Common surgical training program: standardization of learning quality.

A global assessment tool for evaluation of intraoperative laparoscopic skills

BackgroundTraining programs such as the fundamentals of laparoscopic surgery (FLS) that are based on simulation are being currently used in several western countries. FLS allows skill acquisition and evaluation of competency in laparoscopic surgery. On the practical side, evaluation is determined by the MISTELS metrics (MISTELS is the acronym for the McGill inanimate system for training and evaluation of laparoscopic skills).This training program may be modified so that it can be implemented in countries with limited resources using a low-cost trainer box. Would the use of a low-cost trainer box alter the reliability of the MISTELS score?Objective of studyThe aim of the study was to evaluate the reliability of a modified MISTELS using a low-cost trainer box.MethodsIt was a prospective study carried out at Habib Thameur hospital in Tunis (Tunisia), between April 2016 and August 2016. The study involved residents from different surgical specialties in the departments of general surgery and paediatric surgery of the hospital during 2015 and 2016.This study assessed the reliability of a modified MISTELS system (Only three tasks were performed out of the five tasks used in the original MISTELS system). Evaluation was based on Cronbach’s alpha and intraclass correlation coefficients (ICC).A low-cost trainer box was designed and constructed. The residents included in the study performed three series of three tasks using this trainer box. The first series was scored by two trained raters to evaluate inter-rater reliability. The two-other series were successively performed to evaluate test-retest reliability.ResultsThe internal consistency, assessed by Cronbach’s alpha, was at 0.929 which is an acceptable score. As for inter-rater and test-retest reliabilities that were assessed by ICCs, they yielded excellent scores that were at 1 and 0.95 (95% CI, 0.891–0.978) respectively.ConclusionsThe reliability of a modified MISTELS is not altered by the use of a low-cost trainer box. The score of the modified MISTELS is a reliable score for evaluating technical skills of surgical residents using a low-cost trainer box.

Objective:To describe a new simulator, SurgicalSIM LTS, and summarize our preliminary experience with system.Methods:LTS was evaluated in 3 studies: (1) 124 participants from 3 Canadian universities: 13 students; 30 residents, fellows, attendings from surgery; 59 gynecologists; 22 urologists were classified based on laparoscopic experience as novice, intermediate, competent, or expert. All were tested on the LTS. Seventy-four were tested on the LTS and MISTELS (McGill Inanimate System for Training and Evaluation of Laparoscopic Skills). Participants completed a satisfaction questionnaire. (2) Twenty-five international gynecologists in-training at Kiel Gynaecologic Endoscopy Center, and 15 students from the center pretested on LTS underwent voluntary additional trials and posttesting. (3) Seventeen experienced laparoscopic surgeons from 3 specialties were recruited to perform on randomly assigned simulators involving 5 commercial, computer-based systems. The surgeons practiced repetitively for 1.5 days. Efficient, error-free performance was measured and proficiency score formulas were developed.Results:Study A: LTS showed a good correlation with level of experience (P=0.000) and MISTELS (0.79). Satisfaction: LTS vs MISTELS 79.9 vs 70.4 (P=0.012). Study B: Posttest scores were significantly better in all tasks for both groups, P<0.0001. Group mean scores with ≤5 trials were significantly better than with 2 or 3 trials (P<0.012, P<0.018). Study C: LTS had the highest effectiveness rating of the 5 simulators.Conclusions:A new computerized physical reality simulator can be used to assess/train laparoscopic technical skills.

The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) consists of a series of five laparoscopic exercises performed in an endotrainer box. MISTELS has been validated for use in both training and evaluation of general surgery residents in fundamental laparoscopic skills. The purpose of this study was to demonstrate the construct validity of MISTELS for urology residents. Seventeen participants were evaluated during performance of the five MISTELS tasks (peg transfer, pattern cutting, ligating loop, and suturing with extracorporeal and intracorporeal knots) using the standardized scoring system, which rewards both speed and precision. Participants included 13 urology residents (PGY 1-5), 1 fellow, and 3 urologists experienced in laparoscopy. Results are expressed as median (range). The Mann-Whitney U-test was used to compare MISTELS scores for 9 novice (PGY 1-4) and 8 experienced urologists (PGY 5-attending). P < 0.05 was considered statistically significant. The median MISTELS total normalized score for novices was 52.3 (range 15-68.9) compared with 71.7 (range 56.3-82.9) for experienced urologists (P = 0.007). Although the experienced group achieved higher scores in all five individual tasks, statistically significant differences were demonstrated for the peg transfer and intracorporeal suture tasks only. These data provide evidence for construct validity of the MISTELS system for urology residents.

Construction and Validation of a Low-Cost Laparoscopic Simulator for Surgical Education

The national interests of the state are to ensure socio-economic development based on the efficient and rational use, protection and reproduction of land resources in the production of organic products, as well as maintaining a healthy environment. This determines the urgency of harmonizing national policies in the field of reorganization, modernization and development sectors of the economy, and in the provision of services with policies on environmental protection, rational use of natural resources, public health, the formation and use of mechanisms to address these problems, taking into account the situation and the laws of a market economy. This article examines the process of agricultural production taking into account environmental factors and ensuring the rational use of land resources. The importance of soil quality indicators, as well as their impact on land use of agricultural enterprises for the production of organic products is substantiated. The optimal ecological strategy is recommended for most agricultural enterprises of Ukraine. The processes of development of organic food products in Ukraine were considered, as well as the essence and meaning of the concept of “organic products”. The expediency of organic production is proved and the factors of influence of organic products on society are considered. An effective way to improve the condition of soils and lands, increase their fertility in the future. The importance of crop rotations for improving the efficiency and fertility of land resources of Ukraine has been established. Purpose. Creating a market for organic products and proposals for the rational use of land resources. Results. The essence and concept of organic products are revealed. The process of agricultural production is studied taking into account environmental factors and ensuring the rational use of land resources. The importance of soil quality indicators, as well as their impact on land use of agricultural enterprises for the production of organic products is substantiated. The optimal ecological strategy is recommended for most agricultural enterprises of Ukraine. The expediency of organic production is proved and the factors of influence of organic products on society are considered. Proposals for improving the efficiency of land use, improving the condition of soils and lands, increasing their fertility in the future. The national interests of the state are revealed, which are to ensure socio-economic development based on efficient and rational use, protection and reproduction of land resources in the process of organic production, as well as maintaining a healthy environment. Conclusions. The urgency of creating a market for organic products and improving the efficiency of land use and creating sustainable systems of organic production that contribute to the preservation of ecosystems and gradually improve soil quality, which is an integral part of environmental and economic policy, which ensures rational use, protection and management of land resources , is important. In this context, the organization of rational and efficient land use includes creating the best conditions for organic production, reproduction and protection of soil fertility, increasing its role in agricultural production, scientifically sound interaction of soils with other natural factors, ensuring the development of the most complete and correct criteria, methods and techniques. Scientifically substantiated alternation of crops and vapors in time and territory or only in time (rotation) in advance according to a defined plan, and is accompanied by an appropriate tillage system. Thanks to the crop rotation system – a systematic increase in yield, provides the largest production of agricultural products per unit area with the lowest financial costs and labor, and ensures the rational use of land resources in the production of organic products.

The article discusses methodological approaches to modeling and forecasting the rational use of land resources and the use of geotechnologies. Modeling is performed using the concept of "digital twin" and specially developed criteria for the optimality of the rational land use system. The criteria are rea-sonable from the viewpoint of assessing the socio-economic condition of the territory in strategic planning, and environmental analysis. The criteria also correspond to the indicators that are used to assess the effectiveness of the cadastral system. Geotechnologies are used as a method of predictive modeling. The prototype of the system of rational use of land resources is proposed. The system con-sists of four subsystems: zoning and functional zoning; predictive modeling; long-term planning; monitoring of rational land use based on optimality criteria. The structure of the system of rational use of land resources has been developed, showing the relationship between subsystems and targets which are to be reached as the result of system operation. To assess the rational land use system, optimality criteria have been developed: the stability of the spatial structure to external influences; maximum in-volvement of land resources in economic use; value stability of the real estate object; compliance with regulatory requirements; indicators of the demographic situation; economic efficiency. The imple-mented structure of rational use system of land resources is the structure of the digital twin model for optimizing geosystem management processes. Based on the developed optimality criteria, more accu-rately fine-tuned model and cost-effective and environmentally sound management solutions are de-veloped.

Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. III.

The use of ERP systems is becoming an integral part of business information support and allows enterprises to rationalize the use of resources. The purpose of the article is an in-depth analysis of the use of ERP systems in the activities of enterprises, identification of the advantages and limitations of their practical application, which allow the development of ERP systems on the basis of technological, organizational and cognitive convergence to meet the changing needs of modern business. The study used the methods of case analysis, synthesis, and graphical visualization of information. The paper develops the applied aspect of certain areas of modern institutional economic theory, in particular the theory of evolutionary economics. Attention is focused on how the factor of technological progress affects the transformation of company management due to the principle of bounded rationality. The study summarizes the practice of using ERP systems and analyzes the relationship with the processes of convergence of information, communication, management, and cognitive technologies. The factors of rational use of resources based on ERP system data for four types of operating models of companies are identified. They are identified depending on the level of standardization and integration of business processes. Integration contributes to the rational use of resources through the automation of routine processes but requires several business units to use common practices for working with information in terms of its receipt, registration, storage, confidentiality, and distributed access. Standardization brings cost savings and efficiency by unifying and speeding up business processes but limits the ability to transform individual processes to adapt to rapid changes in the environment. The results of the study will help enterprises when implementing or transforming ERP systems to determine their desired configuration, in accordance with business needs, while maintaining the required level of adaptability of business processes. The results will also be useful for researchers conducting comprehensive studies of the impact of information technology on business operations. Technological advances mean that ERP systems continue to evolve and integrate with other technologies, such as artificial intelligence, the Internet of Things, and machine learning, to provide businesses with valuable context that transforms information into unique knowledge, which outlines the prospect for further research.

Development of a simulation minimally invasive surgery (MIS) training program in a curricula of pediatric surgery: A replicable experience

Purpose. The purpose of the article is the formation of theoretical principles of accounting in forestry enterprises on the challenges of the concept of sustainable development, in terms of defining the directions of improving the information support system of rational forestry for the purpose of preservation, reproduction and use of forest resources at the micro and macro levels of the economy. Results. Based on the results of the study, it is established that to ensure the functioning of domestic forestry enterprises on the principles of sustainable development, a necessary condition is to take into account economic, environmental and social goals in management. For this purpose, the directions of economic operations on forest use (harvesting and processing of forest products, reproduction of forest resources) are identified, which can be used as a basis for clarifying the composition of accounting objects specific to forest enterprises for further development of their organizational and methodological support. It is proved that forest resources and losses caused to the environment due to irrational forest use should be reflected in accounting, which will allow forming information support for forest resources management at the microeconomic level. Scientific novelty. The lack of a developed management mechanism that would ensure the conservation, reproduction and rational use of forest resources leads to the loss of national wealth. The evolution of the modern world market economy necessitates the interaction of society and nature, which is based on the postulates of the theory of sustainable development. For forestry, it is the observance of the balance of economic interests of the subjects of forest relations and the protection of forest resources. The above necessitated the delineation of areas for improving the information system of rational forest use in order to preserve, reproduce and use forest resources at the micro and macro levels of the economy. Practical value. The main results of the study can be used: at the microeconomic level (forestry enterprises) – to develop a management mechanism that would ensure the conservation, reproduction and rational use of forest resources; improvement of the system of information support of rational forest use in terms of development of organizational and methodological support of accounting of objects specific to forestry; at the macroeconomic level – to prevent the loss of a component of the country’s national wealth – forest resources; control over the availability and condition of forest resources, which is a component of economic security of the state.

The study was aimed at identifying the potential of modern methods of rational land use in the Karasai district of the Almaty region of Kazakhstan, taking into account their intensive degradation. The research methodology was represented by the methods of statistical observation, comparison, analytical-structural grouping and forecasting. The priority goals of modernisation of agriculture of the Republic in the technological aspect have been analysed. It was established that innovative approaches to land use have the potential to increase the level of efficiency of the agrarian sector, improve the state of local and regional landscape. The concept of improving the state of degraded lands, including a system of management measures and practical activities, has been developed. It was proved that it should be based on the synergy of economic efficiency and environmental safety, with the mandatory introduction of modern innovative technological approaches. The effectiveness of methods of rational use of degraded lands as an effective tool for the transformation of the agrarian sector has been determined. It was proposed to intensify the development of organic agricultural production, which is positioned as the gentlest for degraded landscapes. It was proved that the implementation of sustainable management of landscape complexes in the innovative context implies the use of information monitoring technology, which anticipates the diagnosis, genesis and forecasting of the state of the studied ecosystems. Such measures will make it possible to develop programmes for the restoration of ecological functions of natural landscapes, which is an integral part of sustainable development programmes. Actualised the situation in the context of ecologisation of land use in Kazakhstan, predicted further destruction of ecosystems of agrarian landscapes in case of use of aggressive methods of soil cultivation. The necessity of introduction of improved methods of rational land use is substantiated, and the specificity of the introduction of organic and biological technologies of agricultural production is outlined, with an indication of tangential risks and challenges in the economic realities of Kazakhstan. The study substantiated that the application of integrated management and ecosystem approach have a synergistic potential to ensure the rational use of land in the Almaty region, the Karasai district in the conditions of their degradation

Over the past 30 years, minimally invasive surgery (MIS) has revolutionized the practice of modern surgery and has become standard for the treatment of many surgical conditions. Multiple benefits of MIS compared to traditional open surgery are well documented including less induced surgical trauma and physiologic stress, reduced in-hospital length of stay, decreased postoperative pain, and faster functional recovery as well as improved cosmesis [1–4]. Decades of research examining the physiologic changes, clinical outcomes, and complications associated with MIS, along with major technological advances in optics and MIS instrumentation and surgical training, have led to near universal acceptance of MIS in all surgical specialties for both advanced elective and select emergency operations. For the acute care surgery (ACS) patient, MIS provides clear visualization of the thoracic cavity, the peritoneal space, and the anterior abdominal wall and, unlike other diagnostic modalities, has the potential benefit for therapeutic intervention while also decreasing rates of unnecessary nontherapeutic procedures. Despite these clear potential advantages, MIS has yet to achieve widespread acceptance within the ACS community. Debate continues to surround both the appropriate indications and applications of MIS in the acute emergency general surgery patient.

The purpose of this work is to study the theoretical and practical principles of enogastronomic tourism in the Odessa region, revealing the potential of Odessa region in promoting enogastronomic tours on the example of Bolgrad district of Odessa, using enogastronomic tourism as a tool to promote local products in rural areas by researching preferences and knowledge tourist complex "Frumushika-Nova", in the village of Frumushika-Nova, Bolgrad district, Odessa region. Priority areas of work are the development of rural areas by identifying enogastronomic brands in the study region, the disclosure and promotion of their potential. An important task is the development of a tourist destination by identifying consumer preferences and the development of gastronomic tours that acquaint with the peculiarities of local cuisine, food and beverages, ways to prepare them. Methodology. The methodological basis of scientific research is the method of questionnaires. The following general scientific methods were used to achieve the goal and solve certain tasks of scientific work: abstract-logical (to generalize theoretical positions, determine the essence of certain areas of work, draw conclusions); system analysis; graphic (for visual presentation of data); constructive and experimental. The theoretical and methodological basis of the study are scientific papers on the problem of domestic and foreign scientists, laws and regulations of Ukraine, methods of the World Tourism Organization, guidance materials governing the activities of economic entities, reference and information publications, Internet resources. Results. Conducted marketing research shows interest and expediency of promoting enogastronomic tours in the studied region. Based on the results of the work performed, proposals were developed for further development of eno-gastronomic routes in the direction of the tourist destination of the Bolgrad district of Odessa region. SWOT-analysis of the tourist potential of the Bolgrad district of Odessa region demonstrates the rational and efficient use of all resources of the region and requires long-term program measures, sound management decisions and effective practical actions and the feasibility of enogastronomic tourism.The scientific novelty of the study is to create and promote new enogastronomic routes on the basis of the Center for Ethnographic, Rural Green Tourism and Family Recreation "Frumushika-Nova", which will develop small businesses in rural areas through the tourism industry. The practical significance. The results can be used by local governments in the process of discussing and adjusting local policies, as well as developing programs, grant programs (strategies) of socio-economic development of rural areas, businessmen to organize wine and gastronomic tourism in Odessa region, which will attract many tourists. The measures proposed in the work should be aimed at the integrated development of tourism, ensuring the rational use of tourist resources of the region, as well as addressing the issues of infrastructure and information arrangement of tourist facilities.

The development of scientific ideas about the structure and content of the subject of environmental law, which includes environmental protection relations, ensuring the rational use of natural resources and environmental safety, requires a scientific assessment of the place of environmental safety in the system of environmental law and national security law. This requirement follows from the new nomenclature of scientific specialties, according to which public law regulation of environmental safety is included in scientific specialty 5.1.2. «Public law (state law) sciences». The need to develop ideas about environmental safety law as an academic discipline is also conditioned by the requirements in educational and professional standards that the relevant specialists should have knowledge, skills and professional competences in the field of ensuring environmental safety. Based on the achievements of legal science in the field of legal regulation of environmental safety, the author proposes a system of ideas about the relevant academic discipline. &nbsp;It is grounded on the understanding of environmental safety law as a system of legal norms regulating a homogeneous range of public relations arising in connection with the activities of authorised subjects to ensure the safety of man, society and the state. The academic discipline shall consist of a general and a special part. The general part contains a description of legal norms (institutions) that regulate the majority of specific public relations in the field of environmental safety. The special part includes a system of legal norms (legal institutions) regulating relations on ensuring environmental safety in the process of implementation of certain dangerous (creating threats to environmental safety) types of activities. Such a view of environmental safety law develops the understanding of environmental law, the system and structure of Russian law, and allows solving applied problems about the content of training in the field of environmental safety not only for lawyers, but also for specialists whose activities are associated with the impact on the environment and ensuring national security.