Association between anxiety, depression, and emotional distress and hypoglossal nerve stimulator adherence.

PURPOSE: To evaluate relationships between hypoglossal nerve stimulator (HNS) adherence and the presence of anxiety, depression, and emotional distress. METHODS: This is a cross-sectional study of subjects with moderate to severe obstructive sleep apnea (OSA), who had HNS implanted and activated at The Ohio State University Medical Center (OSUMC). Patient usage data from the previous 6 months was obtained from 33 patients. Adherence was defined as ≥28 h of use per week. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were administered, and the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) score was calculated for all subjects. RESULTS: Sixty-five percent were adherent with average usage of 46.5±11.7 h per week vs 7.7±7.5 h per week in the non-adherent group. The average GAD-7 were 3.90±3.98 in the adherent group vs. 8.27±6.69 in the non-adherent group (p=0.049). PHQ-9 score was 6.15±4.31 vs. 10.09±7.53 (p=0.118), and PHQ-ADS was 10.05±7.49 vs. 19.20±9.80 (p=0.035). There were no statistically significant differences in age, gender, pre-treatment AHI, and post-treatment AHI between the two groups, though there was a trend to higher age in the adherent group. CONCLUSIONS: This study demonstrated higher GAD-7 and PHQ-ADS scores in the non-adherent group compared to those who were adherent to HNS supporting that anxiety and emotional distress may contribute to HNS therapy adherence. To our knowledge, this is the first study evaluating the relationship between anxiety, depression, emotional distress, and HNS adherence. Screening patients with the GAD-7 and PHQ-9 prior to implantation may be helpful when evaluating patient adherence to therapy.

Proficiency-based Fundamentals of Laparoscopic Surgery skills training results in durable performance improvement and a uniform certification pass rate.

BACKGROUND: The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training. METHODS: For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure. RESULTS: None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points. CONCLUSION: The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.

Pretraining on Southwestern stations decreases training time and cost for proficiency-based fundamentals of laparoscopic surgery training.

BACKGROUND: We previously reported a proficiency-based Fundamentals of Laparoscopic Surgery (FLS) curriculum that uniformly resulted in passing the technical skills certification criteria. We hypothesized that pretraining using the Southwestern (SW) videotrainer stations would decrease costs and training time and maintain benefits. STUDY DESIGN: Group I (2nd-year medical student, n = 10) underwent FLS pretesting (Pretest 1), SW station proficiency-based training, repeat FLS testing (Pretest 2), FLS proficiency-based training, and final FLS testing (Posttest). These data were compared with a historic control, group II (2nd-year medical student, n = 10), which underwent FLS pretesting (Pretest 1), proficiency-based training, and final FLS testing (Posttest). RESULTS: During training, group I achieved proficiency (85.4 + or - 26.2 repetitions) for all SW tasks. For both groups, proficiency was achieved for 96% of the FLS tasks, with substantial differences detected for group I and group II repetitions (100.5 + or - 15.9 versus 114 + or - 25.5) and training time (6.0 + or - 1.5 versus 9.2 + or - 2.2 hours), respectively. Per-person material costs were considerably different for groups I and II ($827 + or - 116 versus $1,108 + or - 393). Group I demonstrated significant improvement from Pretest 1 (149 + or - 39; 0% FLS pass rate) to Pretest 2 (293 + or - 83; p < 0.001; 60% FLS pass rate), and to Posttest (444 + or - 60; p < 0.001; 100% FLS pass rate). Group II demonstrated significant improvement from Pretest 1 (158 + or - 78; 0% FLS pass rate) to Posttest (469.7 + or - 12.0; p < 0.001; 100% FLS pass rate). CONCLUSIONS: Pretraining on SW stations decreases training time for FLS skill acquisition and maintains educational benefits. This strategy decreases costs associated with using consumable materials for training.