Evaluation methods and impact of simulation-based training in pediatric surgery: a systematic review.

PURPOSE: The aim of this study was to identify (1) the type of skill evaluation methods and (2) how the effect of training was evaluated in simulation-based training (SBT) in pediatric surgery. METHODS: Databases of PubMed, Cochrane Library, and Web of Science were searched for articles published from January 2000 to January 2017. Search concepts of Medical Subject Heading terms were "surgery," "pediatrics," "simulation," and "training, evaluation." RESULTS: Of 5858 publications identified, 43 were included. Twenty papers described simulators as assessment tools used to evaluate technical skills. Reviewers differentiated between experts and trainees using a scoring system (45%) and/or a checklist (25%). Simulators as training tools were described in 23 papers. While the training's effectiveness was measured using performance assessment scales (52%) and/or surveys (43%), no study investigated the improvement of the clinical outcomes after SBT. CONCLUSION: Scoring, time, and motion analysis methods were used for the evaluation of basic techniques of laparoscopic skills. Only a few SBT in pediatric surgery have definite goals with clinical effect. Future research needs to demonstrate the educational effect of simulators as assessment or training tools on SBT in pediatric surgery.

The role of computer-aided 3-dimensional analytic tools and virtual microscopy in the investigation of radiologic-pathologic correlation.

To cope with recent advances in radiologic imaging technology, a corresponding method for pathomorphologic demonstration should be developed to promote better understanding of radiologic-pathologic correlation. We attempted to obtain gross and microscopic images by using a 3-dimensional analytic tool and virtual microscopy and to link these images with multidetector computed tomography images. Surgically resected specimens were sliced to a thickness of 3 mm, and the digital images of each slice were 3-dimensionally reconstructed with RATOC TRI/3D SRF II software. Histology slides were digitized by using virtual microscopy with an Olympus VS-100. We obtained clear gross pathologic images in arbitrary cut sections of organs, and it was possible to rotate these 3-dimensional images at any angle. Furthermore, we created synchronous cut-section movies of computed tomography and gross pathologic images. Subsequently, we switched from these cut-section movies to virtual microscopy images by clicking on the hyperlink button to observe radiologic-pathologic correlation.

Thallium-201 scintigraphy in bone and soft-tissue tumors: a comparison of dynamic, early and delayed scans.

OBJECTIVE: It has been reported that delayed scan of thallium-201 (201Tl) scintigraphy is useful for differentiating malignant tumors from benign lesions and for evaluating treatment response. However, physiological muscle uptake which usually increases in delayed scans, often makes it difficult to evaluate 201Tl uptake and its washout in bone and soft-tissue tumors. The purpose of this study was to evaluate whether the delayed scan is necessary and whether a dynamic scan is useful in the evaluation of bone and soft-tissue tumors. METHODS: We studied 175 cases of bone and soft-tissue tumors (malignant 45, benign 130). Dynamic scans were acquired every 5 seconds for 10 minutes after 201Tl injection, and time activity curves (TACs) were generated by adaptive smoothing methods. Early and delayed scans were acquired at 10-15 minutes and 2 hours after injection. 201Tl images were visually interpreted and the radioactivity count ratio (T/N) of tumors to normal tissues and washout rate [WR = (early T/N - delayed T/N)/early T/N] were defined. RESULTS: When there were no 201Tl uptake in dynamic (n = 67) and early scans (n = 68), no tumor uptake was also appreciated in delayed scans, and all but two cases of negative scans were benign. In 107 lesions, although there were significant differences in T/Ns between malignant and benign lesions both on early scans (2.84 +/- 1.45 vs. 2.05 +/- 1.13, p < 0.05) and delayed scans (2.17 +/- 1.03 vs. 1.58 +/- 0.64, p < 0.05), there was a substantial overlap. The T/Ns decreased in delayed scans (i.e., WR > 0) in 100 of 107 cases due to increase of surrounding muscle uptake, and there was no difference in WR between malignant tumors and benign lesions (0.21 +/- 0.14 vs. 0.19 +/- 0.14). CONCLUSIONS: For evaluating bone and soft-tissue tumors, delayed scan had little clinical usefulness and it may be time consuming. Dynamic scan would be useful for demonstrating the differences between tumor blood flow and 201Tl uptake in tumors.

Usefulness of brain SPECT to evaluate brain tolerance and hemodynamic changes during temporary balloon occlusion test and after permanent carotid occlusion.

UNLABELLED: The purpose of this study was to evaluate the usefulness of SPECT during temporary carotid balloon occlusion testing and to evaluate the changes in regional cerebral blood flow (CBF) and regional cerebral perfusion reserve (CPR) after permanent carotid occlusion. METHODS: Temporary balloon occlusion testing was performed on 40 patients (24 head and neck tumors, 16 aneurysms). During the balloon occlusion (total time, 30 min), (99m)Tc-ethylcysteinate dimer (ECD) was injected intravenously about 5 min before balloon deflation, followed by SPECT data acquisition. SPECT images were visually evaluated, and the severity of hypoperfusion on the occluded side was classified using 4 grades (normal, mild, moderate, and severe). The count ratio of the occluded side to the contralateral side (L/N ratio) was also analyzed. In 7 patients who subsequently underwent permanent carotid occlusion, CBF and CPR were quantitatively assessed using (133)Xe inhalation dynamic SPECT at rest and after acetazolamide (ACZ) enhancement (CPR was defined as the percentage increase in CBF after ACZ), and the patients were followed up periodically. RESULTS: SPECT after temporary occlusion showed moderate or severe hypoperfusion in 12 patients, whereas neurologic deterioration was observed in only 4 patients. The L/N ratios were 0.96 +/- 0.03 in normal perfusion (13 patients), 0.93 +/- 0.03 in mild hypoperfusion (15 patients), 0.83 +/- 0.03 in moderate hypoperfusion (10 patients) and 0.66 +/- 0.09 in severe hypoperfusion (2 patients) (P < 0.0001). In the 7 patients who underwent permanent carotid occlusion, CPR decreased after surgery (35% +/- 7% vs. 7% +/- 14%, P < 0.05), even though the resting CBF did not change (54 +/- 8 mL/100 g/min vs. 52 +/- 6 mL/100 g/min, not statistically significant). The steal phenomenon (rCPR < 0%) was observed in 3 patients, 1 of whom experienced transient hemiparesis when blood pressure dropped soon after surgery. On follow-up, the decreased CPR gradually improved and no infarction developed. CONCLUSION: SPECT is useful to detect cerebral hypoperfusion during carotid occlusion. Assessment of CPR is recommended to predict the potential risk of postsurgical complications and to follow up patients after permanent carotid occlusion.