Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis.

BACKGROUND: Gastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. METHODS: We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education-accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. RESULTS: Between 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and "other major stomach procedures" (P < .05 for all comparisons). Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). CONCLUSION: There has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.

Operative Experience of Esophageal Surgery among General Surgery Residents in the United States: An Analysis of ACGME Operative Case Logs.

INTRODUCTION: Esophageal surgery is an essential component of general surgery training and encompasses several types of cases that are logged by general surgery residents. There is a scarcity of data on the quality and volume of esophageal surgery experience during surgical residency in the United States. We analyzed trends for 9 different esophageal procedure categories logged by residents in the United States, with the aim to identify areas for improvement in training. METHODS: We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from programs accredited by the ACGME over a fourteen-year period from 2009 to 2023. Data on mean esophageal cases reported by graduates, including mean in each procedure subcategory were retrieved. Cases were categorized as either surgeon chief or surgeon junior for each procedure category. Mann-Kendall trend test was used to obtain tau statistics and p-value for trends in mean operative surgical volume for the total number of cases in each operative category over the study period. Trends in surgeon chief and surgeon junior cases were also investigated for each operative category. RESULTS: The mean number of all esophageal procedures performed per resident during their training increased significantly from 10.5 in 2009 to 16 in 2022 (τ = 0.833, p < 0.001). This trend observed among all esophageal procedures during this 14-year study can be largely attributed to the steady increase in the number and proportion of laparoscopic esophageal antireflux procedures performed (τ = 0.950, p < 0.001). Additionally, esophagectomy procedures had a statistically significant, but modest, increase during the study period (τ = 0.505, p = 0.023), from a mean of 1 case during training in 2009 to a peak of 1.3 in 2020. Although the general trend of esophagus procedures increased during the study period, most categories (7 out of 9) either decreased or did not significantly change. Esophagogastrectomy volume decreased significantly by 30%, from 1 per resident during their training in 2009 to 0.7 in 2022 (τ = -0.510, p = 0.018), esophageal diverticulectomy procedures decreased by 50% from 0.2 to 0.1 (τ = -0.609, p = 0.009), and operations for esophageal stenosis decreased by 75% from 0.4 to 0.1 (τ = -0.734, p = 0.001). Mean number of esophageal bypasses (τ = -0.128, p = 0.584), repair of perforated esophageal disease (τ = -0.333, p = 0.156), and other major esophagus procedures (τ = 0.416, p = 0.063) did not significantly change. CONCLUSION: The operative volume of esophageal surgery that general surgery residents in the United States are exposed to has significantly risen over the past 14 years, largely driven by the increase in laparoscopic antireflux procedures. However, given the recent advances and the resultant heterogeneity in both esophageal surgery, the increase in resident operative volume is still inadequate to ensure the training of safe and adept esophageal surgeons, necessitating postresidency specialized training for trainees interested in esophageal surgery.

Cost of nurse-managed latent tuberculous infection treatment among hard-to-reach immigrants in Israel.

BACKGROUND: Adherence to treatment of latent tuberculous infection (LTBI), an essential component of tuberculosis (TB) elimination, is generally unsatisfactory. OBJECTIVES: To examine the adherence and costs of nurse-managed, semi-directly observed preventive treatment (semi-DOPT) with twice-weekly isoniazid among hard-to-reach Ethiopian immigrants, and to compare the treatment outcomes of onsite vs. regional TB clinic-based physician's follow-up. METHODS: This was a quasi-experimental retrospective cohort analysis of LTBI treatment among Ethiopian immigrants in reception centres in the Zefat subdistrict of Northern Israel, screened and treated for LTBI during 2005-2011. Two physician follow-up appointments were scheduled for each patient. RESULTS: Of 663 eligible Ethiopian immigrants included in the study, 628 (94.7%) completed treatment. Treatment outcomes were similar among onsite vs. regional TB clinic-based physician follow-up. Non-completion was significantly associated with side effects (P < 0.001). The total costs of treatment were relatively low, but were significantly higher for the TB clinic-based physician follow-up group. CONCLUSION: Nurse-managed semi-DOPT for LTBI treatment with reduced physician follow-up among hard-to-reach Ethiopian immigrants was efficient and safe. Providing on-site physician follow-up proved to be cheaper than standard follow-up at the regional TB clinic. Starting LTBI treatment at an early stage after immigration, and providing treatment and convenient transportation free of charge probably also contributed to the high treatment completion rates.

[Antibodies against double-stranded and single-stranded DNA in the aged].

Sera from 183 healthy, elderly subjects and 92 young, control subjects were tested by the Elisa method for antibodies against double-stranded (ds) and single-stranded (ss) DNA, and sera from the elderly were tested for antinuclear antibodies as well. Significantly higher levels of anti-ss-DNA were found in the elderly, but levels of anti-ds-DNA did not differ significantly; no sera positive for anti-ds-DNA were found. levels of antibodies to DNA were similar in men and women. In those 85 and over, mean levels of anti-ds-DNA were lower than in those 65-84 (63 vs. 44, p less than 0.05). 13 of those over 65 (7.1%) tested positive for antinuclear factor, 2 of whom had positive titers of anti-ss-DNA. The results of this study support the hypothesis that elevated levels of anti-ss-DNA are age-related and not disease-related.