Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review I njuries to the liver, extrahepatic biliary tree and pancreas (i.e., the "surgical soul") are often deadly and always challenging. These scenarios will engage all of your senses, test your skills, and demand great teamwork from you and your colleagues. In an effort to offer a continuing medical education review of this topic that consolidates the current published advice on treating hepato-pancreato-biliary (HPB) injuries, we performed a narrative scoping analysis of the literature. Our literature search protocol was developed according to recommendations for designing scoping reviews. 1 Three independent investigators searched MEDLINE, EMBASE, PubMed, Web of Science, Scopus and the Cochrane Library (English language) from their inception dates through to May 1, 2019, without restrictions. Disagreements were resolved by consensus. Literature on bile duct injuries during elective/ emergency cholecystectomy and/or pediatric trauma was excluded. The grey literature (conference abstracts (1988-2019) of the American Association for the Surgery of Trauma, Australasian Trauma Society, Eastern Association for the Surgery of Trauma, Trauma Association of Canada, Western Trauma Association, and 24 textbook chapters) was also searched for discussions not reported in peer-reviewed articles. General results Of the 8438 citations identified, 183 (11.6%) unique articles focused on HPB trauma were included in the scoping review. Agreement among investigators regarding selection of abstracts for full-text review (k-statistic 0.91, 95% confidence interval [CI] 0.88-0.94) and inclusion of articles in the scoping review (k-statistic 0.90, 95% CI 0.89-0.92) was excellent.

Background: Mental toughness is crucial to high-level performance in stressful situations. However, there is no formal evaluation or training in mental toughness in surgery. Our objective was to examine differences in mental toughness between staff and resident surgeons, and whether there is an interest in improving this attribute. Methods: We distributed a survey containing the Mental Toughness Index (domains of self-belief, attention regulation, emotion regulation, success mindset, context knowledge, buoyancy, optimism and adversity capacity) among general surgery residents and staff at 3 Canadian academic institutions. Responses were recorded on a 7-point Likert scale. Participants were also asked about techniques they used to help them perform under pressure and interest in further developing mental toughness. Results: Eighty-three of 193 surgeons participated: 56/105 (52.8%) residents and 27/87 (31.0%) staff. The average age was 29 (standard deviation 5) years and 42 (standard deviation 8) years, respectively. Residents scored significantly lower than staff in all mental toughness domains. Men scored significantly higher than women in attention regulation and emotion regulation. Age, staff experience and resident postgraduate year were not significantly associated with mental toughness scores. Twenty residents (36%) and 17 staff (63%) reported using specific techniques to deal with stressful situations; 49 (88%) and 15 (56%), respectively, were interested in further developing mental toughness. Conclusion: Staff surgeons scored significantly higher than residents in all mental toughness domains measured. Both groups expressed a desire to improve mental toughness. There are many techniques to improve mental toughness, and further research is needed to assess their effectiveness in surgical training. Contexte : La force mentale est indispensable à un rendement de haut niveau en situation de stress. Par contre, il n'existe pas de méthode d'évaluation formelle ni de formation pour promouvoir la force mentale en chirurgie. Notre objectif était de comparer la force mentale des chirurgiens en poste à celle des résidents, et de vérifier si l'amélioration de cette compétence suscite l'intérêt. Méthodes : Nous avons distribué un questionnaire sur les divers domaines qui constituent l'indice de force mentale (confiance en soi, régulation de l'attention et des émotions, attitude gagnante, connaissances du contexte, dynamisme, optimisme et résistance à l'adversité) aux résidents et aux chirurgiens en poste en chirurgie générale dans 3 établissements universitaires canadiens. Les réponses étaient consignées sur une échelle de Likert en 7 points. Les participants ont aussi été interrogés sur les techniques qu'ils utilisent pour mieux composer avec la pression et sur leur intérêt pour l'acquisition d'une plus grande force mentale. Résultats : Quatre-vingt-trois chirurgiens sur 193 ont participé : 56/105 (52,8 %) résidents et 27/87 (31,0 %) chirurgiens en poste. L'âge moyen était de 29 ans (écarttype 5) et de 42 ans (écart-t...