Proficiency-based progression training for robotic surgery skills training: a randomized clinical trial.

OBJECTIVE: To determine whether proficiency-based progression (PBP) training leads to better robotic surgical performance compared to traditional training (TT), given that the value of PBP training for learning robotic surgical skills is unclear. MATERIALS AND METHODS: The PROVESA trial is a multicentric, prospective, randomized and blinded clinical study comparing PBP training with TT for robotic suturing and knot-tying anastomosis skills. A total of 36 robotic surgery-naïve junior residents were recruited from 16 training sites and 12 residency training programmes. Participants were randomly allocated to metric-based PBP training or the current standard of care TT, and compared at the end of training. The primary outcome was percentage of participants reaching the predefined proficiency benchmark. Secondary outcomes were the numbers of procedure steps and errors made. RESULTS: Of the group that received TT, 3/18 reached the proficiency benchmark versus 12/18 of the PBP group (i.e. the PBP group were ~10 times as likely to demonstrate proficiency [P = 0.006]). The PBP group demonstrated a 51% reduction in number of performance errors from baseline to the final assessment (18.3 vs 8.9). The TT group demonstrated a marginal improvement (15.94 vs 15.44) in errors made. CONCLUSIONS: The PROVESA trial is the first prospective randomized controlled trial on basic skills training in robotic surgery. Implementation of a PBP training methodology resulted in superior surgical performance for robotic suturing and knot-tying anastomosis performance. Compared to TT, better surgical quality could be obtained by implementing PBP training for basic skills in robotic surgery.

Is Physical Activity Associated With Loneliness or Social Isolation in Older Adults? Results of a Longitudinal Analysis Using the Irish Longitudinal Study on Ageing.

Social relationships are central to the health and well-being of older adults. Evidence exploring the association of physical activity (PA) with social isolation and loneliness is limited. This study uses a path analysis to investigate the longitudinal association between loneliness and social isolation with PA using the Irish Longitudinal Study on Ageing. Higher levels of social isolation measured using the Berkman-Syme Social Network Index were directly and indirectly associated with lower levels of walking, moderate PA, and vigorous PA over 6 years. Additionally, higher levels of walking were associated with lower levels of loneliness measured using a modified version of the University of California, Los Angeles loneliness scale over a 3-year period. Future interventions should target individuals who are more socially isolated and explore the effects of different types of PA on loneliness over time.

The Mediating Role of Self-Regulation and Self-Efficacy on Physical Activity Change in Community-Dwelling Older Adults (≥65 Years): An Experimental Cross-Lagged Analysis Using Data From SITLESS.

Improving the capacity for physical activity interventions to maintain behavior change is a key public health concern and an important strategy for the health and independence of older adults. Ways of ensuring effective maintenance of physical activity levels in older adults are unclear. This study includes the objective measure of moderate-to-vigorous physical activity (MVPA); self-reported self-efficacy; and self-regulation at four timepoints (baseline, intervention completion at 4 months, 12-, and 18-month follow-up) from the SITLESS study, a clinical trial conducted with a cohort of community-dwelling older adults (≥65 years) from Denmark, Germany, Spain, and the United Kingdom. A cross-lagged analysis found that self-regulation and self-efficacy may be key determinants of MVPA behavior in community-dwelling older adults. More specifically, the use of behavioral support strategies represents an important correlate of MVPA behavior, and its association with MVPA may be mediated by self-regulation and self-efficacy in older adults in the short and long term.

The association between light intensity physical activity with gait speed in older adults (≥ 50 years). A longitudinal analysis using the English Longitudinal Study of Ageing (ELSA).

AIMS: Fall prevention is an important health consideration for older adults. The benefits of moderate-to-vigorous intensity physical activity (MVPA) for fall prevention are well established. Few studies have explored the association between low intensity physical activity (LPA) and fall risk in older adults over time. METHODS: Six waves of data from the English Longitudinal Study of Ageing (ELSA) were analysed. The measures of physical activity (PA) intensity were developed using latent class analysis (LCA). Then, the association between PA intensity and gait speed was analysed using a latent growth model (LGM). RESULTS: Latent class analysis identified three classes of PA-inactive, low intensity, and moderate-vigorous intensity PA. LGM analysis showed that MVPA (Est 1.12, SE 0.05) was associated with a faster gait speed and slower rate of decline over time. LPA (Est 0.96; SE 0.12) was more beneficial than being inactive. Age was found to influence gait speed where MVPA was associated with better gait speed in adults aged ≤ 70 years, and LPA was associated with better gait speed for adults aged ≥ 70 years. DISCUSSION: Moderate-to-vigorous intensity physical activity maybe more beneficial for older adults and current policy supports this. However, LPA is associated with better gait speed in older adults aged ≥ 70 years and also maybe more achievable for older adults. CONCLUSION: Therefore, future fall prevention interventions should also include recommendations for LPA for old-older adults (≥ 70 years).

Is There an Association Between Self-Reported Physical Activity and Self-Rated Vision Over Time? Results From the Irish Longitudinal Study of Ageing.

Research suggests that physical activity (PA) has many health benefits for an aging population. Evidence exploring the association between PA and vision is limited. This study includes the measures of self-reported PA (International Physical Activity Questionnaire) and self-rated vision at three points in time over a 6-year period used in the Irish Longitudinal study of Ageing, a cohort of community-dwelling older adults (50 years or older). A path analysis found that PA was indirectly associated with vision over 6 years controlling for age, sex, marital status, employment, education, depression (Centre for Epidemiologic Studies Depression Scale), self-reported general health, cardiovascular disease (e.g., heart attack), high blood pressure, diabetes, eye disease (e.g., glaucoma, diabetic eye disease, macular degeneration, cataract), and disabilities associated with activities of daily living. Further research is needed to fully understand the relationship over time and generalize the findings.

Food choice motives, attitude towards and intention to adopt personalised nutrition.

OBJECTIVE: The present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns.Design/SettingA survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition. SUBJECTS: Nationally representative samples were recruited in nine EU countries (n 9381). RESULTS: Structural equation modelling indicated that the food choice motives 'weight control', 'mood', 'health' and 'ethical concern' had a positive association and 'price' had a negative association with attitude towards, and intention to adopt, personalised nutrition. 'Health' was positively associated and 'familiarity' negatively associated with attitude towards personalised nutrition. The effects of 'weight control', 'ethical concern', 'mood' and 'price' on intention to adopt personalised nutrition were partially mediated by attitude. The effects of 'health' and 'familiarity' were fully mediated by attitude. 'Sensory appeal' was negatively and directly associated with intention to adopt personalised nutrition. CONCLUSIONS: Personalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.

The association between balance and free-living physical activity in an older community-dwelling adult population: a systematic review and meta-analysis.

BACKGROUND: Poor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults. METHODS: Search methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016. SELECTION CRITERIA: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older). DATA EXTRACTION AND ANALYSIS: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95% confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach. RESULTS: Limited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years' duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test. CONCLUSION: There is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term.

The Economic Burden of PTSD in Northern Ireland.

The objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through extension and investment in effective evidence-based treatments.

An objective evaluation of a multi-component, competitive, selection process for admitting surgeons into higher surgical training in a national setting.

BACKGROUND: Changing work practices make it imperative that surgery selects candidates for training who demonstrate the spectrum of abilities that best facilitate learning and development of attributes that, by the end of their training, approximate the characteristics of a consultant surgeon. AIMS: The aim of our study was to determine the relative merits of components of a program used for competitive selection of trainees into higher surgical training (HST) in general surgery. METHODS: Applicants (N = 98, males 69, mean age 31 years [range 29-40]) to the Royal College of Surgeons in Ireland program for HST in general surgery between 2006 and 2008 were assessed. Clinical, basic surgical training, logbook, research performance, and reference scores were evaluated. A total of 51 candidates were shortlisted and completed a further objective assessment of their technical skills and interview performances. RESULTS: Shortlisted candidates performed better (p < 0.003) on all assessed parameters. Compared with candidates who were not selected for HST, those who were selected (N = 31) significantly outperformed on individual assessments and overall (p < 0.0001). Logistic regression analysis showed that clinical, technical skills, and research assessments, but not interview, predicted (92.2 %) HST selection outcomes. CONCLUSIONS: Candidates selected for the national HST program in Ireland consistently outperformed those who were not. The assessments reliably and consistently distinguished between candidates, and all of the assessed parameters (except interview) contributed to a highly predictive selection model. This is the largest reported dataset from an objective, transparent, and fair assessment program for selection of the next generation of surgeons.

Association between nutrition self-efficacy, health locus of control and food choice motives in consumers in nine European countries.

We investigated associations between food choice motives and psychological determinants of dietary health behaviour change (nutrition self-efficacy, NS-E, and health locus of control, HLoC) among 9381 participants (18-65 years, 49.4% females) from nine European countries. Price was the highest rated food choice motive. Higher importance of all motives was associated with higher NS-E and with higher Internal HLoC. Relationships between food choice motives and External HLoC were also in the expected direction in showing negative associations with Health, Natural Content, Weight Control, Mood and Sensory Appeal. Higher External HLoC was also associated with perceived greater importance of 'external' motives Ethical Concern, Familiarity and Convenience. Relationships between External HLoC and food choice motives were not all in the expected direction. Price was unrelated to External HLoC. Females rated the importance of all motives higher than males. People with less education ascribed greater importance to Price in motivating food choices. Together, these findings imply that self-efficacy and health locus of control should be considered along with motivations for food choice in dietary health promotion.

Citizen attitudes towards the environment and association with perceived threats to the countryside: Evidence from countries in five European biogeographic zones.

Citizens play a crucial role in attaining the United Nations 2030 sustainable development goals (SDGs). There is growing awareness of the importance of understanding citizen perspectives on environmental issues, in relation to developing and maintaining sustainable lifestyles, and in addressing perceived threats to protection and restoration of ecosystems and biodiversity. This analysis sought to understand people's attitudes towards environmental conservation, how they relate to perceived threats to the countryside, and to determine how attitudes and perceived threats vary demographically and between countries. A survey was administered to citizens (quota sampled on age, gender, education, and split between rural and urban residency) across five countries representative of differing biogeographical regions (N = 3,190): Czech Republic (n = 649) (Continental); Spain (Mediterranean) (n = 623); Sweden (Boreal) (n = 645); Switzerland (Alpine) (n = 641); United Kingdom (UK) (Atlantic) (n = 632). Attitudes were measured using the Environmental Attitudes Inventory (EAI-24) on 2 factors (utilization; preservation) and perceived threat to the countryside on 1-factor (15 items). Multigroup regression analysis indicated that preservationist attitudes were associated with greater perceived threat to the countryside in all five countries. Higher perceived threat was associated with activities linked to environmental degradation, socio-economic uncertainty and risks in agri-food supply chains in all countries. The "bad behaviour of visitors" was the greatest perceived threat in the Czech Republic, Switzerland and the UK, while "lack of young farmers taking over farming" was the greatest perceived threat in Spain and Sweden. To promote pro-environmental attitudes and obtain greater public support for policies and interventions targeting environmental conservation, communication about environmental threats is needed, together with threat mitigation measures. Raising peoples' awareness of threats to the countryside through targeted communications could promote pro-environment attitudes and potentially result in pro-environmental behaviours.

Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition.

OBJECTIVES: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. DESIGN: Prospective, randomized, and blinded. PARTICIPANTS: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. RESULTS: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32-42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). CONCLUSIONS: VR simulation training offers a powerful and effective platform for training safer skills.

Family burden, family health and personal mental health.

BACKGROUND: The economic and moral implications of family burden are well recognised. What is less understood is whether or how family health and family burden relate to personal mental health. This study examines family health and perceived family burden as predictors of personal mental health, taking personal and sociodemographic factors into consideration. METHODS: Data used was from the National Comorbidity Study Replication (NCS-R), namely the random 30% of participants (N = 3192) to whom the family burden interview was administered. Measures of family burden and mental health were considered for analysis. RESULTS: Binary logistic regressions were used as means of analyses. Perception of family burden was associated with an increased vulnerability to personal mental health problems, as was the presence of mental health difficulties within the family health profile. Which member of the family (kinship) was ill bore no relation to prediction of personal mental health. Personal and socio-demographic factors of sex, age, marital status, education and household income were all predictive of increased vulnerability to mental health problems over the last 12 months. CONCLUSIONS: Certain elements of family health profile and its perceived burden on the individuals themselves appears related to risk of personal incidence of mental health problems within the individuals themselves. For moral and economic reasons, further research to understand the dynamics of these relationships is essential to aid developing initiatives to protect and support the mental health and wellbeing of relatives of ill individuals.

Trauma associated with civil conflict and posttraumatic stress disorder: evidence from the Northern Ireland study of health and stress.

The authors provide epidemiological estimates of trauma, posttraumatic stress disorder (PTSD), and associated mental disorders in Northern Ireland (NI) with a focus on the impact of civil conflict using data from the NI Study of Health and Stress (NISHS), a representative epidemiological survey of adults in NI. Overall 60.6% had a lifetime traumatic event, and 39.0% experienced a presumed conflict-related event. Men were significantly more likely to experience any traumatic event and most conflict-related event types (p < .05). The lifetime and 12-month prevalence of PTSD were 8.8% and 5.1%, respectively. Furthermore, the lifetime prevalence of any mental disorder among men and women who experienced a conflict-related trauma (46.0% and 55.9%, respectively) was significantly higher than the prevalence among men and women who did not experience this type of traumatic event (27.2% and 31.1%, respectively). Given the public health burden posed by PTSD and additional impact of conflict, specific attention must be paid to the policy, service, and clinical challenge of delivering evidence-based treatments in the wake of a tumultuous period of conflict.

Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial.

Objective: To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background: GEARS-Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods: In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results: The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P < 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions: Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment.

Sex and age differences in attitudes and intention to adopt personalised nutrition in a UK sample.

AIM: There has been an increase in the development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking into consideration extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with personalised nutrition initiatives. SAMPLE AND METHODS: Volunteers were recruited via a social research agency from within the UK. The resultant sample (N = 1061) was 49% female, aged 18-65 years. RESULTS: MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups. CONCLUSION: These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote healthy eating should target males and older people.

Reliability of Observational Assessment Methods for Outcome-based Assessment of Surgical Skill: Systematic Review and Meta-analyses.

BACKGROUND: Reliable performance assessment is a necessary prerequisite for outcome-based assessment of surgical technical skill. Numerous observational instruments for technical skill assessment have been developed in recent years. However, methodological shortcomings of reported studies might negatively impinge on the interpretation of inter-rater reliability. OBJECTIVE: To synthesize the evidence about the inter-rater reliability of observational instruments for technical skill assessment for high-stakes decisions. DESIGN: A systematic review and meta-analysis were performed. We searched Scopus (including MEDLINE) and Pubmed, and key publications through December, 2016. This included original studies that evaluated reliability of instruments for the observational assessment of technical skills. Two reviewers independently extracted information on the primary outcome (the reliability statistic), secondary outcomes, and general information. We calculated pooled estimates using multilevel random effects meta-analyses where appropriate. RESULTS: A total of 247 documents met our inclusion criteria and provided 491 inter-rater reliability estimates. Inappropriate inter-rater reliability indices were reported for 40% of the checklists estimates, 50% of the rating scales estimates and 41% of the other types of assessment instruments estimates. Only 14 documents provided sufficient information to be included in the meta-analyses. The pooled Cohen's kappa was .78 (95% CI 0.69-0.89, p < 0.001) and pooled proportion agreement was 0.84 (95% CI 0.71-0.96, p < 0.001). A moderator analysis was performed to explore the influence of type of assessment instrument as a possible source of heterogeneity. CONCLUSIONS AND RELEVANCE: For high-stakes decisions, there was often insufficient information available on which to base conclusions. The use of suboptimal statistical methods and incomplete reporting of reliability estimates does not support the use of observational assessment instruments for technical skill for high-stakes decisions. Interpretations of inter-rater reliability should consider the reliability index and assessment instrument used. Reporting of inter-rater reliability needs to be improved by detailed descriptions of the assessment process.

Proficiency based progression simulation training significantly reduces utility strikes; A prospective, randomized and blinded study.

OBJECTIVES: We evaluated a simulation-based training curriculum with quantitatively defined performance benchmarks for utility workers location and excavation of utility services. BACKGROUND: Damaging buried utilities is associated with considerable safety risks to workers and substantial cost to employers. METHODS: In a prospective, randomized and blinded study we assessed the impact of Proficiency Based Progression (PBP) simulation training on the location and excavation of utility services work. RESULTS: PBP simulation training reduced performance errors (33%, p = 0.006) in comparison a standard trained group. When implemented across all workers in the same division there was a 35-61% reduction in utility strikes (p = 0.028) and an estimated cost saving of £116,000 -£2,175,000 in the 12 months (47,000 work hours) studied. CONCLUSIONS: The magnitude of the training benefit of PBP simulation training in the utilities sector appears to be the same as it is in surgery, cardiology and procedure-based medicine. APPLICATION: Quality-assured utility worker simulation training significantly reduces utility damage and associated costs.

Attitudes toward genetic testing and personalised nutrition in a representative sample of European consumers.

Negative consumer opinion poses a potential barrier to the application of nutrigenomic intervention. The present study has aimed to determine attitudes toward genetic testing and personalised nutrition among the European public. An omnibus opinion survey of a representative sample aged 14-55+ years (n 5967) took place in France, Italy, Great Britain, Portugal, Poland and Germany during June 2005 as part of the Lipgene project. A majority of respondents (66 %) reported that they would be willing to undergo genetic testing and 27 % to follow a personalised diet. Individuals who indicated a willingness to have a genetic test for the personalising of their diets were more likely to report a history of high blood cholesterol levels, central obesity and/or high levels of stress than those who would have a test only for general interest. Those who indicated that they would not have a genetic test were more likely to be male and less likely to report having central obesity. Individuals with a history of high blood cholesterol were less likely than those who did not to worry if intervention foods contained GM ingredients. Individuals who were aware that they had health problems associated with the metabolic syndrome appeared particularly favourable toward nutrigenomic intervention. These findings are encouraging for the future application of personalised nutrition provided that policies are put in place to address public concern about how genetic information is used and held.