Standard Training Group Research Articles

A Comparison of Different Training Methods in the Successful Learning of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Background: Standardized training of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) is available only in highly developed countries. Objective: To compare the skill differences in the performance of EBUS-TBNA by pulmonologists trained under different learning methods. Methods: We performed a retrospective study of 145 EBUS-TBNA cases. We set up 3 comparative training groups: a standardized training group, a teaching group, and a self-study group. The main clinical outcomes were sensitivity, specificity and accuracy of EBUS-TBNA. Cumulative sum analysis was used to track EBUS-TBNA proficiency of the 3 groups. Results: The sensitivities of EBUS-TBNA in the different groups were 90, 88, and 67%, respectively. The accuracies of the different groups were 91, 90, and 71%, respectively. With respect to the sensitivity and accuracy, there was no significant difference between the standardized training group and teaching group. However, the self-study group was inferior to the other 2 groups. By comparing the learning curve among the groups, we found that the minimum number of operations needed to reach a 90% accuracy for the standardized training group, the teaching group and the self-study group was 17, 32 and 40 cases, respectively. Conclusion: Compared with the teaching and self-study groups, the standardized training group resulted in practitioners achieving high skill levels following the performance of a lower number of cases. Pulmonologists trained in the teaching group achieved a similar level of skills, but required more experience to reach this level. Practitioners in the self-study group did not achieve a satisfactory level of skills, despite performing a high number of cases.

Effect of standardized training on the reliability of the Cochrane risk of bias assessment tool: a prospective study

BackgroundThe Cochrane risk of bias tool is commonly criticized for having a low reliability. We aimed to investigate whether training of raters, with objective and standardized instructions on how to assess risk of bias, can improve the reliability of the Cochrane risk of bias tool.MethodsIn this pilot study, four raters inexperienced in risk of bias assessment were randomly allocated to minimal or intensive standardized training for risk of bias assessment of randomized trials of physical therapy treatments for patients with knee osteoarthritis pain. Two raters were experienced risk of bias assessors who served as reference. The primary outcome of our study was between-group reliability, defined as the agreement of the risk of bias assessments of inexperienced raters with the reference assessments of experienced raters. Consensus-based assessments were used for this purpose. The secondary outcome was within-group reliability, defined as the agreement of assessments within pairs of inexperienced raters. We calculated the chance-corrected weighted Kappa to quantify agreement within and between groups of raters for each of the domains of the risk of bias tool.ResultsA total of 56 trials were included in our analysis. The Kappa for the agreement of inexperienced raters with reference across items of the risk of bias tool ranged from 0.10 to 0.81 for the minimal training group and from 0.41 to 0.90 for the standardized training group. The Kappa values for the agreement within pairs of inexperienced raters across the items of the risk of bias tool ranged from 0 to 0.38 for the minimal training group and from 0.93 to 1 for the standardized training group. Between-group differences in Kappa for the agreement of inexperienced raters with reference always favored the standardized training group and was most pronounced for incomplete outcome data (difference in Kappa 0.52, p < 0.001) and allocation concealment (difference in Kappa 0.30, p = 0.004).ConclusionsIntensive, standardized training on risk of bias assessment may significantly improve the reliability of the Cochrane risk of bias tool.

Speed-Interactive Treadmill Training Using Smartphone-Based Motion Tracking Technology Improves Gait in Stroke Patients

ABSTRACTThis study was conducted to investigate the effects of speed-interactive treadmill training (SITT) using smartphone-based motion tracking technology on gait in stroke patients. Thirty-four chronic stroke patients were randomly divided into a SITT group (n = 18) and a standard treadmill training (control) group (n = 16). The SITT group underwent smartphone-based SSIT while the control group underwent standard treadmill training. Both groups performed the training for 35 min per session, 3 times per week, for 6 weeks. Both groups used nonmotorized treadmills so that patients could control the speed. Evaluation was conducted during the week before and after the training. The OptoGait system measured gait spatiotemporal parameters. Both groups showed significant improvement in the temporal and spatial gait parameters (p < .05). In the SITT group, compared to the control group, the two-way analysis of variance with repeated measures showed an improvement in the temporal and spatial gait parameters after the intervention period (p < .05). This study confirmed that SITT improved the gait function of stroke patients. Based on this result, the authors propose that SITT, by improving gait, can be used as an effective training method to improve patients' functional activities in the clinic.

Simple artificial training device for respiratory muscle strength and lung volumes in healthy young male and female subjects: A pilot study

ObjectiveThe aim of this study was to evaluate the efficiency of a simple artificial device for respiratory muscle strength training and lung volumes using either combined or non-combined exercise with elastic bands in healthy young participants. MethodsForty healthy young participants (20 male and 20 female) aged 19–24 years old were randomized into two main experiments with four sub-groups; (1) artificial device (n = 10) & standard device (n = 10) training, and (2) artificial device training combined with elastic band (EB) exercise (n = 10) & standard device training combined with EB (n = 10) exercise. Respiratory muscle strength with maximal peak inspiratory pressure (PImax), and lung volumes; tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC) were evaluated before and after training once daily for 3 weeks. Moreover, the peak dyspnea score and vital sign parameters were compared between the experimental groups after final training. ResultsAll parameters had no statistical differences (p > 0.5) between the training devices alone and those combined with EB exercise prior to any experiments. Results from the first experiment showed that training with an artificial device increased all parameters (PImax, VC, IRV, ERV) significantly (p < 0.05), except for TV, when compared to pre training results, which were the same as those in the standard device training group. No statistical difference was shown between these groups after the training period had been performed. Furthermore, results of applying artificial device training combined with EB exercise showed a significant increase in all parameters, except for TV, and they were the same as the increased results in training with the standard device combined with EB exercise. There was no significant difference of data between these groups after the training period. Finally, the results of peak dyspnea score and all vital sign parameters from using the artificial device, with or without EB exercise, showed no statistical difference when compared to use of the standard device. ConclusionThis study proposed that a simple artificial device can be used to train the respiratory muscle with or without elastic band exercise in healthy young subjects.

Effects of WeChat group in teaching of standardized training among Operating Room nurses

Objective To explore the effects of WeChat group in teaching of standardized training among Operating Room nurses. Methods A total of 28 nurses accepting standardized training in Operating Room were selected as control group (standardized training) from July 2011 to December 2012. A total of 28 nurses accepting standardized training in Operating Room were selected as intervention group (standardized training & WeChat group teaching ) from January 2013 to July 2014. What was compared after intervention among nurses between two groups included theoretical knowledge, the score of operation skill, nurses′ satisfaction with training, the satisfaction degree of patients and family members and surgeons′ satisfaction with nurses. Results After the intervention with WeChat group teaching, scores of theoretical knowledge and technical knowledge were (96.3±3.6) and (94.5±4.6) in intervention group which were higher than those in control group with significant differences (t=-8.652, -7.254; P 0.05). Scores of suture needle, aseptic technique, transferring equipment in operation, arranging surgical position, surgery cooperation were (92.1±6.2), (91.6±5.2), (95.6±3.3), (96.2±3.6), (97.1±2.6) in intervention group which were higher than those in control group with significant differences (t=-4.125, -4.526, -3.856, -5.846, -9.032; P<0.01). Satisfaction degrees of nurses with training, surgeons with nurses, patients′ family members with treatment in intervention group were obviously better than those in control group with significant differences (P<0.01). Conclusions Training with WeChat group in nurses can visibly improve nurses′ study enthusiasm, theoretical knowledge, operation skill, satisfaction degrees of nurses with training, surgeons with nurses, patients and their family members with treatment and improve the quality of care in operating room at the same time. Key words: Operating Room; Standardized training; WeChat group

Ocena efektów treningu fizycznego z zastosowaniem dodatkowego obciążenia kończyn w trakcie wczesnej rehabilitacji pacjentów po leczonym interwencyjnie ostrym zespole wieńcowym

Introduction. We aimed to investigate the effects of modified cardiac rehabilitation programme on functional fitness level. We modified the programme with the elements of resistance training relied on use of the ankle and wrist weights (1, 0.5 kg each). Material and methods. The study was performed on 40 patients in 2–3 weeks following acute coronary syndrome (ACS), after they underwent percutaneous coronary intervention (PCI). Patients were divided in to two groups: two groups of 20 patients each: control group with standard training and experimental group with elements of resistance training. An analysis of the data was performed before and after 18-session rehabilitation programme. The study was performed only in patients at moderate risk of cardiac disease according to American College of Sports Medicine 8th edition risk stratification. Results. Contemporary standard of cardiac rehabilitation provided to the patients post-ACS improved significantly (p < 0.05) the endurance parameters assessed with the 6-min walking test (from 517.75 ± 57.27 to 581 ± 94.04 m for the standard rehabilitation and from 523.00 ± 45.43 to 598.47 ± 57.30 m for modified programme with the elements of resistance). The strength of the arms and legs assessed with the dynamometry improved significantly with more pronounced improvement in the group with resistance training elements than in the standard rehabilitation group (from 33.10 ± 8.35 to 42.65 ± 11.90 kg and from 127.00 ± 25.49 to 154.40 ± 31.86 kg, respectively; p < 0.05). The strength endurance assessed with the SFT for the legs increased significantly in both groups. Conclusions. Early-phase cardiac rehabilitation extended with the elements of resistance training results in greater improvement, especially in the elements of strength.

Evaluating Eccentric Hip Torque and Trunk Endurance as Mediators of Changes in Lower Limb and Trunk Kinematics in Response to Functional Stabilization Training in Women With Patellofemoral Pain

Background: Altered movement patterns of the trunk and lower limbs have been associated with patellofemoral pain (PFP). It has been assumed that increasing the strength of the hip and trunk muscles would improve lower limb and trunk kinematics in these patients. However, evidence in support of that assumption is limited. Purpose: To determine whether increases in the strength of hip muscles and endurance of trunk muscles in response to functional stabilization training will mediate changes in frontal plane lower limb kinematics in patients with PFP. Study Design: Controlled laboratory study. Methods: Thirty-one female athletes were randomized to either a functional stabilization training group that emphasized strengthening of the trunk and hip muscles or a standard training group that emphasized stretching and quadriceps strengthening. Patients attended a baseline assessment session, followed by 8 weeks of intervention, and were then reassessed at the end of the intervention period. The potential mediators that were evaluated included eccentric torque of hip muscles and endurance of the trunk muscles. The outcome variables were the lower limb and trunk kinematics in the frontal plane assessed during a single-legged squat task. Results: The eccentric strength of the gluteus muscles showed a mediation effect ranging from 18% to 32% on changes to frontal plane kinematics (decreased ipsilateral trunk inclination, pelvis contralateral depression, and hip adduction excursions) observed in the functional stabilization training group after intervention. Conclusion: Although the mediation effects were small, the results suggest that improvements in the strength of the gluteus muscles can influence the frontal plane movement patterns of the lower limb and trunk in women with PFP. Clinical Relevance: Patients with PFP might benefit from strengthening of the hip muscles to improve frontal plane lower limb and trunk kinematics during functional tasks.

Standardized Bowel Training Benefits Patients with Neurogenic Bowel Dysfunction After Spinal Cord Injury

In order to evaluate the effect of standardized management on spinal cord injury patients with neurogenic bowel dysfunction, 50 cases of spinal cord injury patients from January 2011 to December 2013 were treated with neurogenic bowel intestinal standardized management. The effect was compared to that with routine nursing of 32 spinal cord injury patients from January 2009 to December 2010. Data analysis regarding the age, spinal cord injury, neurological movement and basic sensory score showed no statistically significant difference between the two groups (P > 0.05). However, bowel functional indexes including abdominal distension, abdominal pain, evacuation time and anal incontinence of the standardized training group decreased as compared to those of control group (P < 0.05). The bowel way of the standardized training patients was also in line with normal living habits, including fixed time and the toilet bowel movement. In conclusion, standardization bowel management intervention is beneficial to the patients with spinal cord injury to form regular bowel habit.

Enhancement of Arthroscopic Knot-tying Performance with the FAST Workstation and FAST Knot-tester

Knot tying impacts the quality and efficiency of arthroscopic procedures. During training, we generally focus upon knot “appearance”, as opposed to knot resistance to displacement under physiologic loads. Our purpose was to develop and evaluate a new educational approach for these challenging skills. The Fundamentals of Arthroscopic Surgery Training (FAST) workstation was designed for basic motor skills training. For knot tying, the workstation has a stabilized metal mandrel positioned within an opaque dome. The dome has “portals” to mimic surgical ergonomics. Knots are delivered through a cannula and tied around the mandrel under video control, which is achieved by a USB camera and laptop computer. After knot creation, the suture loop is slipped from the mandrel and evaluated using the FAST knot tester, which stresses the loop at 15 pounds for 15 seconds. A calibrated sizer measures loop expansion in mm. The knot tester has very low standard deviation on repeated measures (15.03 + .05 pounds, measured with a digital tensiometer, ten repeated measures). Based upon previous literature, the knot was considered a “failure” if loop expansion > 3 mm after a 15 pound load. Each subject tied five consecutive knots with #2 Fiberwire using the arthroscopic knot of their choice, backed up by three reversed hitches on alternating posts. The first cohort (Faculty) was comprised of twenty experienced surgeons teaching at a dedicated OLC resident's course. All were considered expert arthroscopists (19.9 + 8.25 years in practice; 381 + 150 arthroscopies per year). The second cohort (randomized to Standard Training) involved fourteen PGY4/PGY5 residents who were instructed on knot tying skills with standard methodology during this skills course. The third cohort (randomized to Enhanced Training) involved sixteen PGY4/PGY5 residents who were allowed to use the knot tester for performance feedback during their training experience. When these residents felt ready, they created five knots on the FAST workstation. In the Faculty group, 76% of the knots “passed” with < 3 mm of loop expansion (a 24% failure rate). Our experts were not particularly consistent: 12 had all five knots pass while 2 experts had all of their knots fail under load. In the Standard Training group, 62.9% of the knots passed (37.1% failure rate); 3 of these residents had all knots pass while 2 had all five knots fail. In the Enhanced Training group, 88.8% of the knots passed (11.2% failure rate); 11 had all knots pass and none of the Enhanced Training residents had all knots fail. The FAST workstation and knot tester create new educational opportunities for surgeons to develop basic skills, without negative impact on patient care. Our findings demonstrate the value of immediate evaluation (proximate feedback) for enhancement of the training experience. Average performance of the Enhanced Training group surpassed the Faculty group, with better performance consistency in this resident cohort. We were surprised by the relative inconsistency of knots created by our Faculty experts. This training methodology may be relevant for practicing orthopaedic surgeons who want to maximize knot-tying quality and consistency.

Laparoscopic surgical box model training for surgical trainees with limited prior laparoscopic experience.

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator is an option to supplement standard training. However, the value of this modality on trainees with limited prior laparoscopic experience is unknown. To compare the benefits and harms of box model training for surgical trainees with limited prior laparoscopic experience versus standard surgical training or supplementary animal model training. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013. We planned to include all randomised clinical trials comparing box model trainers versus other forms of training including standard laparoscopic training and supplementary animal model training in surgical trainees with limited prior laparoscopic experience. We also planned to include trials comparing different methods of box model training. Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5. For each outcome, we calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible. We identified eight trials that met the inclusion criteria. One trial including 17 surgical trainees did not contribute to the meta-analysis. We included seven trials (249 surgical trainees belonging to various postgraduate years ranging from year one to four) in which the participants were randomised to supplementary box model training (122 trainees) versus standard training (127 trainees). Only one trial (50 trainees) was at low risk of bias. The box trainers used in all the seven trials were video trainers. Six trials were conducted in USA and one trial in Canada. The surgeries in which the final assessments were made included laparoscopic total extraperitoneal hernia repairs, laparoscopic cholecystectomy, laparoscopic tubal ligation, laparoscopic partial salpingectomy, and laparoscopic bilateral mid-segment salpingectomy. The final assessments were made on a single operative procedure.There were no deaths in three trials (0/82 (0%) supplementary box model training versus 0/86 (0%) standard training; RR not estimable; very low quality evidence). The other trials did not report mortality. The estimated effect on serious adverse events was compatible with benefit and harm (three trials; 168 patients; 0/82 (0%) supplementary box model training versus 1/86 (1.1%) standard training; RR 0.36; 95% CI 0.02 to 8.43; very low quality evidence). None of the trials reported patient quality of life. The operating time was significantly shorter in the supplementary box model training group versus the standard training group (1 trial; 50 patients; MD -6.50 minutes; 95% CI -10.85 to -2.15). The proportion of patients who were discharged as day-surgery was significantly higher in the supplementary box model training group versus the standard training group (1 trial; 50 patients; 24/24 (100%) supplementary box model training versus 15/26 (57.7%) standard training; RR 1.71; 95% CI 1.23 to 2.37). None of the trials reported trainee satisfaction. The operating performance was significantly better in the supplementary box model training group versus the standard training group (seven trials; 249 trainees; SMD 0.84; 95% CI 0.57 to 1.10).None of the trials compared box model training versus animal model training or versus different methods of box model training. There is insufficient evidence to determine whether laparoscopic box model training reduces mortality or morbidity. There is very low quality evidence that it improves technical skills compared with standard surgical training in trainees with limited previous laparoscopic experience. It may also decrease operating time and increase the proportion of patients who were discharged as day-surgery in the first total extraperitoneal hernia repair after box model training. However, the duration of the benefit of box model training is unknown. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the long-term impact of box model training on clinical outcomes and compare box training with other forms of training.

Effects of Functional Stabilization Training on Pain, Function, and Lower Extremity Biomechanics in Women With Patellofemoral Pain: A Randomized Clinical Trial

Randomized clinical trial. To compare the effects of functional stabilization training (FST) versus standard training on knee pain and function, lower-limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee muscle strength in women with patellofemoral pain. A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain. However, there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity. Thirty-one women were randomized to either the FST group or standard-training group. Patients attended a baseline assessment session, followed by an 8-week intervention, and were reassessed at the end of the intervention and at 3 months after the intervention. Assessment measures were a 10-cm visual analog scale for pain, the Lower Extremity Functional Scale, and the single-leg triple-hop test. A global rating of change scale was used to measure perceived improvement. Kinematics were assessed during the single-leg squat. Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment. The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the standard-training group. Lesser ipsilateral trunk inclination, pelvis contralateral depression, hip adduction, and knee abduction, along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat, were only observed in the FST group after the intervention. Only those in the FST group had greater eccentric hip abductor and knee flexor strength, as well as greater endurance of the anterior, posterior, and lateral trunk muscles, after training. An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.

Standardized Patient–Based Simulation Training as a Tool to Improve the Management of Chronic Disease

Patient education is a critical factor in the treatment of chronic disease because it reduces gaps in health care and disease management. We implemented different methods of physician training for patient education of asthma and compared the effects on patients' health. Four interventions were administered to groups of primary care physicians in one health care maintenance organization. All physicians received a list of their patients who were classified with uncontrolled asthma. Additional educational methods were implemented as follows: no additional intervention (group 1); lectures on patient education (group 2); standardized patient-based simulation training (group 3); and lectures and standardized patient-based simulations (group 4). We compared among the intervention groups and to a control group changes in rates of patients with uncontrolled asthma at 1 and 2 years after the intervention. During 1 year of follow-up, rates of uncontrolled asthma decreased from 7.2% to 6.2% (by 15%), from 7.5% to 6.5% (by 13%), from 6.4% to 5.1% (by 19%), and from 6.3% to 4.6% (by 27%) in intervention groups 1 to 4, respectively (P<0.01). Rates decreased by approximately 7% more in all intervention groups at 2 years of follow-up. No decrease in rates was observed in the control group. An intervention for primary care physicians on educating patients with asthma to manage their disease resulted in improved patient health. The most effective intervention was the combination of lectures and standardized patient-based simulation.

Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience.

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator is an option to supplement standard training. However, the value of this modality on trainees with limited prior laparoscopic experience is unknown.To compare the benefits and harms of box model training for surgical trainees with limited prior laparoscopic experience versus standard surgical training or supplementary animal model training.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013.We planned to include all randomised clinical trials comparing box model trainers versus other forms of training including standard laparoscopic training and supplementary animal model training in surgical trainees with limited prior laparoscopic experience. We also planned to include trials comparing different methods of box model training.Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5. For each outcome, we calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible.We identified eight trials that met the inclusion criteria. One trial including 17 surgical trainees did not contribute to the meta-analysis. We included seven trials (249 surgical trainees belonging to various postgraduate years ranging from year one to four) in which the participants were randomised to supplementary box model training (122 trainees) versus standard training (127 trainees). Only one trial (50 trainees) was at low risk of bias. The box trainers used in all the seven trials were video trainers. Six trials were conducted in USA and one trial in Canada. The surgeries in which the final assessments were made included laparoscopic total extraperitoneal hernia repairs, laparoscopic cholecystectomy, laparoscopic tubal ligation, laparoscopic partial salpingectomy, and laparoscopic bilateral mid-segment salpingectomy. The final assessments were made on a single operative procedure.There were no deaths in three trials (0/82 (0%) supplementary box model training versus 0/86 (0%) standard training; RR not estimable; very low quality evidence). The other trials did not report mortality. The estimated effect on serious adverse events was compatible with benefit and harm (three trials; 168 patients; 0/82 (0%) supplementary box model training versus 1/86 (1.1%) standard training; RR 0.36; 95% CI 0.02 to 8.43; very low quality evidence). None of the trials reported patient quality of life. The operating time was significantly shorter in the supplementary box model training group versus the standard training group (1 trial; 50 patients; MD -6.50 minutes; 95% CI -10.85 to -2.15). The proportion of patients who were discharged as day-surgery was significantly higher in the supplementary box model training group versus the standard training group (1 trial; 50 patients; 24/24 (100%) supplementary box model training versus 15/26 (57.7%) standard training; RR 1.71; 95% CI 1.23 to 2.37). None of the trials reported trainee satisfaction. The operating performance was significantly better in the supplementary box model training group versus the standard training group (seven trials; 249 trainees; SMD 0.84; 95% CI 0.57 to 1.10).None of the trials compared box model training versus animal model training or versus different methods of box model training.There is insufficient evidence to determine whether laparoscopic box model training reduces mortality or morbidity. There is very low quality evidence that it improves technical skills compared with standard surgical training in trainees with limited previous laparoscopic experience. It may also decrease operating time and increase the proportion of patients who were discharged as day-surgery in the first total extraperitoneal hernia repair after box model training. However, the duration of the benefit of box model training is unknown. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the long-term impact of box model training on clinical outcomes and compare box training with other forms of training.

Preoperative strength training for elderly patients awaiting total knee arthroplasty.

Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA). Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT), and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA. Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (P > 0.05). Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk (r = 0.50) and the stair climb (r − = 0.58, P < 0.05). Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered with NTR2278.

Board 358 - Research AbstractVirtual-Reality Simulator Training is More Efficient than Apprenticeship Training in the First Part of the Learning Curve

Introduction/Background Endosonography has proven superior to traditional Methods for obtaining tissue samples from the mediastinum and has now become the method of choice for staging lung cancer.1-3 However, the technique is highly operator dependent and focus on training and certification is essential before Results from expert centers can be generalized. Virtual-reality (VR) simulation are superior to no training but studies should instead compare VR training to traditional training.4 Outcomes should be measured on real patients (transfer studies) using assessment tools with established validity evidence from similar settings. Several procedures must be assessed by multiple raters in a blinded fashion to ensure reliability and reduce the risk of bias.5 Credible standards are necessary for summative assessment. The aims of this study were to determine whether simulator training could replace practicing on patients. Secondly, to explore a reliable assessment method and set a credible pass/fail standard. Methods A twelve item EndoBronchial UltraSound Assessment Tool (EBUSAT) was created by experts in endosonography and assessment. Each item was scored from 0 to 4 points giving a maximum score of 48 points. An international volunteer sample of 16 respiratory physicians without EBUS experience and a convenience sample of two EBUS experts were included in the study. The respiratory physicians attended an eight hour theoretical course and participated in two EBUS procedures on patients. Then they were randomized to a standardized, individual four hour training program on a virtual-reality EBUS simulator, administered by the same operator in both countries vs. a half-day, standard, hands-on training on patients supervised by one of two international EBUS experts. Each physician performed three consecutive EBUS-TBNA procedures. The endoscopic and the ultrasound videos were recorded and assessed blindly and independently by three EBUS experts using the EBUSAT. Ten consecutive procedures by EBUS experts were assessed simultaneously to gather validity evidence. Procedures performed by simulator-trained novices, apprenticeship-trained novices and endosonography experts respectively were compared using independent samples t-tests. Reliability was explored using Generalizability Theory (a two-facet design with participants crossed with procedures crossed with raters). The contrasting group’s method was used to set a credible pass/fail-standard (secondary objective). Results The simulator group performed significantly better than the standard training group; 24.2 points vs. 20.1 points, p=0.006. The EBUSAT scores were very reliable; generalizability coefficient=0.85. An acceptable Generalizability Coefficient for high-stakes assessment of 0.8 could be achieved by using three raters, assessing two procedures and two raters assessing three procedures, or one rater assessing six procedures. The experts scored significantly higher than the novices indicating that the EBUSAT possess construct validity; 35.3 points, p<0.001. A credible pass/fail standard could be established = 28.2 points. 4% of the procedures performed by the standard training group passed vs. 17% in the simulation group. Only one of the procedures performed by the experts failed to meet standards (90% passed). Conclusion EBUS training on a virtual-reality simulator is more efficient than standard apprenticeship training in the initial part of the learning curve but subsequent supervised training on patients are necessary to ensure basic competency. The EBUSAT can be used to assess performances in an unbiased, reliable and valid way. A credible standard set by an accepted method make it possible to perform high-stakes certification using the EBUSAT provided that the number of raters and procedures assessed ensures sufficient reliability. Focus on patient safety and competency based education makes virtual-reality training and assessment of competence very relevant issues in the implementation of endosonography.

A Prospective Randomized Controlled Blinded Study to Evaluate the Effect of Short-Term Focused Training Program in Laparoscopy on Operating Room Performance of Surgery Residents (CTRI /2012/11/003113)

Laparoscopic surgery requires certain specific skills. There have been several attempts to minimize the learning curve with training outside the operation room. Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Several randomized controlled trials and systematic reviews have demonstrated that the technical skills learned on these simulators transfer to the operating room. Currently, however, the integration of these simulated models into formal residency training curricula is lacking. In our institute, we have adopted the Tuebingen Trainer devised by Professor GF Buess from Germany. The purpose of this study was to evaluate the training of surgical residents on an ex vivo phantom model for basic laparoscopic skill acquisition and its transferability to the OR performance. Seventeen general surgery residents were randomized into 2 groups: Laparoscopic Training Group (n = 9, Group A) and Standard Training Group (n = 8, Group B). Group A underwent training in the Minimally Invasive Surgery Training Centre on the porcine phantom model and did 10 laparoscopic cholecystectomies, whereas Group B did not undergo training in the Minimally Invasive Surgery Training Centre. All the participants performed a laparoscopic cholecystectomy in the operation theater in the presence of a consultant who was blinded to the training status of the participants. The performance of the residents in both groups in the operation theater was assessed using GOALS criteria, surgical performance assessment parameters, task-specific checklists, and visual analog scale for gallbladder perforation difficulty and overall competence. The Laparoscopic Training Group had better performance than the Standard Training Group regarding operation time, GOALS criteria, and Task-specific checklists. Although the surgical performance assessments, i.e. cystic duct and artery identification scores, gallbladder perforation scores, and liver injury scores, were better in the Laparoscopic Training Groups, they were not statistically significant. The overall difficulty of the surgery was comparable in both the groups. The Laparoscopic Training Group exhibited significant overall competence on visual analog scale scores. Our study has clearly shown that training on the Tuebingen Trainer with integrated porcine organs results in a statistically significant improvement in the operating room performance of surgical residents as compared with the nontrained residents, thereby indicating a transfer of skills from training to the operating room.

Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation

We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.

Functions of standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival

BackgroundCardiopulmonary resuscitation (CPR) is a sudden emergency procedure that requires a rapid and efficient response, and personnel training in lifesaving procedures. Regular practice and training are necessary to improve resuscitation skills and reduce anxiety among the staff. As one of the most important skills mastered by medical volunteers serving for Mt. Taishan International Mounting Festival, we randomly selected some of them to evaluate the quality of CPR operation and compared the result with that of the untrained doctors and nurses. In order to evaluate the functions of repeating standard CPR training on performance qualities of medical volunteers for Mt. Taishan International Mounting Festival, their performance qualities of CPR were compared with those of the untrained medical workers working in emergency departments of hospitals in Taian.MethodsThe CPR performance qualities of 52 medical volunteers (Standard Training Group), who had continually taken part in standard CPR technical training for six months, were tested at random and were compared with those of 68 medical workers (Compared Group) working in emergency departments of hospitals in Taian who hadn’t attended CPR training within a year. The QCPR 3535 monitor (provided by Philips Company) was used to measure the standard degree of single simulated CPR performance, including the chest compression depth, frequency, released pressure between compressions and performance time of compression and ventilation, the results of which were recorded in the table and the number of practical compression per minute was calculated. The data were analyzed by x2 Test and t Test. The factors which would influence CPR performance, including gender, age, placement, hand skill, posture of compression and frequency of training, were classified and given parameters, and were put to Logistic repression analysis.ResultsThe CPR performance qualities of volunteers were much higher than those of the compared group. The overall pass rates were respectively 86.4% and 31.9%; the pass rates of medical volunteers in terms of the chest compression depth, frequency, released pressure between compressions were higher than those of the compared group, which were 89.6%, 94.2%, 95.8% vs 50.3%, 53.0%, 83.1%, P<0.01; there were few differences in overall performance time, which were (118.4±13.5s) vs (116.0±10.4s), P>0.05; the duration time of ventilation in each performance section was much shorter than that in the compared group, which were (6.38±1.2) vs (7.47±1.7), P<0.01; there were few differences in the number of practical compression per minute, which were (78.2±3.5) vs (78.8±12.2), P>0.05); the time proportion of compression and ventilation was 2.6:1 vs 2.1:1. The Logistic repression analysis showed that CPR performance qualities were clearly related to hand skill, posture of compression and repeating standard training, which were respectively OR 13.12 and 95%CI (2.35~73.2); OR 30.89, 95%CI (3.62~263.5); OR 4.07,95%CI (1.16~14.2).ConclusionThe CPR performance qualities of volunteers who had had repeating standard training were much higher than those of untrained medical workers, which proved that standard training helped improve CPR performance qualities.

The effects of resisted sprint training on speed performance in women

PurposeThe main aim of the study was to examine the effects of resisted and standard sprint training on the kinematics of sprintrunning acceleration in women.MethodsThirty-six untrained but physically active female college students were randomly assigned to one of three groups: a running resisted training group (RTG, &lt;i&gt;n&lt;/i&gt; = 12), a standard training group (STG, &lt;i&gt;n&lt;/i&gt; = 12), and a control group (CON, &lt;i&gt;n&lt;/i&gt; = 12). All participants in the experimental groups trained three times a week for four weeks, followed by a 1-week training break, after which they trained again for four weeks. Pre-training, post-training and detraining (three weeks after completing the training programs) measures of mean running velocity, stride length, stride frequency, knee angle at toe off and footstrike, ground contact time, and flight time were analyzed by a 20 m sprint test.ResultsThe RTG improved mean running velocity and increased stride length and knee angle at toe off. Simultaneously, the RTG featured decreased stride frequency and increased ground contact time. The STG demonstrated an increase in mean running velocity due to higher stride frequency and a decrease in ground contact time. All of the measured parameters did not significantly decrease after the three-week detraining period. The control group featured no changes.ConclusionsBoth resisted and standard sprint training improves speed in sprint-running acceleration in women by improving different sprint kinematic parameters.

Meaningful Task-Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial

Background/Objective: The upper extremity motor deficit is one of the functional challenges in post stroke patients. The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training (MTST) on the upper extremity motor recovery during the subacute phase after a stroke. Method: This was a randomized, controlled, double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation institute. A convenience sample of 103 people, 4 to 24 weeks (mean, 12.15 weeks) after the stroke, was randomized into 2 groups (MTST, 51; standard training group, 52). Subjects in the Brunnstrom stage of arm recovery of 2 to 5 were included in the study. Ninety-five participants completed the 8-week follow-up. Interventions: Participants were assigned to receive either the MTST or dose-matched standard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique, 4 to 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA), Action Research Arm Test (ARAT), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL) were outcome measures Results: The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessments in comparison to the control group. Further, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA, ARAT, GWMFT, and MAL. Conclusion: The MTST produced statistically significant and clinically relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke.