Systematic review of the current status of cadaveric simulation for surgical training

Background: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. Methods: A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. Results: A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). Conclusion: There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre

Insider Threats to Information Systems

There are few, if any, organizations immune to the adverse and costly effects of successful information system attacks. As reliance on information systems continues to increase, organizations must continue to implement effective computer security measures to maintain their operability. This paper focuses on internal attacks executed by those individuals within the organization who have authorized access to information systems and behave in an unethical manner. We examine categorization of insiders; the motives and psychological profiles behind their destructive behavior; and conclude with a discussion of several measures that organizations can implement in order to detect and defend against insider threats

Characterization of endospore-forming bacteria associated with entomopathogenic nematodes, Heterorhabditis spp., and description of Paenibacillus nematophilus sp. nov.

Endospore-forming bacteria were isolated from insect-pathogenic nematodes, Heterorhabditis spp., from three diverse geographical locations. Spindle-shaped sporangia of these bacteria adhere to the free-living infective stage of the nematode, which carries them to new insect hosts, where the bacterium reproduces. These isolates were characterized based on phenotypic and chemotaxonomic properties and 16S rRNA gene sequences. Analysis of the 16S rRNA gene placed the isolates within the genus Paenibacillus. The isolates shared higher sequence similarities with each other (95.1-100%) than they did with any other named species within the genus (89.2-94%). Paenibacillus macquariensis, Paenibacillus azoreducens, Paenibacillus amylolyticus and Paenibacillus durus were among the species with highest sequence similarity to these isolates. The isolates shared a high degree of phenotypic similarity and were easily distinguished from closely related members of the genus. Anteiso-C15:0 and C16:0 were among the major fatty acid types and the DNA G + C content was approximately 44 mol% in all isolates. DNA-DNA similarity studies revealed genomic heterogeneity among the isolates, such that they are likely to represent more than one species. Two of the isolates (both from a Heterorhabditis megidis isolate from Estonia) are phenotypically distinguishable from the others and are proposed as a single species, Paenibacillus nematophilus sp. nov. The type strain for this novel species is NEM1aT (=DSM 13559T =NCIMB 13845T). The other isolates, although closely related to the proposed species, are likely to represent at least one, but most likely two, novel species

The effect of surgical approach on the histology of the femoral head following resurfacing of the hip : analysis of retrieval specimens

Objectives: We aimed to determine the effect of surgical approach on the histology of the femoral head following resurfacing of the hip. Methods: We performed a histological assessment of the bone under the femoral component taken from retrieval specimens of patients having revision surgery following resurfacing of the hip. We compared the number of empty lacunae in specimens from patients who had originally had a posterior surgical approach with the number in patients having alternative surgical approaches. Results: We found a statistically significant increase in the percentage of empty lacunae in retrieval specimens from patients who had the posterior approach compared with other surgical approaches (p < 0.001). Conclusions: This indicates that the vascular compromise that occurs during the posterior surgical approach does have long-term effects on the bone of the femoral head, even if it does not cause overt avascular necrosis

Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees : a preliminary, multicentre randomized controlled trial

Aims: Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods: We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Results:Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Conclusion: Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required

Intra-Arterial Blood Pressure Characteristics during Submaximal Cycling and Recovery

The purpose of this study was to measure intra-arterial (IA) blood pressure from rest to steady-state submaximal exercise and immediately post-exercise. Beat-to-beat blood pressure was compared to breath-by-breath VO2 during steady-state and maximal exercise. Fourteen normotensive subjects volunteered. Systolic (SBP), diastolic (DBP) and mean (mBP) blood pressure was measured from rest to steady state during cycling at 45, 60, and 75% maximal power output (POmax). BP was assessed during recovery from VO2peak through 2 min of cycling at 50 W. During the rest to exercise transition, mBP decreased from 103.41 ± 9.4 to 90.1 ± 8.9 mmHg after 11.6 ± 6.2 s (