Global dissemination of knowledge through virtual platforms: Reflections and recommendations from APSA/IPEG

BACKGROUND

The COVID-19 pandemic forced the cancelation of conventional in-person academic conferences due to the risk of virus transmission and limited ability to travel. Both the American Pediatric Surgical Association (APSA) and International Pediatric Endosurgery Group (IPEG) converted to a virtual format for their 2020 annual meetings. The purpose of this article is to review the successful implementation of the APSA and IPEG virtual meetings and reflect upon lessons learned for future virtual conferences.

METHODS

Logistics, structure, and attendance statistics were reviewed. Informal interviews were conducted with key stakeholders and the number of presenters and participants were analyzed. Finally, post-meeting attendee surveys were conducted to elicit feedback after both virtual meetings.

RESULTS

The meetings were organized in different ways, with APSA spreading a mix of scientific and clinical educational content over several months and IPEG keeping the meeting compressed, similar to previous in-person versions. Both meetings were free and therefore attracted a high proportion of participants (720 for APSA and 834 for IPEG). The meetings were felt to be educationally appropriate by most, although timing and lack of Continuing Medical Education (CME) opportunities were detractors. Most attendees said they would be willing to pay fees similar to in-person amounts. IPEG compressed presentations into four 2-hour sessions spread over 4 weeks, but also made material available on-line through a proprietary application. There was a broad range of international attendees. IPEG attracted a larger percentage of non-members than did APSA (3:1 nonmember to member ratio). Both societies reported net losses, largely due to lost registration revenue and non-refundable costs from having to switch from an in-person meeting.

CONCLUSIONS

The main advantage of the virtual meeting was increased participation while disadvantages included the lack of networking. The key lessons learned from the meetings include methods to increase interactivity, adjustments of technical logistics, and creation of enduring material. In the future, hybrid conferences will likely become more prevalent with advantages of both platforms.

LEVEL-OF-EVIDENCE

Level V - Expert Opinion.

Utility of cephalic drains in infants receiving extracorporeal membrane oxygenation

INTRODUCTION

The addition of cephalic drains (CDs) in extracorporeal membrane oxygenation (ECMO) to augment venous drainage may offer benefit, though their use is varied. Our objective was to describe our institution's experience with CDs including flow rates and patency. We also compared complication rates between patients with and without a CD.

METHODS

This retrospective cohort study included infants <12 months of age cannulated for ECMO between January 1, 2010 and September 30, 2019 at a single institution. Flow data were obtained for those with a CD. Demographic and complication rates were obtained for all.

RESULTS

Of 264 patients in the final cohort, 220 (83%) had a CD of which 93.2% remained patent to decannulation. CDs typically provided 30% or more of ECMO flow throughout the ECMO run. The median time to CD clot was 139 h (range 48-635 h). Patients with a clotted CD had longer ECMO runs than those whose CD remained patent (median 382 h [IQR 217-538] vs 139 h [IQR 91-246], p < 0.001). Survival to discharge was lower for those with clotted versus patent CD (14% vs 70%, p < 0.001). Mechanical complications were more common in patients with CD (p = 0.005). Seizures were more common in those without a CD (p = 0.021).

CONCLUSIONS

In this cohort, the majority of CDs placed remained patent at decannulation and provided substantial additional venous drainage. Mechanical problems were common in patients with CDs, but without clinical sequelae. Further study is warranted to elucidate CD impact on short- and long-term outcomes.

The unmeasured quality metric: Burn out and the second victim syndrome in healthcare

Physician Burn Out has become endemic as Healthcare has become increasingly complex and challenging to physicians who provide care to critically ill patients. Physicians are more prone to make errors when burnt out. Most Healthcare institutions have not been responsive to support physicians when burned out or when disturbing outcomes occur. Peer support has evolved as the preferred way to help a physician recover after the loss of a patient or a medical error. Best practices are evolving as awareness increases and better research questions arise. Individuals providers, surgical leaders and institutions can all be influential as we address this problem.

The Immediate Response to Injection Therapy for First-Degree Haemorrhoids

Over an 8-month period, 100 consecutive patients undergoing sclerotherapy for first-degree haemorrhoids were issued with a questionnaire to assess responses to this treatment. Success was defined as complete cessation of bleeding at defaecation. The effect on bleeding was assessed at the end of 24 hours (99 responders) and 4 weeks later (98 responders): of 61 patients (62%) with no bleeding at 24 hours, only 40 (41%) remained symptom-free at 28 days post-injection. Twelve patients were treatment failures (either unchanged or increased bleeding post-injection). More than half the patients (n=59) experienced pain related to the injection, which was severe in 9 cases. Although only 3 patients expressed complete dissatisfaction with the treatment they received, and overall 88% were either cured of bleeding or improved, the results suggest that critical judgment should be exercised before recommending the treatment to patients with minimal occasional bleeding due to first-degree haemorrhoids.

Analysis of surgical interruption of the enterohepatic circulation as a treatment for pediatric cholestasis

To evaluate the efficacy of nontransplant surgery for pediatric cholestasis, 58 clinically diagnosed children, including 20 with Alagille syndrome (ALGS), 16 with familial intrahepatic cholestasis-1 (FIC1), 18 with bile salt export pump (BSEP) disease, and 4 others with low γ-glutamyl transpeptidase disease (levels <100 U/L), were identified across 14 Childhood Liver Disease Research Network (ChiLDReN) centers. Data were collected retrospectively from individuals who collectively had 39 partial external biliary diversions (PEBDs), 11 ileal exclusions (IEs), and seven gallbladder-to-colon (GBC) diversions. Serum total bilirubin decreased after PEBD in FIC1 (8.1 ± 4.0 vs. 2.9 ± 4.1 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.02), but not in ALGS or BSEP. Total serum cholesterol decreased after PEBD in ALGS patients (695 ± 465 vs. 457 ± 319 mg/dL, preoperatively vs. 12-24 months postoperatively, respectively; P = 0.0001). Alanine aminotransferase levels increased in ALGS after PEBD (182 ± 70 vs. 260 ± 73 IU/L, preoperatively vs. 24 months; P = 0.03), but not in FIC1 or BSEP. ALGS, FIC1, and BSEP patients experienced less severely scored pruritus after PEBD (ALGS, 100% vs. 9% severe; FIC1, 64% vs. 10%; BSEP, 50% vs. 20%, preoperatively vs. >24 months postoperatively, respectively; P < 0.001). ALGS patients experienced a trend toward greater freedom from xanthomata after PEBD. There was a trend toward decreased pruritus in FIC1 after IE and GBC. Vitamin K supplementation increased in ALGS after PEBD (33% vs. 77%; P = 0.03). Overall, there were 15 major complications after surgery. Twelve patients (3 ALGS, 3 FIC1, and 6 BSEP) subsequently underwent liver transplantation.

CONCLUSION

This was a multicenter analysis of nontransplant surgical approaches to intrahepatic cholestasis. Approaches vary, are well tolerated, and generally, although not uniformly, result in improvement of pruritus and cholestasis. (Hepatology 2017;65:1645-1654).

Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses

BACKGROUND

Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees.

MATERIALS AND METHODS

After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data.

RESULTS

Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely.

CONCLUSION

Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.

Ciliated hepatic foregut cyst: four case reports with a review of the literature

Ciliated hepatic foregut cysts (CHFCs) are rare congenital legions that arise from the embryonic foregut. The cysts are formed during fetal development by evagination from their respective portions of the foregut, and are characterized by a ciliated epithelial lining. Approximately 100 cases of CHFC have been reported, of which only 13 were in children. Although CHFC is typically benign, malignant transformation to squamous cell carcinoma (SCC) has been reported in 3 cases. Survival rate after progression to malignancy is poor, as SCC in this setting is biologically aggressive. We present 4 new cases of CHFC in children between 5 months and 17 years old. Our cases are unusual, as some of the cysts exhibit multilocularity and biliary communication, and 2 of our patients were diagnosed under the age of 1. Additionally, 1 of the cysts was 19.3 cm in diameter, making it the largest reported CHFC to our knowledge. Ciliated hepatic foregut cysts should be included in the differential diagnosis of hepatic lesions.

Effect of ionic surfactants on bauxite residues suspensions viscosity

Measurement of the rheological property of bauxite residue sample received from an Australian alumina refinery, treated with a number of cationic and anionic surfactant in laboratory has been carried out using a Brookfield viscometer for the assessment of the effect of surfactants on the residue viscosity. Sodium laurate, prepared with an excess of sodium hydroxide, was found to be effective while direct addition of anionic surfactants (lauric acid and sodium laureth sulphate) and cationic (cetyl trimethyl ammonium bromide) produce only moderate effect on the red mud suspension apparent viscosity at 65 degrees C. The experimental data appear to confirm the crucial role of the cation sodium in the process of adsorption of anionic surfactants on the flocculated red mud particles.

Psychological impact of prophylactic oophorectomy in women at increased risk of developing ovarian cancer: a prospective study

OBJECTIVES

The objectives of this study were twofold: to prospectively assess whether expressed intention to undergo prophylactic oophorectomy translated into uptake and to evaluate the psychological impact of the procedure in a sample of unaffected women with a strong family history of breast/ovarian cancer.

METHODS

Ninety-five women, initially assessed at the time of their first attendance at a familial cancer clinic, were followed-up 3 years later. A total of 22 women (23.2%) in this study had undergone a prophylactic oophorectomy. Ten women (10.5%) who had undergone a prophylactic oophorectomy during the 3-year follow-up period were compared to 73 women (76.9%) who did not have a prophylactic oophorectomy. Twelve women (12.6%) who had the procedure prior to study entry were also assessed for psychological adjustment and associated information needs.

RESULTS

Age emerged as a significant predictor of uptake of prophylactic oophorectomy (chi(2) = 7.13, P = 0.009). Among those who had the procedure after study entry, a significant reduction in ovarian cancer anxiety was observed (Z = -2.19, P = 0.029). Of the 22 women who had undergone a prophylactic oophorectomy in total (both before and after study entry), 86.4% reported a high degree of satisfaction with their decision to have the procedure. A low level of screening uptake was also reported by women who did not have a prophylactic oophorectomy but for whom screening was recommended.

CONCLUSION

Findings demonstrate that prophylactic oophorectomy is successful in reducing anxiety about ovarian cancer. The results also suggest that women perceive that the benefit of anxiety reduction may outweigh the potentially adverse effects of the procedure, given that women expressed a high level of satisfaction with their decision.

Leading the change process. Interview by Michael L. Laughlin and Carolyn Dunbar

'Change or cease to exist.' In interviews with Computers in Healthcare six industry leaders agree that increasing market pressures will force many organizations to drastically modify the way they do business. Those that don't will eventually fail.

Electrokinetic bioprocessing under microgravity in France as illustrated by space bioseparation: a programme initiated in France and in cooperation with Belgium and Spain

The use of electrokinetic phenomena should prove to be a promising bioseparation technique especially as an application of bioprocessing under microgravity. Therefore, a bioseparation Research and Development programme involving several research teams has been under way for three years in France. Based upon the results of this fundamental research, a programme is now proposed for the development of an automated process chain making it possible to obtain biological macromolecules of high purity under microgravity. This Space Bio Separation programme received the Eureka label at the 6th Ministerial Eureka conference. The project will last six years. It will involve the cooperation of several scientific and industrial partners in France, in Spain and in Belgium. The programme includes the development and validation of three different bioseparation facilities for space.

A simple stoma wafer cutter

Images