Background Mental practice has been successfully applied in professional sports for skills acquisition and performance enhancement. The goals of this review are to describe the literature on mental ...practice within sport psychology and surgery and to explore how the specific principles of mental practice can be applied to the improvement of surgical performance—both in novice and expert surgeons. Method The authors reviewed the sports psychology, education, and surgery literatures through Medline, PubMed, PsycINFO, and Embase. Results In sports, mental practice is a valuable tool for optimizing existing motor skill sets once core competencies have been mastered. These techniques have been shown to be more advantageous when used by elite athletes. Within surgery, mental practice studies have focused on skill acquisition among novices with little study of how expert surgeons use it to optimize surgical preparation. Conclusions We propose that performance optimization and skills acquisition should be viewed as 2 separate domains of mental practice. Further understanding of this phenomenon has implications for changing how we teach and train not only novice surgeons but also how experienced surgeons continue to maintain their skills, acquire new ones, and excel in surgery.
Abstract
Gastric adenocarcinoma, commonly known as stomach cancer, has a predilection for metastasis to the peritoneum, which portends limited survival. The peritoneal metastatic cascade remains ...poorly understood, and existing models fail to recapitulate key elements of the interaction between cancer cells and the peritoneal layer. To explore the underlying cellular and molecular mechanisms of peritoneal metastasis, we developed an ex vivo human peritoneal explant model. Fresh peritoneal tissue samples were suspended, mesothelial layer down but without direct contact, above a monolayer of red-fluorescent dye stained AGS human gastric adenocarcinoma cells for 24 h, then washed thoroughly. Implantation of AGS cells within the explanted peritoneum and invasion beyond the mesothelial layer were examined serially using real-time confocal fluorescence microscopy. Histoarchitecture of the explanted peritoneum was preserved over 5 days ex vivo. Both implantation and invasion were suppressed by restoration of functional E-cadherin through stable transfection of AGS cells, demonstrating sensitivity of the model to molecular manipulation. Thus, our ex vivo human peritoneal explant model permits meaningful investigation of the pathways and mechanism that contribute to peritoneal metastasis. The model will facilitate screening of new therapies that target peritoneal dissemination of gastric, ovarian and colorectal cancer.
Adverse events are, unfortunately, common components of surgical practice. Much has been done to develop safer systems to prevent these adverse events; however, there has been less focus on the ...surgeon experiencing these events. This article presents a framework to understand surgeons' reactions to adverse events that was derived from a more recent study as well as a review of relevant psychology literatures. This framework is then situated within the broader picture of mindful practice to explore how the psychological and social dimensions of the surgeon can affect judgment and cognition.
ABSTRACT Objective The purpose of this study was to define the overall anatomic success rate in pneumatic retinopexy and to identify morphologic features that may be predictive of treatment failure ...in pneumatic retinopexy. Design and Participants Prospective consecutive interventional case series of patients with new-onset primary rhegmatogenous retinal detachments treated with pneumatic retinopexy. Methods In this interventional case series, consecutive patients with new-onset primary rhegmatogenous retinal detachments were treated with pneumatic retinopexy and followed prospectively. Morphologic data were collected on 3-colour fundus drawings. The primary outcome measure was treatment failure, defined as requirement for scleral buckle or vitrectomy within the follow-up period. Rates of failure for each morphologic feature were compared and a logistic regression model was fit. Results A total of 113 eyes were included in the study. Anatomic success was achieved in 69.6% of patients. Morphologic criteria including the position and number of breaks, position and extent of lattice degeneration, size of the detached area, and macular status were all found not to be significantly related to failure. In multivariate analysis, only 3 predictors, pseudophakic status ( p < 0.05, odds ratio OR 2.9, 95% CI, 1.06–7.88), presence of retinal break greater than 1 clock-hour ( p < 0.05, OR 3.41, 1.06–11.02), and presence of grade C or D proliferative vitreoretinopathy (PVR) ( p < 0.01, OR 31.83, 95% CI, 3.59–282.24), gained statistical significance. Conclusions Only pseudophakia, a large retinal break, and/or PVR was associated with an increased likelihood of failure.
Objective. Tumour budding and desmoplastic reactions in peritumoural stroma are features of the tumour microenvironment that are associated with colorectal cancer prognosis but have not been as ...thoroughly examined in gastric cancer. We aimed to further characterize the prognostic role of tumour budding and desmoplastic reaction in gastric adenocarcinoma with intestinal differentiation. Methods. 76 curative gastrectomy specimens were identified, excluding post-neoadjuvant cases or cases with >50% diffuse-type histology. Tumour budding was defined and graded according to the International Tumor Budding Consensus Conference recommendations and desmoplastic reaction was classified as described by Ueno et al 2017. Tumour budding and desmoplastic reaction were analyzed for associations with pathologic features and clinical outcomes. Results. Tumour budding was associated with pT (P < .001), pN (P < .004), overall stage (P < .001), LVI (P < .001) and PNI (P = .002). Desmoplastic reaction was associated with pT (P < .001), pN (P = .005), overall stage (P = .031) and PNI (P < .001), but not LVI. Survival analysis showed decreased overall survival (OS) and recurrence-free survival (RFS) for intermediate and high grade tumour budding (P = .031, .014 respectively). Immature stroma was significantly associated with RFS but not OS. Neither tumour budding nor desmoplastic reaction were independent predictors of OS or RFS on multivariate analysis in this cohort. Conclusion. Tumour budding and desmoplastic reaction were associated with known pathologic risk factors. Prognostically, tumour budding was associated with OS and RFS while desmoplastic reaction was associated with RFS only. Our data suggest that tumour budding and desmoplastic reaction have prognostic value in intestinal-type gastric adenocarcinoma.
Despite improvements in surgical and perioperative adjuvant therapy, gastric adenocarcinoma carries a 75% case-fatality rate and approximately 40% of Western patients die of recurrent disease. As an ...important regulator of centriolar duplication, cell motility, and invasion, polo-like kinase 4 (PLK4) has been identified as an oncogene which affects tumourigenesis, cancer metastasis, and response to chemotherapy. Change in PLK4 expression has been identified in numerous human cancers, but Plk4’s role in gastric adenocarcinoma is not well defined; I hypothesized that Plk4 or its interactors could be intimately involved in gastric cancer metastasis and progression. The high degree of molecular heterogeneity in gastric adenocarcinoma and variability in patient outcomes highlight the importance of utilizing patient cohorts to identify novel therapeutic targets. As such, I performed a comprehensive clinical chart review of 238 consecutive gastric adenocarcinoma patients who underwent a curative-intent resection. Recurrence remained a major cause of death in this patient cohort and was only predicted by pathologic staging. Our laboratory had previously identified a number of high-confidence functional interactors of Plk4, and, for each interactor, I determined the mRNA expression in tumour vs paired normal mucosa in our patient cohort. From this interrogation, I identified low expression of FAM46C, a Plk4 inhibitor and tumour suppressor in multiple myeloma, as a novel predictor of inferior disease-specific survival and recurrence at locoregional or distant sites. In vitro experiments demonstrate that FAM46C expression is cytotoxic to gastric cancer cells and suppresses cell migration. RNA-sequencing of patients’ gastric tumour and normal mucosa further reveal that ion-channel related pathways are significantly dysregulated in low-FAM46C tumours, but not in high-FAM46C tumours, implying a novel relationship between FAM46C and ion channels. Targeted evaluation revealed a correlation between the expression of FAM46C and KCNQ1, the main potassium recycler in parietal cells, both in vitro and in patient samples. FAM46C-depleted gastric cancer cells were also better able to survive in a high KCl concentration environment. These findings provide support for FAM46C as a tumour suppressor and therapeutic target in gastric adenocarcinoma patients, and potentially reveal a new role for FAM46C in regulating KCNQ1-mediated evasion of apoptosis and epithelial-to-mesenchymal transition.
Medical Education 2012: 46: 1179–1188
Context The adverse patient event is an inherent component of surgical practice, but many surgeons are unprepared for the profound emotional responses these ...events can evoke. This study explored surgeons’ reactions to adverse events and their impact on subsequent judgement and decision making.
Methods Using a constructivist grounded theory approach, we conducted 20 semi‐structured, 60‐minute interviews with surgeons across subspecialties, experience levels, and sexes to explore surgeons’ recollections of reactions to adverse events. Further interviews were conducted with six general surgeons to explore more immediate reactions after 28 adverse events. Data coding was both inductive, developing a new framework based on emergent themes, and deductive, using an existing framework for care providers’ reactions to adverse events.
Results Surgeons expressed feeling unique and alone in the depths of their reactions to adverse events and consistently described four phases of response, each containing cognitive and emotive components, following such events. The initial phase (the kick) involved feelings of failure (‘Am I good enough?’) experienced with a significant physiological response. This was shortly followed by a second phase (the fall), during which the surgeon experienced a sense of chaos and assessed the extent of his or her contribution to the event (‘Was it my fault?’). During the third phase (the recovery), the surgeon reflected on the adverse event (‘What can I learn?’) and experienced a sense of ‘moving on’. In the fourth phase (the long‐term impact), the surgeon experienced the prolonged and cumulative effects of these reactions on his or her own personal and professional identities. Surgeons also described an effect on their clinical judgement, both for the case in question (minimisation) and future cases (overcompensation).
Conclusions Surgeons progress through a series of four phases following adverse events that are potentially caused by or directly linked to surgeon error. The framework provided by this study has implications for teaching, surgeon wellness and surgeon error.
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