Simulation in surgical training: Prospective cohort study of access, attitudes and experiences of surgical trainees in the UK and Ireland.

BACKGROUND: Surgical training is evolving, and simulation is becoming more important as a way to expedite the early learning curve and augment surgical techniques. With novel technology, and innovation, major changes are possible in how surgeons are trained. The integration of these concepts into the surgical curriculum may drive up educational standards and enhance patient safety. This survey sought to determine surgical trainees views on the current place of simulation in surgical training and explore their vision for the future. MATERIAL AND METHODS: This is a prospective, questionnaire-based cross-sectional study by *** and the ***, England. Surgical trainees were surveyed about their experiences of simulation during their training through an electronic questionnaire distributed in the UK and Republic of Ireland through mailing lists of RCS and ***. Quantitative and qualitative research methodology was used. RESULTS: Of 462 surveys submitted, a total of 323 were fully completed and included in the analysis. Core Surgical Trainees represented 28.4% of respondents. The vast majority of respondents (98.9%) considered that simulation training was important, however 55.0% felt it was delivered inadequately. 86.2% wanted greater access to simulation training: Less than half of respondents had access to simulation training at their current place of work or had simulation incorporated into their formal teaching programme (42.4% and 41.6% respectively). CONCLUSION: This study highlights the importance of simulation to trainees. Delivery and accessibility of simulation training varies widely. We highlight areas for improvement and best practice. In a culture of accountability, where patient safety is our highest priority, a "see one, do one, teach one" approach to training is no longer appropriate; instead we must utilise available simulation tools to augment learning.

"Tiers of delay": warfarin, hip fractures, and target-driven care.

Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. Basic demographics, time to theater, length of stay, and mortality were recorded for all patients. Independent samples t-tests were used to identify statistically significant differences between patients on warfarin and those not taking the drug. A total of 83 patients were admitted anticoagulated with a mean international normalized ratio of 2.65 and a median time to theater of 49.7 hours. Of these patients, 79% breached BPT, incurring significant financial loss. In the control group, 908 patients took a median 24.5 hours, a 28% breach of BPT (P < .01). Length of stay, Nottingham Hip Fracture Score, and predicted 30-day mortality were similar for both the groups. As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an "early trigger" anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.

Neighbourhood environment as a predictor of television watching among girls.

BACKGROUND: Television watching, a sedentary activity, has been associated with overweight in children. While the family environment is known to influence television watching, little is known about the influence of the neighbourhood environment. This study is an exploratory examination of the association of socioeconomic characteristics of the neighbourhood environment with television watching among 9-10 year old girls. METHODS: Data collected by the Berkeley site of the National Heart, Lung and Blood Institute Growth and Health Study (NGHS) in 1987-8 from 787 girls who had a complete set of measurements relevant to the analysis were used. These measures included parental education, household income, race and weekly hours spent watching television. Addresses of the girls were geocoded and the median household income for the census tracts in which they lived was used to indicate neighbourhood socioeconomic characteristics. Multilevel modelling procedures were used to estimate fixed effect coefficients for individual and neighbourhood level variables. RESULTS: Living in high income areas was associated with less television watching, a finding that held even when controlling for parental education, household income and race. Race and parental education were also associated with television watching. CONCLUSION: Television watching among girls was associated not only with the socioeconomic characteristics of their households, but also of their neighbourhoods. Future studies should explore the mechanisms that mediate this relation and determine if these results are generalisable to other populations.

Chemical analysis of human blood for assessment of environmental exposure to semivolatile organochlorine chemical contaminants.

A chemical method for the quantitative analysis of organochlorine pesticide residues present in human blood was scaled-up to provide increased sensitivity and extended to include organochlorine industrial chemicals. Whole blood samples were extracted with hexane, concentrated, and analyzed without further cleanup by gas chromatography with electron capture detection. The methodology used was validated by conducting recovery studies at 1 and 10 ng/g (ppb) levels. Screening and confirmational analyses were performed by gas chromatography/mass spectrometry on samples collected from potentially exposed residents of the Love Canal area of Niagara Falls, New York and from volunteers in the Research Triangle Park area of North Carolina for 25 specific semivolatile organochlorine contaminants including chlorobenzene and chlorotoluene congeners, hexachloro-1,3-butadiene, pesticides, and polychlorinated biphenyls as Aroclor 1260. Dichlorobenzene, hexachlorobenzene, and beta-hexachlorocyclohexane residues fell in the range of 0.1 to 26 ppb in a high percentage of both the field and volunteer blood samples analyzed. Levels of other organochlorine compounds were either non-detectable or present in sub-ppb ranges.

Evaluation of gel permeation chromatography for clean up of human adipose tissue samples for GC/MS analysis of pesticides and other chemicals.

Gel permeation chromatography (GPC) has been evaluated for clean up of human adipose tissue sample extracts in preparation for confirmatory analysis by gas chromatography-mass spectrometry (GC/MS). Studies were conducted with standard solutions, fortified chicken fat, and actual human adipose tissue samples. Nearly quantitative removal of lipid material was achieved with minimal losses of 16 organochlorine pesticides and metabolites: two polychlorinated biphenyl (PCB) mixtures, two chlorinated naphthalene (PCN) mixtures, and a polybrominated biphenyl (PBB) mixture. Mass spectra free from interferences were obtained over the mass range from 46 m/z to 560 m/z.