Secondary School Athletic Trainers' Perceptions of How Youth Sport Specialization Impacts Workload.

BACKGROUND: Youth sport specialization is a growing trend in youth sports and is associated with an increased risk of injuries and burnout. However, it is unknown how sport specialization is perceived to be affecting the working environment of secondary school athletic trainers (ATs). The purpose of this paper is to describe how ATs perceive youth sport specialization impacting their workload and whether they perceive it to impact patient safety. HYPOTHESIS: ATs will perceive that youth sport specialization impacts their workload and could impact patient safety. STUDY DESIGN: A sequential, explanatory mixed methods design with 2 phases: (1) cross-sectional surveys and (2) individual interviews. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 487 secondary school ATs completed the online survey (access rate, 8.4%; completion rate, 85.4%). The survey consisted of Likert questions and included sections about aspects of workload impacted by specialization, impacts on patient safety, demographics. Ten participants were selected to complete a semi-structured interview via video conference. RESULTS: Approximately two-thirds of ATs perceive that sport specialization impacts their workload. (Somewhat, 38.6%; Quite a bit, 25.5%; A great deal, 5.5%) Attempts to reduce or modify patient activity and a patient's time for rehabilitation were the highest rated aspects of workload impacted by sport specialization. Approximately 30% ATs (29.9%) perceive that sport specialization impacts their workload to where it may influence patient safety (Somewhat, 21.6%; Quite a bit, 6.4%; A great deal, 1.9%). Three themes and subsequent subthemes were identified from the qualitative interviews: (1) current youth sport expectations, (2) conflict between school and club sports, and (3) AT job impacts. CONCLUSION: Secondary school ATs perceive their workload to be negatively impacted by youth sport specialization and some believe it may impact patient safety. CLINICAL RELEVANCE: Youth sport specialization is impacting youth sport stakeholders, including ATs, in a variety of ways.

Part 1: Assessment of a virtual vs. onsite interview experience from the interviewee perspective.

INTRODUCTION: The University of Texas at Austin College of Pharmacy transitioned the prospective student interview process for the incoming Class of 2025 from an onsite to a virtual Zoom interview. Differences between the two processes were assessed to determine utility of virtual interviews in the future. The objective was to compare preference, impact, and barriers to onsite and virtual interview experiences for prospective students. METHODS: A survey to assess interviewees' opinions regarding the interview process, preference, and barriers to participation was emailed to candidates following the 2020-2021 interviews. Responses were evaluated using descriptive statistics, chi-square, Mann-Whitney U tests, and constant comparison thematic analysis. RESULTS: The survey response rate was 40%. Of these, 54% preferred virtual interviews. Travel, lodging, and time were identified as barriers, with 80.5% of interviewees reporting at least one of these barriers. Respondents who chose time or had more barriers were more likely to prefer virtual interviews. Hosting a pre-interview day helped candidates prepare. Having a pharmacy student in the breakout room helped reduce stress. Interviewees were able to engage, showcase their personality, and learn the culture of the college despite the virtual nature. CONCLUSIONS: From an interviewee perspective, the virtual interview process is a viable method to continue. Virtual interviews decrease barriers to access for candidates unable to attend onsite interviews while still allowing candidates to feel engaged, learn about the program, and have a positive experience. Pharmacy institutions may consider virtual interviews as an alternative or supplement to onsite interviews.

Short- and Long-Term Outcome of Laparoscopic- versus Robotic-Assisted Right Colectomy: A Systematic Review and Meta-Analysis.

Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61−18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28−2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29−1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.

Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery (SIL + 1 additional port)-is an umbilical midline approach really a problem?

PURPOSE: Umbilical midline incisions for single incision- or reduced port laparoscopic surgery are still discussed controversially because of a higher rate of incisional hernia compared to conventional laparoscopic techniques. The aim of this study was to evaluate incidence and risk factors for incisional hernia after reduced port colorectal surgery. METHODS: A total 241 patients underwent elective reduced port colorectal surgery between 2014 and 2020. Follow-up was achieved through telephone interview or clinical examination. The study collective was examined using univariate and multivariate analysis. RESULTS: A total of 150 patients with complete follow-up were included into this study. Mean follow-up time was 36 (IQR 24-50) months. The study collective consists of 77 (51.3%) female and 73 (48.7%) male patients with an average BMI of 26 kg/m2 (IQR 23-28) and an average age of 61 (± 14). Indication for surgery was diverticulitis in 55 (36.6%) cases, colorectal cancer in 65 (43.3%) patients, and other benign reasons in 30 (20.0%) cases. An incisional hernia was observed 9 times (6.0%). Obesity (OR 5.8, 95% CI 1.5-23.1, p = 0.02) and pre-existent umbilical hernia (OR 161.0, 95% CI 23.1-1124.5, p < 0.01) were significant risk factors for incisional hernia in the univariate analysis. Furthermore, pre-existent hernia is shown to be a risk factor also in multivariate analysis. CONCLUSION: We could demonstrate that reduced port colorectal surgery using an umbilical single port access is feasible and safe with a low rate of incisional hernia. Obesity and pre-existing umbilical hernia are significant risk factors for incisional hernia.

Does intraoperative flexible endoscopy offer any benefit compared to conventional air leak testing after circular stapled left-sided laparoscopic colon surgery?

BACKGROUND: Anastomotic leakage is still a feared complication after left-sided colonic resections. Various types of "anastomotic leak testing methods" are described in current literature. In this study we evaluated the use of intraoperative flexible endoscopy in comparison to conventional air leak testing after performing a circular stapled anastomosis in left-sided laparoscopic colon surgery. METHODS: A retrospective database consisting of 130 patients with left sided colonic resections between 01/2015 and 12/2019 at our hospital was evaluated. After performing a circular stapled anastomosis flexible endoscopy was done in 69 cases, 61 patients were controlled with a conventional air leak test. Intraoperative and postoperative complications were recorded and retrospectively evaluated. RESULTS: In the flexible endoscopy group, we observed complications in 13,04%, in the conventional air leak testing group in 9.83%. Postoperative anastomotic leakage was observed in 10,14% in the flexible endoscopy group and 4.91% in the conventional air leak test group. In 10.14% a positive air leak test was seen in the flexible endoscopy group and 11.47% in the conventional air leak testing group. In those cases, we observed no postoperative complications in the first group, in the conventional group we had two anastomotic leakages and one infected haematoma. CONCLUSIONS: In the case of a positive air leak, flexible endoscopy offered a more exact detection of the leak. In those cases, no anastomotic leakage was observed postoperatively. In our opinion, flexible endoscopy should be recommended for testing the anastomosis intraoperatively in every left-sided colon surgery.

Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers.

PURPOSE: The concept of complete mesocolic excision (CME) in right-sided colorectal cancer is well known for open and laparoscopic surgery. The aim of this study was to evaluate and compare perioperative and oncological outcomes of reduced port and open surgery for right-sided colorectal cancer. METHODS: One hundred forty-one patients received elective surgery for right-sided colonic cancer between January 2015 and December 2019 and were included in a retrospective database. RESULTS: We observed longer operation time in the RP-CME group (145 min vs. 119.43 min, p<0.01). Hospital stay (8 days vs. 14 days, p<0.01) and time to first intestinal passage (42 h. vs. 59 h, p<0.01) were significantly shorter in the reduced port group. Postoperative complications were more likely to be observed in the O-CME group (7.2% vs. 14.1%, p=0.28); anastomotic leakage rate was low in both groups (1.8% vs. 2.4%, p=1.00). Specimen scores (score 1= good: 93.8% vs. 91.7%, p=1.00) and average number of retrieved lymph nodes were comparable (24 vs. 23 p=0.69). In O-CME patients, we observed more advanced tumor stages (UICC III: 21.4% vs. 45.9%, p<0.01). CONCLUSION: To our knowledge, this is the first study comparing reduced port to open surgery for right-sided colorectal cancer. We could demonstrate that this technique is feasible for oncological right hemicolectomy with observation of shorter hospital stay and lower morbidity rates compared to open surgery. The oncological outcome did not differ in the present study.