entre as autoras ao longo do mês de abril de 2020, tendo por eixo norteador o tema das análises online. Em uma retomada metodológica da produção teórica pela via das correspondências, amplamente utilizada entre Freud e seus interlocutores, propõe uma tessitura em ato de conceitos-acontecimentos em torno do atendimento mediado pelas tecnologias da informação e da comunicação, bem como dos deslocamentos no estatuto da escuta clínica, que reverberam especialmente sobre o inconsciente, a presença do analista e a questão do registro. A escrita epistolar possibilitou uma elaboração afetuosa e desinstitucionalizada, rompendo com a lógica academicista, sem perder o rigor conceitual do campo freudo-lacaniano na interlocução com outros autores. As discussões apresentadas refletem sobre quais vidas são passíveis de escuta nas análises, online ou não, em variados desdobramentos que circunscrevem uma clínica do contemporâneo.

Abstract This essay consists of eight letters exchanged between the authors over the course of April 2020, on the topic of online analysis. Resuming the methodological approach of theoretical production via correspondence, widely used by Freud and his interlocutors, the article weaves concepts-events regarding psychological care mediated by information and communication technologies, as well as shifts in the status of clinical listening, which reverberate especially on the unconscious, the presence of the analyst and issue of recording. The epistolary writing enabled an affectionate and deinstitutionalized elaboration, breaking with academic logic, without losing the conceptual rigor of the Freudian-Lacanian field in dialogue with other authors. The discussions presented reflect on which lives can be heard in analysis, online or otherwise, in varying unfoldings that circumscribe a contemporary clinic.

Resumen Este artículo consta de ocho cartas intercambiadas entre las autoras durante el mes de abril de 2020, teniendo como eje central el tema de los análisis en línea. En una retomada metodológica de la producción teórica a través de las correspondencias, ampliamente utilizadas entre Freud y sus interlocutores, se propone una costura en acto de conceptos acontecimientos sobre la atención mediada por las tecnologías de la información y la comunicación, así como de los desplazamientos en el estatuto de la escucha clínica, que repercute especialmente en el inconsciente, la presencia del analista y la cuestión del registro. La escritura epistolar posibilitó una elaboración afectuosa y no institucional, rompiendo con la lógica academicista, sin perder el rigor conceptual con el campo freudo-lacaniano en la interlocución con otros autores. Las discusiones que se presentan aquí reflexionan sobre cuáles vidas son susceptibles de escucha en los análisis, en línea o no, en diversos desplazamientos en materia de una clínica de la contemporaneidad.

Résumé Cet essai comprend huit lettres échangées entre les autrices au cours du mois d'avril 2020, sur le thème de l'analyse en ligne. Reprenant l'approche méthodologique de la production théorique par correspondance, largement utilisée par Freud et ses interlocuteurs, l'article tisse des concepts-événements concernant le soin psychologique médiatisé par les technologies de l'information et de la communication, ainsi que des déplacements du statut de l'écoute clinique, qui se répercutent notamment sur l'inconscient, la présence de l'analyste et la question de l'enregistrement. L'écriture épistolaire a permis une élaboration affectueuse et désinstitutionnalisée, en rupture avec la logique académique, sans perdre la rigueur conceptuelle du champ freudo-lacanien en dialogue avec d'autres auteurs. Les discussions présentées réfléchissent sur les vies qui peuvent être entendues en analyse, en ligne ou non, dans des déroulements divers qui circonscrivent une clinique du contemporain.

Use of artificial intelligence for gender bias analysis in letters of recommendation for general surgery residency candidates.

BACKGROUND: Letters of recommendation (LoRs) play an important role in resident selection. Author language varies implicitly toward male and female applicants. We examined gender bias in LoRs written for surgical residency candidates across three decades at one institution. METHODS: Retrospective analysis of LoRs written for general surgery residency candidates between 1980 and 2011 using artificial intelligence (AI) to conduct natural language processing (NLP) and sentiment analysis, and computer-based algorithms to detect gender bias. Applicants were grouped by scaled clerkship grades and USMLE scores. Data were analyzed among groups with t-tests, ANOVA, and non-parametric tests, as appropriate. RESULTS: A total of 611 LoRs were analyzed for 171 applicants (16.4% female), and 95.3% of letter authors were male. Scaled USMLE scores and clerkship grades (SCG) were similar for both genders (p > 0.05 for both). Average word count for all letters was 290 words and was not significantly different between genders (p = 0.18). LoRs written before 2000 were significantly shorter than those written after, among applicants of both genders (female p = 0.004; male p < 0.001). Gender bias analysis of female LoRs revealed more gendered wording compared to male LoRs (p = 0.04) and was most prominent among females with lower SCG (9.5 vs 5.1, p = 0.01). Sentiment analysis revealed male LoRs with female authors had significantly more positive sentiment compared to female LoRs (p = 0.02), and males with higher SCG had more positive sentiment compared to those with lower SCG (9.4 vs 8.2, p = 0.03). NLP detected more "fear" in male LoRs with lower SCGs (0.11 vs 0.09, p = 0.02). Female LoRs with higher SCGs had more positive sentiment (0.78 vs 0.83, p = 0.03) and "joy" (0.60 vs 0.63, p = 0.02), although those written before 2000 had less "joy" (0.5 vs 0.63, p = 0.006). CONCLUSION: AI and computer-based algorithms detected linguistic differences and gender bias in LoRs written for general surgery residency applicants, even following stratification by clerkship grades and when analyzed by decade.

Content of an Educational Handover Letter From Medical Schools to Surgery Residencies: A Mixed Method Analysis.

PURPOSE: To identify the content of an educational handover letter from undergraduate to graduate education in General Surgery. METHOD: Expert consensus was attained on the content of an educational handover letter. A 3-stage Delphi technique was employed with 8 experts in each of 4 stakeholder groups: program directors in general surgery, medical student surgical acting internship or prep course directors, authors of medical student performance evaluations, and current categorical General Surgery residents. Data were collected from April through July 2019. A mixed method analysis was performed to quantitatively assess items selected for inclusion and qualitatively provide guidance for the implantation of such a letter. RESULTS: All 32 experts participated in at least one round. Of the 285 initially identified individual items, 22 were ultimately selected for inclusion in the letter. All but one expert agreed that the list represents what the content of an educational handover letter in General Surgery should be. Qualitative analysis was performed on 395 comments and identified 4 themes to guide the implementation of the letter: "minimize redundancy, optimize impact, use appropriate assessments, and mitigate risk." CONCLUSIONS: A framework and proposed template are provided for an educational handover letter from undergraduate to graduate medical education in General Surgery based on the quantitative and qualitative analysis of expert consensus of major stakeholders. This letter holds promise to enhance the transition from undergraduate to graduate medical education by allowing programs to capitalize on strengths and efficiently address knowledge gaps in new trainees.

Are Narrative Letters of Recommendation for Medical Students Interpreted as Intended by Orthopaedic Surgery Residency Programs?

BACKGROUND: Narrative letters of recommendation are an important component of the residency application process. However, because narrative letters of recommendation are almost always positive, it is unclear whether those reviewing the letters understand the writer's intended strength of support for a given applicant. QUESTIONS/PURPOSES: (1) Is the perception of letter readers for narrative letters of recommendation consistent with the intention of the letter's author? (2) Is there inter-reviewer consistency in selection committee members' perceptions of the narrative letters of recommendation? METHODS: Letter writers who wrote two or more narrative letters of recommendation for applicants to one university-based orthopaedic residency program for the 2014 to 2015 application cycle were sent a survey linked to a specific letter of recommendation they authored to assess the intended meaning regarding the strength of an applicant. A total of 247 unstructured letters of recommendation and accompanying surveys were sent to their authors, and 157 surveys were returned and form the basis of this study (response percentage 64%). The seven core members of the admissions committee (of 22 total reviewers) at a university-based residency program were sent a similar survey regarding their perception of the letter. To answer our research question about whether letter readers' perceptions about a candidate were consistent with the letter writer's intention, we used kappa values to determine agreement for survey questions involving discrete variables and Spearman correlation coefficients (SCCs) to determine agreement for survey questions involving continuous variables. To answer our research question regarding inter-reviewer consistency among the seven faculty members, we compared the letter readers' responses to each survey question using intraclass correlation coefficients (ICCs). RESULTS: There was a negligible to moderate correlation between the intended and perceived strength of the letters (SCC 0.26 to 0.57), with only one of seven letter readers scoring in the moderate correlation category. When stratifying the applicants into thirds, there was only slight agreement (kappa 0.07 to 0.19) between the writers and reviewers. There were similarly low kappa values for agreement about how the writers and readers felt regarding the candidate matching into their program (kappa 0.14 to 0.30). The ICC for each question among the seven faculty reviewers ranged from poor to moderate (ICC 0.42 to 0.52). CONCLUSION: Our results demonstrate that the reader's perception of narrative letters of recommendation did not correlate well with the letter writer's intended meaning and was not consistent between letter readers at a single university-based urban orthopaedic surgery residency program. CLINICAL RELEVANCE: Given the low correlation between the intended strength of the letter writers and the perceived strength of those letters, we believe that other options such as a slider bar or agreed-upon wording as is used in many dean's letters may be helpful.

Characterization of the 2019 Micrographic Surgery and Dermatologic Oncology Standardized Letter of Recommendation.

BACKGROUND: Traditional letters of recommendation used for postgraduate medical training applications have multiple limitations, including a lack of clarity, inflated and overly flattering assessments, and low reliability between interpreting faculty. A micrographic surgery and dermatologic oncology (MSDO) standardized letter of recommendation (SLOR) was created to improve the efficiency, validity, and stratification of applicants to dermatology fellowship training programs. OBJECTIVE: To analyze the MSDO SLOR for trends in grading based on letter-writer and applicant characteristics and to evaluate its ability to demonstrate differences between applicants. METHODS: Standardized letter of recommendations received by 4 fellowship programs from the 2019 San Francisco Match application cycle were reviewed retrospectively. RESULTS: Two hundred forty-nine SLORs were analyzed from 140 applicants. Grade inflation and limited variability in scores were evident. Higher scores correlated with the length of the relationships between letter-writers and applicants and with female letter-writer gender. There was no applicant gender or ethnicity bias detected. CONCLUSION: Despite score inflation, the MSDO SLOR allows for differentiation between fellowship applicants. Future studies are needed to further evaluate the reliability of the SLOR and find ways to improve its content.

Letters of recommendation: Nuanced bias or useful affirmation?

Narrative letters of recommendation (NLORs) have become key elements of the application process for residency and fellowship. The potential to inadvertently admit bias into these subjective narratives has become an area of research focus across many disciplines. In the present review, we have highlighted the current data regarding bias in NLORs. We also believe that one of the most effective methods to eliminate bias from written recommendations is to first understand that it exists. Thus, the objective measures that have been taken to identify bias in NLORs are important steps in the right direction. We have presented and reflected on the accrued data on bias in NLORs pertaining to surgical training.

Módulo Cartas Avales para el Sistema Informático Colpadi de la Unidad Central de Cooperación Médica. Cuba / Module Letters Guarantees for the Colpadi Computer System of the Central Unit for Medical Cooperation. Cuba

La Unidad Central de Cooperación Médica (UCCM) es un centro de excelencia del Ministerio de Salud Pública (MINSAP). Este centro se encarga de garantizar el cumplimiento de los compromisos internacionales contraídos por el MINSAP y el Gobierno de la República de Cuba, en el área de la cooperación médica a través de la asistencia técnica y docente. El objetivo de este desarrollo es implementar un módulo para el Sistema Integral para la Gestión de Información en la Colaboración Médica Cubana (Colpadi), que optimice el proceso de gestión de cartas avales que se generan en la UCCM. El trabajo que se desarrolla contribuye de forma positiva al concepto de excelencia de la institución. El proyecto tiene un enfoque cualitativo, con alcance descriptivo, de tipo retrospectivo y diseño no experimental, de corte transversal. Se emplean los métodos científicos de observación y análisis documental. Además, la implementación utilizando el Lenguaje Unificado de Modelado (UML) y la metodología RUP de desarrollo de software. Como resultado se obtiene un módulo, como parte del sistema informático Colpadi, que optimiza el proceso de gestión de cartas avales. Las cartas avales se entregan a los cooperantes internacionalistas del MINSAP en sus vacaciones y al finalizar su misión en el exterior. Con la implementación de la aplicación informática se obtienen varias ventajas como la automatización de los vuelos de entrada, las solicitudes automáticas para el procesamiento de las cartas avales, los reportes estadísticos y el tratamiento de la información(AU)

Central Unit for Medical Cooperation (UCCM) is a center of excellence of the Ministry of Public Health (MINSAP). This center is in charge for guaranteeing compliance with the international commitments made by MINSAP and the Government of the Republic of Cuba, in the area of ​​medical cooperation through technical and educational assistance. This research contributes positively to the institution's concept of excellence. Its objective is to implement a module for the Colpadi computer system, which it optimizes the process for managing the guarantee letters generated at the UCCM. The research has a qualitative approach, with a descriptive scope, of a retrospective type and a non-experimental, cross-sectional design. Scientific observation and documentary analysis methods are used; as well as UML, and RUP software development methodology in its implementation. As a result, a module is obtained, as part of the Colpadi computer system, which it optimizes the guarantee letter management process. The letters of guarantee are delivered to the internationalist aid workers of the MINSAP, on their vacations and at the end of their mission abroad. With the implementation of the computer application, several advantages are obtained, such as the automation of the incoming flights, the automatic requests for the processing of the letters of guarantee, the statistical reports and the treatment of the information(AU)

The Readability of Outpatient Plastic Surgery Clinic Letters: Are We Adhering to Plain English Writing Standards?

The readability of letters sent to patients plays a pivotal role in facilitating joint decision making and positive health outcomes. Guidance suggests that all correspondence should be directed to patients. Covid-19 led to an increase in direct-to-patient communication. This study aims to determine the quantity and quality of plastic surgery clinic letters sent to patients before and during the Covid-19 pandemic. A total of 127 pre-Covid clinic letters from November to December 2019 and 103 peri-Covid clinic letters from April to May 2020 were identified and assessed for readability. Text was analyzed using a standardized set of commonly used readability formulae, including SMOG, Flesch Reading Ease, and the Coleman-Liao Index. A total of 100 pre-Covid and 58 peri-Covid letters were suitable for inclusion. Median results for formulae that output a U.S. grade score ranged between 9 and 12.9 for letters written prior to Covid-19 and 9 and 13.2 for those written during Covid-19. Eight percent of letters were sent to patients pre-Covid, increasing to 28% during the pandemic. Letters sent to patients had a median grade score of between 8 and 12 prior to Covid-19 and 8 and 10.6 during Covid-19. Letters sent to clinicians ranged between 9 and 13 and 9 and 13.3, respectively. Outpatient plastic surgery letters are written at a readability level too high to facilitate understanding among the general population. The increase in direct-to-patient contact during the Covid-19 outbreak has not led to a significant improvement in the readability of clinic letters. The authors suggest an increase in letter standardization and raising awareness of readability when writing clinic letters.

A Last-Ditch Effort and Personalized Surgeon Letter Improves PROMs Follow-Up Rate in Sports Medicine Patients: A Crossover Randomized Controlled Trial.

Patient-reported outcomes measures (PROMs) are important for the advancement of orthopaedic surgeries. The primary difficulty while collecting PROMs is obtaining adequate follow-up rates. Therefore, it is important to find methods to improve follow-up, especially in patients who have failed to respond to initial attempts. We hypothesized that PROMs follow-up could be effectively increased by sending a salvage-effort personalized surgeon letter to sports medicine patients who failed to respond to initial (centralized electronic, mail, and/or phone contacts) PROMs collection 1 year after surgery. Patients who failed to respond to 1-year follow-up of postoperative PROMs collection at our outpatient sports medicine surgery center were included. Patients were randomized into an intervention or control group. Patients in the intervention group were mailed PROMs form and an Institutional Review Board-approved letter that was personalized with surgical information, surgeon picture, and surgeon signature. Control group was mailed the same letter a month later. Chi-squared analysis was conducted at 5 weeks. Out of 843 surgeries, our initial 1-year PROMs follow-up rate was 65%, which allowed for 292 patients to be eligible for our study. After exclusions, 281 patients (randomized to 140 control group and 141 intervention group) were included in our study. We found a 20% response rate in the intervention group with 28 patients returning PROMs as compared with a 1.4% rate in the control group with two patients returning PROMs. The odds ratio was 17.1 (95% confidence interval: 4-73.3; p < 0.0001). A salvage-effort personalized surgeon letter is an efficient and relatively cost-effective method to increase PROMs follow-up rate, which means that a personalized surgeon letter can reach and engage patients who would otherwise be considered lost to follow-up, allowing for better outcomes monitoring after surgery.

Letters of recommendation for surgical fellowships - Does gender make a difference?

BACKGROUND: Females comprise 1/3 of general surgery residents, 1/4 of surgical faculty and 10% of full professors. Inadequate sponsorship is one proposed mechanism for this decline. This study evaluated letters of recommendation (LOR) among applicants applying to a complex general surgical oncology (CGSO) fellowship. METHODS: Linguistic analysis of LOR for CGSO applicants was conducted. Demographics of authors and features of the LOR were extracted. Differences by gender of the applicant were analyzed. RESULTS: Among 340 letters, 67% were written for male and 33% written for female applicants. Males authored 84% of letters reviewed. Female authors used more grindstone adjectives than males (3.61 v 2.90). However, this difference was seen only among letters written for male applicants (3.82 v. 2.73). All other linguistic features were similar, aside from mention of physical appearance which was significantly more common in letters written about female applicants (4% v. 1%). CONCLUSIONS: Female authors write substantively different letters than males. Physical appearance is a small but important difference in letters for female applicants.

Everyone Is Awesome: Analyzing Letters of Reference in a General Surgery Residency Selection Process.

BACKGROUND: The resident selection process involves the analysis of multiple data points, including letters of reference (LORs), which are inherently subjective in nature. OBJECTIVE: We assessed the frequency with which LORs use quantitative terms to describe applicants and to assess whether the use of these terms reflects the ranking of trainees in the final selection process. METHODS: A descriptive study analyzing LORs submitted by Canadian medical graduate applicants to the University of Ottawa General Surgery Program in 2019 was completed. We collected demographic information about applicants and referees and recorded the use of preidentified quantitative descriptors (eg, best, above average). A 10% audit of the data was performed. Descriptive statistics were used to analyze the demographics of our letters as well as the frequency of use of the quantitative descriptors. RESULTS: Three hundred forty-three LORs for 114 applicants were analyzed. Eighty-five percent (291 of 343) of LORs used quantitative descriptors. Eighty-four percent (95 of 113) of applicants were described as above average, and 45% (51 of 113) were described as the "best" by at least 1 letter. The candidates described as the "best" ranked anywhere from second to 108th in our ranking system. CONCLUSIONS: Most LORs use quantitative descriptors. These terms are generally positive, and while the use does discriminate between different applicants, it was not helpful in the context of ranking applicants in our file review process.

I Thought I Must Have Expired - Experiences of Surgery Before Anaesthesia.

In 1812, Frances (Fanny) Burney (born in 1752 and died in 1840) underwent a mastectomy performed by Larry without anaesthesia. In the days after surgery, Burney wrote a letter to her sister, Esther Burney, describing her experience. In total, the letter is four pages long including information on before, during and after the surgery. Although this letter has been cited in numerous texts, it has yet to be analysed from multiple perspectives, shedding new light on the history of anaesthesia.

A burned body with a gunshot wound in the mouth and a suicide note: A complex or complicated suicide?

The body of a 53-year-old man was found in a burning car. The ignition key was in start position and the accelerator pedal was held down by his right foot. Autopsy revealed a gunshot entrance wound in the hard palate, a bullet track through the anterior cranial fossa and a projectile lodged in the left frontal lobe. The brain stem was free of lesions and any signs of secondary brain injury, such as brain oedema and intracranial haemorrhage, were not significant. Soot deposits and thermal injury to the mucosa were observed in the airways below the glottis and carboxyhaemoglobin (COHb) saturation was 40%. A single bullet case and a handgun were recovered next to the driver's seat. Fire investigators identified the motor as the beginning of the burning: therefore, the conclusion was that the car had caught fire due to overheating of the engine. Differential diagnosis between complex and complicated suicide was essential. The cause of death was identified as carbon monoxide intoxication, and the injuries to the brain were not felt to be immediately fatal. The case has been classified as a complicated suicide. There are no other published cases of a complicated suicide involving exposure to fire or the use of firearms.