Virtual reality simulation based training for endoscopy and laparoscopic surgery

Catedra Chirurgie nr.1 „N.Anestiadi”, Centrul Universitar de Simulare în Instruirea Medicală, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Centrul Universitar de Simulare în Instruirea Medicală (CUSIM) a fost creat cu scop de a spori siguranţa pacienţilor prin utilizarea instruirii prin simulare, a dezvolta noi modalităţi de instruire, a identifica cele mai bune practici şi a încuraja cercetarea şi colaborarea interdepartamentală şi interdisciplinară. Material şi metode: CUSIM este dotat cu 2 simulatoare cu realitate virtuală pentru chirurgia laparoscopică şi un simulator pentru bronhoscopie, endoscopie superioară şi inferioară. Curricula de instruire prin simulare este concepută să satisfacă necesităţile rezidenţilor şi specialiştilor indiferent de nivelul de competenţe şi facilitează obţinerea abilităţilor endoscopice şi de chirurgie laparoscopică pe parcursul rezidenţiatului şi a educaţiei medicale continue. Rezultate: Modulele incluse începînd cu abilităţile de bază şi esenţiale, continuînd apoi cu mediu anatomic complet pentru diverse intervenţii laparoscopice oferă obţinerea într-un mediu sigur a abilităţilor tehnice care pot fi transferate în sala de operaţii. Modulele de endoscopie includ atît procedee diagnostice, cît şi terapeutice pentru o gamă vastă de patologii. Rezultatele instruirii pot fi evaluate prin diferite categorii: economia mişcărilor; timpul de efectuare; ratele de erori şi scorul global al progresului. Concluzii: Instruirea prin simulare poate conduce la îmbunătăţire demonstrabilă a abilităţilor chirurgicale în condiţii clinice şi sala de operaţie. Feedback-ul obţinut sugerează că instruirea prin simulare reprezintă o modalitate sigură de învăţare a competenţelor practice endoscopice şi chirurgicale, de transfer al abilităţilor chirurgicale laparoscopice în sala de operaţ ie şi în final sporirea siguranţei pacienţilor; totuşi, sunt necesare studii ulterioare extinse pentru a determina dacă şi în ce mod simularea poate deveni o parte a curriculei chirurgicale.Introduction: University Center for Simulation in Medical Training was created to promote patient safety through the use of simulation, develop new education technologies, identify best practices, and encourage research and interdepartmental and interdisciplinary collaboration. Material and methods: University Center for Simulation in Medical Training is equipped with 2 virtual reality simulators for laparoscopic surgery and a simulator for bronchoscopy, upper and lower endoscopy. The simulation-based training curricula are designed to fit the needs of residents and specialists of any level of competence and facilitate the acquisition of endoscopic and laparoscopic surgery skills during residency and continuing medical education programs. Results: The included modules starting from basic and essential skills and going through complete anatomical settings of different laparoscopic interventions offer the acquisition of technical skills in a safe setting which could be translatable to the operating room (OR). The endoscopy modules include both diagnostic and therapeutic options for a variety of pathologies. The learning outcomes can be measured in different behavioral categories: economy of movement; performance time; error rates, and global progress rating. Conclusions: Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment and clinical settings. The received feedback suggests that simulation-based training is an effective way to teach endoscopy and laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become a part of surgical curriculum

Second-line drug susceptibility breakpoints for Mycobacterium tuberculosis using the MODS assay.

OBJECTIVE: To establish breakpoint concentrations for the fluoroquinolones (moxifloxacin [MFX] and ofloxacin [OFX]) and injectable second-line drugs (amikacin [AMK], kanamycin [KM] and capreomycin [CPM]) using the microscopic observation drug susceptibility (MODS) assay. SETTING: A multinational study conducted between February 2011 and August 2012 in Peru, India, Moldova and South Africa. DESIGN: In the first phase, breakpoints for the fluoroquinolones and injectable second-line drugs (n = 58) were determined. In the second phase, MODS second-line drug susceptibility testing (DST) as an indirect test was compared to MGIT™ DST (n = 89). In the third (n = 30) and fourth (n = 156) phases, we determined the reproducibility and concordance of MODS second-line DST directly from sputum. RESULTS: Breakpoints for MFX (0.5 μg/ml), OFX (1 μg/ml), AMK (2 μg/ml), KM (5 μg/ml) and CPM (2.5 μg/ml) were determined. In all phases, MODS results were highly concordant with MGIT DST. The few discrepancies suggest that the MODS breakpoint concentrations for some drugs may be too low. CONCLUSION: MODS second-line DST yielded comparable results to MGIT second-line DST, and is thus a promising alternative. Further studies are needed to confirm the accuracy of the drug breakpoints and the reliability of MODS second-line DST as a direct test