The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery.

INTRODUCTION: First released in 2017, the STROCSS guidelines have become integral for promoting high-quality reporting of observational research in surgery. However, regular updates are essential to ensure they remain relevant and of value to surgeons. Building on the 2021 updates, we have developed the STROCSS 2024 guidelines. This timely revision aims to address residual reporting gaps, assimilate recent advances, and further strengthen observational study quality across all surgical disciplines. METHODS: A core steering committee compiled proposed changes to update the STROCSS 2021 guidelines based on identified gaps in prior iterations. An expert panel of surgical research leaders then evaluated the proposed changes for inclusion. A Delphi consensus exercise was used. Proposals that scored between 7-9 on a nine-point Likert agreement scale, by ≥70% of Delphi participants, were integrated into the STROCSS 2024 checklist. RESULTS: In total, 46 of 56 invited participants (82%) completed the Delphi survey and hence participated in the development of STROCSS 2024. All suggested amendments met the criteria for inclusion, indicating a high level of agreement among the Delphi group. All proposed items were therefore integrated into the final revised checklist. CONCLUSION: We present the updated STROCSS 2024 guidelines, which have been developed through expert consensus to further enhance the transparency and reporting quality of observational research in surgery.

Factors associated with the use of medicines and self-medication during the COVID-19 pandemic in 12 Latin American countries.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has triggered a rise in the global phenomenon of self-medication. The use of medicines with unsubstantiated claims of benefit for the prevention and/or treatment of infected people has been widely adopted. Objective: To determine the factors associated with the use of medicines and self-medication by Latin American populations during the COVID-19 pandemic. Methods: This analytical cross-sectional study was conducted via an analysis of secondary data collected from 8777 responses from 12 Latin American countries obtained from a survey on the use of medicines and self-medication during the pandemic. Results: Respondents who reported using Paracetamol, Ibuprofen, or antibiotics (ABx) disclosed this as self-medication in 26.9%, 16.6%, and 9.7% of cases respectively. In our multivariate analysis, significant associations were found between: self-medication by individual choice and the use of Hydroxychloroquine, ABx, or non-steroidal anti-inflammatory drugs (NSAIDs) (p = 0.026, = 0.003, and <0.001 respectively); self-medication on the recommendation of a family member, with ABx, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, and <0.001 respectively); and self-medication on the recommendation of another person, with Chloroquine, Hydroxychloroquine, Azithromycin, Penicillin, other ABx, Warfarin, Ivermectin, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, = 0.001, <0.001, <0.001, = 0.004, <0.001, <0.001, and <0.001 respectively). Conclusion: There was a significantly high prevalence of self-medication in our Latin American study population, including the use of medicines not recommended for COVID-19 treatment and/or prevention. The implementation of public health measures aimed at combating the worrying COVID-19 infodemic is essential to prevent this ongoing issue and its associated negative impacts on both current public health and future medication efficacy. This is especially important in the case of ABx due to the threat of a future antimicrobial resistance pandemic.

Preferred Reporting Of Case Series in Surgery (PROCESS) 2023 guidelines.

INTRODUCTION: The Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines were developed in 2016 in order to improve the reporting quality of surgical case series. Since its inception, it has been updated twice, in 2018 and 2020, and has been cited over 1000 times. PROCESS guidelines have enjoyed great acceptance within the surgical research community. Our aim is to update the PROCESS guidelines in order to maintain its applicability in the field of surgical research. METHODS: A PROCESS 2023 steering group was created. By working in collaboration, members of this group came up with proposals to update the PROCESS 2020 guidelines. These proposals were presented to an expert panel of researchers, who in turn scrutinised these proposals and decided whether they should become part of PROCESS 2023 guidelines or not, through a Delphi consensus exercise. RESULTS: A total of 38 people participated in the development of PROCESS 2023 guidelines. The majority of items received a score between 7 and 9 from greater than 70% of the participants, indicating consensus with the proposed changes to those items. However, two items (3c and 6a) received a score between 7 and 9 from less than 70% of the participants, indicating a lack of consensus with the proposed changes to those items. Those items will remain unchanged. DISCUSSION: The updated PROCESS 2023 guidelines are presented with an aim to continue improving the reporting quality of case series in surgery.

Association between the use of Sci-Hub and consultation of scientific journals by medical students from six Latin American countries: A secondary analysis.

Introduction and objective: Sci-Hub is a website that allows users to download full-text versions of millions of scientific articles for free. The objective of this study was to evaluate the association between the use of Sci-Hub and consultation of scientific journals by medical students from six Latin American countries. Methods: We conducted a secondary analysis of data from a 2017 cross-sectional study of medical students from six Latin American countries (Argentina, Bolivia, Chile, Colombia, Paraguay, and Peru). Consultation of scientific journals was considered as the dependent variable, while the independent variable was the use of Sci-Hub. Responses were categorized as: "do not know"; "did not use it"; "used it at least once a week"; "used it more than once a week"; and "used it every day of the month". In simple and multiple regression analyses, multivariate random-effects models were used to estimate prevalence ratios (PR), with 95% confident intervals (CI). Results: Of the 6632 participants, 38.2% consulted scientific journals and 10.3% used Sci-Hub once a week. Using Sci-Hub at least once a week was associated with a 20% increase in the prevalence of consulting scientific journals (PR: 1.20, 95% CI: 1.10-1.31, p < 0.001). The variables positively associated with Sci-Hub use included being in the sixth year of medical school (PR: 2.34), affiliation to more than one academic research group (PR: 1.81), being a medical student in Colombia (PR: 1.63), intermediate (PR: 1.16) and advanced levels of English (PR: 1.23), and daily use of PubMed (PR: 1.66), SciELO (PR: 1.87), and/or SCOPUS (PR: 1.58). Conclusion: Amongst medical students surveyed from the above six Latin American countries, the use of Sci-Hub at least once a week was significantly associated with the self-reported prevalence of consulting scientific journals.

Outcome measures reported following feminizing genital gender affirmation surgery for transgender women and gender diverse individuals: A systematic review.

Background: Feminizing genital gender affirmation surgery (fgGAS) may be an essential adjunct in the care of some transgender women and gender diverse individuals with gender incongruence. However, the comparison of different techniques of fgGAS may be confounded by variable outcome reporting and the use of inconsistent outcomes in the literature. This systematic review provides the most in-depth examination of fgGAS studies to date, and summarizes all reported outcomes, definitions, and the times when outcomes were assessed following these surgical interventions. Aims/Methods: This work intends to quantify the levels of outcome variability and definition heterogeneity in this expanding field and provides guidance on outcome reporting for future study authors. Candidate studies for this systematic review were sourced via an electronic, multi-database literature search. All primary, clinical research studies of fgGAS were included with no date limits. Paired collaborators screened each study for inclusion and performed data extraction to document the outcomes, definitions, and times of outcome assessment following fgGAS. Results: After screening 1225 studies, 93 studies proceeded to data extraction, representing 7681 patients. 2621 separate individual outcomes were reported, 857 (32.7%) were defined, and the time of outcome assessment was given for 1856 outcomes (70.8%) but relied on nonspecific ranges of follow-up dates. "Attainment of orgasm", "Neovaginal stenosis", and "Neovaginal depth/length" were among the most commonly reported outcomes. Profound heterogeneity existed in the definitions used for these and for all outcomes reported in general. Discussion: The results demonstrate a need for clear outcomes, agreed definitions, and times of outcome assessment following fgGAS in transgender women and gender diverse individuals. The adoption of a consistent set of outcomes and definitions reported by all future studies of fgGAS (a Core Outcome Set) will aid in improving treatment comparisons in this patient group. This review is the first step in that process.

The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines.

BACKGROUND: The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons. MATERIALS AND METHODS: The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by e-mail. An online survey was completed to indicate their agreement with the proposed changes to the guideline items. RESULTS: A total of 54 participants were invited to participate and 44 (81.5%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion. CONCLUSION: Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centred care.

Medical Students and the Impostor Phenomenon: A Coexistence Precipitated and Perpetuated by the Educational Environment?

People who experience the impostor phenomenon have intense thoughts of fraudulence regarding their intellect or professional activities. This perception of illegitimacy leads sufferers to believe that success in their lives is attributable to some form of error. Despite the phenomenon having been thoroughly researched in a plethora of professional and educational environments, there remains a relative lack of insight into the impostor phenomenon amongst medical students. This research aimed to better understand the relationship between medical students and the impostor phenomenon, and subsequently to investigate whether their coexistence is precipitated and perpetuated by the educational environment. A cross-sectional study of medical students was conducted using a pragmatist approach, integrating quantitative and qualitative data, via a questionnaire, focus groups and interviews. The main quantitative measure used was the validated Clance Impostor Phenomenon Scale (CIPS), where higher scores indicate more marked impostor experiences. A total of 191 questionnaire responses were received, and 19 students attended a focus group or interview. The average CIPS score for the cohort was 65.81 ± 13.72, indicating that the average student had "frequent" impostor experiences. Of note, 65.4% of students were classed as having "clinically significant" impostor experiences and females scored 9.15 points higher than males on average (p < 0.0001). Examination rankings were frequently cited as a major contributing factor to students' impostor feelings, and data revealed an increase of 1.12 points per decile that a student drops down the rankings (p < 0.05). Students' quotes were used extensively to underpin the quantitative data presented and offer an authentic insight into their experiences. This study provides new insights and contributes to our understanding of the impostor phenomenon amongst medical students, and eight recommendations for practice are presented, which are intended to provide medical schools with opportunities for pedagogical innovation. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01675-x.

Factors associated with complications of foreign body ingestion and/or aspiration in children from a Peruvian hospital.

Objective: To determine the factors associated with complications of foreign body ingestion and/or aspiration in children from a hospital in the Peruvian social security program. Materials and methods: An observational, retrospective, analytical, and transverse study was undertaken. Medical records of patients under the age of 14 years old, who were admitted to the National Hospital Edgardo Rebagliati Martins between January 2013 and May 2017, and treated with a diagnosis of foreign body in the digestive or respiratory tract, were selected. Variables that characterized the foreign body ingestion and/or aspiration were assessed. STATA v11.1 was used for all subsequent statistical analyzes. Results: A total of 322 cases met the inclusion criteria and the median age of the cohort was 4 years old (interquartile range: 2-6). The most frequently ingested foreign bodies were coins (∼59%) and batteries (∼10%). Fifty-four cases (∼17%) were classed as having a complication. In the multivariate analysis, we observed that the frequency of complications increased when the ingested object was a battery (adjusted prevalence ratio (aPR): 2.89; 95% confidence interval (CI): 2.52-3.32; p-value<0.001), when the time elapsed prior to diagnosis was 8-16 h (aPR: 2.23; 95% CI: 2.18-2.28; p-value<0.001), and when the child was male (aPR: 1.85; 95% CI: 1.24-2.74; p-value = 0.002). However, the frequency decreased in cases where foreign bodies were lodged in the nose (aPR: 0.97; 95% CI: 0.97-0.98; p-value<0.001). Conclusions: Whilst the most frequently ingested foreign bodies in this study were coins, complications were more common in cases of battery ingestion and in those where the diagnosis was made after 8 h.

Rare Intraoperative Finding of the Spinal Accessory Nerve Piercing a Fenestration in the Internal Jugular Vein: A Case Report and Review of the Modern Literature.

Variations in the anatomy of venous structures in the neck are not uncommon, but fenestrations are extremely unusual. Here, we report a rare case of the spinal accessory nerve piercing a fenestration in the internal jugular vein, found during elective neck dissection of a patient undergoing hemiglossectomy. Further, we present a literature review of recent previously published cases of this intraoperative finding. This paper is intended to provide readers with an appreciation for this particularly rare variation and to highlight its existence to surgeons who perform neck dissection. This knowledge is important in order to minimise the possibility of intraoperative damage.

A Multicentre Analysis of Approaches to Learning and Student Experiences of Learning Anatomy Online.

Introduction: The approaches to learning students adopt when learning anatomy online could yield important lessons for educators. Dissection room teaching can encourage students to adopt a deep approach to learning anatomy. It was therefore hypothesized that the proportion of students adopting a deep approach to learning would be lower in a population learning anatomy online. This research aims to investigate the experiences of students learning anatomy online during the COVID-19 pandemic and the approaches to learning they adopted. Methods: A survey was distributed to medical students at 7 universities across the UK and Ireland. The survey included two previously validated questionnaires: Approaches and Study Skills Inventory for Students and Anatomy Learning Experience Questionnaire. Results: The analysis included 224 unique student responses. Students' approach to learning mirrored reports from previous studies conducted during face-to-face tuition with 44.3% adopting deep, 40.7% strategic, 11.4% surface, and 3.6% combined learning approaches. The university (p = 0.019) and changes to formative (p = 0.016) and summative (p = 0.009) assessments significantly impacted approach to learning. Students reported that online resources were effective but highlighted the need for clearer guidance on how to find and use them successfully. Conclusion: It is important to highlight that students value in-person opportunities to learn from human cadaveric material and hence dissection room sessions should remain at the forefront of anatomical education. It is recommended that future online and/or blended provisions of anatomy teaching include varied resources that maximize engagement with media featuring cadaveric specimens. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01633-7.

eHealth, telehealth, and telemedicine in the management of the COVID-19 pandemic and beyond: Lessons learned and future perspectives.

In this article, we discuss evidence supporting the effective implementation of eHealth, telehealth, and telemedicine during the coronavirus disease 2019 pandemic, with a view towards its permanent future integration in healthcare. We performed a literature search for articles describing the use of telehealth/ telemedicine in the pandemic context using five databases. The articles selected describe the use of telemedicine as its advantages in terms of practicality and cost-effectiveness. This synthesis of articles is applicable to high-, middle- and low-income countries. Some of the notable benefits include breaking down geographical and time barriers, reducing waiting lists and crowding in healthcare facilities, and saving on national healthcare expenditure. However, there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns. Moreover, it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence. Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them. In the current socio-economic climate, it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare, as well as leading to an improvement in the quality of life of patients, whilst optimising existing resources and reducing costs. In that regard, the adoption of eHealth, telehealth, and telemedicine services should be considered highly timely, despite current existing limitations.

Optimal configuration of a three-rod ortho-bridge system in the treatment of Vancouver type B1 periprosthetic femoral fractures: A finite element analysis.

Introduction and Aim: Periprosthetic femoral fractures (PFF) represent an increasing clinical and economic burden. This study aims to determine the optimal configuration of a bridge-combined internal fixation system in the treatment of Vancouver type B1 PFF, using finite element analysis. Materials and methods: A three-rod ortho-bridge system (OBS) fixation model was used to evaluate the optimal configuration of four target parameters: position of the third rod; intersection angle between the proximal screws; connecting rod diameter; and number of screws used. Femoral displacement and the maximum von Mises stress of the OBS were used as the evaluation indices, to analyze the PFF and to determine the optimal use of an OBS. For each parameter, various candidate options were tested. Results: Finite element analysis revealed that the rate of femoral displacement and the maximum von Mises stress of the OBS were at a minimum when there was a 35 mm downward movement of the third rod from the baseline. Therefore, the optimal position of third rod fixation was 35 mm below the fovea capitis of the femur. The optimal intersection angles between the proximal screws were found to be 71.92° or 84°. A 6 mm diameter connecting rod proved to be most effective. Configuration d, utilizing 7 screws, represented the most clinically appropriate screw number configuration, despite configuration f, utilizing 9 screws, eliciting the best evaluation indices. Conclusion: An OBS used in the above-described configuration is well suited to the characteristics of PFF and provides an effective and reliable means for their treatment.

Pipe Cleaners as a Low-Cost and Versatile Educational Tool for Teaching Vascular Anatomy.

Teaching and learning vascular anatomy can be challenging for both educators and students. Cadaveric vasculature is difficult to visualise whilst models are costly and fixed in position. This paper proposes the use of pipe cleaners as a low-cost and versatile educational tool for use by both anatomy educators and students.

PRISMA 2020 statement: What's new and the importance of reporting guidelines.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, first published in 2009 [1], was developed in an attempt to increase the clarity, transparency, quality and value of these reports [2]. The 27-item checklist and four-phase flow diagram have become the hallmark of academic rigour in the publication of systematic reviews and meta-analyses, having been cited by over 60,000 papers [3]. These are frequently endorsed by journals in their 'Instructions to Authors' [4]. Developments in the methodology and terminology used when conducting systematic reviews [5], alongside the identification of limitations responsible for poor adherence, such as the use of ambiguous wording [6], have warranted an update to the PRISMA statement. The PRISMA 2020 statement, therefore, is intended to reflect this recent evolution in the identification, selection, appraisal and synthesis of research [7]. Here, we present an interpretive analysis of the updated statement, with a view towards encouraging its adoption by both journals and authors in the pursuit of advancing evidence-based medicine.

Impact of the coronavirus (COVID-19) pandemic on scientific research and implications for clinical academic training - A review.

A pneumonia outbreak of unknown aetiology emerged in Wuhan, China in December 2019. The causative organism was identified on 7th January 2020 as a novel coronavirus (nCoV or 2019-nCoV), later renamed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The resulting coronavirus disease (COVID-19) has infected over 88 million individuals, resulted in over 1.9 million deaths, and has led to an unprecedented impact on research activities worldwide. Extraordinary challenges have also been imposed on medical and surgical trainees following redeployment to full-time clinical duties. Moreover, the introduction of travel restrictions and strict lockdown measures have forced the closure of many institutions and laboratories working on research unrelated to the pandemic. The lockdown has similarly stifled supply chains and slowed research and development endeavours, whilst research charities have endured significant financial strains that have since reshaped the allocation and availability of funds. However, worldwide scientific adaptation to the COVID-19 pandemic has been observed through unprecedented levels of international collaboration alongside the uprise of remote telecommunication platforms. Although the long-term consequence of the COVID-19 pandemic on research and academic training is difficult to ascertain, the current crises will inevitably shape working and teaching patterns for years to come. To this end, we provide a comprehensive and critical evaluation of the impact of COVID-19 on scientific research and funding, as well as academic medical and surgical training.

Resuming cadaver dissection during a pandemic.

Methods of anatomical education have, as with many facets of normal life, been forced to evolve rapidly due to the Covid-19 pandemic. Whilst some authors claim that cadaver dissection is now under threat, we believe the centuries-old practice can and must be upheld.