Validity, reliability and support for implementation of independence-scaled procedural assessment in laparoscopic surgery

Background There is no widely used method to evaluate procedure-specific laparoscopic skills. The first aim of this study was to develop a procedure-based assessment method. The second aim was to compare its validity, reliability and feasibility with currently available global rating scales (GRSs). Methods An independence-scaled procedural assessment was created by linking the procedural key steps of the laparoscopic cholecystectomy to an independence scale. Subtitled and blinded videos of a novice, an intermediate and an almost competent trainee, were evaluated with GRSs (OSATS and GOALS) and the independence-scaled procedural assessment by seven surgeons, three senior trainees and six scrub nurses. Participants received a short introduction to the GRSs and independence-scaled procedural assessment before assessment. The validity was estimated with the Friedman and Wilcoxon test and the reliability with the intra-class correlation coefficient (ICC). A questionnaire was used to evaluate user opinion. Results Independence-scaled procedural assessment and GRS scores improved significantly with surgical experience (OSATS p = 0.001, GOALS p <0.001, independence-scaled procedural assessment p <0.001). The ICCs of the OSATS, GOALS and independence-scaled procedural assessment were 0.78, 0.74 and 0.84, respectively, among surgeons. The ICCs increased when the ratings of scrub nurses were added to those of the surgeons. The independence-scaled procedural assessment was not considered more of an administrative burden than the GRSs (p = 0.692). Discussion/conclusion A procedural assessment created by combining procedural key steps to an independence scale is a valid, reliable and acceptable assessment instrument in surgery. In contrast to the GRSs, the reliability of the independence-scaled procedural assessment exceeded the threshold of 0.8, indicating that it can also be used for summative assessment. It furthermore seems that scrub nurses can assess the operative competence of surgical trainees

Procedure-based assessment for laparoscopic cholecystectomy can replace global rating scales

Introduction Global rating scales (GRSs) such as the Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Surgery (GOALS) are assessment methods for surgical procedures. The aim of this study was to establish construct validity of Procedure-Based Assessment (PBA) and to compare PBA with GRSs for laparoscopic cholecystectomy. Material and methods OSATS and GOALS GRSs were compared with PBA in their ability to discriminate between levels of performance between trainees who can perform the procedure independently and those who cannot. Three groups were formed based on the number of procedures performed by the trainee: novice (1-10), intermediate (11-20) and experienced (>20). Differences between groups were assessed using the Kruskal-Wallis and Mann-Whitney U tests. Results Increasing experience correlated significantly with higher GRSs and PBA scores (all p < .001). Scores of novice and intermediate groups overlapped substantially on the OSATS (p = .1) and GOALS (p = .1), while the PBA discriminated between these groups (p = .03). The median score in the experienced group was higher with less dispersion for PBA (97.2[85.3-100]) compared to OSATS (82.1[60.7-100]) and GOALS (80[60-100]). Conclusion For assessing skill level or the capability of performing a laparoscopic cholecystectomy independently, PBA has a higher discriminative ability compared to the GRSs

Effect of periodontal dressing on nonâ surgical periodontal treatment outcomes: a systematic review

BackgroundPeriodontal dressing has been advocated and showed some positive outcomes for placing over the surgical site after periodontal surgery. However, little is known about its effect on nonâ surgical therapy.PurposeThe aim of this review was to assess the clinical effect of periodontal dressing when used after nonâ surgical therapy.Material and methodsTwo examiners performed an electronic search in several databases for relevant articles published in English up to November 2013. Selected studies were randomized human clinical trials (prospective or retrospective trials) with the clear aim of investigating the effect of periodontal dressing placement upon periodontal nonâ surgical mechanical therapy. Data were extracted from the included articles for analysis.ResultsThree randomized clinical trials fulfilled the inclusion criteria and thus were included in the data analysis. Statistical analysis could not be carried out due to the lack of clear data of the included studies. However, descriptive analysis showed its effectiveness in improving clinical parameters such as gain of clinical attachment level and reduction of probing pocket depth.ConclusionPlacement of periodontal dressing right after nonâ surgical mechanical therapy can be beneficial in improving overall shortâ term clinical outcomes, although more controlled studies are still needed to validate this finding.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122435/1/idh12130.pd

Infrared thermography for the use in facial surgery

Abstract Today infrared thermography seems to be a useful and non-invasive tool in medical research as well as in clinical practice Therapy of midfacial fractures requires accurate reduction and fixation of bones to prevent mobility of fragments during fracture healing. This can be achieved by using titanium miniplates and screws. But drilling and screwing in bones shall be performed with an integrated cooling device for tissues and materials to avoid necrosis of hard and soft tissues. Even damage of nerval tissue and loss of the implants are possible. However, this can be prevented by the use of infrared thermography to measure temperatures on surfaces intraoperatively. In this study first observations were made during 36 experimental drillings on macerated human skulls. Then intraoperative measurements were done during treatment of 13 midfacial fractures

Mu2e Technical Design Report

The Mu2e experiment at Fermilab will search for charged lepton flavor violation via the coherent conversion process mu- N --> e- N with a sensitivity approximately four orders of magnitude better than the current world's best limits for this process. The experiment's sensitivity offers discovery potential over a wide array of new physics models and probes mass scales well beyond the reach of the LHC. We describe herein the preliminary design of the proposed Mu2e experiment. This document was created in partial fulfillment of the requirements necessary to obtain DOE CD-2 approval.Comment: compressed file, 888 pages, 621 figures, 126 tables; full resolution available at http://mu2e.fnal.gov; corrected typo in background summary, Table 3.