Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.
Asia ; Chemoradiotherapy ; Chemoradiotherapy, Adjuvant ; Europe ; Humans ; Neoadjuvant Therapy ; North America ; Prognosis ; Recurrence ; Stomach Neoplasms

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.

Purpose: It is important for emergency physicians to be able to evaluate and manage pediatric respiratory distress, which is rare in general emergency departments. Despite this importance, the emergency departments show inconsistency in pediatric readiness, while emergency medicine (EM) residents express discomfort in caring for critically ill children due to limited exposure during their residency training. The purpose of this study was to meet this educational need by developing and implementing a curriculum to prepare EM residents to provide safe care for pediatric respiratory distress. Methods: We prospectively assessed 20 senior EM residents after undergoing a 3-hour simulation-based curriculum at Indiana University School of Medicine. The curriculum was developed using the Kern’s methodology by content experts. Pre- and post-curriculum confidence, knowledge, competency, and situational awareness were assessed using the 5-point Likert scale, multiple-choice questions, checklists of a pediatric acute respiratory distress scenario, and a novel modified video version of the situational awareness global assessment technique, respectively. Results: From the pre- to post-intervention phases, the confidence improved from 3.2 ± 0.4 to 3.9 ± 0.2 on the Likert scale (P < 0.001). The knowledge improved from 50.3% ± 12.9% to 75.3% ± 10.6% on the multiple-choice questions (P < 0.001). The competency improved from 46.8% ± 16.0% to 73.6% ± 10.6% (P < 0.001) with significant improvements in 7 of the 14 checklist items. The situational awareness raised both data perception (P < 0.001) and comprehension (P = 0.004) with no significant improvements in data extrapolation (P = 0.120). Conclusion Preliminary findings suggest that a 3-hour simulation-based curriculum for EM residents, including implementation of a novel situational awareness assessment tool, can improve learner’s confidence, knowledge, competency, and situational awareness of pediatric respiratory distress.