Technical Scores Research Articles

Brief Motivational Interviewing Training for Outreach in School Health Programming

This study assessed a brief 6-week motivational interviewing (MI) training program for extension field specialists (EFS) involved in supporting a statewide school wellness initiative called SWITCH. A total of 16EFS were instructed in MI principles to support the programming and half (n = 8) volunteered to participate in the hybrid (online and in-person) MI training program. Phone calls between EFS and school staff involved in SWITCH were recorded and coded using the Motivational Interviewing Treatment Integrity (MITI) system to capture data on utilization of MI principles. Differences in MI utilization between the trained (n=8) and untrained (n=8) EFS were evaluated using Cohen’s d effect sizes. Results revealed large differences for technical global scores (d=1.5) and moderate effect sizes for relational global components (d=0.76) between the two groups. This naturalistic, quasi-experimental study indicates a brief MI training protocol is effective for teaching the spirit and relational components of MI to EFS.

Vascular Access Training for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Placement: A Feasibility Study in Emergency Physicians

Background: Training vascular access skills for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to emergency physicians (EPs) could contribute to better outcomes in patients with non-compressible truncal hemorrhage. This study aimed to determine whether a concise training program could train EPs to recognize anatomical structures and correctly visualize and identify the puncture site for percuta­neous REBOA catheter placement. Methods: Our training program included basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills: the identification of anatomical structures, anatomy knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the common femoral artery (CFA). Consultant vascular surgeons functioned as expert controls. Results: Eleven EPs participated. They had a median overall technical skills score of 32.5 (27.0–35.0) and median time to identify the CFA puncture site of 52.9 s (35.6–63.7), which improved to 34.0 s (21.2–44.7) at the post-test (Z = –2.756, P = 0.006). Consultant vascular surgeons were significantly faster (P = 0.000). Conclusions: EPs are capable of visualizing the femoral artery and vein within 1 min. This speed improved rapidly after repetition. Our concise training program proved useful regardless of prior endovascular experience. This program, as a component of an expanded Endovascular Resuscitation and Trauma Management curriculum, in combination with realistic task training models (simulator, perfused cadaver, or live tissue) has the potential to provide effective training of the skills required to competently perform REBOA.

Comparison of Online Learning Video Platforms Regarding Laparoscopic Adrenalectomy: YouTube and WebSurg.

Background: The internet is a widely used source for receiving medical information. Nevertheless, the quality of data on online platforms is still questioned. Our aim was to compare the laparoscopic adrenalectomy videos published on the two online platforms, WebSurg® (WS) and YouTube® (YTb) regarding the quality of data, educational power, and accuracy of the sources. Materials and Methods: Most viewed popular visual content returned by YTb in reply to the keyword "laparoscopic adrenalectomy" were involved in the research protocol. The quality of the data, educational power, and the accuracy and reliability of the sources were assessed by applying new scoring systems. A novel scoring method estimated technical quality. The 10 most viewed videos in the WS were compared with 10 YTb videos with the highest technical scores. Results: Scoring systems measuring the quality of data and educational power of the mostly viewed WS visual content revealed higher scores than those of the most technically qualified 10 YTb videos (10 videos having the highest laparoscopic adrenalectomy scoring system scores [LASS-S]; P = .021; P = .003; P = .025, respectively). Also, there was no significant difference between the top 10 most viewed WS videos and 10 YTb videos having the highest LASS-S in terms of LASS-S (P = .34). Conclusions: Although WS videos were passed through a professional reviewing process, and were mostly provided by academicians, they remained below the expected quality. The presented research showed that attentively chosen YTb content on laparoscopic adrenalectomy is almost as accurate as WS content. Notwithstanding all its limitations, the informative power or potential of YTb should not be neglected.

On the relevance of modulation transfer function measurements in digital mammography quality control.

Purpose: The relevance of presampling modulation transfer function (MTF) measurements in digital mammography (DM) quality control (QC) is examined. Two studies are presented: a case study on the impact of a reduction in MTF on the technical image quality score and analysis of the robustness of routine QC MTF measurements. Approach: In the first study, two needle computed radiography (CR) plates with identical sensitivities were used with differences in the 50% point of the MTF ( ) larger than the limiting value in the European guidelines ( change between successive measurements). Technical image quality was assessed via threshold gold thickness of the CDMAM phantom and threshold microcalcification diameter of the L1 structured phantom. For the second study, presampling MTF results from 595 half-yearly QC tests of 55 DM systems (16 types, six manufacturers) were analyzed for changes from the baseline value and changes in between successive tests. Results: A reduction of 20% in of the two CR plates was observed. There was a tendency to a lower score for task-based metrics, but none were significant. Averaging over 55 systems, the absolute relative change in between consecutive tests (with 95% confidence interval) was 3% (2.5% to 3.4%). Analysis of the maximum relative change from baseline revealed changes of up to for one a-Se based system and for a group of CsI-based systems. Conclusions: A limit of 10% is a relevant action level for investigation. If exceeded, then the impact on performance has to be verified with extra metrics.

Technical inefficiency of Dutch vegetable farms: Specific-input analyses

Differences in technical efficiency across farms are one of the major factors explaining differences in farm survival and growth and changes in farm industry structure. This study employs Data Envelopment Analysis (DEA) to compute technical inefficiency scores for output, energy, materials, pesticides and fertiliser of a sample of Dutch indoor vegetable farms within the period 2006–2016. A bootstrap truncated regression model is used to determine statistical associations between producer-specific characteristics and technical inefficiency scores for the specified inputs. For the sample of indoor growers, the average technical inefficiency was about 14% for energy, 23% for materials, 24% for pesticides and 22% for fertilisers. The bootstrap truncated regression suggested that the degree of specialisation exerts adverse effects on the technical inefficiency of variable inputs. While age, short-term, long-term debt and subsidy were statistically significant, the coefficients were not economically significant. Building the capacity of farmers to reduce input inefficiency will enable farmers to be competitive and reduce the adverse effects of input overuse on the environment.

The Use of an Online Tennis Learning Platform for Sedentary Adults

The purpose of this research was to analyse the impact of a web platform as a result of its use to support a leisure-time physical activity program based on the organized practice oftennis. The hypothesis of this research is based on the assumption that the use of a web platform for a recreational physical activity program, in particular a tennis one, will havebeneficial effects on the effectiveness of learning the game technique. The research was carried out on a sample of 47 volunteer subjects, all of them working in a sedentaryenvironment. The subjects of the study were divided into 3 groups, the intervention program consisted of 90-minute tennis training sessions, twice a week, for 4 months. Thestatistical analysis of the data was accomplished by using the IBM SPSS Statistics 20 program. At the end of the study, could be observed in total technical score, staticforehand, dynamic forehand, static backhand, dynamic backhand and serve score.

Reliability of simulation-based assessment for practicing physicians: performance is context-specific

IntroductionEven physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.MethodsStandardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.ResultsThe behavioural score was not more reliable than the technical score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters for a given scenario would have little effect on reliability.ConclusionsThe performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. More importantly, aggregate data from a population of participants may have an even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and inform continuing education improvements across the profession.

Survival Analysis Using Surgeon Skill Metrics and Patient Factors to Predict Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

BackgroundIt has been shown that metrics recorded for instrument kinematics during robotic surgery can predict urinary continence outcomes. ObjectiveTo evaluate the contributions of patient and treatment factors, surgeon efficiency metrics, and surgeon technical skill scores, especially for vesicourethral anastomosis (VUA), to models predicting urinary continence recovery following robot-assisted radical prostatectomy (RARP). Design, setting, and participantsAutomated performance metrics (APMs; instrument kinematics and system events) and patient data were collected for RARPs performed from July 2016 to December 2017. Robotic Anastomosis Competency Evaluation (RACE) scores during VUA were manually evaluated. Training datasets included: (1) patient factors; (2) summarized APMs (reported over RARP steps); (3) detailed APMs (reported over suturing phases of VUA); and (4) technical skills (RACE). Feature selection was used to compress the dimensionality of the inputs. Outcome measurements and statistical analysisThe study outcome was urinary continence recovery, defined as use of 0 or 1 safety pads per day. Two predictive models (Cox proportional hazards [CoxPH] and deep learning survival analysis [DeepSurv]) were used. Results and limitationsOf 115 patients undergoing RARP, 89 (77.4%) recovered their urinary continence and the median recovery time was 166 d (interquartile range [IQR] 82–337). VUAs were performed by 23 surgeons. The median RACE score was 28/30 (IQR 27–29). Among the individual datasets, technical skills (RACE) produced the best models (C index: CoxPH 0.695, DeepSurv: 0.708). Among summary APMs, posterior/anterior VUA yielded superior model performance over other RARP steps (C index 0.543–0.592). Among detailed APMs, metrics for needle driving yielded top-performing models (C index 0.614–0.655) over other suturing phases. DeepSurv models consistently outperformed CoxPH; both approaches performed best when provided with all the datasets. Limitations include feature selection, which may have excluded relevant information but prevented overfitting. ConclusionsTechnical skills and “needle driving” APMs during VUA were most contributory. The best-performing model used synergistic data from all datasets. Patient summaryOne of the steps in robot-assisted surgical removal of the prostate involves joining the bladder to the urethra. Detailed information on surgeon performance for this step improved the accuracy of predicting recovery of urinary continence among men undergoing this operation for prostate cancer.

Examining the Relation Between Technical and Global Competence in Two Treatments for Youth Anxiety

Although technical (quality of delivering techniques from a specific treatment) and global (general clinical expertise) competence are believed to be important ingredients of successful psychosocial treatment with youth, there have been few empirical efforts to measure both dimensions. Efforts to understand the role that each competence dimension plays in the process and outcome of youth treatment starts with determining whether the dimensions can be measured separately. This study examined whether scores from measures designed to assess technical and global competence were distinct. Treatment sessions (N = 603) from 38 youths (M age = 9.84 years, SD = 1.65; 60.5% White; 52.6% male) treated for primary anxiety problems within a randomized effectiveness trial were coded. Four coders used observational measures designed to assess technical competence, global competence, protocol adherence, and the alliance. Mean item interrater reliability was .70 (SD = .09) for technical competence and .66 (SD = .05) for global competence. While most components of global competence were distinct from technical competence scores, two components showed redundancy (r > .70). Scores on both competence measures were empirically distinct (r < .70) from scores on measures of protocol adherence and the alliance. Although the measures did not fully distinguish between technical and global competence, our findings do indicate that some components of technical and global competence may provide unique information about competence.

Barriers and Facilitators for Implementing Motivational Interviewing as a Return to Work Intervention in a Norwegian Social Insurance Setting: A Mixed Methods Process Evaluation

Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for “beginning proficiency” whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.Trial registration ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).

Individual versus collective debriefing after interprofessional training course simulation: The randomised DEBRIEF-SIM trial

IntroductionDebriefing is a critical phase in simulation-based education that is extremely time-consuming for the instructors. The aim of the study was to assess whether a collective debriefing was non-inferior to an individual debriefing to improve learning outcomes after a simulation session. MethodsThis randomised controlled multicentre non-inferiority study included pairs comprising one resident and one student nurse in anaesthesia. Each pair underwent two sessions of a simulated life-threatening emergency held at a 6-week interval. Six participant pairs underwent simulation sessions every half-day of training. The debriefing performed after the first session was either individual (1 debriefing by pair; individual group) or collective (1 debriefing by 6 pairs; collective group). The primary outcome was the evolution of a 34-parameter technical skill score (Delta-TSS-34) between the two simulation sessions. The non-inferiority margin was 5. The change in the Anaesthetists’ Non-Technical Skills score (Delta-ANTS), and the debriefing duration per participant pair were secondary endpoint measures. ResultsRespectively 23 and 21 pairs were included in the collective and individual groups. Delta-TSS-34 was non-inferior in the collective group compared to the individual group (mean intergroup difference [95% confidence interval]: 2.71 [0.44–4.98]). Delta-ANTS did not significantly differ between the two groups (median [interquartile range]: 22 [10–37] versus 25 [17–35], p = 0.57; respectively in the collective and individual groups). The debriefing duration per participant pair was significantly lower in the collective group (10 [10–11] min versus 27 [25–28] min; p < 0.001). ConclusionCollective debriefing was non-inferior to individual debriefing to improve learning outcomes after simulation of medical emergencies and allows a significant reduction in the time dedicated to the debriefing.

Impact of motivational interviewing training on emergency department nurses’ skills: A one-group pretest–posttest pilot study

BackgroundOverdose from opioid abuse is an increasing cause of mortality worldwide. Emergency department nurses experience barriers when caring for patients with illicit opioid use. Motivational interviewing (MI) may help address these barriers. MethodsA one-group pretest–posttest design was used to investigate the impact of an eight-hour MI training workshop for 39 emergency department nurses at a community hospital. Audio-recorded interviews of nurses with standardized patients were assessed before, immediately after, and three to five months after training. Proficiency was assessed using the Motivational Interviewing Treatment Integrity 4.2.1. ResultsPaired t-test analysis found statistically significant technical score increases from 2.20 (SD = 0.64) to 2.51 (SD = 0.52, p = 0.02) but not in relational scores, 2.04 (SD = 0.59) to 2.46 (SD = 0.53, p = 0.06), during the immediate pretest–posttest period. At follow-up, proficiency in MI was unattained and both technical (2.35, SD = 0.61, p = 0.49) and relational scores regressed (2.08, SD 0.74, p = 0.19). ConclusionsAlthough short-term improvements in technical scores were observed, proficiency in MI was not attained and skills regressed over time. This suggests that a one-day training session may be inadequate. On-going coaching and supervision may be beneficial to maintain MI skills.

Measuring dynamic inefficiency in the presence of corporate social responsibility and input indivisibilities

This article proposes a model for evaluating inefficiency accounting for firms’ corporate social responsibility engagement as part of their broader output production activities. The model combines the production of marketable outputs, socially responsible outputs, and undesirable outputs into overall measures of firm performance using data envelopment approaches. Methodologically, the article builds on the dynamic by-production model, which accounts for adjustment costs related with investments, allowing for non-convexities of the production set and input indivisibility, as well as firm corporate social responsibility activities. This study compares dynamic technical inefficiency scores for each input, output, and investment, estimated assuming the presence of input indivisibility (non-convexity) and its absence (convexity). The empirical application focuses on European firms in three industries (offering capital, consumption, and other goods) for the period 2010–2017. The results show significant differences between inefficiencies with and without the convexity assumption and find evidence for non-convexity of firms’ production set and inputs’ indivisibility. Overall, among all outputs, the results reveal the highest inefficiency in the production of socially responsible outputs.

Community-based postnatal care services for women and newborns in Kenya: an opportunity to improve quality and access?

BackgroundIn resource-constrained settings, Community Health Workers (CHWs) are the first point of contact between communities and the health system, as providers of maternal and newborn health services. However, little is known of the quality of community-based postnatal care (PNC). We assessed the content of PNC provided by CHWs and women’s experiences of care in two Kenyan counties.MethodsWe used a cross-sectional, mixed methods design to examine the quality of PNC services provided by CHWs. Trained observers attended PNC home visits to assess technical quality using a 25-item checklist covering four PNC domains: infant health warning signs, maternal health warning signs, essential newborn care, and breastfeeding. The observers completed an 8-item communication quality checklist. We conducted follow-up surveys with observed PNC clients to assess their experiences of care. Finally, we used in-depth interviews with CHWs and focus group discussions with observed PNC clients to understand the experiential quality of care.ResultsObservations suggest shortcomings in the technical quality of PNC home visits. CHWs completed an average of 6.4 (standard deviation SD = 4.1) of the 25 PNC technical quality items. CHWs often lacked essential supplies, and only six percent carried all four of the CHW job aids and tools specified in the national guidelines for maternal health at community level. However, CHWs completed an average of 7.3 (SD = 1.1) of the 8 communication quality items, and most PNC clients (88%) reported being satisfied during follow-up interviews. Higher technical quality scores were associated with older mothers, better communication, longer visit duration, and CHWs who carried at least three job tools. CHWs expressed a strong sense of responsibility for care of their clients, while clients underscored how CHWs were trusted to maintain their clients’ confidentiality and were a valuable community resource.ConclusionThis study identified gaps in the technical quality of CHW PNC practices, while also recognizing positive elements of experiential quality of care, including communication quality, and trusting relationships. This study also demonstrated the strength of the CHWs’ role in establishing linkages between the community and facilities, as long as the CHW are perceived as, and enabled to be, an integral part of the PHC network in Kenya.

Abstract P233: Descriptions of the Meaning of Modified Rankin Scale Outcomes in Acute Stroke Clinical Trials: Meta-Analysis and Call to Corrective Action

Background: The modified Rankin scale, a 7-level, clinician-reported, measure of global disability, is the most widely employed outcome scale in acute stroke trials. As the meaning of technical mRS scores (e.g. mRS 1, mRS 4) is not well-known among general clinicians, patients, and policy-makers, trialists sometimes apply valence (e.g. “excellent”, “good”) and health-state (e.g. “disabled”, “dependent”) terms to convey the clinical meaning of trial findings. The terms employed have not been well-delineated. Methods: Systematic meta-analysis assessing mRS descriptive terms across all large (n ≥ 100) RCTs for acute ischemic or hemorrhagic stroke reported 2000 - 2020, following PRISMA guidelines. Results: Among the 60 RCTs meeting study entry criteria, patient populations were acute ischemic stroke (AIS) in 88%, intracerebral hemorrhage in 8%, both in 3%. Among the 55 AIS trials, tested agents included: antiplatelet - 28%, endovascular thrombectomy - 20%, IV lytics - 20%, neuroprotective - 11%. The mRS was a major endpoint measure in 82% of trials (primary in 60%, secondary in 22%). Table 1 shows frequency of different valence terms (1A) and health state terms (1B) for 9 types of mRS analysis. Trials often used mutually contradictory terms for particular mRS outcomes. e.g. “good outcome” was applied to outcomes mRS 0-1 (2 trials), mRS 0-2 (2 trials), mRS 0-3 (1 trial), and ordinal mRS (3 trials); “favorable” was applied to mRS 0-1 (5 trials), mRS 0-2 (6 trials), and ordinal mRS (6 trials). Also many trials provided no meaningful descriptor (no valence descriptor in 82%, no health state descriptor in 58%). Conclusion: Across major acute stroke trials of the past 20 years, the valence and health state terms for different mRS outcomes have been often mutually contradictory or not provided at all. A standardized nomenclature for mRS outcome description would improve clinician and policy-maker understanding of trial results

Preface

Associated research Centers for the Urban Underground Space (ACUUS) is an international, non-governmental organisation, promoting the sustainable use of the underground space.The ACUUS 2020 Virtual Conference took place in Helsinki, Finland on 3-4 February 2021 and was organized by the International organisation ACUUS, Finnish Tunnelling Association (MTR-FTA), Finnish Association of Architects (SAFA) and Finnish Association of Civil Engineers (RIL). The original dates for this conference were in September 2020. Due to covid-19 travel restrictions, the conference was postponed and it was arranged only virtually. Most of the scientific papers were received before summer holidays 2020 and it would have been unpleasant to postpone publishing these papers any longer.The conference included 96 presentations altogether. There were three categories of presentations: eight keynote speeches, 68 live presentations and 20 on demand video presentations. The keynotes represented current topics from the underground architecture to the latest developments in using underground space as well as the impact of the covid-19 Pandemic. The live presenters had 12 minutes time for presentation and then three minutes for Q/A.Moreover, 1400 chat messages were sent between participants during the conference.This publication consists of 51 accepted scientific papers under the following themes:ArchitectureUrban planningCity developmentUnderground infrastructuresDesignReuse of underground spaceSustainability and environmentGeothermal energySafety and human factorsPerspectivesTechnical approaches and innovationsThe ACUUS 2020 conference had 195 participants from 24 countries. The participants in order of magnitude were from Finland, China, Japan, Hong Kong, Sweden, United States, Greece, Russia, United Kingdom, Singapore, Canada, Norway, Switzerland, Australia, Albania, Austria, Belgium, France, India, Iran, Israel, Italy, Serbia and Spain. The ACUUS 2020 conference was broadcasted in two parallel streams by ProspectumLIVE system. The papers were evaluated and reviewed by Ex-Ordo’s management system. The conference was considered very successful based on the participants’ feedback giving mean score of 4.3 (1 poor…5 excellent) for the overall conference experience and the overall technical quality mean score of 4.4.The ACUUS 2020 conference in Helsinki was the 17th in its history. The next conference will be held in Singapore in 2023.We want to take the opportunity to thank the authors of the published articles, the Scientific Committee members for their improving comments to the submitted papers in the review process and all active conference participants for interesting discussions during the sessions and breaks that contributed to the ACUUS 2020 Helsinki success.EditorsIlkka VähäahoChair of the ACUUS 2020 Scientific CommitteeErik JohanssonCo-chair of the ACUUS 2020 Scientific Committee

Percutaneous peritoneal drain placement: A pilot study of pediatric surgery simulation-based training for general surgery residents

General surgery residents often feel unprepared to perform pediatric surgery procedures since case volume and experience may be low. Previously, we successfully implemented a simulation-based training (SBT) module for placement of a silastic silo for gastroschisis. Therefore, we designed a single institution pilot study to assess whether SBT for placement of a percutaneous peritoneal drain for perforated necrotizing enterocolitis (NEC) was feasible and lead to skill acquisition and increased confidence. Our newly created NEC module within our pediatric surgery SBT curriculum for general surgery residents was used. Residents completed two simulation sessions three months apart with confidence testing before and after each session. Skill acquisition and performance were assessed using a standardized case scenario and procedure checklist. Changes in residents' confidence and performance were determined using Wilcoxon Signed-Rank Tests. Nine post-graduate-year three general surgery residents completed this curriculum. Following completion, residents reported improved confidence completing each step of the procedure initially (p=0.005) and at 3 months (p=0.008) with improved technical scores (p=0.011). The number of residents deemed proficient significantly improved (p=0.031). Implementation of SBT module for perforated NEC was feasible and improved residents' confidence and proficiency completing the procedure.

A Training Model for Local Flaps Using Fresh Human Skin Excised During Body Contouring Procedures

BackgroundThe safe execution of local flaps tends to be challenging for surgical residents. Thus, the purpose of the study was to evaluate a training model of local flaps based on fresh human skin excised from body contouring procedures. Materials and methodsA questionnaire and surgical skills evaluation—analyzing the theoretical and procedural knowledge about local flaps—were held both before and after the surgical skills training. All surgical procedures were executed on a simulation model based on fresh human skin. Skills evaluation was done according to a modified version of the Objective Structured Assessment of Technical Skills Score. Results before and after the training were compared using SPSS, version 21. ResultsIn pretraining evaluation, residents showed great difficulty regarding the accuracy of flap design and sufficiency of wound coverage indicating the need for surgical training outside the operating theater. After training, the procedural skills significantly improved as depicted by the modified Objective Structured Assessment of Technical Skills score with a mean cumulative pretraining score of 26.81 ± 5.41 and posttraining score of 43.59 ± 5.72 (P = 0.008). Also, theoretical knowledge significantly improved in the posttraining evaluation with exception to the indication of a Z-plasty (P = 0.257). The training model itself was generally regarded as highly useful and thus recommendable to others. ConclusionsSurgical handling and the understanding of tissue rotation clearly improved by the presented model which mimics very realistic conditions. The simulation model based on fresh human skin shows cost-effectiveness and allows a broad range for flap procedures wherefore its use should be further promoted.

Hyperlactataemia as a predictor of adverse outcomes post-cardiac surgery in neonates with congenital heart disease.

To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery. Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children's hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score. Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87). We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.

Surgical Outcomes, Technical Performance, and Surgery Burden of Robotic Total Gastrectomy for Locally Advanced Gastric Cancer: A Prospective Study.

To compare the short-term outcomes, surgery burden, and technical performance of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) for gastric cancer (GC). The impact of robotic systems on total gastrectomy remains obscure. This prospective study included 50 patients with advanced proximal GC underwent RTG combined with spleen-preserving splenic hilar lymphadenectomy between March 2018 and February 2020. Patients who underwent LTG in the FUGES-002, http://links.lww.com/SLA/C929 study were enrolled to compare the outcomes between RTG and LTG. After propensity score matching, 48 patients in the RTG group and 96 patients in the LTG group were included in the analysis. The RTG group had a lower volume of intraoperative blood loss than the LTG group (38.7 vs 66.4 mL, P = 0.042). Significantly more extraperigastric lymph nodes were retrieved in the RTG group than in the LTG group (20.2 vs 17.5, P = 0.039). The average number of errors was lower in the RTG group than in the LTG group (43.2 vs 53.8 times/case, P < 0.001). The RTG group had a higher technical skill score (30.2 vs 28.4, P < 0.001) and a lower surgery task load index (33.2 vs 39.8, P < 0.001) than the LTG group. No significant difference was found in terms of postoperative morbidity between the 2 groups (14.6% vs 16.7%, P = 0.748). In complex total gastrectomy for GC, compared with traditional laparoscopic surgery, robotic surgery provides a technically superior operative environment and reduces surgeon workload at high-volume specialized institutions.