Implementation of the Esophagectomy Complication Consensus Group definitions: the benefits of speaking the same language.

In 2015 the Esophagectomy Complication Consensus Group (ECCG) reported consensus definitions for complications after esophagectomy. This aimed to reduce variation in complication reporting, attributed to heterogeneous definitions. This systematic review aimed to describe the implementation of this definition set, including the effect on complication frequency and variation. A systematic literature review was performed, identifying all observational and randomized studies reporting complication frequencies after esophagectomy since the ECCG publication. Recruitment periods before and subsequent to the index ECCG publication date were included. Coefficients of variance were calculated to assess outcome heterogeneity. Of 144 studies which met inclusion criteria, 70 (48.6%) used ECCG definitions. The median number of separately reported complication types was five per study; only one study reported all ECCG complications. The coefficients of variance of the reported frequencies of eight of the 10 most common complications were reduced in studies which used the ECCG definitions compared with those that did not (P = 0.036). Among ECCG studies, the frequencies of postoperative pneumothorax, reintubation, and pulmonary emboli were significantly reduced in 2020-2021, compared with 2015-2019 (P = 0.006, 0.034, and 0.037 respectively). The ECCG definition set has reduced variation in esophagectomy morbidity reporting. This adds greater confidence to the observed gradual improvement in outcomes with time, and its ongoing use and wider dissemination should be encouraged. However, only a handful of outcomes are widely reported, and only rarely is it used in its entirety.

BET 2: Caffeine as an analgesic adjunct in tension-type headache and migraine.

A short-cut review of the literature was carried out to examine the benefits of caffeine as an analgesic adjunct in tension-type and migraine-type headache. Six papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that caffeine provides effective analgesia as an adjunctive treatment in the management of secondary headache syndromes.

Comics as Reflection: In Opposition to Formulaic Recipes for Reflective Processes.

The importance of reflection in the continued learning and professional development of health care professionals is imparted to medical students soon after they begin their training. However, in both undergraduate and postgraduate medical training, reflection is most commonly "assessed" in extended pieces of formal writing-something that can inhibit natural approaches to reflective practice. The development of compulsory, standardized reflection aims to enable everyone to reflect on their practice, learn from it, and improve, but it does a disservice to those who already have mechanisms in place to reflect naturally and appropriately. It could be argued that standardized or formulaic recipes for reflective processes stunt the development of "creative, adaptive, and autonomous persons," actually resulting in the opposite of what reflection aims to achieve. Facilitating reflection in ways that suit learners and practitioners may help to overcome this. In opposition to formal, standardized approaches to reflection, it is argued that comics can mesh congruously with multiple approaches to reflection and, as such, can promote legitimate natural reflective processes, which may appeal to health care professionals.