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Background The objective of this randomized controlled trial was to determine whether a goal-setting program integrated into a surgical training curriculum would improve performance on simulation testing times and confidence with laparoscopic operative skills. Methods Beginning in 2013, 36 students and 26 general surgery residents were randomized separately into 3 groups. Trainees were either given no time goals for each of 5 Fundamentals of Laparoscopic Surgery (FLS) tasks or were given time goals that were the mean time scores or the best time scores reported in the literature for passing each FLS task. All trainees were evaluated for each task with time scores and a confidence survey both prior to and after the training program. Results For the students, all confidence scores and task times improved significantly from pre- to post-training. The average percent improvement in task times was greater for all 5 tasks in the 2 groups assigned to the goals compared to the no-goals group with the combined 5-task, mean percent improvement ( P = .02). Overall, the students assigned to the mean-goal group improved more than the best or no-goal groups ( P = .048). In the residents assigned to goals, all task times improved significantly pre/post, although the overall average percent improvement between groups was not different. Residents in both the no-goals and the goals groups improved their confidence with skills pre- to post-training. Conclusion The addition of achievable goals, defined as the average task time for residents who passed the FLS, was beneficial to students, because by achieving these goals, the students were able to achieve faster task times with improved confidence. Setting appropriate goals may improve laparoscopic operative skills in students. Suitable goals were also shown to strengthen accuracy and confidence in residents’ laparoscopic operative skills. [ABSTRACT FROM AUTHOR]

Background: Recent studies have revealed that Glasgow prognostic score (GPS), an inflammation-based prognostic score, is associated with poor outcome in a variety of tumors. However, few studies have investigated whether GPS measured prior to neoadjuvant chemoradiotherapy (nCRT) is useful for postoperative prognosis of patients with advanced esophageal squamous cell carcinoma (ESCC). Methods: GPS was calculated on the basis of admission data as follows: patients with both an elevated C-reactive protein (>10 mg/L) and hypoalbuminaemia (<35 g/L) were allocated a GPS score of 2. Patients in whom only 1 of these biochemical abnormalities was present were allocated a GPS score of 1, and patients with a normal C-reactive protein and albumin were allocated a score of 0. All patients underwent radical en-bloc resection 3–4 weeks after nCRT. Results: A total of 48 patients with clinical TNM stage II/III were enrolled. Univariate analyses revealed that there were significant differences in cancer-specific survival in relation to grade of response to nCRT (P = .004), lymph node status (P = .0065), lymphatic invasion (P = .0002), venous invasion (P = .0001), pathological TNM classification (P = .015), and GPS (P < .0001). GPS classification showed a close relationship with lymphatic invasion, venous invasion, and number of lymph node (P = .0292, .0473, and .0485, respectively). GPS was found to be the only independent predictor of cancer-specific survival (odds ratio, 0.17; 95% confidence interval, 0.06–0.52; P = .0019). Conclusions: GPS, measured prior to nCRT, is an independent novel predictor of postoperative outcome in patients with advanced ESCC. [Copyright &y& Elsevier]

Background: Despite the major advances in analgesic techniques, pain relief in coughing after abdominal surgery remains challenging. Cough-related pain causes postoperative respiratory complications by impairing sputum clearance; nevertheless, an effective technique to abolish it is not yet available. We devised the bilateral flank compression (BFC) maneuver, in which the flanks are compressed medially using both hands. We conducted a prospective, single-center, single arm, nonrandomized, open-label, interventional trial, to investigate whether the BFC maneuver relieves cough-related pain after abdominal surgery and examined the efficacy of this maneuver in relation to patient characteristics and surgical factors.Study Design: Participants were patients who underwent gastroenterologic surgery (except for open inguinal hernia repair) at the Department of Surgery, Kyorin University School of Medicine. We evaluated postoperative pain, from postoperative days (PODs) 1 to 7, on coughing, with and without the BFC maneuver, using the Prince Henry pain scale.Results: We finally analyzed 514 patients. On each of the first 7 PODs, the BFC maneuver significantly relieved cough-related pain, especially on POD1; (the mean pain scores [standard deviation] with and without the BFC maneuver were 0.98 [1.030] vs 1.63 [1.112] points, p < 0.0001). On each POD, more patients were free of cough-related pain with than without the BFC maneuver, with the most marked difference on POD7 (52.0% [208/400] vs 16.8% [67/400], p < 0.0001).Conclusions: The BFC maneuver relieves cough-related pain after abdominal surgery and may help prevent of postoperative pulmonary complications. [ABSTRACT FROM AUTHOR]