scholarly journals Magnetic flexible endoscope for colonoscopy: an initial learning curve analysis

2021 ◽  
Vol 09 (02) ◽  
pp. E171-E180
Author(s):  
Alexander P. Mamunes ◽  
Federico Campisano ◽  
James Martin ◽  
Bruno Scaglioni ◽  
Evangelos Mazomenos ◽  
...  
Keyword(s):  
Learning Curve ◽  
User Experience ◽  
Magnetic Coupling ◽  
Wall Stress ◽  
Learning Curves ◽  
Flexible Endoscope ◽  
Colon Wall ◽  
Task Load ◽  
Perceived Workload ◽  
Experienced Endoscopists

Abstract Background and study aims Colonoscopy is a technically challenging procedure that requires extensive training to minimize discomfort and avoid trauma due to its drive mechanism. Our academic team developed a magnetic flexible endoscope (MFE) actuated by magnetic coupling under supervisory robotic control to enable a front-pull maneuvering mechanism, with a motion controller user interface, to minimize colon wall stress and potentially reduce the learning curve. We aimed to evaluate this learning curve and understand the user experience. Methods Five novices (no endoscopy experience), five experienced endoscopists, and five experienced MFE users each performed 40 trials on a model colon using 1:1 block randomization between a pediatric colonoscope (PCF) and the MFE. Cecal intubation (CI) success, time to cecum, and user experience (NASA task load index) were measured. Learning curves were determined by the number of trials needed to reach minimum and average proficiency—defined as the slowest average CI time by an experienced user and the average CI time by all experienced users, respectively. Results MFE minimum proficiency was achieved by all five novices (median 3.92 trials) and five experienced endoscopists (median 2.65 trials). MFE average proficiency was achieved by four novices (median 14.21 trials) and four experienced endoscopists (median 7.00 trials). PCF minimum and average proficiency levels were achieved by only one novice. Novices’ perceived workload with the MFE significantly improved after obtaining minimum proficiency. Conclusions The MFE has a short learning curve for users with no prior experience—requiring relatively few attempts to reach proficiency and at a reduced perceived workload.

scholarly journals LEARNING CURVE IN SINGLE-LEVEL MINIMALLY INVASIVE TLIF: EXPERIENCE OF A NEUROSURGEON

2017 ◽  
Vol 16 (4) ◽  
pp. 279-282 ◽  
Author(s):  
Samuel Romano-Feinholz ◽  
Sergio Soriano-Solís ◽  
Julio César Zúñiga-Rivera ◽  
Carlos Francisco Gutiérrez-Partida ◽  
Manuel Rodríguez-García ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Learning Curves ◽  
Surgical Experience ◽  
Surgical Time ◽  
Intraoperative Bleeding ◽  
Single Level ◽  
Piecewise Regression ◽  
The Mean

ABSTRACT Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.

Research on the Potential of Resource Saving and Emission Reducing in Anhui Province: Based on Environment Learning Curve

2011 ◽  
Vol 361-363 ◽  
pp. 1000-1004
Author(s):  
Qi Li
Keyword(s):  
Energy Consumption ◽  
Learning Curve ◽  
Water Consumption ◽  
Exponential Model ◽  
Learning Curves ◽  
Anhui Province ◽  
Resource Saving ◽  
Environmental Learning ◽  
Discharge Water ◽  
Resource And Environment

Based on the statistics data from 1990 to 2008 in Anhui province, this article selects four indexes which include energy consumption, SO2 discharge, water consumption and COD discharge per ten thousand yuan GDP, and establishes environment learning curves of energy consumption and air pollution, water consumption and pollution in Anhui province. According to these models, the potentials of resources saving and pollution reducing in different periods are calculated and analyzed, represented by the decrease of each index when the per capita GDP increase 1000 yuan. The result shows that: (1) With the growth of GDP per capital, each index falls by power exponential model which follows "environmental learning curve", illustrating that the burden of resource and environment was steady declining. (2) The potentials of saving energy resources and reducing pollution in Anhui province gradually descents from 1990 to 2008, illustrating that the reduction in marginal cost by the development of technology is becoming smaller and smaller, and the enhancement of resource using efficiency and pollution reducing efficiency is not unlimited.

scholarly journals REGIONAL TECHNOLOGICAL LEARNING IN TURKISH CEMENT INDUSTRY

2020 ◽  
Vol 8 (4) ◽  
pp. 204-216
Author(s):  
Gurkan Calmasur ◽  
◽  
Meryem Emre Aysin ◽  
Keyword(s):  
Learning Curve ◽  
Linear Models ◽  
Raw Materials ◽  
Analysis Data ◽  
Vital Role ◽  
Learning Curves ◽  
Cement Industry ◽  
Company Performance ◽  
Technological Learning ◽  
The Impact

The learning curve reflects the reduction in average costs as the company's cumulative production increases. These curves are utilized when measuring company performance, managing production processes, and planning. In terms of cost reduction and profitability, the impact of learning is particularly important. The learning curves have been traditionally used in industries. In this study, the learning curves concerning the cement industry are examined. The cement sector inherits a high export potential in Turkey. Additionally, it is the industry branch that supplies the raw materials needed by countries' construction industries. On the other hand, the construction sector is a leading sector that mobilizes other markets. This sector is a major contributor to production, investment, and employment and plays a vital role in the development of the country. This paper aims to make a detailed analysis of the learning curves regarding the Turkish cement industry at the regional level covering the 2000-2018 period. In order to realize this aim, the linear and cubic learning models have been applied and the technological learning values for regions from 2000 to 2018 have been calculated. For the analysis, data of 68 factories operating in the Turkish cement industry obtained from Turkey Cement Manufacturers' Association have been used. The estimated results suggest that cubic models explain technological learning better than the linear models. The results indicated that learning levels differed across regions and times. While the highest learning level was observed in 2004, the highest level of forgetting was recorded in 2018. Finally, we can state that the learning curve of the Turkish cement industry between 2000 and 2018 is convex.

scholarly journals Learning curve in rat dissection for experimental sciatic nerve repair

2019 ◽  
pp. 243-248
Author(s):  
Marin Andrei ◽  
Marin Georgiana Gabriela ◽  
Dobrete Nicoleta Amalia ◽  
Enescu Dan Mircea
Keyword(s):  
Sciatic Nerve ◽  
Learning Curve ◽  
Nerve Regeneration ◽  
Experimental Model ◽  
Rat Model ◽  
Surgical Intervention ◽  
Nerve Repair ◽  
Learning Curves ◽  
Rat Sciatic Nerve ◽  
Nerve Surgery

The baseline for any key research in nerve regeneration is an experimental model and the sciatic nerve in the rat model is the workhorse in this field. Although physically resistant to external traumas, a surgical intervention constitutes a major distress even for a rat. In the following presentation, we will analyse the learning curves for different stages in the rat sciatic nerve surgery as well as possible factors which influence these times.

Getting it right first time: implementation of laparoscopic pyloromyotomy without a learning curve

2021 ◽  
Vol 103 (2) ◽  
pp. 130-133
Author(s):  
GS Arul ◽  
W Moni-Nwinia ◽  
G Soccorso ◽  
M Pachl ◽  
M Singh ◽  
...  
Keyword(s):  
Learning Curve ◽  
New Technologies ◽  
Wound Dehiscence ◽  
Learning Curves ◽  
Routine Practice ◽  
Female Ratio ◽  
Day Range ◽  
Implementation Period ◽  
Mucosal Perforation ◽  
Laparoscopic Pyloromyotomy

Introduction Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve. Materials and methods Five consultants tasked one surgeon to pilot and establish laparoscopic pyloromyotomy before mentoring the others until they were performing the procedure independently; all agreed to use exactly the same instruments and operative technique. This involved a 5mm 30-degree infra-umbilical telescope with two 3mm instruments. Data were collected prospectively. Results Between 1 January 2013 and 31 December 2017, 140 laparoscopic pyloromyotomies were performed (median age 27 days, range 13–133 days, male to female ratio 121:19). Fifty-five per cent of procedures were performed by trainees. Complications were one mucosal perforation and one inadequate pyloromyotomy. There were no injuries to other organs, problems with wound dehiscence or other significant complications. The median time of discharge was one day (range one to six days). Conclusion Our rate of perforation and incomplete pyloromyotomy was 1.4%, which is equivalent to the best published series of either open or laparoscopic pyloromyotomy. We believe that this resulted from the coordinated implementation of the procedure using a single technique to reduce clinical variability, increase mentoring and improve training. This approach appears self-evident but is rarely described in the literature of learning curves. In this age of increased accountability, new technologies should be incorporated into routine practice without an increase in morbidity to patients.

Learning curves for transradial access versus transfemoral access in diagnostic cerebral angiography: a case series

2021 ◽  
pp. neurintsurg-2021-017460
Author(s):  
Michael K Tso ◽  
Gary B Rajah ◽  
Rimal H Dossani ◽  
Michael J Meyer ◽  
Matthew J McPheeters ◽  
...  
Keyword(s):  
Learning Curve ◽  
Case Series ◽  
Learning Curves ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Steep Learning Curve ◽  
Transradial Access ◽  
Primary Operator ◽  
Technical Proficiency ◽  
Over Time

BackgroundThe perception of a steep learning curve associated with transradial access has resulted in its limited adoption in neurointervention despite the demonstrated benefits, including decreased access-site complications.ObjectiveTo compare learning curves of transradial versus transfemoral diagnostic cerebral angiograms obtained by five neurovascular fellows as primary operator.MethodsThe first 100–150 consecutive transradial and transfemoral angiographic scans performed by each fellow between July 2017 and March 2020 were identified. Mean fluoroscopy time per artery injected (angiographic efficiency) was calculated as a marker of technical proficiency and compared for every 25 consecutive procedures performed (eg, 1–25, 26–50, 51–75).ResultsWe identified 1242 diagnostic angiograms, 607 transradial and 635 transfemoral. The radial cohort was older (64.3 years vs 62.3 years, p=0.01) and demonstrated better angiographic efficiency (3.4 min/vessel vs 3.7 min/vessel, p=0.03). For three fellows without previous endovascular experience, proficiency was obtained between 25 and 50 transfemoral angiograms. One fellow achieved proficiency after performing 25–50 transradial angiograms; and the two other fellows, in <25 transradial angiograms. The two fellows with previous experience had flattened learning curves for both access types. Two patients experienced transient neurologic symptoms postprocedure. Transradial angiograms were associated with significantly fewer access-site complications (3/607, 0.5% vs 22/635, 3.5%, p<0.01). Radial-to-femoral conversion occurred in 1.2% (7/607); femoral-to-radial conversion occurred in 0.3% (2/635). Over time, the proportion of transradial angiographic procedures increased.ConclusionTechnical proficiency improved significantly over time for both access types, typically requiring between 25 and 50 diagnostic angiograms to achieve asymptomatic improvement in efficiency. Reduced access-site complications and decreased fluoroscopy time were benefits associated with transradial angiography.

scholarly journals A-111 The Relationship between Bilingualism and Perceived Workload on the Symbol Digit Modalities Test in Traumatic Brain Injury Survivors

2020 ◽  
Vol 35 (6) ◽  
pp. 904-904
Author(s):  
Lopez-Hernandez D ◽  
Litvin P ◽  
Rugh-Fraser R ◽  
Cervantes R ◽  
Martinez F ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Language Use ◽  
Group Differences ◽  
Task Load ◽  
Language Groups ◽  
Perceived Workload ◽  
Nasa Tlx ◽  
Nasa Task Load Index ◽  
The Relationship

Abstract Objective We evaluated perceived workload (measured by the NASA Task Load Index; NASA-TLX) as related to Symbol Digit Modalities Test (SDMT) performances in monolingual and bilingual traumatic brain injury (TBI) survivors and healthy comparison participants (HC). Method The sample consisted of 28 TBI survivors (12 monolinguals & 16 bilinguals) and 50 HC (20 monolinguals & 30 bilinguals). SDMT written (SDMT-W) and SDMT oral (SDMT-O) were used to evaluate group differences. Results ANCOVA, controlling for age, revealed that the HC group outperformed the TBI group on SDMT-W, p = .001, and SDMT-O, p = .047. Furthermore, bilinguals outperformed monolinguals on SDMT-W, p = .017. On the NASA-TLX, an interaction emerged on temporal demand rating, p = .023, with TBI bilinguals reporting higher temporal demand on SDMT tasks compared to TBI monolinguals, while the HC monolingual participants reported higher temporal demands ratings compared to HC bilingual participants. Furthermore, monolingual participants showed higher levels of frustration with regard to the SDMT task compared to bilingual participants, p = .029. Conclusion Our data revealed TBI survivors underperformed on both SDMT trials compared to the HC participants. Also, bilingual participants demonstrated better SDMT-W performances compared to monolingual participants. Furthermore, our TBI bilingual sample reported themselves to be more rushed to complete the SDMT compared to monolingual TBI sample, but they were less frustrated. Meanwhile, our HC monolingual sample felt more rushed to complete the SDMT tasks compared to HC bilingual participants, but they were less frustrated. While we observed differences in workload ratings between language groups, it is unclear if language use, and/or other variables are driving these results.

scholarly journals Early Learning Curve in the Assessment of Deep Pelvic Endometriosis for Ultrasound and Magnetic Resonance Imaging

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
T. Indrielle-Kelly ◽  
D. Fischerova ◽  
P. Hanuš ◽  
F. Frühauf ◽  
M. Fanta ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Learning Curve ◽  
Uterosacral Ligament ◽  
Learning Curves ◽  
Pelvic Endometriosis ◽  
Resonance Imaging ◽  
Deep Endometriosis ◽  
Kappa Agreement ◽  
Radiology Trainee

Purpose. We aimed to compare the learning curves of an ultrasound trainee (obstetrics and gynecology resident) and a radiology trainee when assessing pelvic endometriosis. Methods. Consecutive patients with suspected endometriosis were prospectively enrolled in a tertiary center. They underwent an ultrasound and magnetic resonance imaging preoperatively, which was reported according to the International Deep Endometriosis Analysis (IDEA) group consensus. Trainees reported on deep endometriosis (DE), endometriomas, frozen pelvis, and adenomyosis. Using the Kappa agreement, their findings were compared against laparoscopy/histology and expert findings. The learning curve was considered positive when performance improved over time and indeterminate in all other cases. Results. Reports from thirty-five women were divided chronologically into 3 equal blocks to assess the learning curve. For ultrasound, trainee versus expert showed a positive learning curve in overall pelvic DE assessment. There was an excellent agreement for adenomyosis (Kappa=1.00, p=0.09), frozen pelvis (Kappa=0.90, p=0.01), bowel (Kappa=1.00, p=0.01), and bladder DE assessment (Kappa=1.00, p=0.01). Endometrioma and uterosacral ligament assessment showed an indeterminate curve. For radiology, trainee versus expert showed a positive curve when detecting adenomyosis (Kappa=0.42, p=0.09) and bladder DE (Kappa=1.00, p=0.01). The assessment of endometriomas, frozen pelvis, overall pelvic DE, bowel, and uterosacral ligament DE showed indeterminate curve. Agreement between trainees and laparoscopy/histology showed a positive curve for bladder (both) and frozen pelvis (ultrasound only). Conclusion. A positive learning curve can be seen in some areas of pelvic endometriosis mapping after as little as 35 cases, but a bigger caseload is required to demonstrate the curve in full. The ultrasound trainee had positive learning curves in more anatomical locations (bladder, adenomyosis, overall bowel DE, frozen pelvis) than the radiology trainee (bladder, adenomyosis), which could be down to individual factors, differences in training, or the imaging method itself.

scholarly journals UUX Evaluation of a Digitally Advanced Human–Machine Interface for Excavators

2020 ◽  
Vol 4 (3) ◽  
pp. 57
Author(s):  
Sebastian Lorenz ◽  
Jens R. Helmert ◽  
Ruben Anders ◽  
Christian Wölfel ◽  
Jens Krzywinski
Keyword(s):  
User Experience ◽  
User Interfaces ◽  
Quality Measurement ◽  
Industrial Applications ◽  
Human Machine Interface ◽  
The Novel ◽  
Task Load ◽  
System Usability Scale ◽  
Machine Interface ◽  
The Right

With the evaluation of a next-generation human–machine interface (HMI) concept for excavators, this study aims to discuss the HMI quality measurement based on usability and user experience (UUX) metrics. Regarding the digital transformation of construction sites, future work environments will have to be capable of presenting various complex visual data and enabling efficient and safe interactivity while working. The evaluated HMI focused on introducing a touch display-based interface, providing advanced operation functions and different interaction modalities. The assessment of UUX should show whether the novel HMI can be utilised to perform typical tasks (usability) and how it is accepted and assessed in terms of non-instrumental qualities (user experience, UX). Using the collected data, this article also aims to contribute to the general discussion about the role of UX beyond usability in industrial applications and deepen the understanding of non-instrumental qualities when it comes to user-oriented process and machine design. The exploratory study examines insights into the application of elaborated UUX measuring tools like the User Experience Questionnaire (UEQ) on the interaction with industrial goods accompanied by their rating with other tools, namely System Usability Scale (SUS), Intuitive Interaction Questionnaire (INTUI) and the National Aeronautics and Space Administration (NASA) Task Load Index (NASA-TLX). Four goals are pursued in this study. The first goal is to compare in-depth two different ways of interaction with the novel HMI—namely one by a control pad on the right joystick and one by touch. Therefore, a sample of 17 subjects in total was split into two groups and differences in UUX measures were tested. Secondly, the performances of both groups were tested over the course of trials to investigate possible differences in detail. The third goal is to interpret measures of usability and user experience against existing benchmark values. Fourth and finally, we use the data gathered to analyse correlations between measures of UUX. The results of our study show that the different ways of interaction did not impact any of the measures taken. In terms of detailed performance analysis, both groups yielded differences in terms of time per action, but not between the groups. The comparison of UUX measures with benchmark values yielded mixed results. The UUX measures show some relevant significant correlations. The participants mostly reported enjoying the use of the HMI concept, but several practical issues (e.g., efficiency) still need to be overcome. Once again, the study confirms the urge of user inclusion in product development. Especially in the course of digitalisation, as big scale advancements of systems and user interfaces bring uncertainty for many manufacturers regarding whether or how a feature should be integrated.

scholarly journals Learning curve in minimally invasive mitral valve surgery: a single-center experience

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Anh Tuan Vo ◽  
Dinh Hoang Nguyen ◽  
Sy Van Hoang ◽  
Khoi Minh Le ◽  
Thu Trang Nguyen ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Mitral Valve Surgery ◽  
Learning Curves ◽  
Valve Surgery ◽  
Technical Failure ◽  
Cumulative Number ◽  
Excellent Outcome ◽  
Single Center Experience

Abstract Background Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. Methods A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. Results MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. Conclusion MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. Trial registration The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.

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