Three-Dimensional Peripheral Bloodstream Model of the Uterus for Laparoscopic Radical Hysterectomy.

Trainees require extensive experience to perform radical hysterectomy. Before starting training during an actual operation, trainees should be familiar with the pelvic anatomy and should simulate surgical procedures. Many simulators are available for virtual reality training of laparoscopic operations, but they are very expensive. The materials required to construct our model included sponges and colored wires sold in home improvement stores that allowed for superior cost effectiveness. The model represented almost all peripheral vessels and nerves around the uterus, including the minor vessels. Attaching and detaching the vessels was easy, facilitating reconstruction of the dissected vessels. The wires were easy to bend, ensuring high operability. This model allows for the simulation of laparoscopic radical hysterectomy in a dry box. Our model was superior to a 2-dimensional picture for the memorization of branching and positional relationships of the blood vessels. Comparison of our model with actual operative videos showed that the dry box provided an identical surgical view of an actual laparoscopic radical hysterectomy. We developed a peripheral bloodstream model of the uterus for repeated simulation of laparoscopic radical hysterectomy with an actual surgical view using a dry box.

4273π: bioinformatics education on low cost ARM hardware.

BACKGROUND: Teaching bioinformatics at universities is complicated by typical computer classroom settings. As well as running software locally and online, students should gain experience of systems administration. For a future career in biology or bioinformatics, the installation of software is a useful skill. We propose that this may be taught by running the course on GNU/Linux running on inexpensive Raspberry Pi computer hardware, for which students may be granted full administrator access. RESULTS: We release 4273π, an operating system image for Raspberry Pi based on Raspbian Linux. This includes minor customisations for classroom use and includes our Open Access bioinformatics course, 4273π Bioinformatics for Biologists. This is based on the final-year undergraduate module BL4273, run on Raspberry Pi computers at the University of St Andrews, Semester 1, academic year 2012-2013. CONCLUSIONS: 4273π is a means to teach bioinformatics, including systems administration tasks, to undergraduates at low cost.

Five really easy steps to build a homemade low-cost simulator.

AIM: The aim of this study was to evaluate how simple it is to build a homemade low-cost simulator using a simple 5-step scheme. METHODS: A scheme explaining how to build an endoscopic surgery simulator in 5 easy steps was presented to 26 surgeons. The simulator required a pair of scissors and easy-to-find materials. Its total cost was less than €35. The participants assessed the simulator using common endoscopic training toys or ex vivo tissue and completed an anonymous query comparing it with other commercial simulators that they had experienced before. RESULTS: In all, 84.6% found the simulator really easy to build. Every participant felt that he or she could do the same simulator themselves. Comparing with other commercial available box simulators, the majority of participants found the homemade simulator easier to (a) mount and dismount, (b) transport, (c) clean, and (d) use when practicing alone. CONCLUSIONS: Anyone can build its own simulator for a small amount of money.

Phase II Practice-based Evidence in Nutrition (PEN) evaluation: interviews with key informants.

PURPOSE: Dietitians of Canada has collaborated with experts in knowledge translation and transfer, technology, and dietetic practice to develop and implement an innovative online decision-support system called Practice-based Evidence in Nutrition (PEN). A study was conducted to evaluate the perceived facilitators and barriers that enable dietitians to use or prevent them from using PEN. METHODS: As part of the overall evaluation framework of PEN, a qualitative descriptive research design was used to address the research purpose. Individual, semi-structured telephone interviews with 17 key informants were completed, and the interview transcripts underwent qualitative content analysis. RESULTS: Respondents identified several facilitators of and barriers to PEN use. Facilitators included specificity to dietetics, rigorous/expert review, easy accessibility, current content, credible/secure material, well-organized/easy-to-use material, material that is valuable to practice, and good value for money. Barriers included perceived high cost, fee structuring/cost to students, certain organizational aspects, and a perceived lack of training for pathway contributors. CONCLUSIONS: This formative evaluation has indicated areas in which PEN could be improved and strategies to make PEN the standard for dietetic education and practice. Ensuring that PEN is meeting users' knowledge needs is of the utmost importance if dietitians are to remain on the cutting edge of scientific inquiry.

Newsletters and adherence to a weekly home spirometry program after lung transplant.

CONTEXT: Newsletters are a common intervention for patients in clinical trials. However, it is not clear whether newsletters are associated with increased adherence to the health regimen, and if so, which aspects of the newsletter are reported as most helpful to patients. OBJECTIVE: To examine the association between patients' ratings of worthwhileness of a quarterly newsletter and adherence with a home spirometry regimen. DESIGN: Patients (n=48) were in a research-based spirometry program after lung transplant and had received at least 1 newsletter; 24 (50%) returned completed surveys via postal mail. MAIN OUTCOME MEASURES: Adherence for forced vital pulmonary function tests for respondents versus nonrespondents, number of weeks they were adherent, ratings they gave the newsletter, and which components of the newsletters were helpful to the respondents. RESULTS: Respondents had more forced vital capacity pulmonary function tests ("blows") overall, blew more times weekly, and blew more consistently from week to week than did nonrespondents. Although it was not statistically significant, a mild correlation was found between the number of weeks that the respondents were adherent and their ratings of the newsletter (r = 0.36, P = .08). Most respondents reported that newsletter length was "about right", and 86% reported that newsletters helped encourage regular spirometer use, maintain interest in the study, educate about general health, and alert readers to seasonal health risks. IMPLICATIONS FOR PRACTICE: High ratings for newsletters used to encourage participation among adults in our home spirometry study were associated with higher adherence.

The EZ Trainer: validation of a portable and inexpensive simulator for training basic laparoscopic skills.

PURPOSE: We assessed the face and content validity of a new portable laparoscopic trainer, the EZ Trainer. MATERIALS AND METHODS: The portable, affordable EZ trainer system was conceived, designed and commissioned by academic surgeons from the departments of urology at our 2 institutions with the express purpose of advancing laparoscopic surgical training. A total of 42 participants, including general surgeons, obstetricians/gynecologists, urologists and industry representatives, assessed the face and the content validity of the trainer using a standard questionnaire. Participants were stratified into high (greater than 30 laparoscopic cases per year) and low (less than 30 cases per year) volume laparoscopists. RESULTS: Of the participants 96% rated the trainer as a realistic laparoscopic training format. Of high volume laparoscopists 81.5% rated the trainer as comfortable to use, 92.6% found that the trainer was a realistic practice format, 70.4% would purchase the trainer for personal use and 85.2% would recommend that the trainer be made available to surgical residents in their discipline. Of low volume laparoscopists 87% rated the trainer as comfortable to use, 93.3% found that the trainer was a realistic practice format, 73.3% would purchase the trainer for personal use and 80% would recommend that the trainer be made available to diverse surgical residents. CONCLUSIONS: The EZ trainer system has face and content validity as a portable laparoscopic trainer across a broad range of surgical disciplines.

A lifelike patient simulator for teaching robotic colorectal surgery: how to acquire skills for robotic rectal dissection.

BACKGROUND: The use of robotic systems for colorectal resections is well documented, but robotic surgery is not yet established as a substitute for all laparoscopic colorectal procedures. The features of the new-generation robotic system seem to be well suited for proper mesorectal excision, with the identification and preservation of autonomic pelvic nerves. Proper training in the use of robotic skills is essential. METHODS: This report describes the creation of a pelvic model that can be used to teach the complex skills needed for successful completion of robotic rectal dissection. The model was designed to be cost effective, portable, and reusable in multiple teaching programs. Both the setup and size of the trainer were designed to be the same as those for a real patient and to allow for proper simulation of port placement in a true robotic rectal dissection. The operative field was molded directly onto a replica of a human skeleton, and the materials that make up the trainer closely replicate the consistency of a real patient. RESULTS: To date, no adequate artificial pelvic models have been available for rectal dissection. Cadaveric models are expensive, and virtual reality trainers, although offering an attractive alternative for some procedures, currently are not available for complex robotic tasks such as rectal dissection. One major advantage of this trainer is that it allows for the surgeon to develop proficiency in both the areas of robotic setup and console without the assistance of a second surgeon. CONCLUSIONS: The trainer described in this report provides an accurate simulation of true robotic rectal dissection. Its portability makes it easy to use at various hospitals. As robotic surgery becomes more common, this training tool has the potential to help surgeons quickly build the skills necessary for the successful use of robotic surgery in the area of rectal dissection.

[Students of medicine are turning medical education on its head; from a closed to an open learning environment]. / Medisch student zet geneeskundeonderwijs op zijn kop.

These days, students are gathering their own source materials using Google and leave the required textbooks on the shelves. This means the future of medical education lies in facilitating and freely sharing modern learning resources. This rapid shift, away from traditional textbooks, is causing unrest in academic education. The faculty is losing control and the overall picture. Existing teaching materials with strict copyrights have made it difficult for teachers and students to learn from each other. The productivity and professional curiosity of a sector that not only desires but also requires life-long learning, is being undermined by meaningless barriers and duplication of work. Free learning resources are making it easier for both students and professionals to learn, share and quickly get access to the right information. In this article, we explain what this means for medical education, what is needed and we provide a few examples.

An economic analysis of patient simulators clinical training in nursing education.

Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined.

Teaching insect retinal physiology with newly designed, inexpensive micromanipulators.

In this article, we detail how to produce two inexpensive micromanipulators that offer high precision (approximately 25 microm) along a single axis of movement. The more expensive of the designs provides improved versatility along multiple axes. Both manipulators offer substantial savings over commercially available micromanipulators with comparable capabilities. Plans and instructions are given such that a novice can produce the manipulators with simple tools. The manipulators are designed to serve undergraduate teaching exercises in physiology. An electroretinogram exercise is suggested in adult house flies (Musca) or flesh flies (Neobellieria). Measuring the intensity-response function and temporal characteristics of visual transduction are discussed. A brief introduction to the field of visual transduction and the physiology of the laboratory exercises is provided as well.

A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of Ob-Gyn residents: a low-cost laparoscopic trainer.

INTRODUCTION: Residents traditionally acquire surgical skills through on-the-job training. Minimally invasive laparoscopic techniques present additional demands to master complex surgical procedures in a remote 2-dimensional venue. We examined the effectiveness of a brief warm-up laparoscopic simulation toward improving operative proficiency. METHODS: Using a "Poor-Man's Laparoscopy Simulator," 12 Ob/Gyn residents and 12 medical students were allocated 10 minutes to transfer 30 tablets with a 5-mm grasper from point A to point B via laparoscopic visualization in a warm-up exercise. Participants repeated the exercise following a 5-minute pause. Mean scores, expressed in seconds/tablet, and overall improvement (percentage difference between warm-up and follow-up) were analyzed according to postgraduate standing (PGY14), dexterity skills, and pertinent vocational activities. RESULTS: Significant improvements were noted for both residents (+25%) and medical students (+29%), P<0.0001. Scores between the 2 groups, however, were not significant (P=0.677). Proficiency was not influenced by PGY standing. Interestingly, the best (8.73 sec/pill) and the worst (25 sec/pill) scores were attained by a medical student and a chief resident, respectively, suggesting the contribution of individual aptitude. CONCLUSION: A brief warm-up exercise before an actual laparoscopic surgical procedure significantly improves subsequent laparoscopic performance.

Low Cost Simulator for Heart Surgery Training.

Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Monitoring the use of anatomical teaching material using a low-cost radio frequency identification system: A comprehensive assessment.

The correct tracking and monitoring of anatomical specimens is not only imperative in any modern body donation programs but also in any universities for which teaching the next generation of health care professionals is the primary mission. This has long been an arduous process for anatomy institutions across the world, and the recent focus of new curricula on self-directed learning adds new stress on specimens which are used by students. The radio frequency identification (RFID) technology has been proposed as a very effective tracking system in healthcare considering that it enables automatic identification and data capture of multiple items at once. In this study, the feasibility of a low-cost RFID inventory system is assessed, from its design to the performance of commercially available RFID tags in a gross anatomy laboratory. The results show that ultrahigh frequency-based RFID tags successfully performed when attached to a collection of 112 plastinated and 280 wet dissected specimens. Comparison analysis of different tags reveals, however, that careful selection of RFID tags needs to be considered when wet specimens need to be tracked as preservation fluids can absorb radio waves energy. This study demonstrates that it is economically feasible to incorporate RFID technology to closely monitor the use of anatomical teaching specimens. The described RFID inventory system was not only able to preserve the integrity of the specimens being used by limiting handling and therefore human error but was also able to identify missing or misplaced specimens and to update their status.

Genomics and public health: development of Web-based training tools for increasing genomic awareness.

In 2001, the Centers for Disease Control and Prevention funded three Centers for Genomics and Public Health to develop training tools for increasing genomic awareness. Over the past three years, the centers, working together with the Centers for Disease Control and Prevention's Office of Genomics and Disease Prevention, have developed tools to increase awareness of the impact genomics will have on public health practice, to provide a foundation for understanding basic genomic advances, and to translate the relevance of that information to public health practitioners' own work. These training tools serve to communicate genomic advances and their potential for integration into public heath practice. This paper highlights two of these training tools: 1) Genomics for Public Health Practitioners: The Practical Application of Genomics in Public Health Practice, a Web-based introduction to genomics, and 2) Six Weeks to Genomic Awareness, an in-depth training module on public health genomics. This paper focuses on the processes and collaborative efforts by which these live presentations were developed and delivered as Web-based training sessions.

Experience report on teaching surgical technique without animal use.

PURPOSE: To report the experience of the school in implementing the 3 Rs replace, reduce and refine; showing time and assembling cost of the experimental models used in the teaching of Surgical Technique and Experimental Surgery. METHODS: Assembly time and costs of models: grafts and flaps performed in pork belly, model of intestinal anastomosis and jejunostomy done in Bahiana box and black box model for training videosurgery. RESULTS: Average time and cost estimate: ten minutes-pork belly, cost $ 6.00 per kilogram; two minutes-Bahiana box, cost $ 27.2; Black box-3.6 hours for manufacturing, cost $ 100.00. The repetition of each practice the cost is $ 3.20 for Bahiana box and at no cost to the black box. CONCLUSION: The experimental models presented are easily reproducible and of low cost.

The pediatrician's guide to computer videodiscs.

Computer-videodisc technology is currently redefining the uses and possibilities of media-assisted education. A specific videodisc program developed for use in pediatric education is described; the present state of videodisc technology is explained; possible future medical applications of this technology are suggested.

Relative value of analog and digital teaching files.

RATIONALE AND OBJECTIVES: This study was performed to determine if it is financially reasonable for radiology residency programs that create and maintain their own teaching files to switch from analog teaching files (ATFs) to digital teaching files (DTFs). MATERIALS AND METHODS: Radiology residency program directors were surveyed electronically about the monetary value and importance of conventional ATFs and DTFs. The costs for maintaining each type of file were calculated at the authors' institution. RESULTS: Surveys were sent to the program directors of all 197 accredited radiology residencies. Responses were received from 48 (24%). DTFs were scored as more important than ATFs, but the difference was not significant (P = .22). DTFs were rated as less complete (P = .01) but more current (P << .001) than ATFs. DTFs included the American College of Radiology Learning File (85%), in-house productions (77%), and other commercially available products (63%). Thirty percent of respondents had a DTF integrated into a picture archiving and communication system, and 28% reported having a technician dedicated to the teaching file. Program directors ascribed total median dollar values of $250 and $3,000 per year to their ATFs and DTFs, respectively. The annual costs at the authors' institution were much higher than these ascribed values: $44,720 ($91 per case) for maintaining a DTF produced in house and $24,601 ($50 per case) for maintaining an ATF, excluding physician time. CONCLUSION: Program directors are more willing to pay for a DTF than an ATF. For both, the costs of maintenance are great and the relative monetary value is low.

Perceived effectiveness, cost, and availability of patient education methods and materials.

To determine the efficacy of and need for patient education methods and media, a needs assessment was sent to 816 members of the American Association of Diabetes Educators. Respondents (n = 325, 40%) included 62% RNs, 36% RDs, 1% other; 62% CDEs. Their mean number of years experience in diabetes education was 8.5, and 99% routinely provided patient education. Respondents indicated that videotapes and slide tapes were the most educationally effective media and books and audiotapes were the least effective. Booklets and videotapes were the most cost-effective and computer-assisted instruction the least effective. While respondents perceived one-to-one counseling, skills training, and diabetes content sessions to be the three most educationally effective methods, support groups and large and small discussion groups were seen as the three most cost-effective educational methods. Among nine potential barriers to quality patient education listed, educators rated lack of third-party reimbursement as a major barrier most frequently and national availability of quality education materials as a barrier least frequently.