Development and validation of a realistic type III esophageal atresia simulator for the training of pediatric surgeons.

BACKGROUND: The technical complexity and limited casuistry of neonatal surgical pathology limit the possibilities of developing the necessary technical competencies by specialists in training. Esophageal atresia constitutes the paradigm of this problem. The use of synthetic 3D models for training is a promising line of research, although the literature is limited. METHODS: We conceptualized, designed, and produced an anatomically realistic model for the open correction of type III oesophageal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content-validity questionnaires. RESULTS: The model was validated by nine experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 34.0 and 38.4 min, respectively. Two non-experts did not complete the procedure at the designed time (45 min). Regarding the face validity questionnaire, the mean rating of the model was 3.2 out of 4. Regarding the construct validity, we found statistically significant differences between groups for the equidistance between sutures, 100% correct in the expert group vs. 42.9% correct in the non-expert group (p = 0.02), and for the item "Confirms that tracheoesophageal fistula closure is watertight before continuing the procedure", correctly assessed by 66.7% of the experts vs. by 11.1% of non-experts (p = 0.05). Concerning content validity, the mean score was 3.3 out of 4 for the experts and 3.4 out of 4 for the non-experts. CONCLUSIONS: The present model is a cost-effective, simple-to-produce, and validated option for training open correction of type III esophageal atresia. However, future studies with larger sample sizes and blinded validators are needed before drawing definitive conclusions.

Development and Validation of a Realistic Neonatal Intestinal Jejunoileal Atresia Simulator for the Training of Pediatric Surgeons.

Background: Neonatal surgical pathology presents highly technical complexity and few opportunities for training. Many of the neonatal surgical entities are not replicable in animal models. Realistic 3D models are a cost-effective and efficient alternative for training new generations of pediatric surgeons. Methods: We conceptualized, designed, and produced an anatomically realistic model for the open correction of jejunoileal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content validity questionnaires. Results: The model was validated by eleven experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 41 and 42 min, respectively. Six non-experts and one expert did not complete the procedure by the designed time (45 min) (p = 0.02). The mean score of face validity was 3.1 out of 4. Regarding construct validity, we found statistically significant differences between groups for the correct calculation of the section length of the antimesenteric border (Nixon's technique) (p < 0.01). Concerning content validity, the mean score was 3.3 out of 4 in the experts group and 3.4 out of 4 in the non-experts group. Conclusions: The present model is a realistic and low-cost valid option for training for open correction of jejunoileal atresia. Before drawing definitive conclusions, future studies with larger sample sizes and blinded validators are needed.

Development and validation of a low-cost laparoscopic simulation box.

INTRODUCTION: The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. METHODS: A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. RESULTS: The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points). CONCLUSION: The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.

Development and validation of a low-cost laparoscopic simulation box / Desarrollo y validación de un simulador laparoscópico de bajo coste

Introduction: The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. Methods: A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. Results: The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points). Conclusion: The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique. (AU)

Introducción: La adquisición de las habilidades propias de la técnica laparoscópica en quirófano está condicionada por la experiencia del tutor y el número de intervenciones que realiza el aprendiz. Para que los estudiantes y cirujanos en formación utilicen un simulador laparoscópico para entrenar sus habilidades es importante que este esté previamente validado. Métodos: Se diseñó una caja de simulación laparoscópica, junto con 6 juegos de entrenamiento intercambiables. El simulador fue validado por un grupo de 19 expertos, médicos con experiencia de al menos 100 cirugías laparoscópicas y 20 estudiantes de 4º a 6º del Grado en Medicina (no expertos). Para evaluar su validez de constructo, se evaluó el tiempo hasta la finalización y el número de juegos completados con éxito. Se utilizaron cuestionarios de 11 y 9 ítems para recopilar información sobre la validez de contenido y la validez aparente, respectivamente. En ambos cuestionarios, las respuestas se recogieron con escalas tipo Likert de 1 a 5. Resultados: El grupo de expertos necesitó menos tiempo y completó con éxito más juegos que el grupo de no expertos (p < 0.01). El grupo de no expertos puntuó con ≥ 4 puntos cada una de las preguntas relativas a la validez del contenido, sin embargo, el grupo de experto dio una puntuación significativamente menor la necesidad del simulador para aprender la técnica laparoscópica (3,68 puntos; p < 0,01). En cuanto a la validez aparente, todos los ítems fueron calificados con una puntuación ≥ 4 puntos excepto el relativo al realismo espacial (3,82 puntos). Conclusión: La caja de simulación de laparoscopia y los juegos que desarrollamos son válidos para que cirujanos y estudiantes de medicina desarrollen las habilidades necesarias para la cirugía laparoscópica. (AU)

[Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. / Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado.

OBJECTIVE: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. DESIGN: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. PARTICIPANTS: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. MAIN MEASUREMENTS: We analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. RESULTS: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3-24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. CONCLUSIONS: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

[Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)]. / Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD).

OBJECTIVES: To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. DESIGN: Descriptive study based on personal interviews by professionals using a standardised method. SETTING: Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. PARTICIPANTS: Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. INTERVENTION: Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). MAIN MEASUREMENTS: The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). DISCUSSION: The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study.

Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado / Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests

Objetivo: Estimar la prevalencia de deterioro cognitivo (DC) en ancianos de la comunidad. Evaluar el rendimiento diagnóstico de los principales test de cribado cognitivo usados en atención primaria: miniexamen cognoscitivo (MEC), test del reloj (TR), test de fluencia verbal (TFV) y test del informador (TIN). Calcular la concordancia entre ellos y su validez como pruebas de cribado. Diseño: Estudio descriptivo transversal. Participantes: Doscientos noventa y tres personas de ambos sexos, mayores de 64 años, residentes en la provincia de Huesca, seleccionados mediante muestreo aleatorizado sistemático. Marco muestral: base de datos de Tarjeta Sanitaria Individual. Ámbito provincial. Mediciones: Variables sociodemográficas básicas, y exploración del DC con MEC, TR, TFV y TIN. Resultados: En función del MEC y los diagnósticos previos, la prevalencia de DC es del 18,1% (IC del 95%: del 15,3 al 24,4%). Resultados: La concordancia del MEC con el resto de los test de cribado es moderada: con el TR kappa (κ)=0,40, con el de TFV: 0,33, con el TIN: 0,36. Resultados: La concordancia global del conjunto de los test cognitivos es moderada-baja: κ (Jackknife)=0,35 (IC del 95%: 0,269 a 0,444). Resultados: Considerando patrón de oro al MEC junto con el diagnóstico previo de DC, el TR presenta una sensibilidad del 78,3% y una especificidad del 76,9%; el TFV presenta el 80 y el 70%, respectivamente, y el TIN presenta el 76,7 y el 71,4%, respectivamente. El área bajo la curva ROC (receiver operating characteristics) del TFV es significativamente superior al resto. Conclusión: La concordancia entre los distintos test de cribado cognitivo es moderada. El TFV es el que mejor rendimiento diagnóstico presenta (AU)

Objective: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. Design: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. Participants: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. Participants: Main measurementsWe analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. Results: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3–24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. Conclusions: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy (AU)

Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD) / Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)

Objetivos. Detectar factores físicos, psíquicos, sociodemográficos y funcionales asociados con el desarrollo de trastornos mentales en los ancianos, determinar su magnitud, estimar el riesgo individual y preparar el terreno para un posterior estudio longitudinal que nos permita en el futuro definir el anciano con fragilidad psíquica en la comunidad y el diseño de modelos predictivos de deterioro mental en el anciano. Diseño. Estudio descriptivo mediante entrevistas personales realizadas por profesionales estandarizados. Emplazamiento. En total, 28 centros de salud de la provincia de Huesca (índice de envejecimiento > 24,6%). Participantes. Participarán 326 personas mayores de 64 años residentes en la provincia de Huesca (España). Intervención. Entrevista personal por profesionales estandarizados (30 médicos de familia y un becario psicólogo). Se valorará la presencia de deterioro cognitivo (Mini-Examen Cognoscitivo), depresión (Escala de depresión geriátrica de Yesavage), ansiedad (Subescala de ansiedad del test de Goldberg) y alucinaciones, ideas delirantes, obsesiones e ideas hipocondríacas (Geriatric Mental State-GMS). Mediciones principales. Se estimará la prevalencia de factores de riesgo: variables sociodemográficas (edad, sexo, estado civil, nivel educativo, convivencia), situación funcional (índice de Barthel), gravedad física (índice acumulativo de enfermedad), antecedentes patológicos (somáticos y psíquicos) y acontecimientos vitales estresantes en el último año. Se ajustará un modelo de regresión logística para determinar la magnitud del efecto de cada factor ajustado para todos los demás. Se estimará el riesgo individual para el desarrollo de cada enfermedad (depresión, ansiedad, deterioro cognitivo/demencia, síntomas psicóticos, ideas obsesivas). Discusión. La fiabilidad del cuestionario se garantiza con el empleo de tests diagnósticos de comprobada validez y fiabilidad, la estandarización de los investigadores y la realización de un pilotaje del cuaderno de recogida de datos

Objectives. To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. Design. Descriptive study based on personal interviews by professionals using a standardised method. Setting. Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. Participants. Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. Intervention. Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). Main measurements. The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). Discussion. The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study