scholarly journals Indigenous Inexpensive Practice Models for Skill Development in Neuroendoscopy

2017 ◽  
Vol 08 (02) ◽  
pp. 170-173 ◽  
Author(s):  
Jitin Bajaj ◽  
Yad Ram Yadav ◽  
Anurag Pateriya ◽  
Vijay Parihar ◽  
Shailendra Ratre ◽  
...  
Keyword(s):  
Animal Models ◽  
Ethical Issues ◽  
Ligamentum Flavum ◽  
Cost Effective ◽  
Fellowship Program ◽  
Practice Models ◽  
Significant Difference ◽  
Hands On ◽  
Hand Eye Coordination ◽  
Keyhole Concept

ABSTRACT Introduction: Neurosurgery is a branch having a tough learning curve. Residents generally get very less hands-on exposure for advanced procedures like neuroendoscopy. With the limited number of cadavers available and ethical issues associated with animal models, practice models, and simulators are becoming the able alternative. Most of these simulators are very costly. We tried to build indigenous inexpensive practice models that can help in developing most of the skills of neuroendoscopy. Materials and Methods: Models were built for learning hand-eye coordination, dexterity, instrument manipulation, cutting, fine dissection, keyhole concept, drilling, and simulation of laminectomy and ligamentum flavum resection. These were shown in the neuroendoscopic fellowship program conducted in authors’ institute, and trainees’ responses were recorded. Results: Both novice and experienced neuroendoscopic surgeons validated the models. There was no significant difference between their responses (P = 0.791). Conclusion: Indigenous innovative models can be used to learn and teach neuroendoscopic skills. The presented models were reliable, valid, eco-friendly, highly cost-effective, portable, easily made and can be kept in one’s chamber for practicing.

scholarly journals A new model of inexpensive portable homemade PERC Mentor (IPHOM) and its validation

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abhishek Shukla ◽  
Gurwinder Sethi ◽  
Ananya Dutta ◽  
Puneet Aggarwal ◽  
Ayon Gupta
Keyword(s):  
Ethical Issues ◽  
Low Cost ◽  
Ball Bearings ◽  
Expert Group ◽  
Significant Difference ◽  
Hands On ◽  
Expert And Novice ◽  
Hospital Wastes ◽  
Complex Surgery ◽  
At Home

Abstract Background Percutaneous nephrolithotomy (PCNL) is a complex surgery and has a flat learning curve. Due to this and the ethical issues, trainees do not get enough hands on exposure. Virtual simulator is very expensive and bulky. Animal model requires legal clearance. This inexpensive portable homemade PERC Mentor (IPHOM) teaches all the major aspects of PCNL surgery. This article has shown the way to make this model and its validation study. Methods IPHOM can be made at home with carton box, ball bearings, LED torch and some hospital wastes. After a short demonstration of IPHOM, 14 residents and 4 urologists were given 8 tasks to perform on it followed by 15-min supervised practice exercise on day 0 and day 1. Their performance was reassessed on day 2 and 3. Response to 17 feedback points was recorded on a seven-point Likert scale. Results There was significant difference between the performance of expert and novice on day 0. Expert completed all the tasks in less time and no. of attempts. The time for tract dilatation and duration of radiation exposure were significantly less in the expert group. The performance of both expert and novice improved on day 2 and 3, but the improvement was significantly more in novice. Response to the feedback points showed no difference between expert and novice (p > .05). Conclusions We have found that training on IPHOM has improved the concept and skills of PCNL in residents. The simplicity and low cost of the model make it constructible at home.

scholarly journals Effect of leg wrapping technique on prevention of spinal induced hypotension and fetal acidosis during cesarean section: Randomized controlled trial

2019 ◽  
Vol 10 (2) ◽  
pp. 70
Author(s):  
Samah Nasser Abd El-Aziz El-Shora ◽  
Amina Mohamed Rashad El-Nemer
Keyword(s):  
Randomized Controlled Trial ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cost Effective ◽  
Control Group ◽  
Induced Hypotension ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Wrapping Technique

Background and aim: Hypotension during cesarean section (CS) under spinal anesthesia has been a subject of scientific study for more than 50 years and the search for the most effective strategy to achieve hemodynamic stability remains challenging. Aim: The study was carried out to apply leg wrapping technique for the prevention of spinal-induced hypotension (SIH) during CS.Methods: Randomized Controlled Trial design was utilized at cesarean delivery operating room Mansoura General Hospital in El-Mansoura City during the period from May 2018 to November 2018. A purposive sample of 88 pregnant women, assigned randomly to an intervention group (n = 44) in which their legs wrapped with elastic crepe bandage and control group (n = 44) in which no wrapping was done. Data collected for maternal, neonatal hemodynamic and signs of hypotension, the feasibility of application and cost analysis.Results: There was a statistically significant difference in the incidence of SIH and Ephedrine use among both groups (18.20% in leg wrapping group whereas 75% in control group). In addition, neonatal acidosis and NICU admission were less among leg wrapping group (11.40%, 9.10% respectively). Economically, leg wrapping technique was cost effective compared to the cost of the hospital regimen for treating SIH and admission to (NICU).Conclusion and recommendations: Leg wrapping technique was cost effective and an efficient method for decreasing SIH, neonatal acidosis and Ephedrine administration. It is recommended to apply leg wrapping technique in maternal hospitals' protocol of care for decreasing SIH during CS.

scholarly journals Transdisciplinary AI Observatory—Retrospective Analyses and Future-Oriented Contradistinctions

Philosophies ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 6
Author(s):  
Nadisha-Marie Aliman ◽  
Leon Kester ◽  
Roman Yampolskiy
Keyword(s):  
Ethical Issues ◽  
Descriptive Analysis ◽  
Research Direction ◽  
Short Term ◽  
Safety Critical ◽  
Safety Research ◽  
Hands On ◽  
Near Term ◽  
Ai Safety

In the last years, artificial intelligence (AI) safety gained international recognition in the light of heterogeneous safety-critical and ethical issues that risk overshadowing the broad beneficial impacts of AI. In this context, the implementation of AI observatory endeavors represents one key research direction. This paper motivates the need for an inherently transdisciplinary AI observatory approach integrating diverse retrospective and counterfactual views. We delineate aims and limitations while providing hands-on-advice utilizing concrete practical examples. Distinguishing between unintentionally and intentionally triggered AI risks with diverse socio-psycho-technological impacts, we exemplify a retrospective descriptive analysis followed by a retrospective counterfactual risk analysis. Building on these AI observatory tools, we present near-term transdisciplinary guidelines for AI safety. As further contribution, we discuss differentiated and tailored long-term directions through the lens of two disparate modern AI safety paradigms. For simplicity, we refer to these two different paradigms with the terms artificial stupidity (AS) and eternal creativity (EC) respectively. While both AS and EC acknowledge the need for a hybrid cognitive-affective approach to AI safety and overlap with regard to many short-term considerations, they differ fundamentally in the nature of multiple envisaged long-term solution patterns. By compiling relevant underlying contradistinctions, we aim to provide future-oriented incentives for constructive dialectics in practical and theoretical AI safety research.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

scholarly journals Ethical issues relating to qualitative research

2005 ◽  
Vol 61 (1) ◽  
Author(s):  
J. Jelsma ◽  
S. Clow
Keyword(s):  
Qualitative Research ◽  
Health Research ◽  
Ethical Issues ◽  
Ethical Principles ◽  
Ethical Review ◽  
Paper Briefly ◽  
Ethical Problems ◽  
Scientific Rigour ◽  
Hands On

Qualitative research or naturalistic research has moved from the sidelines into the mainstream of health research and an increasing number of qualitative research proposals are being presented for ethical review Qualitative research presents ethical problems that which are unique to the intensive hands-on paradigm which characterises naturalistic research. This paper briefly outlines the most common methodologies used in this research. The four ethical principles of benevolence, non-maleficence, autonomy and justice will be used as a framework to explore specific ethical issues related to this form of inquiry. The need for scientific rigour will also be explored as research that is scientifically unsound can never be ethical.

CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 189-192 ◽  
Author(s):  
Anis Dosani ◽  
Sameer K. Khan ◽  
Sheila Gray ◽  
Steve Joseph ◽  
Ian A. Whittaker
Keyword(s):  
Carpal Tunnel ◽  
Wound Closure ◽  
Unit Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

scholarly journals Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Joseph A. Gil ◽  
Avi D. Goodman ◽  
Andrew P. Harris ◽  
Neill Y. Li ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Operating Room ◽  
Cost Effective ◽  
Initial Management ◽  
Fingertip Amputation ◽  
Significant Difference ◽  
Initial Procedure ◽  
The Cost ◽  
Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

Meta-analysis and machine learning-augmented mixed effects cohort analysis of improved diets among 5,847 medical trainees, providers, and patients

2021 ◽  
pp. 1-27
Author(s):  
Dominique J. Monlezun ◽  
Christopher Carr ◽  
Tianhua Niu ◽  
Francesco Nordio ◽  
Nicole DeValle ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cohort Study ◽  
Nutrition Education ◽  
Meta Analysis ◽  
Cohort Analysis ◽  
Cost Effective ◽  
Number Needed To Treat ◽  
Nutrition Counseling ◽  
Medical Trainees ◽  
Hands On

Abstract Objective: We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition. Design: (Part A) A systematic review and meta-analysis informing (Part B) the intervention analyzed in the world’s largest prospective multi-center cohort study on hands-on cooking and nutrition education for medical trainees, providers, and patients. Settings: (A) Medical educational institutions. (B) Teaching kitchens. Participants: (A) Medical trainees. (B) Trainees, providers, and patients. Results: (A) Of the 212 citations identified (N=1,698 trainees), 11 studies met inclusion criteria. The overall effect size was 9.80 (95%CI 7.15-12.456.87-13.85; p<0.001), comparable to the machine learning (ML)-augmented results. The number needed to treat for the top performing high quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study was applied for medical trainees and providers who subsequently taught patients in the same curriculum (N=5,847). The intervention compared to standard medical care and education alone significantly increased the odds of superior diets (high/medium versus low Mediterranean diet adherence) for residents/fellows most (OR 10.79, 95%CI 4.94-23.58; p<0.001) followed by students (OR 9.62, 95%CI 5.92-15.63; p<0.001), providers (OR 5.19, 95%CI 3.23-8.32, p<0.001), and patients (OR 2.48, 95%CI 1.38-4.45; p=0.002), results consistent with those from ML. Conclusions: This study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.

scholarly journals SPECIAL TUTORIAL CLASSES TO UPGRADE LEARNING ACHIEVEMENT OF STUDENTS ENROLLED IN MATHEMATICS FOR SOCIAL SCIENCE AT STOU

2008 ◽  
Vol 3 (2) ◽  
pp. 122-133
Author(s):  
Sakorn Boondao
Keyword(s):  
Social Science ◽  
Cost Effective ◽  
Developed Countries ◽  
Pass Rate ◽  
Final Exam ◽  
Face To Face ◽  
Tutorial Program ◽  
Significant Difference ◽  
Level Scale ◽  
Teaching Programs

Unlike distance education institutions in developed countries Sukhothai Thammathirat Open University makes very limited use of assignments in its teaching programs. The main means of interaction between tutors and students consists of free face-to-face tutorials conducted three times per semester in provincial centers throughout the country. In courses with low enrolments (less than 1000 students) such tutorials have recently been deemed not to be cost effective. Alternative regional or central intensive programs have been developed. These involve 20 hours of tutorial classes and assignment work over two weekends in the final month of the semester and count for 30% of the assessment. A small charge is made for registration. The Mathematics for Social Science course was affected by this change. Since mathematics is a difficult subject for students, (only about 30% normally passed the course) the special tutorial program was used to help students in the second semester of 2006. Students were more interested in this approach than in the regular face-to-face tutorials. After the project was advertised, 98 students applied. While this was more than three times the number who had attended the free tutorials in the previous semester, it was not sufficient to justify tutorials in the four regions. Instead, three classes were conducted in Bangkok. Only 71 of the original applicants attended. During the program the better students were asked to assist those who needed help. Student questionnaires indicated that more than half identified themselves as weak in mathematics, most had completed year 12 and just over three-quarters had never attended regular face-to-face tutorials. They were asked to rank items about the classes on a five-level scale. The availability of up to 30% of the marks for the course was the major attraction. Most indicated that they were pleased with the classes, and gained more knowledge; while assignments, as well as the solutions given after submission, helped them understand the contents. Having classmates help them with learning also encouraged them with their study. They felt that they needed more time to study and do assignment work, and would like more marks to be allocated for the assignments. It was found that the achievement of students who attended the special tutorial classes was significantly higher than that of those who did not. The pass rate in this semester dramatically increased compared to the previous semester, 50.72% and 30.34% respectively. But when comparing students' final exam scores for both groups, it was found that there was no significant difference in the scores. However students were satisfied with these special tutorial classes.

scholarly journals CAN VIRTUAL REALITY BE AS GOOD AS OPERATING ROOM TRAINING? EXPERIENCE FROM A RESIDENCY PROGRAM IN GENERAL SURGERY

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Bruno Della Mea GASPERIN ◽  
Thamyres ZANIRATI ◽  
Leandro Totti Cavazzola
Keyword(s):  
Virtual Reality ◽  
Operating Room ◽  
General Surgery ◽  
Training Experience ◽  
Total Procedure Time ◽  
Significant Difference ◽  
Hands On ◽  
Second Year ◽  
Practice Time

ABSTRACT Background: The increasingly intense usage of technology applied to videosurgery and the advent of robotic platforms accelerated the use of virtual models in training surgical skills. Aim: To evaluate the performance of a general surgery department’s residents in a video-simulated laparoscopic cholecystectomy in order to understand whether training with virtual reality is sufficient to provide the skills that are normally acquired in hands-on experience at the operating room. Methods: An observational study with twenty-five first- and second-year general surgery residents. Each subject performed three video-laparoscopic cholecystectomies under supervision in a simulator. Only the best performance was evaluated in the study. Total number of complications and total procedure time were evaluated independently. The groups were defined according to total practice time (G1 and G2) and the year of residency (R1 and R2), each being analysed separately. Results: Twenty-one residents finished the three practices, with four follow-up losses. Mean practice time was 33.5 hours. Lowering of the rate of lesions in important structures could be identified after a level of proficiency of 60%, which all participants obtained regardless of previous in vivo experience. No significant difference between the R1 and R2 groups was observed. Conclusion: Learning in groups R1 and R2 was equal, regardless of whether previous practice was predominantly in vivo (R2) or with virtual reality (R1). Therefore, it is possible to consider that skills obtained in virtual reality training are capable of equalising the proficiency of first- and second-year residents, being invaluable to increase patient safety and homogenise learning of basic surgical procedures.

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