Boot camps were shown as an effective educational strategy to improve learners' clinical skills, knowledge, and confidence. Focus on pretest/posttest research designs limits the strength of these findings.

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Subsequent intervention after the initial treatment of achalasia is common. Although the risk of subsequent interventions among persons treated with surgical myotomy in typical practice settings is higher than previously thought, the risk of subsequent intervention is greater among persons treated with pneumatic dilatation than with surgical myotomy. This difference is attributable to the use of subsequent pneumatic dilatation rather than surgical procedures.

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BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct‐current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation‐based laparoscopic surgical skill acquisition.MethodsIn this double‐blind, sham‐controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation‐based training. Primary outcomes of laparoscopic pattern‐cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent‐to‐treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern‐cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non‐simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).

BackgroundControversy exists about the most appropriate treatment for high-risk superficial (stage T1; grade G3) bladder cancer. Immediate cystectomy offers the best chance for survival but may be associated with an impaired quality of life compared with conservative therapy. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) for both of these treatments for men and women of different ages and comorbidity levels.Methods and FindingsWe evaluated two treatment strategies for high-risk, T1G3 bladder cancer using a decision-analytic Markov model: (1) Immediate cystectomy with neobladder creation versus (2) conservative management with intravesical bacillus Calmette-Guérin (BCG) and delayed cystectomy in individuals with resistant or progressive disease. Probabilities and utilities were derived from published literature where available, and otherwise from expert opinion. Extensive sensitivity analyses were conducted to identify variables most likely to influence the decision. Structural sensitivity analyses modifying the base case definition and the triggers for cystectomy in the conservative therapy arm were also explored. Probabilistic sensitivity analysis was used to assess the joint uncertainty of all variables simultaneously and the uncertainty in the base case results. External validation of model outputs was performed by comparing model-predicted survival rates with independent published literature. The mean LE of a 60-y-old male was 14.3 y for immediate cystectomy and 13.6 y with conservative management. With the addition of utilities, the immediate cystectomy strategy yielded a mean QALE of 12.32 y and remained preferred over conservative therapy by 0.35 y. Worsening patient comorbidity diminished the benefit of early cystectomy but altered the LE-based preferred treatment only for patients over age 70 y and the QALE-based preferred treatment for patients over age 65 y. Sensitivity analyses revealed that patients over the age of 70 y or those strongly averse to loss of sexual function, gastrointestinal dysfunction, or life without a bladder have a higher QALE with conservative therapy. The results of structural or probabilistic sensitivity analyses did not change the preferred treatment option. Model-predicted overall and disease-specific survival rates were similar to those reported in published studies, suggesting external validity.ConclusionsOur model is, to our knowledge, the first of its kind in bladder cancer, and demonstrated that younger patients with high-risk T1G3 bladder had a higher LE and QALE with immediate cystectomy. The decision to pursue immediate cystectomy versus conservative therapy should be based on discussions that consider patient age, comorbid status, and an individual's preference for particular postcystectomy health states. Patients over the age of 70 y or those who place high value on sexual function, gastrointestinal function, or bladder preservation may benefit from a more conservative initial therapeutic approach.

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Partially fluorinated poly(vinyl ether)s with C4F9 and C6F12H groups in the side chain were synthesized via living cationic polymerization in the presence of an added base in a fluorine‐containing solvent, dichloropentafluoropropanes. For comparison, the polymerization of vinyl ether monomers with C2F5 and C6F13 groups and nonfluorinated monomers were also carried out. The characterization of the product polymers using size exclusion chromatography with a fluorinated solvent as an eluent indicated that all polymers had narrow molecular weight distributions (Mw/Mn ∼ 1.1). Interestingly, the moderately fluorinated polymers with C4F9 exhibited upper critical solution temperature‐type phase separation in various organic solvents with wide‐ranging polarities, whereas highly fluorinated polymers with C6F13 are insoluble in nonfluorinated solvents. Polymers with C4F9 groups exhibited temperature dependent solubility transitions not only in common organic solvents (e.g., toluene, chloroform, tetrahydrofuran, and acetone) but also in perfluoro solvents [e.g., perfluoro(methylcyclohexane) and perfluorodecalin]. On the other hand, the solubility of polymers with C6F12H showed completely different from that of polymers with C6F13, despite their similar fluorine content. In addition, various types of fluorinated block copolymers were prepared in a living manner. The block copolymers with a thermosensitive fluorinated segment underwent temperature‐induced micellization and sol–gel transition in various organic solvents. © 2011 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2011