Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation.

BACKGROUND: Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. METHODS: After randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. RESULTS: After 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. CONCLUSIONS: Using a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.

Analyzing depression coping strategies of patients with epilepsy: a preliminary study.

PURPOSE: To determine whether individuals with epilepsy who are depressed have different coping reactions, such as increased use of disengagement-type coping reactions, compared to those who are not. METHODS: We surveyed 200 patients with epilepsy and obtained demographic and clinical information. We used the Neurological Institute Disorders Depression Inventory for Epilepsy (NIDDI-E) to determine those patients who had a major depression (NIDDI-E score >15) and administered the Quality of Life in Epilepsy-10 Inventory (QOLIE-10), Beliefs About Medicines Questionnaire-Specific, Sheehan Disability Scale, a screening question for health literacy ("How confident are you filling out medical forms by yourself?"), and the Brief Coping with Problems Experienced (Brief-COPE). Using univariate analysis, we determined those demographic and clinical variables that were associated with depression. We also determined the coping reactions more frequently utilized by individuals with depression, and using multivariate analysis, determined whether those coping reactions retained statistical significance. We performed subgroup analysis of depressed epilepsy patients to determine whether coping reactions they preferentially utilized were associated with seizure frequency and quality of life. RESULTS: Seventy-one patients had a major depression while 128 did not. On univariate analysis, not driving, not working, higher seizure frequency, experiencing convulsions, poorer quality of life, and higher disability scores were significantly associated with major depression. These individuals used denial more often as a coping reaction. On multiple linear regression, the association between the use of denial and being depressed retained statistical significance. The mean denial coping scores were higher among depressed patients with more frequent seizures. However, this did not reach statistical significance. CONCLUSION: Individuals with epilepsy who have a major depression utilize denial more often as a coping reaction. Realizing this is of value to caregivers as they help patients deal with their stressful situation. This also provides additional impetus to more effectively and aggressively treatment depression in the epilepsy population.

Determining the coping strategies of individuals with epilepsy.

PURPOSE: The purpose of the present study was to determine whether the coping styles of patients with epilepsy are associated with certain demographic, clinical, and psychosocial variables. METHODS: A survey of 200 patients using several tests including the Brief-COPE was conducted. RESULTS: Nine subscales of the Brief-COPE achieved acceptable internal consistency and were employed in study analysis. Using principal component analysis, six subscales correlated well with one another, representing engagement-type coping strategies. The other three also correlated well, representing disengagement-type strategies. As a group, our patients favored engagement-type strategies. On univariate analysis, increased age, being African-American, receiving disability benefits, and work status were associated with the use of engagement-type strategies, while on multiple linear regression, only age and race were independently associated. Low BMQ-S scores, low income level, and not driving were associated with the use of disengagement-type strategies both on univariate and multivariate analyses. CONCLUSION: Among patients with epilepsy, certain demographic and psychosocial variables are associated with particular coping styles.