Surgical Specialties Research Articles

877 Demand-Side Barriers to Surgical Care in Low- and Middle-Income Countries - a Scoping Review

Abstract Aim Thirty per cent of diseases worldwide can be treated by surgery or require the direct care of a surgeon. The Lancet Commission (2015) found that five billion people lack access to safe surgery, predominately those living in low- and middle-income countries, where nine out of ten people cannot access basic surgical care. Numerous studies have examined supply-side barriers, but few have examined the demand-side. We report a scoping review to identify and explore the barriers that prevent patients from seeking surgical care. Method A systematic search of multiple databases using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was conducted, looking for papers published between January 2015 and November 2023. Two independent reviewers charted qualitative variables and significant demographic data. Results Out of 2,899 studies examined, 228 met the inclusion criteria. The studies spanned six continents and fifty-seven countries. 14% were multi-country. Forty-seven barriers were identified and organised under ten headings. The five most frequently cited barriers were distance, fear/lack of trust, transport costs, reliance on religious/traditional healers and indirect costs (food/accommodation/companion). Conclusions Our review demonstrates the breadth of barriers contributing to the unmet need for surgery amongst all surgical specialities. While countries pursue their 2030 target to increase the provision of safe surgical care, there also needs to be a clear focus on understanding the factors that prevent patients from accessing established surgical care and how to mitigate them.

Studying Provider’s Satisfaction on Video Consultation by Ain Shams University Virtual Hospital

Abstract Background Video consultations were developed to allow long-distance patient and clinician contact, care, advice and monitoring which has been shown to improve patient health status. When rural settings, lack of transport, a lack of mobility, decreased funding, or a lack of staff restrict access to care, video consultation may bridge the gap. Objective To measure satisfaction of physicians involved in video consultations services provided at Ain Shams Virtual Hospitals (AVH). To identify the main factors affecting satisfaction of physicians involved in such video consultations services provided at AVH. Methods A descriptive cross-sectional study was conducted to measure satisfaction of a sample of providers of video consultations at AVH from December 2020 to March 2021. Results Total 37 physicians were included in the study, 29 physicians responded (78.3%). The mean age ±SD is 37.97 ±6.3 and their main specialties were neuropsychiatry (40.7%), internal medicine subspecialties (40.7%), and surgical specialties (18.5%). About 83% were confident with their diagnoses in video consultations and (13.8%, 75.9%) of the physicians reported that they always/sometimes suffered from bad quality of image/sound respectively. More than half of the physicians (53.5%) thought that lack of physical examination would affect the accuracy of the diagnoses and 53.5% of the physicians thought that video consultation would be suitable for follow-up patients post operatively. Conclusion Two thirds of the physicians had a positive experience and were satisfied with using video consultations in their clinical practices. Recommendations It is recommended to use video consultations in following-up of patients. It is also recommended to monitor provider`s satisfaction over time.

1170 Bridging the Gap in Surgical Robotics Education

Abstract Aim Despite rapid evolution of surgical robotics systems, training opportunities are very limited especially for medical students and junior doctors. We organised a free-of-charge regional robotics workshop in collaboration with CMR Surgical with the goal of increasing exposure to surgical robotics technology. We also evaluated the delegates’ perception on current surgical robotics training and the workshop. Method CMR Surgical was invited to exhibit their Versius® robot and Virtual-Reality trainer for a one-day workshop at Glenfield Hospital, Leicester. The workshop was advertised across universities and hospital trusts in East Midlands. Registration form included pre-workshop questionnaire which assessed the motivation and barriers to attending surgical robotics courses, and their familiarity with robotics surgery. After 1-hour hands-on exercise supervised by consultants and CMR Surgical trainers, delegates were asked to complete post-workshop questionnaire to evaluate shift in familiarity, interest, and confidence in basic robotic skills. Results 75 delegates registered with 93% having never attended similar workshop before and the barriers were perceiving that robotics surgery skills are for advanced surgeons only (37%), cost (26%), no accessible courses (24%), time constraints (9%) and others (4%). The primary motivation to attend this workshop were learning basic robotic skills (49%), exploring innovative technology (44%) and networking (7%). 30 delegates were shortlisted for 1-hour hands-on experience into six groups consisting of 18 students and 12 junior doctors. Post-workshop feedback showed a positive shift in familiarity, interest, and confidence in basic robotic skills. Delegates also expressed increased interest in surgical specialties after this workshop. They also found VR station was enjoyable and believed it has potential in training future robotic surgeons. Conclusions These findings highlight the feasibility and importance of creating accessible training opportunities to bridge the gap in surgical robotics education.

1096 The African Surgical Outcomes Study in Paediatric Patients (ASOS-Paeds) and Global Paediatric Perioperative Mortality - a Meta-analysis

Abstract Aim There is little data for surgical outcomes of children in Africa. This is of particular importance as children constitute 40% of the African population, compared to a global average of 25%. As part of ASOS-Paeds - a prospective cohort study of children undergoing surgery in African countries, we undertook a meta-analysis to synthesise the evidence on global paediatric perioperative mortality. Method We searched MEDLINE, Embase and WHO Global Index Medicus for studies published within the last decade, reporting paediatric perioperative mortality. We included studies with ≥200 children that reported perioperative mortality for multiple surgical specialties and procedures. Perioperative mortality was defined as death within 30 days of surgery. For meta-analysis, proportions were combined using a random effects model. Results After screening 13,258 s and reviewing 158 full-text reports, data from 9 studies were eligible for synthesis along with data from ASOS-Paeds. The meta-analysis included 579,733 children from Africa, Europe, and North America. The pooled perioperative mortality rate per 1,000 children (95% CI) was 17.91 (9.78, 26.04) in Africa compared to 2.18 (0.95, 3.42) in Europe and North America. This equates to excess paediatric perioperative mortality in Africa between 6 (in the best-case scenario) to 25 (in the worst-case scenario) per 1,000 children. Conclusions Perioperative mortality for children undergoing surgery in Africa is 8-fold higher than in Europe and North America. Access to safe and affordable anaesthesia and surgery should be a public health priority and urgent action is needed to improve surgical outcomes for children in Africa.

578 Optimising Emergency Theatre Efficiency with the Use of a Pre-Anaesthetic Holding Bay, a Quality Improvement Project

Abstract Aim An efficient emergency theatre depends on the coordination of multiple surgical specialties, anaesthetists, and theatre staff. The serial nature of an operating list leads to downtime between cases. We sought to reduce delays between emergency cases by implementing a pre-anaesthetic holding bay. Method Anonymised data was collected from a prospectively maintained mandatory database of theatre activity. Exclusion criteria were non-surgical procedures, first case, out-of-hours procedures, and critical care admissions. Suitability was determined from a period pre-implementation and a pre-defined trial period to ensure safe rollout. Pre-, trial, and post-implementation were compared. Results 349 emergency procedures were performed in three months post-implementation. After exclusion criteria 110 were suitable for pre-anaesthetic holding bay use, and in 35 (31.8%) it was utilised. Most cases were general surgery (61%), vascular surgery (15%), and gynaecology (12%). Holding bay use decreased time without a patient in the anaesthetic room from 50 to 5 minutes (p<.001) and the time between procedures from 86 to 43 minutes (p<.001). There was no difference in anaesthetic time between the groups (36 vs 38 minutes, p=.40). Over the three months 40 more in-hours cases were completed in 48 days with no difference in procedures across the periods. Conclusions Pre-anaesthetic holding bay use reduced theatre downtime by 90%, allowing more procedures to be performed in-hours. All specialties engaged with the holding bay but to varying extent, and ensuring investment from surgeons, anaesthetists, and theatre staff is essential. This intervention, implemented with no extra resources, has increased efficiency and improved safety in the emergency theatre list.

Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India. Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics. Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process. Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

37 Evaluation of Prophylactic Negative Pressure Wound Therapy Versus Standard Surgical Dressings on Wound Outcomes in Posterior Spinal Surgery Patients: A Systematic Review and Meta-Analysis

Abstract Aim Negative pressure wound therapy has frequently been used in a variety of surgical specialities, yet its effectiveness as a prophylactic therapy in spinal surgery remains unclear. A comprehensive systematic review and meta-analysis was performed, incorporating the most recent evidence, addressing this paucity in the literature. Method A systematic search of the literature from inception to June 2023 was conducted using the following databases: Ovid Medline, EMBASE, Cochrane Register of Controlled Trials (CENTRAL) and Web of Science. All included studies assessed primary wound closure for posterior spinal surgical incisions. Evidence was quality assessed and outcomes of interest were meta-analysed using odds ratios, comparing negative pressure wound therapy and standard dressing groups. Results Seven studies (n = 1319, mean age = 59.9 years, 55.8% male) were included. Patients with negative pressure dressings had a reduced risk of surgical site infection (odds ratio = 0.45, 95% CI 0.29 to 0.72, p < 0.001). Wound dehiscence approached significance favouring negative pressure dressings (odds ratio = 0.53, 95% CI 0.26 to 1.06, p = 0.07). Patients requiring a return to theatre for wound related complications showed no significant difference between groups (odds ratio = 0.66, 95% CI 0.37 to 1.18, p = 0.16). Conclusions Negative pressure wound therapy reduces the risk of surgical site infection in posterior spinal surgery patients. Given that surgical site infection in spine surgery is associated with significant morbidity and financial costs, implementation of prophylactic negative pressure wound therapy for this patient demographic may be beneficial.

Trends in Gender, Ethnicity and Less-Than-Full-Time Training among Reconstructive Plastic Surgery Registrars and Consultants between 2009 and 2020

ObjectiveThis study aimed to examine the trends in gender, ethnicity and less-than-full-time (LTFT) training in reconstructive plastic surgery from 2009 to 2020 in the UK by comparing them to overall surgical specialties. MethodsWe analysed NHS Digital workforce data from 2009 to 2020 by examining trends in gender, ethnicity and LTFT working among reconstructive plastic surgery consultants and registrars and comparing them to overall surgical specialties. Data were analysed using linear regression models. ResultsThe percentage of female reconstructive plastic surgery consultants and registrars increased significantly over the period, with reconstructive plastic surgery groups having higher percentages of females than overall surgical specialties. LTFT working trends varied, with declining trends among consultants and increasing trends among registrars. Ethnicity trends were complex, varying between different ethnic categories and between consultants and registrars, but showing an increase in diversity within the workforce. ConclusionThe demographics of reconstructive plastic surgeons in the UK became more diverse from 2009 to 2020 with trends indicating that this will continue in the future. However, there were significant variations among the different groups and levels of seniority, suggesting the need for targeted interventions to promote diversity and inclusivity in surgical specialties.

Blue Ribbon Committee II: Report of the Subcommittee on Faculty Development and Educational Support.

The American College of Surgeons, American Board of Surgery, and the American Surgical Association have created a Blue Ribbon Committee II to evaluate the current status of surgical education in the United States. As part of this endeavor, a subcommittee was formed to address issues pertinent to development of surgical faculty as teachers. This entailed multiple discussions among a group of experienced surgical educators, a review of the literature, and a delphi analysis of possible suggested improvements for faculty educational support, resulting in a final set of recommendations for improvement for future surgical faculty development. These recommendations include a task force to establish a validated system of compensation for faculty teaching, a task force to determine an accurate assessment of the value of surgical trainees to health systems, a review by the Surgical Residency Review Committee and the Association of Program Directors in Surgery of minimal faculty resources for program accreditation in the area of teaching learners, collaborative efforts across surgical specialties for the definition of a national curriculum for faculty, and development of a tool for evaluation of faculty teaching performance.

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center

BackgroundVascular surgeons play a critical role in the functioning of a healthcare system. As a service line, vascular surgery not only performs its own complex operations but also provides support to other surgical specialties by assisting in the management of vascular-related complications. Previous reports have acknowledged the value of consulting vascular surgeons; however, these studies have primarily been limited to single-center series. In this study, we aim to contribute to the existing literature by sharing our experience and highlighting the financial value of consulting vascular surgeons at a large tertiary academic medical center. MethodsInstitutional electronic medical records were retrospectively queried for all operations performed by vascular surgeons from 2020-2022. Two separate procedural groups were identified. The first group comprised all surgeries where vascular surgery was listed as a co-surgeon for other surgical specialties. The second group comprised all surgeries where vascular surgery was the primary surgeon for service-level cases. Service cases were defined as operations resulting directly from (1) iatrogenic complications from other services, (2) consultations for traumatic injury, or (3) primary surgeon for non-vascular cases. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule was used to calculate work relative value units (wRVU) per primary procedure code. ResultsA total of 7821 surgeries were performed with vascular involvement over the study period. Of these, 726 operations (9.3%) were co-surgeon cases requiring intraoperative vascular assistance, from 109 surgeons across all 16 surgical specialties. There was no missing data. The most common specialties requesting vascular assistance included cardiac surgery (n=247, 34.0%), orthopedic surgery (n=152, 20.9%), and neurosurgery (n=131, 18.0%). Total procedural wRVU for co-surgeon cases was 16,220, and total charges exceeded $77.5 million dollars. Vascular surgery served in a primary surgeon role in an additional 154 service-level cases (2.0%) resulting from ten non-surgical services. The most common service-level indication was iatrogenic vascular injury (n=87, 56.4%), and the majority of service-level cases required urgent or emergent surgery (n=123, 79.9%). These procedures generated an additional 2,150 wRVU and $1.1 million dollars in charges for the hospital system. Of all co-surgeon or service-level cases, 19.1% (n=168) occurred after-hours and 10.3% (n=91) occurred on a holiday or weekend. ConclusionVascular surgery is crucial to the operation of all surgical services and many non-surgical service lines within an academic medical center. Apart from providing essential services for primary vascular diseases, the vascular surgery service line offers substantial financial benefits to the healthcare system through its consulting role. A considerable portion of operative consultations are performed under urgent or emergent circumstances, often necessitating surgical intervention outside regular working hours or on holidays/weekends. These findings have significant implications for assessing the value and compensation of vascular surgeons in today's healthcare landscape.

Mise en place d’une antenne pharmaceutique de blocs opératoires dans un centre hospitalier universitaire

An operating room pharmaceutical unit centralizes medical devices and drugs for various surgical specialities. The aim of this work is to present the methodology used in our establishment to set up the operating room pharmaceutical unit. This approach involved the formation of multi-professional working groups. The needs of operating theatres were defined based on an analysis of healthcare product consumption and stock inventories. Material sheets were defined for each procedure. On the basis of simulations, material supply arrangements were selected, specifying material flows, equipment, workstations and information systems. Over 3200 healthcare product references were identified and 862 equipment files were created. Local stocks have been limited to medical trolleys for nursing staff. Emergency operating packs have been deployed for unforeseen operations. Cabinets have been dedicated to transporting re-sterilizable medical devices, and carts have been purchased for programmed operating packs. The equipment is made available by logistics agents and pharmacy assistants under pharmaceutical responsibility. This innovative approach is a model for facilities desiring to centralize and secure the logistics of healthcare products in the operating room. Ongoing adjustments will be required to meet new operating rooms needs.

The impact of disability on recruitment to higher surgical specialty training: A retrospective cohort study

BackgroundUK examining bodies are required to eliminate discrimination against people with protected characteristics. To achieve this in surgery, differential attainment (DA) in assessments used as gatekeepers to career progression must be ruled out. This study investigated the impact of disability status on the likelihood of success at national selection for Higher Surgical Training (HST). MethodsA retrospective cohort study of all UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST (ST3) from 2012 to 2019 (n = 2875). Univariate analysis identified differences in success rates at first-application. Logistic regression models identified whether disability was a predictor of success after adjusting for sociodemographic factors and prior MRCS performance. ResultsThere was no significant difference in success rates between candidates with and without disabilities (all p > 0.05) for any surgical specialty. Disability status was not a statistically significant predictor of success. Female candidates were 25 % more likely to be successful (OR 1.25 [95%CI 1.05 to 1.49]) and Non-White candidates were 20 % less likely to be successful (OR 0.80 [95%CI 0.68 to 0.96]). Candidates who passed MRCS Part A and Part B at the first attempt were 49 % (OR 1.49 [95%CI 1.25 to 1.77]) and 90 % (OR 1.90 [95%CI 1.58 to 2.28]) more likely to be successful. ConclusionNo significant difference was found in the likelihood of being successful at HST selection for any surgical specialty between applicants with and without disabilities, regardless of type of disability. DA was identified between other sociodemographic groups which requires further exploration.

Perceptions of Surgeons in the Kurdistan Region of Iraq Regarding the Use of Artificial Intelligence.

Artificil intelligence (AI) is revolutionizing healthcare by seamlessly integrating into various aspects of human life. From robotic surgery to virtual nursing assistants and image analysis applications, AI is transforming the way we approach and deliver healthcare. By leveraging AI, patients can gain a deeper understanding of their symptoms, empowering them to make informed decisions about their health and ultimately improving their quality of life. Methods: An online survey collected data from social media platforms regarding the surgeon society in the Kurdistan region of Iraq. All statistical analyses were carried out using IBM SPSS Statistics for Windows, Version 25(Released 2017; IBM Corp., Armonk, New York). A total of 316 surgeons responded to the survey. A significant majority believed that using artificial intelligence benefits patients, and a substantial number advocated for its avoidance as a matter of principle. More than half said that AI would always impact education, and half of the participants said that AI would always affect complication prediction. This is the first study investigating surgeon attitudes and perceptions regarding the use of AI in the Kurdistan region. The surgeons who responded generally appreciated AI's use in their practice. Notably, general surgeons showed greater openness to integrating AI into their daily practices compared to those in other surgical specialties.

652 Inspiring Future Surgeons - Exploring Influences on Year 3 UK Medical Students' Interest in Surgical Specialties: A Thematic Analysis

652 Inspiring Future Surgeons - Exploring Influences on Year 3 UK Medical Students' Interest in Surgical Specialties: A Thematic Analysis

The COVID-19 Pandemic Led To A Large Decline In Physician Gross Revenue Across All Specialties In 2020.

US health care use declined during the initial phase of the COVID-19 pandemic in 2020. Although utilization is known to have recovered in 2021 and 2022, it is unknown how revenue in 2020-22 varied by physician specialty and practice setting. This study linked medical claims from a large national federation of commercial health plans to physician and practice data to estimate pandemic-associated impacts on physician revenue (defined as payments to eligible physicians) by specialty and practice characteristics. Surgical specialties, emergency medicine, and medical subspecialties each experienced a greater than 9percent adjusted gross revenue decline in 2020 relative to prepandemic baselines. By 2022, pathology and psychiatry revenue experienced robust recovery, whereas surgical and oncology revenue remained at or below baseline. Revenue recovery in 2022 was greater for physicians practicing in hospital-owned practices and in practices participating in accountable care organizations. Pandemic-associated revenue recovery in 2021 and 2022 varied by specialty and practice type. Given that physician financial instability is associated with health care consolidation and leaving practice, policy makers should closely monitor revenue trends among physicians in specialties or practice settings with sustained gross revenue reductions during the pandemic.

Direct observation of procedural skills evaluation of suturing skills in surgical interns: A comprehensive analysis

Background: The internship period in medical education serves as a critical phase for students transitioning from theoretical learning to practical application within clinical settings. Surgical specialties, in particular, demand a high level of skill and competence from interns due to the inherent risks associated with surgical procedures. However, there is often a gap between the theoretical knowledge gained in medical college and the practical skills required in surgical practice. Aims and Objectives: Therefore, keeping all the above facts in mind, the present study was undertaken to implement direct observation of procedural skills (DOPS) as a method for evaluating the suturing skills performance in interns. Materials and Methods: This study focused on an intern in the Department of Surgery, aiming to assess their suturing skills using the DOPS method. A structured workshop was conducted to provide interns with hands-on training in suturing techniques. Subsequently, interns were divided into groups and assessed by assigned assessors using the checklist. Feedback was provided to interns after each assessment session. Data were collected through self-administered questionnaires distributed to interns and assessors, and statistical analysis was performed using SPSS software. Results: Analysis of the data revealed a significant improvement in suturing skill scores among interns following the implementation of DOPS assessments. Mean scores increased substantially from the initial to subsequent attempts, indicating enhanced proficiency in suturing skills. Interns expressed positive perceptions of the DOPS methodology, highlighting its effectiveness in driving learning and improving confidence in performing surgical procedures. Conclusion: DOPS not only facilitates skill development but also promotes confidence and competence in interns, preparing them for clinical practice. Overall, DOPS emerges as a valuable approach for evaluating and improving suturing skills among interns, contributing to their professional development as competent health-care practitioners.

393 Towards Sustainable Care Pathways: A Review of Outpatient Appointments for Elderly Patients Under Fast-Track Discharge from Surgical Specialties

393 Towards Sustainable Care Pathways: A Review of Outpatient Appointments for Elderly Patients Under Fast-Track Discharge from Surgical Specialties

Augmented Reality (AR) in Surgery in Low- and Middle-Income Countries (LMICs): A Scoping Review.

Surgical disparities persist in low- and middle-income countries (LMICs). Insufficient access to surgical care places a large burden on these regions, with high mortality rates for otherwise standard procedures performed in high-income countries (HICs). Augmented Reality (AR) and Virtual Reality (VR) now provide us with a platform to improve the delivery of surgical access and training to LMICs. The use of AR technologies to provide additional training to surgeons and residents globally can help bridge the gap and reduce health disparities in LMICs. The goal of this scoping review is to evaluate whether surgical trainees and surgeons from LMICs have access to or use AR software in their training or practice. A systematic search was conducted on seven databases. Inclusion criteria included populations in LMICs with access to AR-based training. Articles using VR software, or those conducted in HICs were excluded from the review. From the 428 records screened, 58 reports were assessed for eligibility, and of these, a total of six studies were included in the review. Five of the six studies used mentors from an HIC, including the United States (US) and the United Kingdom (UK), whereas one study had mentorship from another LMIC. Three surgical specialties were explored: neurosurgery, plastic surgery, and urology. Although the integration of AR in surgical training is promising, the six studies evaluated in this review emphasize that costs and connection issues are major challenges that can set back these technologies in the operating room. Despite these revelations, with certain improvements, AR training programs are promising as they can help to reduce the global disparity in surgical proficiency.

Educating Our Future Medical Leaders: An Innovative Longitudinal Course Across Surgical and Medical Specialties in Graduate Education.

Increasing healthcare system complexity, multidisciplinary care delivery, and the need to deliver high-quality, cost-effective care drive a critical need for leadership development. Currently, few examples of multidisciplinary leadership development exist in the medical education literature. The Accreditation Council for Graduate Medical Education (ACGME) has identified leadership domains as essential milestones in residency education, encompassing areas such as interpersonal communication, quality improvement, and systems-based practice. Presently, published GME leadership curricula vary widely in content, delivery, and duration and rarely include multispecialty cohorts. The study authors designed and implemented a longitudinal leadership curriculum for a multispecialty cohort of senior residents and fellows from multiple hospitals within a large integrated GME program. Between July 2022-June 2023, authors delivered 12 monthly sessions on core leadership concepts. Sessions delivered relevant work-based content via large-group didactics with embedded opportunities for small-group interactive experiential and reflective practice, critical thinking, and application. Thirty GME trainees participated in the longitudinal curriculum. Interval pre-/post-session assessments demonstrated significant improvement in composite scores for 6 of 9 sessions assessed. Participants rated each module's overall importance, applicability, and acceptability highly on a summative program evaluation. This longitudinal leadership curriculum adheres to best leadership development practices, demonstrates improvement in knowledge and self-reported attitudes and behaviors related to cognitive, character, and emotional leadership domains, and develops a psychologically safe community of practice for GME participants.

Evaluation of Two Readings for the QuicGM Aspergillus Lateral Flow Assay in a Group of Immunocompromised Patients in Iraq

Background: Aspergillus spp. causes a wide range of diseases called Invasive Aspergillosis (IA) which is a fatal illness that affects a variety of immunocompromised people worldwide. Objective: Using the lateral flow test for the detection of Galactomannan antigen in immunocompromised patients suspected to have IA. Patients and Methods: This study was conducted on 72 patients, whose samples (serum, Bronchoalveolar lavage, Blood) were collected from the Hematology-Oncology Unit at Baghdad Teaching Hospital and Pediatric Welfare Hospital, and ICU in Ghazi AL-Hariri Surgical Specialties Hospital, and Bone Marrow Transplantation Center in period between November 2022 to February 2023. Patients’ blood and sputum were sent for fungal culture to confirm the diagnosis in most cases. Results: QuicGM Aspergillus Lateral Flow Assay was conducted on 72 patients, of whom 34 () were positive and 38 (52.7) were negative (P-value of 0.001 and 0.5) respectively. This screening aimed at detecting IA. One week later, the second confirmative result was obtained from 24 patients to determine the response to antifungal drugs or recovery from neutropenia on which 15 readings were negative and nine were positive. Out of 48 single readings, 25 were positive and 23 were negative. All for 72 members of the control group gave negative results. This study is the first in Iraq to use this assay. Conclusion: QuicGM Aspergillus Lateral Flow Assay was found to be reliable, sensitive, and specific, and proved to be a very good guide for the early diagnosis of IA in immunocompromised patients and in monitoring treatment outcomes and follow-up.