The aim of this study was to determine the effect of male gender on the clinical presentation of symptomatic cholelithiasis. Laparoscopic cholecystectomy (LC) has been accepted as standard procedure for the management of symptomatic cholelithiasis even when the gallbladder is acutely inflamed. With the accumulated experience in the management of acute cholecystitis, some factors including male gender were recognized to influence the clinical presentation of symptomatic cholelithiasis and increase the conversion rate during LC. This retrospective study tried to clarify the correlation between male gender and the clinical presentation of symptomatic cholelithiasis. The medical records of all patients presenting with symptomatic cholelithiasis from January 1994 to August 1999 were evaluated. These cases were divided into four groups as follows: (1) elective LC group: patients with a history of biliary colic or acute attack of cholecystitis but whose LC was performed electively without any inflammatory change in the gallbladder during operation; (2) acute LC group: patients presenting with acute cholecystitis, and LC was performed successfully without conversion; (3) acute conversion group: patients who underwent LC during the course of acute cholecystitis but the procedure were disturbed by severe inflammatory change so they were converted to open surgery; (4) acute open group: patients whose acute cholecystitis was managed by direct open surgery due to the preoperative prediction that LC would not succeed. The correlation of gender, age, and operating time were assessed among these four groups. We found that: (1) the male/female ratio increased (in the patient group sequence of simple LC, acute LC, acute open, and acute conversion group); (2) in the acute LC group male patients had significantly (p = 0.04, t-test) longer operating time than females; (3) although there was no significant difference between the mean age of male (55.7 +/- 13.4) and female (56.3 +/- 15.7) patients in the acute cholecystitis groups (i.e., all patients in the acute LC, acute conversion, and acute open groups), the distribution curve by age in male patients showed a significantly shift to a younger age compared with female patients (p = 0.009, Fisher's exact test).

Only 68% of patients with LC-associated MBDI who underwent reconstructive surgery at our institution had long-term success. A serum alkaline phosphatase level above 400 IU in the sixth postoperative month was predictive of nonsuccess. For better long-term results, repair should be performed by the referral surgeon at a stage without coexisting active inflammation.

ObjectiveSimulation technology has been integrated into team resource management (TRM) training in many hospitals. We designed a simulation-based TRM training scenario (SBTRM) aiming to help post graduate year (PGY) physicians to fulfil the requirements of the entrustable professional activities 13 (EPA 13). In this study, we investigate and report the SBTRM effectiveness.MethodsA total of 61 physicians received the SBTRM from March to November 2017. The SBTRM covers the core contents of teamwork skills. The trainees were evaluated with qualified clinical instructors after SBTRM training. The evaluation form is a 15-item questionnaire that evaluates the communication, situation monitoring, attitudes and clinical treatment of trainee behaviour.ResultsA total of 75% of trainees agreed that the simulation is close to the usual care behaviour and helpful in thinking about changes in the surrounding conditions. More than 80% of trainees can actively communicate the care process; 82% of trainees can provide appropriate clinical treatment for patients. We found that physicians did not pay enough attention to the definition of ‘nursing work’. 75% of the overall performance of teamwork and patient safety reached only ‘good’ level.ConclusionsCurrent medical education is increasingly using simulation to learn teamwork skills, with the hope that trainees use systematic thinking to carry out the care process. In this study, we designed a SBTRM and evaluation form that meets the requirements of EPA 13 for trainees. This training should improve physicians’ safety awareness in the first post-graduate year.