The Quality In-Training Initiative: Giving Residents Data to Learn Clinical Effectiveness.

BACKGROUND: Training programs are expected to provide clinical outcomes data to residents. Few systems have the necessary infrastructure. We evaluated initial adoption and use of the Quality In-Training Initiative (QITI) platform linking National Surgical Quality Improvement Program (NSQIP) data to trainees. STUDY DESIGN: Proportions of Accreditation Council for Graduate Medical Education general surgery residency programs with differing levels of NSQIP and QITI affiliation were calculated and program characteristics were compared. All NSQIP sites that captured QITI custom field data from July 2013 to June 2016 were included in case analysis. Differences in case collection were compared between participating (P) sites that actively participated in QITI and nonparticipating (NP) sites that did not. Resident participation by procedure type was examined. RESULTS: Of 268 accredited general surgery residency programs, 92% (n = 248) is affiliated with a NSQIP hospital and 61% of all clinical months is spent at NSQIP sites. For 42% of all programs (n = 114), the primary teaching hospital is affiliated with the QITI. In all, 74 P sites and 89 NP sites captured a total of 417,816 cases. The median number of cases captured per site was statistically higher for P sites (3063) compared with NP sites (2307, p < 0.001). A total of 68.3% of all cases captured had resident participation indicated by postgraduate year (n = 285,469). The most common procedures with resident participation were laparoscopic appendectomy (n = 17,082, 6.0%) and laparoscopic cholecystectomy (n = 15,502, 5.4%). Percentage coverage rates ranged from 17.3% to 91.8%. CONCLUSION: Most general surgery rotations are at NSQIP sites. Identifying resident participation in captured NSQIP cases is feasible on a large scale. Captured cases reflect national case-mix. The platform has the potential to collect data on institutional and program-level variation in resident operative experience that may be used to improve training.

Radiographic and functional evaluation of dogs at least 1 year after tibial plateau leveling osteotomy.

The progression of osteoarthritis and clinical function in 29 dogs at least 1 year after tibial plateau leveling osteotomy was evaluated. A previously reported radiographic scoring system was used by 3 investigators to evaluate preoperative and postoperative radiographs for evidence of stifle osteoarthritis. The combined scores were then used to evaluate the progression of osteoarthritis. The difference between the preoperative scores, derived from radiographs taken at the time of surgery, and the postoperative scores based on radiographs taken at least 1 year later was modest but statistically significant. Despite this finding, client satisfaction was very good. Clinical function was assessed by using a previously reported client questionnaire. According to owner assessment at least 1 year after surgery, there was a significant improvement in function after tibial plateau leveling osteotomy when compared with the preoperative status. Improvement in function as measured by the client questionnaire did not significantly predict the radiographic osteoarthritis score.

Comparison of the standard predictive equation for calculation of resting energy expenditure with indirect calorimetry in hospitalized and healthy dogs.

OBJECTIVE: To determine the level of clinical agreement between 2 methods for the measurement of resting energy expenditure (REE). DESIGN: Prospective case series. ANIMALS: 77 dogs. PROCEDURE: Oxygen consumption (Vo2) and CO2 production (Vco2) were measured with an open-flow indirect calorimeter in healthy (n = 10) and ill (67) dogs. Measurements were collected at 3 time periods on 2 days. The Vo2 and the Vco2 measurements were then used to calculate the REE values. RESULTS: Mean values of measured (MREE) and predicted (PREE) REEs in healthy dogs and a dog with medical illnesses or trauma were not significantly different. There was a significant difference on day 2 between the MREE and PREE in the group of dogs recovering from major surgery. More importantly, there was significant variation between the PREE and MREE on an individual-dog basis. The PREE only agreed to within +/- 20% of the MREE in 51% to 57% of the dogs. CONCLUSIONS AND CLINICAL RELEVANCE: The level of agreement between these two methods for determining the 24-hour REE was poor in individual dogs. The level of disagreement between the 2 methods indicates that these methods may not be used interchangeably in a clinical setting. Measurement of REE by use of indirect calorimetry may be the only reliable method of determining REE in an individual ill or healthy dog.

Effects of adenosine pretreatment on detection of free radicals in ischemic and reperfused canine gracilis muscle flaps by use of spin-trapping electron paramagnetic resonance spectroscopy.

OBJECTIVE: To determine whether adenosine pretreatment attenuates free radical production and muscle damage in ischemic and reperfused canine skeletal muscle. ANIMALS: 9 healthy mixed-breed dogs. PROCEDURE: Dogs were anesthetized, and both gracilis muscles were isolated, leaving only the major vascular pedicle intact. Saline (0.9% NaCl) solution was injected into the artery supplying the control flap, whereas adenosine (10 mg) was injected into the contralateral artery. Ischemia was induced in both flaps for 4 hours. alpha-Phenyl-N-tert-butylnitrone was administered IV to each dog 1 hour prior to reperfusion. Following 15 minutes of reperfusion, effluent blood samples from each muscle flap were obtained and processed for spin-trapping electron paramagnetic resonance (EPR) spectroscopy. Muscle biopsy specimens were obtained for histologic evaluation, and dogs were euthanatized. RESULTS: EPR spectra of strong intensity were obtained from analysis of 5 of 9 paired samples. Signals identified were characteristic of oxygen- and carbon-centered free radical adducts. Signal intensity of spectra from adenosine-treated flaps was significantly less than that of control flaps; mean signal attenuation was 36% in the adenosine-treated group. Histologic evaluation of muscle flaps did not reveal significant differences between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Treatment of canine muscle flaps with adenosine prior to a period of ischemia reduced but did not completely attenuate free radical production after reperfusion. However, adenosine pretreatment did not affect histologic abnormalities.