An integrative longitudinal resilience curriculum.

BACKGROUND: It is well documented that student well-being is challenged at medical school and that levels of distress increase as students navigate their training. The Doctor of Medicine (MD) programme at the University of Toronto developed a 4-year resilience curriculum (RC) to encourage students to reach out for help and equip them with resilience-building strategies to manage adversities in a demanding academic and clinical programme. … resilience curriculum (RC) to encourage students to reach out for help and equip them with resilience-building strategies METHODS: Satisfaction surveys, consisting of statements rated by a five-point Likert scale and short-answer questions, were distributed to 518 students; in total, data from four workshops were collected. Two focus groups comprising 12 participants in total were facilitated (n = 6 per group). A thematic content analysis was conducted for the focus group data; open coding was used for transcriptions via an iterative process and inductive analysis. FINDINGS: Preliminary quantitative and qualitative data suggest that students valued the curriculum. The main themes generated from the thematic content analysis were the value of the RC, the delivery of the RC, and developing a resilient community. DISCUSSION: More research must be conducted to assess whether the RC has affected student well-being and resilience. The sustainability of the curriculum depends on the faculty members that support it; faculty development within the areas of wellness and resilience is imperative. INNOVATION AND IMPLICATIONS: The RC, embedded in the core curriculum and integrated within a medical community, is gaining momentum and is valued by students. Further research will assist in the creation of an innovative tool to assess the impact of the RC on medical students.

Incentive Spirometry After Lung Resection: A Randomized Controlled Trial.

BACKGROUND: Incentive spirometry (IS) is thought to reduce the incidence of postoperative pulmonary complications (PPC) after lung resection. We sought to determine whether the addition of IS to routine physiotherapy following lung resection results in a lower rate of PPC, as compared with physiotherapy alone. METHODS: A single-blind prospective randomized controlled trial was conducted in adults undergoing lung resection. Individuals with previous lung surgery or home oxygen were excluded. Participants randomized to the control arm (PHY) received routine physiotherapy alone (deep breathing, ambulation and shoulder exercises). Those randomized to the intervention arm (PHY/IS) received IS in addition to routine physiotherapy. The trial was powered to detect a 10% difference in the rate of PPC (ß = 80%). Student's t test and chi-square were utilized for continuous and categorical variables, respectively, with a significance level of p = 0.05. RESULTS: A total of 387 participants (n = 195 PHY/IS; n = 192 PHY) were randomized between 2014 and 2017. Baseline characteristics were comparable for both arms. The majority of patients underwent a pulmonary lobectomy (PHY/IS = 59.5%, PHY = 61.0%; p = 0.84), with no difference in the rates of minimally invasive and open procedures. There were no differences in the incidence of PPC at 30 days postoperatively (PHY/IS = 12.3%, PHY = 13.0%; p = 0.88). There were no differences in rates of pneumonia (PHY/IS = 4.6%, PHY = 7.8%; p = 0.21), mechanical ventilation (PHY/IS = 2.1%, PHY = 1.0%; p = 0.41), home oxygen (PHY/IS = 13.8%, PHY = 14.6%; p = 0.89), hospital length of stay (PHY/IS = 4 days, PHY = 4 days; p = 0.34), or rate of readmission to hospital (PHY/IS = 10.3%, PHY = 9.9%; p = 1.00). CONCLUSIONS: The addition of IS to routine postoperative physiotherapy does not reduce the incidence of PPC after lung resection.

Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI.

INTRODUCTION: In our model of comprehensive clinical staging (CCS) for lung cancer, patients with a computerized tomography scan of the chest and upper abdomen not showing distant metastases will then routinely undergo whole body positron emission tomography/computerized tomography and magnetic resonance imaging (MRI) of the brain before any therapeutic decision. Our aim was to determine the accuracy of CCS and the value of brain MRI in this population. METHODS: A retrospective analysis of a prospectively entered database was performed for all patients who underwent lung cancer resection from January 2012 to June 2014. Demographics, clinical and pathological stage (seventh edition of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, and metastasis staging manual), and costs of staging were collected. Correlation between clinical and pathological stage was determined. RESULTS: Of 315 patients with primary lung cancer, 55.6% were female and the mean age was 70 ± 9.6 years. When correlation was analyzed without consideration for substages A and B, 49.8% of patients (158 of 315) were staged accurately, 39.7% (125 of 315) were overstaged, and 10.5% (32 of 315) were understaged. Only 4.7% of patients (15 of 315) underwent surgery without appropriate neoadjuvant treatment. Preoperative brain MRI detected asymptomatic metastases in four of 315 patients (1.3%). At a median postoperative follow-up of 19 months (range 6-43), symptomatic brain metastases developed in seven additional patients. The total cost of CCS in Canadian dollars was $367,292 over the study period, with $117,272 (31.9%) going toward brain MRI. CONCLUSION: CCS is effective for patients with resectable lung cancer, with less than 5% of patients being denied appropriate systemic treatment before surgery. Brain MRI is a low-yield and high-cost intervention in this population, and its routine use should be questioned.

Rare case of subcarinal thymic carcinoma in the middle mediastinum.

We report an extremely rare case of a thymic carcinoma occurring in the subcarinal location of the middle mediastinum, masquerading as subcarinal adenopathy. A 6.2 × 5 cm mass was detected on computed tomography scan and found to be hypermetabolic on positron emission tomography scan. Transbronchial biopsy was performed and the mass was found to be suspicious for malignancy. A thoracoscopic resection of the mass was performed and found to be thymic carcinoma. The patient underwent a course of adjuvant radiation. To the best of our knowledge, this is the first reported case of a thymic carcinoma resected from the middle mediastinum.