56 research outputs found
Development and evaluation of a graduate surgical skills curriculum: How to make medical simulation data Findable, Accessible, Interoperable and Reusable
No full textIntroductionIncreasingly more simulation studies are published under the Open Access publishing model making them freely accessible online to everyone. Often, the only aspect that is not yet open are the underlying datasets from these publications. Publishing datasets improves reproducibility and reliability of research, it increases visibility of research, and accelerates innovation. Furthermore, unique and highly valuable data from i.e. simulation-based training or surgical techniques is not available to everyone.Our aim is to present a best practice for publishing medical simulation data. A study on development and evaluation of a proficiency-based and simulation-based surgical skills training for technical medicine students is used as an example.MethodsA four-station procedural assessment was developed of basic surgical tasks that included scrubbing and donning, local anaesthesia, incision/excision, and suturing. Performance indicators were determined by an expert panel consisting of four professors in surgery and two technical physicians in surgery. A rubric was developed for scrubbing and donning and procedure-specific rating scales were developed for local anaesthesia, incision/excision, and suturing. The surgical skills training was evaluated after at least one clinical rotation with an online survey.Data are published according to the FAIR principles: Findable, Accessible, Interoperable and Reusable. To be ‘Findable’, a unique digital object identifier (DOI) was assigned to the dataset, and metadata described the content, contact information, location, items and definitions. The data repository is indexed by search engines, i.e. Google Scholar. The data is ‘Accessible’ for everyone under Open Access. To be ‘Interoperable’, MeSH standards were used. Finally, to be ’Reusable’, the data were made readable by translating and describing the assessment scoring rubrics, addition of documentation, and a license permitting data reuse was assigned.Results & DiscussionData for 116 master students from two academic years were refined, and student and assessor data anonymised. Age information was grouped by age intervals, so it can be openly published in an external repository. The dataset was made publicly available in the 4TU.ResearchData repository for reuse in i.e. SESAM community. Researchers should be attributed when data is reused under a CC-BY-SA licence.For medical simulation studies, it is feasible to publish data alongside Open Access peer-reviewed journal articles. The FAIR principles for data management should be incorporated in the design and implementation of future simulation studies.Clinical speciality keyword Surgery References/AcknowledgementsThe authors gratefully acknowledge the Noun Project for the Figure icons: "find" by Adrien Coquet, "context" by Nithinan Tatah, "padlock" by Fahmihorizon, "Recycle" by sripfoto.Underlying study: Halfwerk, F., Groot Jebbink, E., & Groenier, M. (2020). Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students. MedEdPublish, 9(1), [3523], https://tinyurl.com/Halfwerk202
Selected Abstracts from the 27th Annual Meeting of the Society in Europe for Simulation Applied to Medicine: Development and evaluation of a graduate surgical skills curriculum: How to make medical simulation data Findable, Accessible, Interoperable and Reusable
Get PDFIntroduction Increasingly more simulation studies are published under the Open Access publishing model making them freely accessible online to everyone. Often, the only aspect that is not yet open are the underlying datasets from these publications. Publishing datasets improves reproducibility and reliability of research, it increases visibility of research, and accelerates innovation. Furthermore, unique and highly valuable data from i.e. simulation-based training or surgical techniques is not available to everyone. Our aim is to present a best practice for publishing medical simulation data. A study on development and evaluation of a proficiencybased and simulation-based surgical skills training for technical medicine students is used as an example. Methods A four-station procedural assessment was developed of basic surgical tasks that included scrubbing and donning, local anaesthesia, incision/excision, and suturing. Performance indicators were determined by an expert panel consisting of four professors in surgery and two technical physicians in surgery. A rubric was developed for scrubbing and donning and procedure-specific rating scales were developed for local anaesthesia, incision/excision, and suturing. The surgical skills training was evaluated after at least one clinical rotation with an online survey. Data is published according to the FAIR principles: Findable, Accessible, Interoperable and Reusable. To be ‘Findable’, a unique digital object identifier (DOI) was assigned to the dataset, and metadata described the content, contact information, location, items and definitions. The data repository is indexed by search engines, i.e. Google Scholar. The data is ‘Accessible’ for everyone under Open Access. To be ‘Interoperable’, MeSH standards were used. Finally, to be ’Reusable’, the data were made readable by translating and describing the assessment scoring rubrics, addition of documentation, and a license permitting data reuse was assigned. Results & Discussion Data for 116 master students from two academic years were refined, and student and assessor data anonymised. Age information was grouped by age intervals, so it can be openly published in an external repository. The dataset was made publicly available in the 4TU.ResearchData repository for reuse in i.e. SESAM community. Researchers should be attributed when data is reused under a CC-BY-SA licence. For medical simulation studies, it is feasible to publish data alongside Open Access peer-reviewed journal articles. The FAIR principles for data management should be incorporated in the design and implementation of future simulation studies
Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease
Get PDFIntroduction: Severe stenosis or occlusion of the aortoiliac bifurcation is typically treated with open surgery. Patency results of aorto-bifemoral bypass are up to 90 % at 5 years. However, the number and severity of complications seem to have reached a plateau level. A less invasive technique, the kissing stent (KS) is available nowadays. The goal of this review was to give an overview of the current results and status of the kissing stent technique. Method: The Scopus search engine was used to retrieve articles concerning KS, this retrieved 78 abstracts, 60 were rejected and 4 more were rejected after full text screening. One article was included after cross referencing. After a quality check, data was extracted for further analysis. Results: 810 patients ( 72.8 % Rutherford classification of 1/2/3) were included. The most prevalent risk factor was hypertension (37.5-96%) and 50% of patients were treated for TASC C & D lesions. Overall the technical success rate was 98.2 %. Procedural protocols greatly differed on applying protrusion and pre or post dilatation. Clinical improvement at 30 days was achieved in 89.9%. Primary patency at 12, 24, and 36 months was 88.8%, 78.9 and 68.5, respectively. A complication rate of 11 % was reported, of which most are minor . No detailed analysis could be performed because individual patient data are lacking. Conclusion: KS treatment of aortoiliac disease is related with only minor complications and acceptable midterm patency results, this can however not surpass the results seen with open surgery
Detection of ‘best’ positive end-expiratory pressure derived from electrical impedance tomography parameters during a decremental positive end-expiratory pressure trial
Get PDFIntroduction: This study compares different parameters derived from electrical impedance tomography (EIT) data to define 'best' positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. 'Best' PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury.Methods: A decremental PEEP trial (from 15 to 0 cm H2O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO2/FiO2 ratio.Results: Dynamic compliance and the PaO2/FiO2 ratio had the highest value at 10 and 15 cm H2O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H2O PEEP for the non-dependent lung region and a maximal value at 15 cm H2O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H2O PEEP, whereas for COV and the RVD index this was at 15 cm H2O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient.Conclusion: In post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate 'best' PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome
Ventilation area measured with eit in order to optimize peep settings in mechanically ventilated patients
Get PDFINTRODUCTION. Electrical Impedance Tomography (EIT) is a non-invasive imaging technique, which can be used to visualize ventilation. Ventilation will be measured by impedance changes due to ventilation. OBJECTIVES. The aim of this study was to optimize PEEP settings based on the ventilation area of EIT images during a decremental PEEP trial. METHODS. After a recruitment maneuver, a decremental PEEP trial was performed in 10 mechanically ventilated post cardiac surgery patients. Ventilation area, blood gases, FRC and compliance were measured at each PEEP level. The ventilation area was defined as the surface of ventilation at one lung slice measured with EIT and was expressed as percentage of its maximum obtained during a recruitment maneuver (RM). RESULTS. The amount of ventilated pixels during the RM is set as 100 %. Figure 1 shows the amount of ventilated pixels as percentage compared to its maximum during the RM. The ventilation area was significantly smaller at 5 and 0 PEEP compared to its maximum at both the dependent and non-dependent lung. Also PaO2/FiO2 and FRC were significantly lower at these PEEP levels. (Figure presented) Bars represent the mean + SD. Black = dependent lung region, White = non-dependent lung region. *
Proficient before practice:Graduate simulation-based surgical skills training increases confidence in technical skills
No full textIntroductionSurgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study evaluates a proficiency-based, simulation-based course for basic surgical skills at graduate level. This study aims to show the effect of a preclinical curriculum to teach 21st century Surgical Skills (Halfwerk et al., 2020), and evaluate this curriculum with a pre-post-course questionnaire on confidence.MethodsGraduate Technical Medicine students from academic year 2020-2021 entered a mandatory 10-week, 3 European Credit Transfer and Accumulation System (ECTS) graduate surgical skills course. Learning outcomes are measured at the level of knowledge and skills and are evaluated with a pre-post-course questionnaire on confidence based on the Task Confidence Measure (Bevilacqua et al., 2020). The New General Self-Efficacy Scale (NGSE) is used as control, where no improvements in self-efficacy are expected. A Wilcoxon signed-rank test with Holm-Bonferroni correction is used to assess differences between time points.Results & DiscussionIn total 107 students enrolled the surgical skills course. 84 students completed the pre-course survey (79%), and 61 students (57%) completed the post-course survey. The control questionnaire (NGSE) on self-efficacy did now show higher self-efficacy scores in 7 questions (p > 0.05). However, students stated after the course more often that “compared to other people, they can do most tasks very well” (p < 0.01).Students felt more confident in all technical surgical skills after the surgical skills course (p < 0.001), as well as obtaining informed consent (p < 0.001), see attached Figure. Confidence in interpreting medical imaging did not improve with the course (p > 0.05).Often limited time is scheduled for preclinical surgical skills training, which results in limited skills development and only a small increase in confidence. This study shows that it is feasible to have a major increase in confidence in technical surgical skills with a graduate curriculum. We recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients
Clinical validation of 2D perfusion angiography using Syngo iFlow software during peripheral arterial interventions
No full textObjective: Endovascular surgery is an important treatment modality in peripheral arterial disease. Digital subtraction angiography is the standard post revascularisation diagnostic tool to locate lesions and to evaluate the effect of an intervention. However, interpretation of digital subtraction angiography images is subjective and it is difficult to determine whether revascularisation has been sufficient for clinical improvement. A new technique is 2D perfusion angiography, which creates a 2D colour map and time density curve from the digital subtraction angiography scan for an objective evaluation of the results. However, its clinical relevance is unknown. The aim is to evaluate the association between 2D perfusion angiography parameters and clinical outcome after peripheral arterial interventions. Methods: In this retrospective study, post revascularisation angiographic data and clinical data were reviewed of patients who underwent treatment of femoral-popliteal or femoral-tibial arteries. The outcome was assessed at three time points using three classification systems for peripheral arterial disease: Fontaine classification, American Medical Association whole person impairment classification (AMA) and average wound, ischemia, foot infection score. Post revascularisation angiographic data consisted of time density curves of the foot and lower leg which were extracted from the Syngo iFlow system (Siemens Healthineers). For each time density curve, five descriptive parameters were calculated: time of arrival, time to peak, mean transit time, wash-in rate and area under the curve. The association between the time density curve parameters and peripheral arterial disease classification systems was assessed using a regression analysis. Results: Between July 2016 and December 2018, 103 patients underwent peripheral endovascular interventions in the hybrid operating room; 39 patients were suitable for analysis, of which 28 patients underwent digital subtraction angiography of the lower leg, 3 patients underwent digital subtraction angiography of the foot and 8 patients underwent digital subtraction angiography of both regions. Limited significant relations were found for time of arrival with Fontainde classification (B = 0.806, p = 0.043) and area under the curve with AMA classification (B = −0.027, p = 0.047). Conclusion: In this retrospective study, time density curve parameters (time of arrival and area under the curve), measured in the lower leg, showed a limited significant association with two classification systems for peripheral arterial disease. Future prospective studies to determine the clinical relevance of this 2D perfusion angiography method should focus on standardisation of angiography protocols and comparison of pre- and post-intervention parameters
A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair
Get PDFObjective: The long-term outcomes after endovascular abdominal aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) have been inferior to those after open surgical repair with regard to reinterventions and late mortality. AAA sac remodeling after EVAR has been associated with endoleaks, reinterventions, and mortality. Therefore, knowledge of the predictors of AAA sac remodeling could indirectly give insight into the long-term EVAR outcomes. In the present review, we aimed to provide an overview of the evidence for anatomic predictors of positive and negative AAA sac remodeling after EVAR.Methods: A systematic literature review and analysis were conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and Cochrane guidelines. The PubMed and Scopus databases were searched using terms of AAA sac growth, shrinkage, and remodeling. Eligible studies were identified, and only those studies that had included currently used endografts were included.Results: A total of 19 studies that had reported on a total of 27 anatomic parameters of the aortoiliac anatomy were included. Only 4 parameters had been investigated by more than five studies, 7 parameters were investigated by three to five studies, 7 parameters were investigated by two studies, and 9 parameters were investigated by one study. For the presence of neck thrombus, three of four studies had reported similar results, indicating that the presence of neck thrombus might predict for less AAA sac shrinkage. AAA thrombus, the total AAA volume, the flow-lumen volume, aortic calcification, and the number of hostile neck parameters were only investigated by two to three studies. However, these parameters seemed promising for the prediction of sac remodeling. For hostile neck anatomy, neck length, infrarenal neck angulation, and patency of the inferior mesenteric artery, no significant association with any category of AAA sac remodeling was found.Conclusions: The present review demonstrates neck thrombus, AAA thrombus, number of hostile neck parameters, total AAA volume, AAA flow-lumen volume, and aortic calcification as important anatomic features that are likely to play a role in AAA remodeling after endovascular repair and should be further explored using advanced imaging techniques. We also found that strong, consistent evidence regarding the anatomic predictors of AAA sac remodeling after EVAR is lacking. Therefore, further research with large patient groups for a broad range of predictors of AAA sac change after EVAR is needed to complement the current gap in the evidence.</p
Geometrical consequences of kissing stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation
Get PDFItem does not contain fulltextOBJECTIVE: Kissing stents (KS) are commonly used to treat aortoiliac occlusive disease, but patency results are often lower than those of isolated stents. The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique was recently introduced to reconstruct the aortic bifurcation in a more anatomical and physiological fashion. The aim of this study is to compare the geometrical consequences of various stent configurations in vitro. METHODS: Anatomic vessel phantoms of the aortoiliac bifurcation were created to accommodate stent configurations. Self-expandable nitinol KS, balloon-expandable covered KS, and two versions of the CERAB configuration were deployed, one with the iliac legs positioned inside the tapered part of the aortic cuff (1) and one with the legs deployed above this level (2). Computed tomography data were obtained to assess the geometry. The conformation ratio (D-ratio) was calculated by use of the ratio of the major and minor axes. The proximal mismatch area, mean mismatch area, and total mismatch volume were calculated. RESULTS: The highest D-ratios were observed in the nitinol KS and the CERAB configuration, implying an ideal "double-D" shape. The proximal and mean mismatch areas were four- to sixfold lower in the CERAB (1) configuration when compared with nitinol KS and CERAB (2), respectively, whereas the covered KS had the highest mismatch area. Nitinol and covered KS had the largest mismatch volume, whereas the mismatch volume was the lowest in the CERAB (1) configuration. CONCLUSIONS: Although nitinol self-expandable stents have a high stent conformation, the lowest radial mismatch was found in the CERAB (1) configuration, supporting the hypothesis that the CERAB configuration is the most anatomical and physiological reconstruction of the aortic bifurcation. Within the CERAB configuration, the two limbs are ideally positioned inside the tapering portion of the cuff, minimizing mismatch
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