Implementation of a Cross-specialty Training Program in Basic Laparoscopy

Background and Objectives:

Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment.

Methods:

Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills.

Results:

We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory–based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points.

Discussion:

Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up.     

La psychiatrie de la personne âgée : enjeux et perspectives

Psychiatry in the elderly is a recent branch of psychiatry, born with the increased elderly population, and which tries to be an autonomous discipline in France. European and international Psychiatry in the elderly developed a corpus of knowledge, practices and institutional organizations of its own since 1950s. In France, its current organization is very recent and unequal between regions, so it needs to be clarified and developed. Its teaching has also to be delimited in order to give a better training for different levels of professionals, especially psychiatrists. We will discuss the current situation in France in the light of national and international data and will make hypothesis for development perspectives of its teaching.     

Brain simulation of action may be grounded in physical experience

An intriguing quality of our brain is that when actions are imagined, corresponding brain regions are recruited as when the actions are actually performed. It has been hypothesized that the similarity between real and simulated actions depends on the nature of motor representations. Here we tested this hypothesis by examining S.D., who never used her legs but is an elite wheel chair athlete. Controls recruited motor brain regions during imagery of stair walking and frontal regions during imagery of wheel chair slalom. S.D. showed the opposite pattern. Thus, brain simulation of actions may be grounded in specific physical experiences.     

Comparison of the effects of continuous positive airway pressure,oral appliance and exercise training in obstructive sleep apnea syndrome

OBJECTIVE:

There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments.

METHODS:

Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392

RESULTS:

After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness.

CONCLUSIONS:

Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.     

Operative terminology and post-operative management approaches applied to hepatic surgery:Trainee perspectives

Outcomes in hepatic resectional surgery(HRS) have improved as a result of advances in the understanding of hepatic anatomy,improved surgical techniques, and enhanced peri-operative management.Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period,however,greater acceptance and understanding of HRS has meant that care is transferred,usually after 24-48 h,to a standard ward environment.Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call,and it is therefore important to acknowledge the key points in managing HRS patients.Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken.Increasingly,enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia,careful fluid balance,nutrition and thromboprophlaxis.Complications can occur including liver,renal and respiratory failure,hemorrhage,and sepsis,all of which require prompt recognition and management.We provide an overview of the relevant terminology applied to hepatic surgery,an approach to the post-operative management,and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients.     

Long-term maintenance of novel vocabulary in persons with chronic aphasia

Background: The study of novel word learning in aphasia can shed light on the functionality of patients' learning mechanisms and potentially help in treatment planning. Previous studies have indicated that persons with aphasia are able to learn some new vocabulary. However, these learning outcomes appear short-lived and evidence for the ability to use the newly learned words in the long term is lacking.

Aims: Participants with aphasia and matched controls underwent short training where they were taught to name novel objects with novel names. We studied the participants' word learning and particularly their long-term maintenance. We also examined whether the language and verbal short-term memory impairments of the participants with aphasia related to their ability to acquire and maintain phonological and semantic information on novel words.

Methods & Procedures: Two participants with nonfluent aphasia, LL and AR, and two matched controls took part in the experiment. They were taught to name 20 unfamiliar objects by repeating the names in the presence of the object picture. Half of the items carried a definition that was used to probe incidental semantic learning. There were four training sessions, a post-training test, and follow-up tests up to 6 months post-training. Learning measures included recognition of the trained objects, as well as spontaneous and cued recall in visual confrontation naming. Incidental semantic learning was measured by spontaneous recall of the definitions.

Outcomes & Results: Combining spontaneous and phonologically cued responses, LL acquired 70% and AR 55% of the novel words. With phonological cueing, LL named 50% of the items correctly up to 6 months post-training (vs 95–100% for the controls) and AR 25% up to 8 weeks post-training. AR's lexical-semantic processing, pseudoword repetition and verbal short-term capacity were inferior to those of LL. In line with this, AR learned fewer words and showed more decline in recognition memory for the trained items, and weaker recall of the semantic definitions.

Conclusions: Our results support previous findings that people with aphasia can learn to name novel items. More importantly, the results show for the first time that, with phonological cueing, an individual with aphasia can maintain some of this learning up to 6 months post-training. Moreover the results provide further evidence for the significance of the functional status of lexical-semantic processing on word learning success.     

Suicide-preventive activities in psychiatric care: Evaluation of an educational programme in suicide prevention

To promote implementation of suicide-preventive activities, the Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) introduced a 200-h academic, postgraduate educational programme (based on the training-of-trainers model) in suicide prevention. This programme was provided at Karolinska Institute, Stockholm, for key persons in psychiatric care. Twenty-nine key persons from 11 psychiatric intervention clinics in Stockholm County attended the first course. Preconditions for implementing suicide-preventive activities were assessed by means of semi-structured interviews with all course participants still working in the intervention clinics (n=10). In all but one of these 10 clinics, a wide range of suicide-preventive activities had been implemented as a result of the NASP course. Activities varied in scope, but the key persons seemed to have succeeded in pinpointing the key elements in suicide prevention – the need for specific knowledge about the suicidal process and for well-defined suicide-preventive routines. However, organizational factors and staff turnover were obstacles to maintaining and making the activities routine. There is a need to strengthen the course participants’ formal roles as implementers and encourage the clinical management in their continuous implementation of suicide-preventive activities.     

Communication: Preparing undergraduate radiation therapy students for initial clinical patient interactions

IntroductionRadiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations.MethodsThe module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively.ResultsFour hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions.ConclusionOverall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.     

The diagnostic accuracy of radiographers assessing screening mammograms: A systematic review

This systematic review aims to evaluate the literature on the performance of radiographers in assessment of screening mammograms compared with radiologists. Measurable performance criteria were essential as well as a gold standard with which to compare both performance, and outcomes by means of biopsy reports or consequent negative screenings. The level of training of the radiographers in mammogram assessment was also documented. The majority of the literature demonstrated that the performance statistics of radiographers are equivalent to that of radiologist readers. Although formal training of radiographers demonstrates improved sensitivity, results of all performance data suggest no statistical difference at the 95% level between trained or untrained radiographers and radiologists.