56 research outputs found
Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum
The complexity of acquiring minimally invasive surgical (MIS) skills, combined with smaller case volumes for residents have pushed the development of skills training facilities on simulators outside the operating room (OR). Medico-legal and financial constraints have stimulated this development even more. However, the implementation of simulator training into a residency curriculum is shown to be troublesome. MIS skills training is organized in a uniform and easily applicable way in the Dutch obstetrics and gynecology residency curriculum. Every resident is obliged to attend the same basic surgical skills course, named Cobra-alpha course, intentionally during postgraduate year (PGY) 1 or 2. Furthermore, surgical skills are trained, evaluated and expanded on simulators in teaching hospitals. Additional to the Cobra-alpha course, residents may attend advanced training courses and congresses focusing on laparoscopy and hysteroscopy. This organization guarantees a uniform introduction to MIS skills training for every resident. However, preconditions for continuous training and evaluation after this introduction have to be optimized
Six weeks of home enteral nutrition versus standard care after esophagectomy or total gastrectomy for cancer: study protocol for a randomized controlled trial
Background: Each year approximately 3000 patients in the United Kingdom undergo surgery for esophagogastric
cancer. Jejunostomy feeding tubes, placed at the time of surgery for early postoperative nutrition, have been
shown to have a positive impact on clinical outcomes in the short term. Whether feeding out of hospital is of
benefit is unknown. Local experience has identified that between 15 and 20% of patients required ‘rescue’
jejunostomy feeding for nutritional problems and weight loss while at home. This weight loss and poor nutrition
may contribute to the detrimental effect on the overall quality of life (QoL) reported in these patients.
Methods/Design: This randomized pilot and feasibility study will provide preliminary information on the routine
use of jejunostomy feeding after hospital discharge in terms of clinical benefits and QoL. Sixty participants
undergoing esophagectomy or total gastrectomy will be randomized to receive either a planned program of six
weeks of home jejunostomy feeding after discharge from hospital (intervention) or treatment-as-usual (control). The
intention of this study is to inform a multi-centre randomized controlled trial. The primary outcome measures will
be recruitment and retention rates at six weeks and six months. Secondary outcome measures will include disease
specific and general QoL measures, nutritional parameters, total and oral nutritional intake, hospital readmission
rates, and estimates of healthcare costs. Up to 20 participants will also be enrolled in a qualitative sub-study that will
explore participants’ and carers’ experiences of home tube feeding.
The results will be disseminated by presentation at surgical, gastroenterological and dietetic meetings and
publication in appropriate peer review journals. A patient-friendly lay summary will be made available on the
University of Leicester and the University Hospitals of Leicester NHS Trust websites. The study has full ethical and
institutional approval and started recruitment in July 2012.
Trial registration: UKClinical Research Network ID #12447 (Main study); UKCRN ID#13361 (Qualitative sub study);
ClinicalTrials.gov #NCT01870817 (First registered 28 May 2013
Role of β3-adrenergic receptors in the action of a tumour lipid mobilizing factor
Induction of lipolysis in murine white adipocytes, and stimulation of adenylate cyclase in adipocyte plasma membranes, by a tumour-produced lipid mobilizing factor, was attenuated by low concentrations (10−7–10−5 M) of the specific β3-adrenoceptor antagonist SR59230A. Lipid mobilizing factor (250 nM) produced comparable increases in intracellular cyclic AMP in CHOK1 cells transfected with the human β3-adrenoceptor to that obtained with isoprenaline (1 nM). In both cases cyclic AMP production was attenuated by SR59230A confirming that the effect is mediated through a β3-adrenoceptor. A non-linear regression analysis of binding of lipid mobilizing factor to the β3-adrenoceptor showed a high affinity binding site with a Kd value 78±45 nM and a Bmax value (282±1 fmole mg protein−1) comparable with that of other β3-adrenoceptor agonists. These results suggest that lipid mobilizing factor induces lipolysis through binding to a β3-adrenoceptor
An Event-Driven Framework for the Simulation of Complex Surgical Procedures
Abstract. Existing surgical simulators provide a physical simulation that can help a trainee develop the hand-eye coordination and motor skills necessary for specific tasks, such as cutting or suturing. However, it is equally important for a surgeon to gain experience in the cognitive processes involved in performing an entire procedure. The surgeon must be able to perform the correct tasks in the correct sequence, and must be able to quickly and appropriately respond to any unexpected events or mistakes. It would be beneficial for a surgical procedure simulation to expose the training surgeon to difficult situations only rarely encountered in actual patients. We present here a framework for a fullprocedure surgical simulator that incorporates an ability to detect discrete events, and that uses these events to track the logical flow of the procedure as performed by the trainee. In addition, we are developing a scripting language that allows an experienced surgeon to precisely specify the logical flow of a procedure without the need for programming. The utility of the framework is illustrated through its application to a mastoidectomy.
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