Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

BACKGROUND: Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence. Methods: We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes. RESULTS: Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening. CONCLUSIONS: There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented

Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

OBJECTIVE: To assess the impact of risk-reducing surgery (RRS) for breast cancer (BC) and ovarian cancer (OC) prevention on quality-of-life (QoL). We consider risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), and risk-reducing early-salpingectomy and delayed-oophorectomy (RRESDO). DATA SOURCES: We followed a prospective protocol (PROSPERO: CRD42022319782) and searched MEDLINE, EMBASE, PubMed, and Cochrane Library from inception to February 2023. STUDY ELIGIBILITY CRITERIA: We followed a PICOS framework. The population included women at increased risk of BC or OC. We focused on studies reporting QoL outcomes (health-related QoL (HRQoL), sexual function, menopause symptoms, body image, cancer-related distress or worry, anxiety or depression) after RRS, including RRM for BC and RRSO or RRESDO for OC. STUDY APPRAISAL AND SYNTHESIS METHODS: We used the Methodological Index for Non-Randomized Studies (MINORS) for study appraisal. Qualitative synthesis and fixed-effects meta-analysis was performed. RESULTS: Thirty-four studies were included (RRM:16 studies, RRSO: 19 studies, RRESDO: 2 studies). HRQoL was unchanged or improved in 13/15 studies post-RRM (N=986) and 10/16 studies post-RRSO (N=1617), despite short-term deficits (N=96 post-RRM and N=459 post-RRSO). Sexual function (using Sexual Activity Questionnaire) was affected in 13/16 studies (N=1400) post-RRSO, in terms of decreased sexual pleasure (-1.21[-1.53,-0.89]; N=3070) and increased sexual discomfort (1.12[0.93,1.31]; N=1400). Hormone replacement therapy after pre-menopausal RRSO was associated with an increase (1.16[0.17,2.15]; N=291) in sexual pleasure and a decrease (-1.20[-1.75,-0.65]; N=157) in sexual discomfort. Sexual function was affected in 4/13 studies (N=147) post-RRM, but stable in 9/13 studies (N=799). Body image was unaffected in 7/13 studies (N=605) post-RRM, whereas 6/13 studies (N=391) reported worsening. Increased menopause symptoms were reported in 12/13 studies (N=1759) post-RRSO with a reduction (-1.96[-2.81,-1.10]; N=1745) in Functional Assessment of Cancer Therapy-Endocrine Subscale. Cancer-related distress was unchanged or decreased in 5/5 studies post-RRM (N=365) and 8/10 studies post-RRSO (N=1223). RRESDO (2 studies, N=413) had better sexual function and menopause-specific QoL. CONCLUSION: RRS may be associated with QoL outcomes. RRM and RRSO reduce cancer-related distress, and do not affect HRQoL. Women and clinicians should be aware of body image problems post-RRM, together-with sexual dysfunction and menopause symptoms post-RRSO. RRESDO may be a promising alternative to mitigate QoL-related risks of RRSO

In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment.

An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students' inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL

Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK

Funding: This research was funded by the British Gynaecological Cancer Society (EMSG1L5R) and Ovacome charity. It is supported by the National Cancer Research Institute Gynaecological Cancer Clinical Studies Group and the British Association of Gynaecological Pathologists. The funding bodies had no role in the study design, data collection, analysis, interpretation or writing of the report, or decision to submit for publication. The research team was independent of funders. Acknowledgments: The study is supported by researchers at the Barts Cancer Research United Kingdom Centre for Excellence, Queen Mary University of London (C16420/A18066). We are grateful for the endorsement and support from charities and patient support groups such as Ovacome, The Eve Appeal, Target Ovarian Cancer, Ovarian Cancer Action, Jo’s Cervical Cancer Trust, and GO Girls. We are grateful for the support received from the Royal College of Obstetricians and Gynaecologists, the National Cancer Research Institute Gynaecological Cancer Clinical Studies Group, and the British Association of Gynaecological Pathologists.Peer reviewedPublisher PD

Developing a swine wet lab model for basic clinical skills' training, and teaching essential principles in surgical approach

Background:Essential Skills in the Management of Surgical Cases (ESMSC) is an international, animal model-based course. It combines Applied Surgical Science interactive lectures and basic science workshops, with wet lab simulation modules on a swine model. It consists of two In Vivo experiments, including Anatomy Demonstration and Heart and Transplant Surgery, as well as four Ex Vivo stations i.e. suturing, wound debridement, intravenous (IV) access, Open Reduction Internal Fixation of Hand Fractures (ORIF). Aim:To evaluate the effectiveness of a combined applied surgical science and wet lab simulation course as a teaching model for surgical skills at the undergraduate level.Materials and Methods:49 Medical Students (Male, N=27, Female N=22, mean age = 23.7 years old), doing their clinical rotations, attended the course. Out of these 26.5% (N=13) were Year 3 students from King’s College London (KCL), whereas 73.5% (N=36) were students from Greek Universities, from whom, 32.7% (N=16) were Year 4, 22.4 (N=11) Year 5 and 18.4% (N=9) Year 6. Participants underwent a Multiple Choice Question (MCQ) exam, consisting of 32 questions before and after the course, as well as Direct Observation of Procedural Skills (DOPS) assessments, before and after completion of every wet lab skill module. The paired t-test was used to evaluate whether there was statistically significant improvement. Feedback questionnaires were filled out throughout the course. Results:The overall idea of the course was thought to be effective by participants (9.42/10, min=7, max=10, SD=0.72), who think that this would improve their ability to deal with surgical cases (9.50/10, min=7, max=10, SD=0.86), and they prefer this to be part of their Medical School Curriculum (9.78/10, min, min=7, max=10, SD=0.61). The mean MCQ score was improved by 2.33 out of 32 (15.33 versus 18.00, p<0.005). Surgical skills competences, as defined by DOPS scores, were improved in a statically significant manner (p<0.005 for all paired t-test correlations for the in vivo and ex vivo model). Conclusions:ESMSC seems to be an effective teaching model, which improves the understanding of the surgical approach and the basic surgical skills. In vivo models could be used potentially as a step further in the Undergraduate Surgical Education. The vast majority of delegates would prefer this to be part of the Medical School curriculumΓενικά στοιχεια:Το Essential Skills in the Management of Surgical Cases (ESMSC) {Βασικές Δεξιότητες στη Διαχείριση Χειρουργικών Περιστατικών} είναι ένα διεθνές σεμινάριο με πρακτική άσκηση βασισμένο σε ζωϊκό πρότυπο χοίρου. Συνδυάζει διαδραστικές διαλέξεις εφαρμοσμένης χειρουργικής επιστήμης και βασικής επιστήμης με ενότητες προσομοίωσης που λαμβάνουν χώρα στο εργαστήριο σε πειρατικά μοντέλα χοίρων. Αποτελείται από δύο in vivo πειράματα, όπου περιλαμβάνουν επίδειξη ανατομίας και In Vivo μεταμόσχευση καρδιάς, ενώ περιλαμβάνει ακόμα άλλα τέσσερα ex vivo πειράματα, όπως χειρουργικά ράμματα, μηχανικός καθαρισμός τραύματος, ενδοφλέβια πρόσβαση, Ανοιχτή Ανάταξη & Εσωτερική Οστεοσύνθεση Καταγμάτων Άκρας Χείρας.Σκοπός:Να αξιολογηθεί η αποτελεσματικότητα μιας του συνδυασμού της εφαρμοσμένης χειρουργικής επιστήμης και του wet lab σεμιναρίου προσομοίωσης ως μοντέλο διδασκαλίας για χειρουργικές δεξιότητες σε προπτυχιακό επίπεδο.Υλικά & Μέθοδος:49 φοιτητές Ιατρικής (Άρρενες, Ν=27, Θήλεις, Ν=22, μέση ηλικία = 23,7 χρόνια), οι οποίοι βρίσκονται σε κλινικά έτη προπτυχιακών σπουδών, παρακολούθησαν το σεμινάριο. Από αυτούς το 26,5% (Ν=13) ήταν 3ετείς Φοιτητές του King’s College του Λονδίνου, ενώ το 73,5% (Ν=36) ήταν φοιτητές Ελληνικών Πανεπιστημίων, από τους οποίους το 32,7% (Ν=16) ήταν 4ετείς, το 22,4% (Ν=11) ήταν 5ετείς και το 18,4% (Ν=9) 6ετείς. Οι συμμετέχοντες υποβλήθηκαν σε ένα διαγώνισμα 32 ερωτήσεων πολλαπλής επιλογής πριν και μετά το σεμινάριο, ενώ υποβλήθηκαν μέσω συγκεκριμένης φόρμας αξιολόγησης σε Άμεση Εκτίμηση των Δεξιοτήτων (DOPS) πριν και μετά την ολοκλήρωση κάθε ενότητας δεξιοτήτων στο εργαστήριο. Το paired t-test χρησιμοποιήθηκε για να αξιολογηθεί εάν υπήρχε στατιστικώς σημαντική βελτίωση. Ερωτηματολόγια Αξιολόγησης του σεμιναρίου με σχόλια από τους εκπαιδευόμενους συμπληρώθηκαν για όλο το σεμινάριο. Αποτελέσματα:Η γενική ιδέα του σεμιναρίου θεωρήθηκε πως είναι αποτελεσματική από τους συμμετέχοντες (9.42/10, min=7, max=10, SD=0.72), οι οποίοι πιστεύουν ότι αυτό θα μπορούσε να αναπτύξει την ικανότητά τους να διαχειρίζονται χειρουργικά περιστατικά (9.50/10, min=7, max=10, SD=0.86), ενώ επίσης θα προτιμούσαν κάτι τέτοιο να είναι μέρος του Προγράμματος Σπουδών της εκάστοτε Ιατρικής που φοιτούν (9.78/10, min, min=7, max=10, SD=0.61). Η μέση βαθμολογία στο διαγώνισμα των ερωτήσεων πολλαπλής απάντησης βελτιώθηκε κατά 2,33 με άριστα το 32 (15.33 versus 18.00, p<0.005). Οι ικανότητες στις χειρουργικές δεξιότητες βρέθηκε ότι βελτιώθηκαν στατιστικώς σημαντικά. (p<0.005 για όλα τις paired t-test συσχετίσεις για το in vivo και το ex vivo μοντέλο).Συμπεράσματα:Το ESMSC φαίνεται πως είναι ένα αποτελεσματικό μοντέλο διδασκαλίας, το οποίο βελτιώνει την κατανόηση της χειρουργικής προσέγγισης και των βασικών χειρουργικών δεξιοτήτων. Τα in vivo μοντέλα θα μπορούσαν να χρησιμοποιηθούν δυνητικά ως το βήμα παραπάνω στην Προπτυχιακή Χειρουργική Εκπαίδευση. Η συντριπτική πλειοψηφία των υποψηφίων θα προτιμούσε αυτό να αποτελεί κομμάτι του Προγράμματος Σπουδών της εκάστοτε Ιατρικής Σχολής που φοιτού