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Background: Stoma creation is standard in general surgery, yet complication rates remain high., Purpose: This study investigated the incidence and risk factors for early postoperative stoma complications in elective vs emergency surgery., Methods: All patients who underwent stoma creation between June 2015 and November 2020 were retrospectively reviewed and analyzed. Patients were divided into 2 groups based on the surgery type: elective vs emergency., Results: A total of 375 patients were included in this study. Two hundred fifty-three patients (67.5%) underwent elective stoma creation, while 122 (32.5%) underwent stoma creation during an emergency surgery. In the emergency group, white blood cell, blood urea nitrogen, and creatinine levels were statistically significantly higher (P = .001, .001, and .002, respectively). Albumin levels were statistically significantly lower in the emergency group (P = .001). The mean Emergency Surgery Score was 5.17 ± 2.73 in the emergency group compared to 4.4 ± 2.44 in the elective group (P = .006). Colorectal cancer was the most common cause of stoma creation in both groups. In terms of stoma creation, colostomy was statistically significantly more common in the emergency group (59%, P = .001), compared to ileostomy in the elective group (58.9%, P = .001). Complications were observed in 135 of all patients (36%). Necrosis was statistically significantly more common in emergency cases (9.9%, P < .001)., Conclusion: Surgeons should strive to optimize the patient's condition prior to the operation and, if possible, perform stoma marking or involve a stoma nurse in the operating room to select the most suitable site. In high-risk patients, where complications are more likely, the use of a stoma should be minimized and definitive management should always be pursued if feasible.

Background: Mammographic breast density (MBD), a well-established factor linked to breast cancer, is the focus of this preliminary report among women across multiple centers in Riyadh. The study aims to identify risk factors associated with high breast density., Methods: MBD was assessed at three hospitals in Riyadh, Saudi Arabia, using the American College of Radiology (ACR) categories: A (almost entirely fatty), B (scattered areas of fibroglandular density), C (heterogeneously dense), and D (extremely dense). Breast density distributions were analyzed in relation to age, body mass index (BMI), family history, parity, and hormonal therapy usage., Results: The study included 1,530 women, revealing an inverse association between dense breast proportion and age/BMI. Notably, 43.3% [95% confidence interval (CI): 43.2% to 43.5%] of women aged 40-79 years exhibited heterogeneously or highly dense breasts, with this proportion inversely correlated with age and BMI., Conclusions: Healthcare providers should consider breast density for appropriate screening and, if necessary, recommend supplemental methods. Policymakers and healthcare providers, when discussing breast density notification legislation, should be mindful of its high prevalence, ensuring women notified have opportunities to evaluate breast cancer risk and pursue supplemental screening options if deemed appropriate., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-23-374/coif). The authors have no conflicts of interest to declare., (2024 Gland Surgery. All rights reserved.)

Background: The unprecedented COVID-19 pandemic has caused significant disruption to medical students' education. It imposed challenges that required rapid adaptation to enforced lockdowns and remote learning and changed curriculum delivery from in-person to online learning and virtual technology., Objective: This study aimed to determine the trends and ratings of using Internet resources and social media platforms by medical students during the COVID-19 pandemic., Methods: A validated questionnaire was used to explore preferences for Internet resources and social media platforms among undergraduate medical students (years 1, 3, and 5) at King Saud University. The questionnaire comprised three sections- (i) demographic information, (ii) access and use of Internet resources/social media platforms, and (iii) students' ratings and reasons for using technology-enabled learning during the COVID-19 pandemic., Results: A total of 320 undergraduate medical students responded to the online questionnaire. The difference in the number of students using the Internet daily across academic years increased significantly as they progressed in the medical course (p = 0.025). For learning, YouTube and Videoconferencing (e.g. Zoom) were used by 83.1% and 73.4% of students, respectively, followed by WhatsApp 198 (61.9%). For social interaction, WhatsApp, 310 (96.6%); YouTube, 296 (92.8%); Twitter, 288 (90%); and Zoom, 269 (84.1%) were the platforms used by most students. Regarding concerns about the impact of COVID-19 and social isolation, 250 (78.1%) agreed that technology helped them gain a sense of connectedness to their peers. Over half of students, 187 (58.4%) wished that technologies be integrated more often in their courses, as 245 (76.7%) agreed that it helped engage them with classes., Conclusion: The study shows that the use of the Internet and social media resources is increasing at all levels to fill the gap in learning and social interaction because of the COVID-19 pandemic. Medical institutions should embrace the effective use of Internet resources and use the experience gained and lessons learned in guiding educators on what type of online resources should be created to add value to students learning even post-pandemic., (© 2023. The Author(s).)

Background: Due to the unmet need for valid instruments that evaluate critical components of simulation scenarios, this research aimed to develop and validate an instrument that measures the quality of healthcare simulation scenarios., Methods: A sequential transformative mixed-method research design was used to conduct the study. The development and validation of the instrument involved two phases: the qualitative phase, which included defining the instrument's theoretical background and instrument construction, followed by the quantitative phase, where the instrument was piloted and validated. The qualitative study included 17 healthcare simulation experts, where three focus group was conducted, and the first version of the instrument was constructed based on the focus group analysis and the theoretical framework constructed using the literature review. During the quantitative phase, the instrument's quantitative piloting included 125 healthcare simulation scenarios; then, the instrument went through construct validity and reliability testing., Results: Content experts confirmed the theoretical model and instrument framework. The average item content validity index (I-CVI) scores and the average of the I-CVI scores (S-CVI/Ave) for all items on the scale or the average proportion relevance judged by all experts was 0.87. The conformity factor analysis results showed a good fit for the proposed 10-factor model (CFI (the comparative fit index) = 0.998, Tucker-Lewis index = 0.998, Root mean square error of approximation (RMSEA) = 0.061. The final instrument included ten domains: 1. Learning objectives, 2. Target group, 3. Culture, 4. Scenario case, 5. Scenario narrative briefing, 6. Scenario complexity, 7. Scenario flow, 8. Fidelity, 9. Debriefing, and 10., Assessment: The SSQI included 44 items that are rated on a 3-point scale (Meets Expectations = (2), Needs Improvement, (1), Inadequate (0))., Conclusion: This validated and reliable instrument will be helpful to healthcare educators and simulation experts who want to develop simulation-based training scenarios and ensure the quality of written scenarios., (© 2023. The Author(s).)

Rationale: Gastrointestinal (GI) motility disorders represent a set of variable presentations caused by an abnormal functioning enteric neuromusculature. Any part of the GI tract can be affected, and depending on the organ involved, the patient presentation will differ., Patient Concerns: A 26-years old female who had a history of laparoscopic Heller myotomy 15 years ago for progressive dysphagia. She presented with peritonitis and sigmoid colon perforation secondary to severe chronic constipation. Later after undergoing Hartman procedure, she continued to have significant constipation. In addition, she reported progressive dysphagia and regurgitation to both solids and liquids., Diagnosis: An esophageal manometry revealed Achalasia type 3, and stomach motility nuclear study showed mild delay in gastric emptying., Interventions: Initially, Hartmann procedure was performed. Afterward, we performed a reversal of Hartman, robotic redo of Heller myotomy, and Dor fundoplication was performed., Outcomes: The patient had an uneventful postoperative course and was discharged in good condition., Lessons: Our case highlights an unusual presentation of GI motility disorder resulting in peritonitis from sigmoid colon perforation. Early recognition and prompt treatment of GI motility disorders are essential to avoid severe complications., Competing Interests: The authors do not have any conflict of interest or funding source to declare., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Numerous studies have evaluated the use of autologous abdominal tissue for breast reconstruction; nevertheless, complications and donor site morbidity rates vary significantly. The study aims to compare the literature regarding morbidity of the donor site and complication rates of breast reconstruction with autologous abdominal flaps., Methods: The databases of MEDLINE, EBSCO, Scopus, Wiley Library, and Web of Sciences were searched for studies that compared different flaps in terms of complications and donor site morbidity. The procedures studied included pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps. A total of 34 studies were included. Of these, 28 were retrospective studies and 9 were prospective cohort studies., Results: When compared to DIEP, fTRAM flaps were found to have a decreased incidence of flap fat necrosis, hematoma, and total thrombotic events, yet a higher risk of donor site hernia/bulging. pTRAM flaps were also associated with an increased risk of hernia/bulging at the donor site, as well as wound infection, yet flap hematoma was less common. On the other hand, SIEA flaps showed the lowest risk of donor site hernia/bulging while still having a high risk of wound infection., Conclusion: fTRAM procedures comparatively had the least complications. However, regarding flap choice, patients would benefit most from a case-by-case analysis, taking into consideration individual risk factors and preferences., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Hatan Mortada et al.)

Background Due to the coronavirus disease 2019 (COVID-19) pandemic, the world has seen a surge in utilizing videoconferencing technology. It can be a useful approach for qualitative research. This study describes the feasibility of virtual focus groups in qualitative research. Methods Videoconferencing software was used to conduct virtual focus groups. A dry run was conducted a day before the focus group to ensure the research team was acquainted with the software on the focus group day. Results Using distance videoconferencing software was cost-effective compared to face-to-face focus groups. The moderator was responsible for leading the discussion virtually. Unlike in-person focus groups, the virtual focus group scheduling was flexible, and it was easier to find replacements for participants who dropped out. Conclusion This study found that conducting virtual focus groups utilizing videoconferencing software was time-saving and cost-efficient compared to face-to-face focus groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Almujlli et al.)

Introduction: Our goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas., Methods: We conducted a feasibility study to establish the process for successful delivery of educational content to learners overseas via telesimulation over a five-month period. Participants were registrants in an EMS course on MCI triage broadcast from University of California, Irvine Medical Simulation Center. The intervention was a Simple Triage and Rapid Treatment (START) course. The primary outcome was successful implementation of the course via telesimulation. The secondary outcome was an assessment of participant thoughts, feelings, and attitudes via a qualitative survey. We also sought to obtain quantitative data that would allow for the assessment of triage accuracy. Descriptive statistics were used to express the percentage of participants with favorable responses to survey questions., Results: All 32 participants enrolled in the course provided a favorable response to all questions on the survey regarding their thoughts, feelings, and attitudes toward learning via telesimulation with wearable/mobile technology. Key barriers and challenges identified included dependability of Internet connection, choosing appropriate software platforms to deliver content, and intercontinental time difference considerations. The protocol detailed in this study demonstrated the successful implementation and feasibility of providing education and training to learners at an off-site location., Conclusion: In this feasibility study, we were able to demonstrate the successful implementation of an intercontinental MCI triage course using telesimulation and wearable/mobile technology. Healthcare providers expressed a positive favorability toward learning MCI triage via telesimulation. We were also able to establish a process to obtain quantitative data that would allow for the calculation of triage accuracy for further experimental study designs., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Telesimulation is a new and innovative concept and process that has been used to provide education, training, and assessment in health-related fields such as medicine. This new area of simulation, and its terminology, has its origins within the past decade. The face validity and ability to provide the benefits of simulation education to learners at off-site locations has allowed the wide and rapid adoption of telesimulation in the field of medical education. Telesimulation has been implemented in areas such as pediatric resuscitation, surgery, emergency medicine, ultrasound-guided regional anesthesia in anesthesiology, nursing, and neurosurgery. However, its rapid expansion and current use has outgrown its recent description less than a decade ago. To date, there is no unifying definition of telesimulation that encompasses all the areas where it has been used while simultaneously allowing for growth and expansion in this field of study. This article has two main objectives. The first objective is to provide a comprehensive and unifying definition of telesimulation that encompasses all the areas where it has been used while allowing for growth and expansion in the field of study. The secondary objective is to describe the utility of telesimulation for emergency medicine educators in the context of the current evidence to serve as a background and framework that educators may use when considering creating educational programs that incorporate telecommunication and simulation resources. This article is complementary to the large group presentation where this new comprehensive and unifying definition was introduced to the simulation community at the International Meeting on Simulation in Healthcare in January 2016.