Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs.

OBJECTIVE: To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Seventeen fourth-year veterinary students. METHODS: After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey. RESULTS: All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog. CONCLUSION: Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance. CLINICAL SIGNIFICANCE: This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.

A comparison of nurses' needs/concerns and hospital disaster plans following Florida's Hurricane Floyd.

INTRODUCTION: The idea for this study was inspired by the response to Hurricane Floyd. Nurses are relied upon and expected to fulfill responsible roles during disaster situations, but little is known about the needs or concerns that nurses experience when they meet expectations and function as disaster responders. METHODS: Official copies of disaster protocols from 4 area hospitals were reviewed, and 4 focus groups consisting of ED nurses from respective hospitals provided information about nurses' concerns or needs in response to Hurricane Floyd. RESULTS: Of primary importance to nurses was family safety, pet care, and personal safety while at work. Secondary concerns were basic needs such as food, water, sleep, shelter, and rest. Group commitment levels to providing care during disaster situations varied greatly. Participants requested that hospital policy revisions address work assignments, pay/financial compensation, flexibility for extenuating circumstances, pet care, family sheltering, and provision of basic needs. DISCUSSION: It is not sufficient for a few key officials and planners to know their roles and responsibilities during a disaster; the roles of everyone involved must be clearly understood. Many participants described their conflict as family commitment versus professional obligation. We identified several areas of concerns in our interviews, and those areas have been clearly defined in the revised protocols. Other areas have yet to be addressed.