Development of a comprehensive vascular skills assessment for surgical trainees

Background

Although vascular skills are important to general surgeons, vascular surgery has become a separate specialty, and therefore, there may be an erosion of vascular skills acquired by general surgical trainees. The purpose of this study was to develop a reliable and valid comprehensive vascular skills assessment (CVSA) of both knowledge and technical skills.

Methods

Twenty-four of 38 general surgical residents at the University of British Columbia completed a two-part CVSA consisting of a written examination and a series of 4 technical stations in a skills laboratory. Technical performance was rated using validated scales.

Results

The mean overall CVSA score was 50%. The CVSA demonstrated construct validity, with improvement in scores with increasing postgraduate year level (P = .01). The overall reliability (Cronbach's α) was .90.

Conclusions

The CVSA developed in this study is a comprehensive assessment of vascular skills that is both valid and reliable. It offers an objective and feasible assessment of general surgical trainees' vascular skills.     

ICAM-1 molecular mechanism and genome wide SNP's association studies

Macrophages transformed foam cell formation occurs as a result of leukocyte accumulation mediated through intercellular adhesion molecule 1 (ICAM1), vascular cell adhesion molecule 1 (VCAM1), and E-selectin, secreted by inflamed or damaged endothelium. The key molecule is the ICAM-1, member of the adhesion immunoglobulin super family that maps to chromosome 19 p13.2-p13.3 codes for 505 amino acids have five extracellular domains including circulatory leukocytes binding site (primarily monocytes) for recruiting it at the sites of inflammation and the tight adhesion with vascular endothelium for the above mentioned pathogenesis as an initial step. Hence the objective of the current paper is to review the Genome Wide Association (GWA) studies and summarizes its understanding of functional Single Nucleotide Polymorphism (SNP''s) of ICAM-1 clinical association to provide better guidance for the clinicians and researchers of the merits, demerits of the current results and direct them to do research on larger number of population for better prospective.     

Peroxydisulphate initiated graft copolymerization of o‐toluidine onto synthetic fibres – A kinetic approach

Graft copolymerization of o‐toluidine onto poly(ethylene terephthalate) and nylon 66 fibres initiated by peroxy disulphate was carried out under nitrogen atmosphere. Various graft parameters such as rate of grafting, percentage grafting and percentage efficiency were evaluated. The rate of homopolymerization was also determined. The experimental results indicate the first order dependence of both R_h and R_g on [monomer], [initiator] and (amount of fibre). The chemical grafting was confirmed through cyclic voltammetry, differential thermal analysis, weight loss method and conductivity measurements. A probable mechanism has been proposed to explain the experimental results obtained.     

5-HT3 antagonist ICS 205-930 enhances naltrexone's effects on ethanol intake

Opioid receptor antagonist naltrexone has shown some efficacy in decreasing ethanol consumption in humans. However, naltrexone treatment is not always efficacious and produces several aversive effects such as nausea, anxiety and weight loss. Serotonin-3 (5-HT3) receptor antagonists also modulate some of the behavioral effects of alcohol and may decrease alcohol consumption. We examined the effects of the combination of 5-HT3 receptor antagonist ICS 205-930 ((3-tropanyl-indole-1-carboxylate, tropisetron) and naltrexone on ethanol and food intake in Sprague-Dawley rats. Both naltrexone (0.56-10 mg/kg) and ICS 205-930 (5.6 mg/kg), when administered intraperitoneally 30 min before the scheduled 3-h access to ethanol, significantly suppressed ethanol intake. Naltrexone (1 mg/kg) when given in combination with ICS 205-930 (5.6 mg/kg) was significantly more efficacious in suppressing ethanol intake in comparison with naltrexone (1 mg/kg) administered alone. The drug combination did not affect the food intake. These data suggest that 5-HT3 receptor antagonist ICS 205-930 may be used as an effective adjunct for pharmacotherapy of alcoholism.     

Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity

Our purposes were: 1) to establish the predictive validity of stereoscopic visual acuity and microsurgical performance, and 2) to establish the construct and concurrent validity of hand-motion analysis as an objective and sensitive measure of microsurgical performance. Using a surgical microscope, 50 surgical residents completed a standardized microsurgical suturing task at baseline and following microsurgical training. Microsurgical performance was evaluated by blinded, expert microsurgeons using global rating scales. Measures of stereoscopic visual acuity and hand-motion analysis were correlated with expert global rating scores. Global rating scores correlated significantly with number of hand movements (r = -0.47, P = 0.001) and hand-travel distance (r = -0.37, P = 0.008). Economy of hand-motion improved significantly following microsurgical training (number of hand movements, P = 0.046; hand-travel distance, P = 0.04). Measures of stereoscopic visual acuity did not correlate significantly with global rating scores. Hand-motion analysis appears to be an objective and sensitive instrument for assessing microsurgical performance, with evidence of both concurrent and construct validity. The predictive validity of stereoscopic visual acuity and microsurgical performance remains unclear.