A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Yinin Hu ◽  
Alex D. Michaels ◽  
Rachita Khot ◽  
Worthington G. Schenk ◽  
John B. Hanks ◽  
...  
Keyword(s):  
Learning Curves ◽  
Delphi Panel ◽  
Thyroid Ultrasound ◽  
Point Scale ◽  
Image Capture ◽  
Delphi Approach ◽  
Inflection Points ◽  
Operative Planning ◽  
Positioning Technique ◽  
Formally Trained

Background Thyroid ultrasounds extend surgeons’ outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound proficiency metric through a collaborative Delphi approach. Methods Clinical faculty experienced in thyroid ultrasound participated on a Delphi panel to design the thyroid Ultrasound Proficiency Scale (UPS-Thyroid). Participants proposed items under the categories of Positioning, Technique, Image Capture, Measurement, and Interpretation. In subsequent rounds, participants voted to retain, revise, or exclude each item. The process continued until all items had greater than 70% consensus for retention. The UPS-Thyroid was pilot tested across 5 surgery residents with moderate ultrasound experience. Learning curves were assessed with cumulative sum. Results Three surgeons and 4 radiologists participated on the Delphi panel. Following 3 iterative Delphi rounds, the panel arrived at >70% consensus to retain 14 items without further revisions or additions. The metric included the following items on a 3-point scale for a maximum of 42 points: Positioning (1 item), Technique (4 items), Image Capture (2 items), Measurement (2 items), and Interpretation (5 items). A pilot group of 5 residents was scored against a proficiency threshold of 36 points. Learning curve inflection points were noted at between 4 to 7 repetitions. Conclusions A multidisciplinary Delphi approach generated consensus for a thyroid ultrasound proficiency metric (UPS-Thyroid). Among surgery residents with moderate ultrasound experience, basic proficiency at thyroid ultrasound is feasible within 10 repetitions.

scholarly journals Fostering the employability of business studies graduates

2015 ◽  
Author(s):  
Shairn Hollis-Turner
Keyword(s):  
Higher Education ◽  
Qualitative Data ◽  
Business Administration ◽  
Learning Opportunities ◽  
Delphi Panel ◽  
Corporate Sector ◽  
Business Studies ◽  
Delphi Approach ◽  
Workplace Experience ◽  
Work Integrated Learning

Higher education is under pressure to enhance the employability of graduates by ensuring that they acquire competencies that make them employable in the labour market. This research project investigated the contribution of higher education towards the employability of graduates within a business diploma programme. A Delphi approach was employed with the Delphi panel consisting of three types of professionals – employers within the corporate sector, academics in the field of business studies, and graduates with workplace experience in the corporate sector. Both quantitative and qualitative data were obtained from three rounds of surveys. The findings show that disciplinary knowledge of Information Administration, Business Administration, Communication and Personnel Management, and the simulation of workplace practices as well as work-integrated learning opportunities are significant to enhancing the employability of office administrators and office managers. These findings provided academics with the opportunity to make improvements to the curriculum to foster the employability of the graduates.

scholarly journals Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy

2020 ◽  
Vol 102 (9) ◽  
pp. 717-725
Author(s):  
A Tamhankar ◽  
N Spencer ◽  
A Hampson ◽  
J Noel ◽  
O El-Taji ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Learning Curves ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Large Dataset ◽  
Laparoscopic Prostatectomy ◽  
Assessment Of Learning ◽  
Inflection Points ◽  
Estimated Blood Loss

Introduction The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases. Methods We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases. Results A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D’Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins. Conclusions It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.

A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach

2015 ◽  
Vol 221 (4) ◽  
pp. S47
Author(s):  
Alex D. Michaels ◽  
Yinin Hu ◽  
Philip W. Smith ◽  
John B. Hanks ◽  
Worthington G. Schenk ◽  
...  
Keyword(s):  
Thyroid Ultrasound ◽  
Delphi Approach

scholarly journals The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience

2020 ◽  
Author(s):  
Roberto Persiani ◽  
Annamaria Agnes ◽  
Francesco Belia ◽  
Domenico D’Ugo ◽  
Alberto Biondi
Keyword(s):  
Rectal Cancer ◽  
Learning Curve ◽  
Major Complication ◽  
Reoperation Rate ◽  
Learning Curves ◽  
Low Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Inflection Points ◽  
Institutional Experience ◽  
Reoperation Rates

Abstract Background Transanal total mesorectal excision (TaTME) was introduced in 2009 as a dedicated approach for the treatment of mid-low rectal cancer. We aimed to describe and discuss the learning curve for 121 consecutive TaTME procedures performed by the same team. Methods The primary outcome was the number of operations required to decrease the mean operative time (mOT). The secondary outcomes were the number of operations required to decrease the major complication (MC) rate, the anastomotic leakage (AL) rate, the clinical anastomotic failure rate, and the reoperation rate. A cumulative sum (CUSUM) curve analysis was used to identify the inflection points. As an integrative analysis, Bernoulli CUSUM curves, risk-adjusted CUSUM curves based on the observed-expected outcomes, and CUSUM curves targeting results reported in the literature were created. Results Seventy-one cases were needed to overcome the OT learning curve sufficiently to reach mastery. The MC and reoperation rates started to decrease after the 54th case and further decreased after the 69th case. The AL rate started to decrease after the 27th case and remained stable at 5–5.1%. The comparison between the different phases of the learning curves confirmed these turning points. Conclusions TaTME had a learning curve of 71 cases for the mOT, 55–69 cases for MCs and reoperation, and 27 cases for AL. According to our results, attention should be paid during the first part of the learning curve to avoid an increased rate of MCs and AL.

scholarly journals Definitions and Concepts on Keratoconus and Ectatic Corneal Diseases: Panamerican Delphi Consensus — A Pilot for the Global Consensus on Ectasias

2014 ◽  
Vol 3 (3) ◽  
pp. 99-106 ◽  
Author(s):  
Victor L Perez ◽  
Juan Carlos Abad ◽  
José Alvaro P Gomes
Keyword(s):  
Latin American ◽  
Front Surface ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Web Based ◽  
Global Consensus ◽  
Delphi Approach ◽  
Disease Staging ◽  
Question Survey

ABSTRACT Purpose To establish consensus on definitions and concepts of keratoconus and ectatic corneal diseases by using Delphi approach. Materials and methods Seventeen Latin American experts on keratoconus and ectatic corneal diseases participated in a 3-round Delphi panel approach. A web-based 12 question survey was answered by panelists in two rounds, followed by life discussion meeting. A two-third majority strategy was defined as a consensus. Results Corneal ectatic diseases were defined as progressive thinning conditions without acute stromal inflammation, and were classified as keratoconus, pellucid marginal degeneration (PMD), keratoglobus, and ectasia after trauma or surgery. The pattern of thinning was considered the main aspect for the classification of ectatic diseases, but criteria for staging the disease needs to be improved. Corneal tomography with 3D reconstruction, distinguished from Placido-disk based front surface topography was elected as the diagnostic procedure currently capable of detecting the earliest clinical ectatic changes. Biomechanical alterations were considered to be the first event for ectasia development. Eye rubbing was directly related to the development and progression of ectasia. Inflammation was considered as a possible event on the physiopathology. Keratoconus was considered as a bilateral disease, with often asymmetric presentation, while ectasia may occur unilaterally if there is significant corneal insult, leading to biomechanical failure. No consensus was achieved for the definitions on forme fruste keratoconus (FFKC). Conclusion Consensus was achieved on definitions of corneal ectatic diseases. Disease staging, including criteria for FFKC or subclinical ectasia remains controversial. A larger consensus including experts from different groups around the world is needed. How to cite this article Ambrósio RJr, Belin MW, Perez VL, Abad JC, Gomes JAP. Definitions and Concepts on Keratoconus and Ectatic Corneal Diseases: Panamerican Delphi Consensus — A Pilot for the Global Consensus on Ectasias. Int J Kerat Ect Cor Dis 2014;3(3):99-106.

Correlative video enhanced differential interference contrast light microscopy (VDIC)-LM), low-voltage high-resolution SEM (LV-HR-SEM), and high-voltage electron microscopy (HVEM) in the observation of gold-labelled surface antigens and the subjacent cytoskeletal matrix

1989 ◽  
Vol 47 ◽  
pp. 904-905
Author(s):  
Ralph M. Albrecht ◽  
Scott R. Simmons ◽  
Marek Malecki
Keyword(s):  
High Resolution ◽  
Light Microscopy ◽  
Low Voltage ◽  
Microscopic Analysis ◽  
Cell Labelling ◽  
Video Technology ◽  
Electron Microscopic ◽  
Image Capture ◽  
High Voltage Electron Microscopy ◽  
Fluorescence Studies

The development of video-enhanced light microscopy (LM) as well as associated image processing and analysis have significantly broadened the scope of investigations which can be undertaken using (LM). Interference/polarization based microscopies can provide high resolution and higher levels of “detectability” especially in unstained living systems. Confocal light microscopy also holds the promise of further improvements in resolution, fluorescence studies, and 3 dimensional reconstruction. Video technology now provides, among other things, a means to detect differences in contrast difficult to detect with the human eye; furthermore, computerized image capture, processing, and analysis can be used to enhance features of interest, average images, subtract background, and provide a quantitative basis to studies of cells, cell features, cell labelling, and so forth. Improvements in video technology, image capture, and cost-effective computer image analysis/processing have contributed to the utility and potential of the various interference and confocal microscopic instrumentation.Electron microscopic technology has made advances as well. Microprocessor control and improved design have contributed to high resolution SEMs which have imaging capability at the molecular level and can operate at a range of accelerating voltages starting at 1KV. Improvements have also been seen in the HVEM and IVEM transmission instruments. As a whole, these advances in LM and EM microscopic technology provide the biologist with an array of information on structure, composition, and function which can be obtained from a single specimen. Corrrelative light microscopic analysis permits examination of living specimens and is critical where the “history” of a cell, cellular components, or labels needs to be known up to the time of chemical or physical fixation. Features such as cytoskeletal elements or gold label as small as 0.01 μm, well below the 0.2 μm limits of LM resolution, can be “detected” and their movement followed by VDIC-LM. Appropriate identification and preparation can then lead to the examination of surface detail and surface label with stereo LV-HR-SEM. Increasing the KV in the HR-SEM while viewing uncoated or thinly coated specimens can provide information from beneath the surface as well as increasing Z contrast so that positive identification of surface and subsurface colloidal gold or other heavy metal labelled/stained material is possible. Further examination of the same cells using stereo HVEM or IVEM provides information on internal ultrastructure and on the relationship of labelled material to cytoskeletal or organellar distribution, A wide variety of investigations can benefit from this correlative approach and a number of instrumentational configurations and preparative pathways can be tailored for the particular study. For a surprisingly small investment in time and technique, it is often possible to clear ambiguities or questions that arise when a finding is presented in the context of only one modality.

Perception of Distorted "R" Sounds in the Synthesized Speech of Chlldren and Adults

1983 ◽  
Vol 26 (4) ◽  
pp. 516-524 ◽  
Author(s):  
Donald J. Sharf ◽  
Ralph N. Ohde
Keyword(s):  
Speech Language Pathology ◽  
Graduate Level ◽  
Point Scale ◽  
Synthesized Speech ◽  
Language Pathology ◽  
High Degree

Adult and Child manifolds were generated by synthesizing 5 X 5 matrices of/Cej/ type utterances in which F2 and F3 frequencies were systematically varied. Manifold stimuli were presented to 11 graduate-level speech-language pathology students in two conditions: (a) a rating condition in which stimuli were rated on a 4-point scale between good /r/and good /w/; and (b) a labeling condition in which stimuli were labeled as "R," "W," "distorted R." or "N" (for none of the previous choices). It was found that (a) stimuli with low F2 and high F3 frequencies were rated 1.0nmdas;1.4; those with high F2 and low F3 frequencies were rated 3.6–4.0, and those with intermediate values were rated 1.5–3.5; (b) stimuli rated 1.0–1.4 were labeled as "W" and stimuli rated 3.6–4.0 were labeled as "R"; (c) none of the Child manifold stimuli were labeled as distorted "R" and one of the Adult manifold stimuli approached a level of identification that approached the percentage of identification for "R" and "W": and (d) rating and labeling tasks were performed with a high degree of reliability.

1528: Improved Sentinel Node Detection and Pre-Operative Planning in Prostate Cancer by Image Fusion of CT/MRI and Spect

2005 ◽  
Vol 173 (4S) ◽  
pp. 414-414
Author(s):  
Frank G. Fuechsel ◽  
Agostino Mattei ◽  
Sebastian Warncke ◽  
Christian Baermann ◽  
Ernst Peter Ritter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sentinel Node ◽  
Image Fusion ◽  
Sentinel Node Detection ◽  
Operative Planning

Abstract #1021: Abnormal Thyroid Ultrasound Findings in Pediatric Patients with Pten Mutation During Endocrinology Surveillance

2015 ◽  
Vol 21 ◽  
pp. 200
Author(s):  
Adriana Herrera ◽  
Claudia Zapata ◽  
Parul Jayakar ◽  
Aparna Rajadhyaksha ◽  
Ricardo Restrepo ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Thyroid Ultrasound ◽  
Pten Mutation ◽  
Ultrasound Findings

Positive First or Negative First?

Methodology ◽  
2010 ◽  
Vol 6 (3) ◽  
pp. 118-127 ◽  
Author(s):  
Dagmar Krebs ◽  
Juergen H.P. Hoffmeyer-Zlotnik
Keyword(s):  
Job Characteristics ◽  
Two Dimensions ◽  
Response Behavior ◽  
Point Scale ◽  
Response Scale ◽  
Job Motivation ◽  
Ballot Design ◽  
Subjective Importance ◽  
Scale Format ◽  
Scale Types

To examine whether starting a response scale with the positive or the negative categories affects response behavior, a split-ballot design using reverse forms of an 8-point scale assessing the subjective importance of job characteristics was used. Response behavior varied according to the scale format employed. Responses were more positive on the scale starting with the category “very important” (split 2). By contrast, the scale starting with the category “not at all important” (split 1) did not elicit more negative responses, but rather less positive ones. However, differences in response behavior did not systematically reflect the direction of the respective scales. Starting with the differences between the two split versions, the factorial structure of indicators assessing two dimensions of job motivation was tested for each scale type separately and then for both scale types simultaneously. Finally, models placing increasingly severe equality constraints on both scale types were tested. The paper concludes with a discussion of the results and desiderata for further research.

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