Prospective comparison of single encounter versus distributed laparoscopic training in novice learners: A controlled trial.

BACKGROUND: The traditional model of teaching surgical skills on "real" patients using graded responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. The purpose of our study was to determine if the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest that distributed training programs might have better outcomes, but the results are inconclusive. We designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained using the distributed method may have enhanced learning outcomes. MATERIALS AND METHODS: 100 medical students were assigned in a 1:1 ratio to one of two groups. Group A underwent a single orientation and supervised practice session of 3 h duration. Group B underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive weeks. Participant scores were analyzed before and after the intervention and at 3- and 6-month intervals using repeat measures of ANOVA. RESULTS: Pretest and immediate posttest scores were comparable between the two groups. The 3-month interval test showed significantly higher scores in Group B (difference = -2.90, P < 0.001). The 6-month interval test showed no differences in scores between the two groups (P = 0.178). CONCLUSIONS: Distributed teaching resulted in significantly enhanced scores at 3-month assessment. However, similar scores at 6 months suggest the need for repeated intervention.

Not All Street Food Is Bad: Low Prevalence of Antibiotic-Resistant Salmonella enterica in Ready-to-Eat (RTE) Meats in Ghana Is Associated with Good Vendors' Knowledge of Meat Safety.

Foodborne infections due to the consumption of meat is a significant threat to public health. However, good vendor and consumer knowledge of meat safety could prevent meat contamination with and transmission of foodborne pathogens like Salmonella. Thus, this study investigated the vendor and consumer perception, knowledge, and practices of meat safety regarding ready-to-eat (RTE) meat and how this affected the prevalence and antibiotic susceptibility of Salmonella enterica in RTE meats in the streets of Ghana. A semi-structured questionnaire was used to obtain the demographics, knowledge, and practices of meat safety data from RTE meat vendors (n = 300) and consumers (n = 382). Salmonella enterica detection was done according to the United State of America (USA)-Food and Drugs Administration (FDA) Bacteriological Analytical Manual. The disk diffusion method was used for antibiotic resistance testing. The results revealed that most of the respondents had heard of meat safety (98.3% vendors, 91.8% consumers) and knew that meat could be contaminated by poor handling (100.0% vendors, 88.9% consumers). The respondents knew that regular hand washing reduced the risk of meat contamination (100.0% vendors, 94.0% consumers). Responses to the practices of meat safety by vendors were generally better. A very low Salmonella enterica prevalence was observed in the samples, ranging between 0.0 and 4.0% for guinea fowl and beef, respectively. However, the six isolates obtained were resistant to five of the nine antibiotics tested, with all isolates displaying different resistance profiles. Overall, the good knowledge and practice of meat safety demonstrated by the respondents corroborated the negligible prevalence of Salmonella in this study, reiterating the importance of vendor meat safety knowledge. However, the presence of resistant Salmonella enterica in some of the meat samples, albeit in a very low prevalence, warrants stricter sanitary measures and greater meat safety awareness in the general population to prevent meat-borne infections and potential transmission of drug-resistant bacteria to humans.

Effectiveness of Laparoscopic Skills Workshop on Enhancing Knowledge and Skills of Surgical Residents and Its Comparison with DOPS (Direct Observation of Procedural Skills) Scores: Prospective Cohort Study.

INTRODUCTION: Simulation-based surgical skills workshops are commonly used in the surgical training programs to enhance the knowledge and psychomotor skills of the residents, but there is scarcity of objective data on their effectiveness. The aim of our study was to explore if a 1-day laparoscopic skills workshop enhanced the knowledge and skills of surgical residents in minimal access surgery and if it had any correlation with the Direct Observation of Procedural Skills (DOPS) scores. METHODS: This was a quasi-experimental, single-arm, repeat measure, prospective cohort study design. Thirty-three residents from general surgery and obstetrics/gynecology programs of Aga Khan University participated in the study. A daylong laparoscopic skills workshop consisting of lectures, videos, and hands-on practice was offered. The pre-workshop knowledge and skills scores of residents were assessed and compared with immediate post-workshop scores and scores of repeat assessment at 2 months. The scores of DOPS on laparoscopic procedures before and after the workshop were also compared. RESULTS: The results of our study indicated that mean post-workshop (p < 0.001) and interval scores (p < 0.001) for both cognitive and psychomotor skills were significantly higher compared with mean pre-workshop scores. Similarly, post-workshop DOPS scores were significantly higher (p < 0.011) compared with pre-workshop DOPS scores. CONCLUSIONS: One-day laparoscopic skills workshop resulted in significant improvement in knowledge and psychomotor skills of the surgical residents. The skills gained from the workshop also resulted in improvement of DOPS scores reflecting the transfer of skills to real-life performance. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT03982927.

Guillain-Barré syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review.

Obesity is a major health problem worldwide. Bariatric surgery has been increasingly used to manage obesity. Many acute as well as chronic neurological complications have been reported after bariatric surgery including Guillain-Barré syndrome (GBS). An autoimmune process has been postulated as the underlying pathophysiology. Most of the reported cases of GBS after bariatric surgery are of the axonal variety. Here, we report a case of a demyelinating variety of GBS in a young woman who presented with acute onset of progressive weakness and paresthesia of all limbs within six weeks after bariatric surgery. She was treated with intravenous immunoglobulin (IVIG) and rehabilitation. She had complete recovery on follow-up. We believe that onset of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is demyelinating variety of GBS, is associated with changes in immune system after bariatric surgery.

Recurrent spontaneous splenic rupture in a patient with congenital factor XIII deficiency.

We describe an unusual presentation of factor XIII (FXIII) deficiency in a 17-year-old boy who was diagnosed with this congenital deficiency at the age of 18 months. He had a history of spontaneous splenic rupture 8 years ago, which was managed conservatively. He now presented with sudden severe abdominal and left shoulder pain for 1 day, with no history of antecedent trauma. He was in shock, and examination revealed diffuse peritonitis. A computed tomography scan showed a grade IV splenic laceration. He was taken as an emergency to the operating room where he was found to have a shattered spleen, and a splenectomy was performed. He received cryoprecipitate transfusions perioperatively. After an uneventful recovery, the patient was discharged. To the best of our knowledge, this is the first described case of a recurrent splenic rupture in a patient with FXIII deficiency.

Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study.

OBJECTIVE: This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC). METHODS: Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded. RESULTS: Mean age (TVC: 33.5 ± 3.0 year; SILC: 38.4 ± 3.3 year; 4PLC: 35.5 ± 4.1 year; p = 0.58) and mean BMI (TVC: 28.8 ± 1.5 kg/m(2); SILC: 31.8 ± 1 kg/m(2); 4PLC: 31.4 ± 2.2 kg/m(2); p = 0.35) were not statistically significant. However, mean operative time (TVC: 67 ± 3.9 min; SILC: 48.9 ± 2.6 min; 4PLC: 42.3 ± 3.9 min; p < 0.001) was significantly longer for TVC. Numerical pain scales showed significantly lower pain scores on POD 1 and 3 for TVC compared with SILC and 4PLC (TVC: 4.1 ± 0.5 and 2.9 ± 0.7; SILC: 6.1 ± 0.5 and 5.3 ± 0.5; 4PLC: 5.7 ± 0.4 and 4.7 ± 0.3; p = 0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4 ± 1.5 days; SILC: 13.1 ± 1.3 days; 4PLC: 14.1 ± 1.4 days; p < 0.001) also was significantly faster for patients in the TVC group. One conversion in the TVC group to a 4PLC was necessary due to adhesions within the pelvis. One dislodged IUD was seen and immediately replaced in the TVC group. One hernia was observed in the SILC group. CONCLUSIONS: Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3 days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy.