Validity of a cross‐specialty test in basic laparoscopic techniques (TABLT)

Background:Simulation is the most effective and safe way to train laparoscopic surgeons in an era of limited work hours, lack of funding, and increasing malpractice costs. However, the costs associated with the use of virtual reality simulators are significant, and although very technically sophisticated they still lack tactile feedback. We are proposing a physical reality simulator, the LTS 2000, as a reliable and effective alternative to virtual reality. This study was carried out to establish how reliably the simulator was able to differentiate between different levels of laparoscopic experience and to analyze the detection of skills improvement after simulation and clinical training.Methods:This study was carried out, between July 2002 and August 2003, in the departments of Surgery and Obstetrics and Gynecology at 2 separate institutions. We enrolled 40 individuals in the study who had experience ranging from postgraduate year-1 to full-time faculty level. Five postgraduate year-3 residents were subsequently retested after rotating on clinical services, performing advanced laparoscopic procedures to assess whether the simulator was sensitive enough to detect improvements in laparoscopic skills at the intermediate level. Six tasks were included in the test, and they were scored for speed and precision with the McGill system. Two scores were obtained: a coordination score and a suturing score combined in a total score. Other variables analyzed were handedness, specialty, number of laparoscopic procedures performed, and hours spent on the simulator.Results:Forty-five tests were performed. The number of subjects in each group based on level of experience was equally distributed. No difference occurred in scores between institutions, specialty, and right- or left-handed surgeons. A significant increase occurred in the coordination score and suturing score combined in the total score with increasing experience (P<0.05) at each level. Furthermore, the simulator was sensitive enough to detect a significant difference in all 3 scores between subjects who had practiced with the simulator before being tested (P<0.05). The scores of the 5 postgraduate year-3 participants doubled when tested, without reaching statistical significance due to the small sample size.Conclusions:Our study shows that the LTS 2000 reliably and reproducibly detects different levels of laparoscopic expertise and progression of the learning curve. LTS 2000 as a model of physical reality simulation should be considered a reliable alternative to virtual reality simulation.

Recent reports indicate that there is a trend toward the use of models and simulators to teach basic orthopaedic operative skills. We describe a high-fidelity model for teaching basic orthopaedic fracture manipulation. A model of a distal radial fracture was developed and validated by orthopaedic surgeons with different levels of experience, who examined and manipulated the model and then completed a structured questionnaire. The participants mostly agreed (designated as 4 in the questionnaire) that the model performed well on the degree to which the manipulation represented real life. The participants agreed (designated as 5 in the questionnaire) that the model scored high on the appearance and feel of the fracture and its ability to be used as a teaching tool. There was no difference between perceptions of participants with regard to different levels of occupational experience or model use. We believe that this model could be used to teach the skill of closed reduction of a distal radial fracture in the preclinical setting.

Veterinary professionals experience higher psychological distress and lower wellbeing compared with the general population. Identifying workplace stressors is key to understanding and alleviating these difficulties. Identify the severity of workplace stressors in veterinary professions across different levels of professional experience. A cross-sectional quantitative design was utilised via administration of a veterinary stressor questionnaire that measured the severity of 93 generic and veterinary-specific workplace stressors. A total of 658 participants reported stressor severity score. Factor analysis revealed four main stressor categories: workload and job demands, client relations stress, performance and accountability, patient care challenges. An inverse relationship was found between experience level and stressor severity scores. Furthermore, the most severe stressors varied as a function of career stage. Stressor severity tends to decrease with increasing experience levels. Stressors can be categorised by theme and unique stressor profiles can be derived for practitioners according to experience level. This knowledge can assist in the design and delivery of workplace support initiatives. Identify key stressors across different levels of experience is important in focusing efforts to support people in the workplace.

The purpose of this article is to compare transrectal ultrasound (TRUS) biopsy accuracies of operators with different levels of prostate MRI experience using cognitive registration versus MRI-TRUS fusion to assess the preferred method of TRUS prostate biopsy for MRI-identified lesions. SUBJECTS AND METHODS; One hundred patients from a prospective prostate MRI-TRUS fusion biopsy study were reviewed to identify all patients with clinically significant prostate adenocarcinoma (PCA) detected on MRI-targeted biopsy. Twenty-five PCA tumors were incorporated into a validated TRUS prostate biopsy simulator. Three prostate biopsy experts, each with different levels of experience in prostate MRI and MRI-TRUS fusion biopsy, performed a total of 225 simulated targeted biopsies on the MRI lesions as well as regional biopsy targets. Simulated biopsies performed using cognitive registration with 2D TRUS and 3D TRUS were compared with biopsies performed under MRI-TRUS fusion. Two-dimensional and 3D TRUS sampled only 48% and 45% of clinically significant PCA MRI lesions, respectively, compared with 100% with MRI-TRUS fusion. Lesion sampling accuracy did not statistically significantly vary according to operator experience or tumor volume. MRI-TRUS fusion-naïve operators showed consistent errors in targeting of the apex, midgland, and anterior targets, suggesting that there is biased error in cognitive registration. The MRI-TRUS fusion expert correctly targeted the prostate apex; however, his midgland and anterior mistargeting was similar to that of the less-experienced operators. MRI-targeted TRUS-guided prostate biopsy using cognitive registration appears to be inferior to MRI-TRUS fusion, with fewer than 50% of clinically significant PCA lesions successfully sampled. No statistically significant difference in biopsy accuracy was seen according to operator experience with prostate MRI or MRI-TRUS fusion.

Reliability and reproducibility analysis of the AOSpine Sacral Fractures Classification System by spinal and pelvic surgeons

BackgroundThe clinical outcome of hip resurfacing (HR) as a demanding surgical technique associated with a substantial learning curve depends on the position of the femoral component. The aim of the study was to investigate the effects of the level of surgical experience on computer-assisted imageless navigation concerning precision of femoral component positioning, notching, and oversizing rate, as well as operative time.MethodsThree surgeons with different levels of experience in both HR and computer-assisted surgery (CAS) prepared the femoral heads of 54 synthetic femurs using the DuromTM Hip Resurfacing (Zimmer, Warsaw, IN, USA) system. Each surgeon prepared a total of 18 proximal femurs using the Navitrack® system (ORTHOsoft Inc., Montreal, Canada) or the conventional free-hand DuromTM K-wire positioning jig. The differences between planned and postoperative stem shaft angle (SSA) and anteversion angle in standardized x-rays were measured and the operative time, not including the time for calibrating the CAS-system, was documented. Notching was evaluated by the three surgeons in a randomized manner. Oversizing was determined by the difference of the preoperative determined cap and the cap size advised by the CAS-system.ResultsCAS significantly reduced the overall mean deviation between planned and postoperative SSA in comparison with the conventional procedure (mean ± SD, 1 ± 1.7° vs. 7.4 ± 4.4°, P <0.01) regardless of the surgeon’s level of experience. The incidence of either varus or valgus SSA deviations exceeding 5° were 1/27 for CAS and 15/27 for the conventional method, respectively (P <0.001), corresponding to a reduction by 97%. Using CAS, the rate of notching was reduced by 100%.ConclusionsThe accuracy of femoral HR component orientation is significantly increased by use of CAS regardless of the surgeon’s level of experience in our preclinical study. Thus, imageless computer-assisted navigation can be a valuable tool to improve implant positioning in HR for surgeons at any stage of their learning curve.

INTEREXAMINER RELIABILITY OF TRANSRECTAL ULTRASOUND FOR ESTIMATING PROSTATE VOLUME

Humans differ in how they perceive, assess, and measure animal behaviour. This is problematic because strong observer bias can reduce statistical power, accuracy of scientific inference, and in the worst cases, lead to spurious results. Unfortunately, reports and studies of measurement reliability in animal behaviour studies are rare. Here, we investigated two aspects of measurement reliability in working dogs: inter‐observer agreement and criterion validity (comparing novice ratings with those given by experts). Here, we extend for the first time a powerful framework used in human psychological studies to investigate three potential aspects of (dis)agreement in nonhuman animal behaviour research: (a) that some behaviours are easier to observe than others; (b) that some subjects are easier to observe than others; and (c) that observers with different levels of experience with the subject animal give the same or different ratings. We found that novice observers with the same level of experience agreed upon measures of a wide range of behaviours. We found no evidence that age of the dogs affected agreement between these same novice observers. However, when observers with different levels of experience (i.e., novices vs. a working dog expert) assessed the same dogs, agreement appeared to be strongly affected by the measurement instrument used to assess behaviour. Given that animal behaviour research often utilizes different observers with different levels of experience, our results suggest that further tests of how different observers may measure behaviour in different ways are needed across a wider variety of organisms and measurement instruments.

Laparoscopic and robotic surgery is a challenge to the surgeon's hand–eye coordination ability, which requires constant practice. Traditional mentor training is gradually shifting to simulation training based on various models. Laparoscopic and robotic bilioenteric anastomosis is an important and difficult operation in hepatobiliary surgery. We constructed and optimized the reusable modular 3D-printed models of choledochal cyst. The aim of this study was to verify the ability of this optimized model to distinguish between surgeons with different levels of proficiency and the benefits of repeated practice. A total of 12 surgeons with different levels participated in the study. Operation completion time and OSATS score were recorded. The model was validated by Likert scale. Surgeons were shown the steps and contents before performing laparoscopic or robotic bilioenteric anastomosis using the model. Surgeons with different levels of experience showed different levels when performing laparoscopic bilioenteric anastomosis on this model. Repeated training can significantly shorten the time of laparoscopic bilioenteric anastomosis and improve the operation scores of surgeons with different levels of experience. At the same time, preliminary results have shown that the performance of surgeons on the domestic robotic platform was basically consistent with their laparoscopic skills. This model may distinguish surgeons with different levels of experience and may improve surgical skills through repeated practice. It is worth noting that in order to draw more reliable conclusions, more subjects should be collected and more experiments should be done in the future.

BackgroundRobotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation...

The purpose of this study was to examine the removal of the epithelium in the periodontal pocket using a diode (980 nm) laser in comparison with the conventional techniques in an animal experimental model. The goal of periodontal therapy is to reduce the bacterial deposits in the pockets and to enhance the clinical attachment. Different surgical techniques have been used in the past, which control the epithelial migration and promote the connective tissue formation. The buccal pockets of the posterior teeth in 10 freshly sacrificed adult pigs were scaled by three different examiners (with different levels of experience in periodontal surgery) using conventional curettes. The lingual pockets were treated using a diode (980 nm) laser. The laser was used in a continuous wave (c. w.) mode with two different power settings (2 and 4 Watts) with a 300-microm-thick glass fiber. The instrumentation period revealed 15 sec in all of the sites. Soft tissue biopsies of the instrumented sites were removed and examined histologically. In all of the lased sections, no epithelial remnants were found. The laser with a low power was able to remove the thin pocket epithelium in the same way regardless of the level of surgical experience of the examiner. A high-power setting presented significant damage to the underlying connective tissues. The sites, which were instrumented with the conventional curettes, demonstrated significant epithelial remnants in all of the tissues regardless of the level of periodontal surgical experience. The histological findings presented in this study showed that instrumentation of the soft periodontal tissues with a diode laser (980 nm) leads to a complete epithelial removal in comparison to conventional treatment methods with hand instruments (independent of the clinician's experience).

Introduction:The introspective experience of cancer patients using mistletoe therapy has received little scientific interest, although it is crucial for a holistic understanding of this therapy. This study contributes to patient-centered research and treatment by documenting the subjective experiences of individuals undergoing mistletoe therapy.Methods:In this qualitative, explorative study, 20 outpatients with a history of various cancer types were recruited from Arlesheim Hospital (Arlesheim, Switzerland). All patients received subcutaneous mistletoe therapy for at least 2 years (median 7.5 years). Data was collected through 2 semi-structured, in-depth interviews per patient. Qualitative content analysis was applied to examine the data. The individual experience of mistletoe therapy was analyzed in relation to 6 predefined levels of human experience: physical, vital, emotional, mental, spiritual and social. In addition, 3 further aspects, considered as cross-dimensional perspectives, emerged out of the material: warmth, immune strengthening, and general wellbeing.Results:Data analysis revealed considerable heterogeneity among patients’ experiences with mistletoe therapy. The importance of specific aspects became apparent, such as increased vitality to manage daily life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, heightened self-awareness and improved self-care, as well as sensations of spiritual connectedness.Conclusions:Prior to this study it had not been shown that cancer patients using mistletoe therapy do have observations on different levels of experience. These results may lead to a deeper understanding of patients receiving mistletoe therapy, enabling them to be supported in a more holistic way both during mistletoe treatment and on their life path. Further investigations into the effects of mistletoe therapy on the emotional, mental, and spiritual level are warranted.

Nowadays, recommender systems have become a hot research area. It plays an important role in providing personalized information. Recent research has considered the evolution of consumer tastes over time. But these studies are all from the perspective of the community to study the evolution of the overall taste. As a matter of fact, because of the different personal experiences, each person's tastes will evolve in different ways. In this paper, we consider the evolution of tastes on a personal level. At the same time, we model the influence of conformity psychology. That is, to consider the impact of public ratings on consumers at different levels of experience. Finally, we proposed the Experience and Conformity Probability Decomposition (ec-MF) model and apply the model to three real data sets. Experiments show that our model achieves better results. Besides, We find that there is a close connection between the level of personal experience and the conformity mentality. There are also significant differences in rating behaviors among consumers at different experience levels.

2660 Bimanual Fundamentals: Validation of A New Virtual Reality Curriculum for Advanced Laparoscopic Skills Training

Úvod: Poran&#283;ní zvratného nervu je jedna znejzáva&#382;n&#283;j&#353;ích komplikací chirurgie &#353;títné &#382;lázy, chirurgie p&#345;í&#353;títných t&#283;lísek achirurgie kr&#269;ních obratl&#367;. Vliteratu&#345;e se popisuje poran&#283;ní zevní v&#283;tve hrtanových nerv&#367; jako mén&#283; &#269;asté. Tato komplikace je natolik vá&#382;ná, &#382;e m&#367;&#382;e vést kinvalidizaci hlasových profesionál&#367; (u&#269;itel&#367;, herc&#367;, zp&#283;vák&#367;, profesionálních &#345;e&#269;ník&#367; amana&#382;er&#367;). Sou&#269;asná klinická praxe je spojena se zvý&#353;eným úsilím operopera&#269;ní ochranu funkce zvratných nerv&#367; vyu&#382;íváním elektrofyziologické monitorace funkce inervace hrtanu asou&#269;asné vizualizace zvratných nerv&#367;. Metody: Design studie je prospektivní observa&#269;ní. Ze souboru 100 po sob&#283; jdoucích operací byly chirurgy náhodn&#283; vytvo&#345;eny dv&#283; skupiny: Skupina A- spou&#382;itím neuromonitoringu (IONM) askupina B - identifikace avizualizace zvratného nervu (NLR) bez IONM. Jeden tým chirurg&#367; byl slo&#382;en zexperta (více ne&#382; 1000 provedených operací) aza&#269;ínajícího chirurga (mén&#283; ne&#382; 100 operací) adruhý ze dvou zku&#353;ených chirurg&#367; (jeden více ne&#382; 150 operací adruhý více ne&#382; 500 operací). Ka&#382;dý tým byl zapojen do operací n&#283;kolikrát vtýdnu. Porovnání bylo provedeno statistickými metodami apomocí indexu poran&#283;ní zvratného nervu (recurrent nerve injury - IRI). Cílem studie je porovnat incidenci parézy zvratných nerv&#367; p&#345;i vyu&#382;ití neuromonitorace (IONM) avyu&#382;ití peropera&#269;ní vizualizace anatomicky neporan&#283;ného nervu dv&#283;ma týmy chirurg&#367;. Výsledky: Bylo analyzováno 100 operací, respektive 50 operací ve skupin&#283; Aa50 ve skupin&#283; B. Skupina Azahrnovala 43 totálních thyreoidektomií a7 hemithyreoidektomií abyly zji&#353;t&#283;ny dv&#283; do&#269;asné jednostranné parézy. Skupina Am&#283;la IRI=1,075. Skupina B zahrnovala 48 totálních thyreoidektomií a2 hemithyreoidektomie. Vtéto skupin&#283; byly zji&#353;t&#283;na také dv&#283; jednostranné do&#269;asné parézy zvratného nervu. Skupina B m&#283;la IRI=1,02. Uvedené hodnoty IRI tak charakterizují asymetrické soubory, itato drobná asymetrie je ve výsledku hodnoty patrna. Celková incidence poran&#283;ní zvratných nerv&#367; vcelém souboru operovaných sledovaného roku, ve kterém byl výb&#283;r pacient&#367; dle metodiky této práce, byla 1,3%. Vsouboru bylo 16 do&#269;asných a4 permanentní parézy zvratného nervu ve v&#353;ech p&#345;ípadech na jedné stran&#283;. Vesledovaném období nebyla zji&#353;t&#283;na ani jediná oboustranná paréza trvalá ani do&#269;asná. Index IRI pro operace &#353;títné &#382;lázy vuvedeném období byl 2,26. Tento soubor byl srovnáván se soubory skupiny Aaskupiny B avýsledky nevykazují statisticky významné rozdíly na hladin&#283; významnosti 1% (p=0,01). Záv&#283;r: Studie neprokázala statisticky významné rozdíly incidence poran&#283;ní zvratného nervu (trvalá jednostranná paréza) vzávislosti na chirurgické technice bez vyu&#382;ití IONM asvyu&#382;itím IONM provád&#283;ných chirurgem srozdílnou zku&#353;eností vchirurgii &#353;títné &#382;lázy. Studie prokázala, &#382;e IONM m&#367;&#382;e pomoci vyrovnat handicap uza&#269;ínajících amén&#283; zku&#353;ených chirurg&#367; aomezit incidenci morbidity zvratného nervu vchirurgii &#353;títné &#382;lázy.