Patients and hospital managers want laparoscopic simulation training to become mandatory before live operating:a multicentre qualitative study of stakeholder perceptions

Background Surgical procedures are complex and susceptible to human error. Individual surgical skill correlates with improved patient outcomes demonstrating that surgical proficiency is vitally important for patient safety. Evidence demonstrates that simulation training improves laparoscopic surgical skills; however, projects to implement and integrate laparoscopic simulation into core surgical curricula have had varied success. One barrier to successful implementation has been the lack of awareness and prioritisation of simulation initiatives by key stakeholders. Objective To determine the knowledge and perceptions of patients and hospital managers on laparoscopic surgery and simulation training in patient safety and healthcare. Method A qualitative study was conducted in the Southwest of England. 40 semistructured interviews were undertaken with patients attending general gynaecology clinics and general surgical and gynaecology hospital managers. Results Six key themes identified included: Positive expectations of laparoscopic surgery; perceptions of problems and financial implications of laparoscopic surgery; lack of awareness of difficulties with surgical training; desire for laparoscopic simulation training and competency testing for patient benefit; conflicting priorities of laparoscopic simulation in healthcare; and drawbacks of surgical simulation training. Patients and managers were largely unaware of the risks of laparoscopic surgery and challenges for training. Managers highlighted conflicting financial priorities when purchasing educational equipment. Patients stated that they would have greater confidence in a surgeon who had undertaken mandatory surgical simulation training and perceived purchasing simulation equipment to be a high priority in the National Health Services. Most patients and hospital managers believed trainees should pass an examination on a simulator prior to live operating. Conclusions Competency-based mandatory laparoscopic simulation was strongly supported by the majority of stakeholders to augment the initial learning curve of surgeons

Validation of virtual-reality simulation for obstetric ultrasonography: A prospective cross-sectional study

In bagged and unbagged shoot experiments, we investigated the survival and growth rate of first instar larvae of Chrysophtharta bimaculata on 9 families of a natural host, Eucalyptus regnans. Families used had been previously assessed as being either of low or high susceptibility to C. bimaculata damage. In conjunction with larval experiments, we measured 24 tree and leaf characteristics (including foliar elemental concentrations, foliar terpenes, leaf toughness and tree growth rates) and attempted to correlate the plant characters measured with differences in larval performance and previous scorings of E. regnans family susceptibility.\ud \ud First instar larval growth and survival did not differ significantly across families or between low and high susceptibility family groups (=susceptibility classes), although survival was significantly greater in bagged than unbagged treatments. As predators were in low abundance at the study site, we attribute higher survival rates of larvae in bagged treatments to increased protection from adverse weather conditions. Only one plant character measured, an unidentified foliar phlorglucinol, was significantly negatively correlated with larval survival. Of the 24 plant characters measured, 11 were significantly different between families and 10 were significantly different between susceptibility classes. Only 4 plant characters were significantly different at both the family and susceptibility class levels; viz. proportion red leaves, tree height at end of season, trunk volume at end of season and relative growth rate based on tree height. Principle Component Analysis using all plant characters measured, or subsets of them, could not separate individual families or susceptibility classes. Our results suggest that herbivore resistance mechanisms in E. regnans do not affect C. bimaculata larvae, but may influence adult feeding and/or oviposition

Real-time monitoring and feedback to improve shared decision-making for surgery (the ALPACA Study): protocol for a mixed-methods study to inform co-development of an inclusive intervention

Introduction High-quality shared decision-making (SDM) is a priority of health services, but only achieved in a minority of surgical consultations. Improving SDM for surgical patients may lead to more effective care and moderate the impact of treatment consequences. There is a need to establish effective ways to achieve sustained and large-scale improvements in SDM for all patients whatever their background. The ALPACA Study aims to develop, pilot and evaluate a decision support intervention that uses real-time feedback of patients’ experience of SDM to change patients’ and healthcare professionals’ decision-making processes before adult elective surgery and to improve patient and health service outcomes.Methods and analysis This protocol outlines a mixed-methods study, involving diverse stakeholders (adult patients, healthcare professionals, members of the community) and three National Health Service (NHS) trusts in England. Detailed methods for the assessment of the feasibility, usability and stakeholder views of implementing a novel system to monitor the SDM process for surgery automatically and in real time are described. The study will measure the SDM process using validated instruments (CollaboRATE, SDM-Q-9, SHARED-Q10) and will conduct semi-structured interviews and focus groups to examine (1) the feasibility of automated data collection, (2) the usability of the novel system and (3) the views of diverse stakeholders to inform the use of the system to improve SDM. Future phases of this work will complete the development and evaluation of the intervention.Ethics and dissemination Ethical approval was granted by the NHS Health Research Authority North West-Liverpool Central Research Ethics Committee (reference: 21/PR/0345). Approval was also granted by North Bristol NHS Trust to undertake quality improvement work (reference: Q80008) overseen by the Consent and SDM Programme Board and reporting to an Executive Assurance Committee.Trial registration number ISRCTN17951423; Pre-results