To summarize and compare worldwide colorectal cancer (CRC) screening recommendations in order to identify similarities and disparities.
A systematic literature search was performed using MEDLINE, ...EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website, Google and Google Scholar was performed.
Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy (every 10 years), or flexible sigmoidoscopy (FS, every 5 years) or fecal occult blood test (FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening.
Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.
General surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial simulators are often ...costly. The objective of this study is to assess the efficacy of a new, affordable silicone small bowel simulator, made with a three-dimensional (3D) printed mold, as a training tool to learn this technique.
This was a single-blinded pilot randomized controlled trial comparing two groups of eight junior surgical residents. All participants completed a pretest using an inexpensive, custom developed 3D-printed simulator. Next, participants randomized to the experimental group practiced the HSBA skill at home (eight sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator as for the pretest and practice sessions, and the retention-transfer test was performed on an anesthetized porcine model. Pretests, posttests and retention-transfer tests were filmed and graded by a blinded evaluator using assessments of technical skills, quality of final product, and tests of procedural knowledge.
The experimental group significantly improved after practicing with the model (P = 0.01), while an equivalent improvement was not noted in the control group (P = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the retention-transfer test (P = 0.95).
Our 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.
Feedback is an essential component of medical education, especially during clinical rotations. There is growing interest in learner-related factors that can optimize feedback's efficiency, including ...goal orientation, reflection, self-assessment, and emotional response. However, no mobile application or curriculum currently exists to specifically address those factors. This technical report describes the concept, design, and learner-based feedback of an innovative online application, available on mobile phones, developed to bridge this gap. Eighteen students in their third or fourth year of medical school provided comments on a pilot version of the application. The majority of learners deemed the module relevant, interesting, and helpful to guide reflection and self-assessment, therefore fostering better preparation before an upcoming feedback session. Minor improvements were suggested in terms of content and format. The learners' initial positive response supports further efforts to engage in validity and evaluation research. Future steps include modifying the mobile application based on learners' comments, evaluating its efficacy in a real clinical setting, and clarifying whether it is most beneficial for mid-rotation or end-of-rotation feedback sessions.
Simulation-based medical education allows for the training and maintenance of healthcare skills in a safe and controlled environment. In this technical report, the development and initial evaluation ...of a bile duct anastomosis simulator are described. The simulator was developed using additive manufacturing techniques such as three-dimensional (3D) printing and silicone work. The final product was produced by maxSIMhealth, a research lab at Ontario Tech University (Oshawa, ON, Canada), and included four individual silicone bile ducts, based on the expert opinions from surgeons at the Centre Hospitalier de l'Université de Montréal (Montreal, QC, Canada), and a 3D-printed maxSIMclamp, which was described in a previous report. The evaluation was conducted by nine individuals consisting of surgeons, surgical residents, and medical students to assess the fidelity, functionality, and teaching quality of the simulator. The results from the evaluation indicate that the simulator needs to improve its fidelity by being softer, thinner, and beige. On the other hand, the results also indicate that this simulator is extremely durable and can be used as a training tool for surgical residents with some minor improvements.
Suturing of different layers, such as deep lacerations, is a challenging clinical skill for residents. Currently, there is a lack of general suturing instructions and practice in undergraduate ...medicine curricula which would add to the education required during residency and could be impactful to patient safety. Therefore, in order to adequately prepare trainees for clinical practice, training in suturing needs to be made more robust and executable. One way to facilitate this is to provide easy access to equipment that can offer good educational value while allowing for adequate repetition of suturing deep lacerations outside of clinical settings, similar to how it has been done for superficial lacerations. Simulation-based medical education addresses this by training residents in healthcare skills in a safe and controlled environment. Our technical report aims to describe the development and initial evaluation of a deep laceration simulator designed to train residents in suturing. The simulator was made using additive manufacturing techniques such as three-dimensional printing and silicone. Feedback on the simulator was provided by Centre Hospitalier de l'Université de Montréal clinicians from various specialties and residents. The simulator was assessed mainly as being easy to use, durable, and having anatomically accurate characteristics. The main improvements suggested were to make the skin thinner, divide the epidermis and dermis, add a fascia, and create a looser and friable layer of fat. Overall, the respondents rated the simulator as a good educational tool with a few minor adjustments.
Hand-sewn bowel anastomosis (HSBA) is an essential skill for surgical residents to learn, as it is used in numerous surgical procedures. However, the opportunities to practice this skill before ...attempting it on patients are limited. Practice on simulators can help improve this technique, but there is a paucity of realistic, cost-efficient simulators for the acquisition of HSBA skills. This technical report describes the development of our simulator that consists of a small bowel manufactured from silicone and a 3D-printed clamp system to hold the bowel in place. Our simulator was co-designed by a clinical team of surgeons and then assessed for perceived acceptability and effectiveness by 16 junior residents in various surgical specialties at our faculty. A majority of the learners rated our simulator to be a good or very good learning tool for HSBA, although they suggested some minor improvements. Overall, our silicone small bowel model appears to be an effective and inexpensive way to acquire this surgical skill.
Background: General surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial ...simulators are often costly. The objective of this study was to assess the efficacy of a new, affordable silicone small bowel simulator, made with a 3D-printed mould, as a training tool to learn this technique. Methods: This was a single-blinded pilot randomized controlled trial comparing 2 groups of 8 junior surgical residents. All participants completed a pretest using an pensive, 3D-printed simulator. Next, participants randomized to the experimental group practised the HSBA skill at home (8 sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator used for the pretest and practice sessions, and the transfer test was performed on an anesthetized porcine model. Pre-, post- and transfer tests were filmed and graded by a blinded evaluator based on technical skills, procedural knowledge and quality of the final product. Results: The experimental group significantly improved after practising with the model (p = 0.01), while an equivalent improvement was not noted in the control group (p = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the transfer test (p = 0.95). Conclusion: Our 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.
The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate to provide annual updates ...on cancer incidence and mortality and trends by cancer type, sex, age group, and racial/ethnic group in the United States. In this report, we also examine trends in stage-specific survival for melanoma of the skin (melanoma).
Incidence data for all cancers from 2001 through 2017 and survival data for melanoma cases diagnosed during 2001-2014 and followed-up through 2016 were obtained from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries. Data on cancer deaths from 2001 to 2018 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in age-standardized incidence and death rates and 2-year relative survival were estimated by joinpoint analysis, and trends in incidence and mortality were expressed as average annual percent change (AAPC) during the most recent 5 years (2013-2017 for incidence and 2014-2018 for mortality).
Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval CI = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = -2.2%, 95% CI = -2.5% to -1.9%) and females (AAPC = -1.7%, 95% CI = -2.1% to -1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females.
Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations.
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