| 1. |
- Dokoutsidou, Eleni, et al.
(författare)
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Performance Assessment of Subjects With Nursing Education Trained in Sigmoidoscopy by Means of a Simulator.
- 2020
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Ingår i: Gastroenterology Nursing. - : Society of Gastroenterology Nurses and Associates.. - 1042-895X .- 1538-9766. ; 43:6, s. 411-421
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Tidskriftsartikel (refereegranskat)abstract
- Reports evaluating simulation-based sigmoidoscopy training among nurses are scarce. The aim of this prospective nonrandomized study was to assess the performance of nurses in simulated sigmoidoscopy training and the potential impact on their performance of endoscopy unit experience, general professional experience, and skills in manual activities requiring coordinated maneuvers. Forty-four subjects were included: 12 nurses with (Group A) and 14 nurses without endoscopy unit experience (Group B) as well as 18 senior nursing students (Group C). All received simulator training in sigmoidoscopy. Participants were evaluated with respect to predetermined validated metrics. Skills in manual activities requiring coordinated maneuvers were analyzed to draw possible correlations with their performance. The total population required a median number of 5 attempts to achieve all predetermined goals. Groups A and C outperformed Group B regarding the number of attempts needed to achieve the predetermined percentage of visualized mucosa (p = .017, p = .027, respectively). Furthermore, Group A outperformed Group B regarding the predetermined duration of procedure (p = .046). A tendency was observed for fewer attempts needed to achieve the overall successful endoscopy in both Groups A and C compared with Group B. Increased score on playing stringed instruments was associated with decreased total time of procedure (rs = -.34, p = .03) and with decreased number of total attempts for successful endoscopy (rs = -.31, p = .046). This study suggests that training nurses and nursing students in simulated sigmoidoscopy is feasible by means of a proper training program. Experience in endoscopy unit and skills in manual activities have a positive impact on the training process.
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| 2. |
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| 3. |
- Oussi, Ninos, et al.
(författare)
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Validation of a Novel Needle Holder to Train Advanced Laparoscopy Skills to Novices in a Simulator Environment
- 2020
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Ingår i: Surgical Innovation. - : Sage Publications. - 1553-3506 .- 1553-3514. ; 27:2, s. 211-219
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Tidskriftsartikel (refereegranskat)abstract
- Background: Our aim was to determine if a newly designed Najar needle holder (NNH) shortens the time for novices to improve advanced laparoscopy (AL) techniques (suturing/knot tying), compared with a conventional macro needle holder (MNH) in a simulator. Furthermore, we aimed to validate a new video scoring system determining AL skills.Methods: Forty-six medical students performed identical surgical tasks in a prospective, crossover study evaluating AL skills (NNH vs MNH). All subjects performed a double-throw knot, 2 single-throw knots following 3 running sutures in the Simball Box (SB) simulator. After resting, subjects switched needle holders. All tasks were videotaped and analyzed using SB software and by 2 independent reviewers using the Objective Video Evaluation Scoring Table (OVEST). Trial performance expressed as SB Overall Score (SBOS) and OVEST.Results: In the group starting with NNH (followed by MNH) OVEST was consistently high during both trials (median = 12.5, range = 6.5-18.0, and median = 13.5, range = 6.5-21.0; P = .2360). However, in the group starting with MNH, OVEST improved significantly when the participants changed to NNH (median = 10.0, range = 2.5-19.5, vs median = 14.5, range = 4.5-18.0; P = .0003); an improvement was also found with SBOS (median = 37%, range = 27% to 92%, vs median = 48%, range = 34% to 70%; P = .0289). In both trials, both independent reviewers' OVEST measures correlated well: Trial 1: beta = 0.97, P < .0001; and Trial 2: beta = 0.95, P < .0001. A correlation also existed between SBOS and OVEST in both trials (beta = 2.1, P < .0001; and beta = 1.9, P = .0002).Conclusions: This study indicates a significantly higher improvement in laparoscopic suturing skills in novices training AL skills using NNH compared with MNH. Starting early, AL training in novices using NNH is a feasible option. Furthermore, OVEST used in experimental settings as an evaluation tool is comparable with the validated SBOS.
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| 4. |
- Oussi, Ninos, et al.
(författare)
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Video analysis in basic skills training : a way to expand the value and use of BlackBox training?
- 2018
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 32:1, s. 87-95
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBasic skills training in laparoscopic high-fidelity simulators (LHFS) improves laparoscopic skills. However, since LHFS are expensive, their availability is limited. The aim of this study was to assess whether automated video analysis of low-cost BlackBox laparoscopic training could provide an alternative to LHFS in basic skills training.MethodsMedical students volunteered to participate during their surgical semester at the Karolinska University Hospital. After written informed consent, they performed two laparoscopic tasks (PEG-transfer and precision-cutting) on a BlackBox trainer. All tasks were videotaped and sent to MPLSC for automated video analysis, generating two parameters (Pl and Prtcl_tot) that assess the total motion activity. The students then carried out final tests on the MIST-VR simulator. This study was a European collaboration among two simulation centers, located in Sweden and Greece, within the framework of ACS-AEI.Results31 students (19 females and 12 males), mean age of 26.2 ± 0.8 years, participated in the study. However, since two of the students completed only one of the three MIST-VR tasks, they were excluded. The three MIST-VR scores showed significant positive correlations to both the Pl variable in the automated video analysis of the PEG-transfer (RSquare 0.48, P < 0.0001; 0.34, P = 0.0009; 0.45, P < 0.0001, respectively) as well as to the Prtcl_tot variable in that same exercise (RSquare 0.42, P = 0.0002; 0.29, P = 0.0024; 0.45, P < 0.0001). However, the correlations were exclusively shown in the group with less PC gaming experience as well as in the female group.ConclusionsAutomated video analysis provides accurate results in line with those of the validated MIST-VR. We believe that a more frequent use of automated video analysis could provide an extended value to cost-efficient laparoscopic BlackBox training. However, since there are gender-specific as well as PC gaming experience differences, this should be taken in account regarding the value of automated video analysis.
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| 5. |
- Austrin, Per, et al.
(författare)
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Better Balance by Being Biased : A 0.8776-Approximation for Max Bisection
- 2016
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Ingår i: ACM Transactions on Algorithms. - : ASSOC COMPUTING MACHINERY. - 1549-6325 .- 1549-6333. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Recently, Raghavendra and Tan (SODA 2012) gave a 0.85-approximation algorithm for the MAX BISECTION problem. We improve their algorithm to a 0.8776-approximation. As MAX BISECTION is hard to approximate within alpha(GW) + epsilon approximate to 0.8786 under the Unique Games Conjecture (UGC), our algorithm is nearly optimal. We conjecture that MAX BISECTION is approximable within alpha(GW) - epsilon, that is, that the bisection constraint (essentially) does not make MAX CUT harder. We also obtain an optimal algorithm (assuming the UGC) for the analogous variant of MAX 2-SAT. Our approximation ratio for this problem exactly matches the optimal approximation ratio for MAX 2-SAT, that is, alpha(LLZ) + epsilon approximate to 0.9401, showing that the bisection constraint does not make MAX 2-SAT harder. This improves on a 0.93-approximation for this problem from Raghavendra and Tan.
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| 6. |
- Björkman, Andrea, et al.
(författare)
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Aberrant recombination and repair during immunoglobulin class switching in BRCA1-deficient human B cells.
- 2015
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Ingår i: Proceedings of the National Academy of Sciences. - : Proceedings of the National Academy of Sciences. - 1091-6490 .- 0027-8424. ; 112:7, s. 2157-2162
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Tidskriftsartikel (refereegranskat)abstract
- Breast cancer type 1 susceptibility protein (BRCA1) has a multitude of functions that contribute to genome integrity and tumor suppression. Its participation in the repair of DNA double-strand breaks (DSBs) during homologous recombination (HR) is well recognized, whereas its involvement in the second major DSB repair pathway, nonhomologous end-joining (NHEJ), remains controversial. Here we have studied the role of BRCA1 in the repair of DSBs in switch (S) regions during immunoglobulin class switch recombination, a physiological, deletion/recombination process that relies on the classical NHEJ machinery. A shift to the use of microhomology-based, alternative end-joining (A-EJ) and increased frequencies of intra-S region deletions as well as insertions of inverted S sequences were observed at the recombination junctions amplified from BRCA1-deficient human B cells. Furthermore, increased use of long microhomologies was found at recombination junctions derived from E3 ubiquitin-protein ligase RNF168-deficient, Fanconi anemia group J protein (FACJ, BRIP1)-deficient, or DNA endonuclease RBBP8 (CtIP)-compromised cells, whereas an increased frequency of S-region inversions was observed in breast cancer type 2 susceptibility protein (BRCA2)-deficient cells. Thus, BRCA1, together with its interaction partners, seems to play an important role in repairing DSBs generated during class switch recombination by promoting the classical NHEJ pathway. This may not only provide a general mechanism underlying BRCA1's function in maintaining genome stability and tumor suppression but may also point to a previously unrecognized role of BRCA1 in B-cell lymphomagenesis.
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| 7. |
- Boyanov, Nikola, et al.
(författare)
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Use of saliva stress biomarkers to estimate novice male endoscopist's stress during training in a high-end simulator
- 2021
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 56:11, s. 1380-1385
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment.Methods: Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL)diff of each of the four saliva biomarkers was calculated and examined for correlation to VS.Results: sCgAdiff showed the best correlation with VS, followed by sAAdiff.Cconclusions: sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.
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| 8. |
- de Miranda, Noel F. C. C., et al.
(författare)
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DNA repair genes are selectively mutated in diffuse large B cell lymphomas
- 2013
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Ingår i: Journal of Experimental Medicine. - : Rockefeller University Press. - 0022-1007 .- 1540-9538. ; 210:9, s. 1729-1742
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Tidskriftsartikel (refereegranskat)abstract
- DNA repair mechanisms are fundamental for B cell development, which relies on the somatic diversification of the immunoglobulin genes by V(D)J recombination, somatic hypermutation, and class switch recombination. Their failure is postulated to promote genomic instability and malignant transformation in B cells. By performing targeted sequencing of 73 key DNA repair genes in 29 B cell lymphoma samples, somatic and germline mutations were identified in various DNA repair pathways, mainly in diffuse large B cell lymphomas (DLBCLs). Mutations in mismatch repair genes (EXO1, MSH2, and MSH6) were associated with microsatellite instability, increased number of somatic insertions/deletions, and altered mutation signatures in tumors. Somatic mutations in nonhomologous end-joining (NHEJ) genes (DCLRE1C/ARTEMIS, PRKDC/DNA-PKcs, XRCC5/KU80, and XRCC6/KU70) were identified in four DLBCL tumors and cytogenetic analyses revealed that translocations involving the immunoglobulin-heavy chain locus occurred exclusively in NHEJ-mutated samples. The novel mutation targets, CHEK2 and PARP1, were further screened in expanded DLBCL cohorts, and somatic as well as novel and rare germline mutations were identified in 8 and 5% of analyzed tumors, respectively. By correlating defects in a subset of DNA damage response and repair genes with genomic instability events in tumors, we propose that these genes play a role in DLBCL lymphomagenesis.
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| 9. |
- de Miranda, Noel F. C. C., et al.
(författare)
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Exome sequencing reveals novel mutation targets in diffuse large B-cell lymphomas derived from Chinese patients
- 2014
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 124:16, s. 2544-2553
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Tidskriftsartikel (refereegranskat)abstract
- Next-generation sequencing studies on diffuse large B-cell lymphomas (DLBCLs) have revealed novel targets of genetic aberrations but also high intercohort heterogeneity. Previous studies have suggested that the prevalence of disease subgroups and cytogenetic profiles differ between Western and Asian patients. To characterize the coding genome of Chinese DLBCL, we performed whole-exome sequencing of DNA derived from 31 tumors and respective peripheral blood samples. The mutation prevalence of B2M, CD70, DTX1, LYN, TMSB4X, and UBE2A was investigated in an additional 105 tumor samples. We discovered 11 novel targets of recurrent mutations in DLBCL that included functionally relevant genes such as LYN and TMSB4X. Additional genes were found mutated at high frequency (>= 10%) in the Chinese cohort including DTX1, which was the most prevalent mutation target in the Notch pathway. We furthermore demonstrated that mutations in DTX1 impair its function as a negative regulator of Notch. Novel and previous unappreciated targets of somatic mutations in DLBCL identified in this study support the existence of additional/alternative tumorigenic pathways in these tumors. The observed differences with previous reports might be explained by the genetic heterogeneity of DLBCL, the germline genetic makeup of Chinese individuals, and/or exposure to distinct etiological agents.
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| 10. |
- Dimov, Petar, et al.
(författare)
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Effect of Video Games Playing on Surgical Simulation Training: a Systematic Review
- 2021
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Ingår i: Folia Medica. - : Pensoft Publishers. - 0204-8043 .- 1314-2143. ; 63:5, s. 647-656
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills.Aim: This study aims to systematically review the existing evidence.Materials and methods: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria.Results: Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively).Conclusions: Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.
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| 11. |
- Georgiou, Andrea N., et al.
(författare)
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Investigating the shared genetic basis and causal relationships between mucosa-associated lymphoid tissue inflammation and psychiatric disorders
- 2024
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic and acute inflammation of the mucosa-associated lymphoid tissue have been positively linked to the development of psychiatric disorders in observational studies. However, it remains unclear whether this association is causal. In the present study, we investigated this association, using as proxies genetically predicted tonsillectomy, appendectomy and appendicitis on psychiatric disorders including major depressive disorder (MDD), schizophrenia (SCZ), bipolar depression (BD) and anxiety (ANX) via a two-sample Mendelian randomization (MR) analysis.Methods: Genetic association summary statistics for tonsillectomy, appendectomy and appendicitis were sourced from FinnGen Consortium, comprising data from 342,000 participants. Genetic correlations between all exposures and outcome were calculated with Linkage Disequilibrium Score (LDSC) Regression analysis. MR estimates were then calculated to assess their impact on the risk of developing psychiatric disorders. Sensitivity analysis was employed to test for any directional pleiotropy.Results: Our results suggest that there is no direct causal association between tonsillectomy, appendectomy or appendicitis with a heightened risk for development of psychiatric disorders. The robustness of the results of the main MR analysis was further confirmed with additional sensitivity analyses. However, a moderate inverse genetic correlation was observed between tonsillectomy and MDD traits (rg=-0.39, p-value (P)=7.5x10-5).Conclusion: Our findings provide, for the first time, evidence that there is no causal association between tonsillectomy or appendectomy on subsequent vulnerability of developing psychiatric disorders. Future studies using larger sample size GWAS should focus on unraveling the confounding factors and mediators to investigate this relationship further.
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| 12. |
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| 13. |
- Georgiou, Konstantinos, et al.
(författare)
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Genetic basis of PD-L1 overexpression in diffuse large B-cell lymphomas
- 2016
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 127:24, s. 3026-3034
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Tidskriftsartikel (refereegranskat)abstract
- Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive types of B-cell lymphoma. Deregulation of proto-oncogene expression after a translocation, most notably to the immunoglobulin heavy-chain locus (IGH), is one of the hallmarks of DLBCL. Using whole-genome sequencing analysis, we have identified the PD-L1/PD-L2 locus as a recurrent translocation partner for IGH in DLBCL. PIM1 and TP63 were also identified as novel translocation partners for PD-L1/PD-L2. Fluorescence in situ hybridization was furthermore used to rapidly screen an expanded DLBCL cohort. Collectively, a subset of samples was found to be affected by gains (12%), amplifications (3%), and translocations (4%) of the PD-L1/PD-L2 locus. RNA sequencing data coupled with immunohistochemistry revealed that these cytogenetic alterations correlated with increased expression of PD-L1 but not of PD-L2. Moreover, cytogenetic alterations affecting the PD-L1/PD-L2 locus were more frequently observed in the non-germinal center B cell-like (non-GCB) subtype of DLBCL. These findings demonstrate the genetic basis of PD-L1 overexpression in DLBCL and suggest that treatments targeting the PD-1-PD-L1/PD-L2 axis might benefit DLBCL patients, especially those belonging to the more aggressive non-GCB subtype.
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| 14. |
- Georgiou, Konstantinos
(författare)
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Genetics of diffuse large B-cell lymphoma
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diffuse large B-cell lymphoma (DLBCL) is one the most common forms of non-Hodgkin lymphoma and one of the most aggressive B-cell neoplasms. Although most patients respond to current standard treatments, a significant number of them relapse and become refractory to treatment. Hence, there is a need for new approaches in the management of DLBCL. In recent years, a number of studies using next-generation sequencing (NGS) have contributed to the characterization of the disease and have revealed a set of deregulated cellular mechanisms in DLBCL. However, DLBCL is a very heterogeneous disease and additional work is required in order to achieve a comprehensive understanding of the mechanisms underlying its lymphomagenesis. The work described in this thesis aimed to further characterize the genome of DLBCL and identify novel genomic alterations by employing a number of NGS methods. Furthermore, this thesis sought to functionally describe the effect of some of these alterations and explore how they could be meaningful from a therapeutic perspective. We first embarked on a targeted sequencing approach in order to assess the impact of mutations in a set of key DNA repair genes. DNA repair is critical in B-cell development as it ensures the regulation of antibody diversification processes. The results showed that half of the tumors analyzed carry mutations in DNA repair genes and the most frequently targeted mechanisms are mismatch repair, DNA damage response, homologous recombination and non-homologous end-joining. Moreover, functional analysis enabled the association of a number of those mutations to specific phenotypes. Whole exome sequencing identified a number or previously unreported somatic mutation targets in DLBCL. In addition, it revealed that some genes known to be involved in DLBCL were mutated at a much higher frequency in Chinese patients as compared to patients from Western populations. The impact of mutations in DTX1, a gene encoding for a negative regulator of Notch signaling, was functionally assessed and a number of mutations were found to be deleterious. Finally, whole genome sequencing enabled the identification of structural variations such as translocations in the genome of DLBCL. IGH translocations are a hallmark of DLBCL and the locus is often found juxtaposed to proto-oncogenes which leads to their upregulation. We identified PD-L1, a common culprit of immune suppression in cancer, as a novel IGH translocation partner in DLBCL. Translocations involving the PD-L1 locus were found to impact patient survival and were associated with the more aggressive non-germinal center-like subtype of the disease
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| 15. |
- Georgiou, Konstantinos, et al.
(författare)
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Intraoperative cholangiography 2020 : Quo vadis? A systematic review of the literature
- 2022
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Ingår i: Hepatobiliary & Pancreatic Diseases International. - : Elsevier. - 1499-3872. ; 21:2, s. 145-153
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Forskningsöversikt (refereegranskat)abstract
- Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting.Methods: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging” or “retained stones” in combination with IOC. All identified references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias.Results: The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately.Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
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| 16. |
- Georgiou, Konstantinos, et al.
(författare)
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Saliva stress biomarkers in ERCP trainees before and after familiarisation with ERCP on a virtual simulator
- 2024
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Ingår i: Frontiers in Surgery. - : Frontiers Media S.A.. - 2296-875X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stress during the early ERCP learning curve may interfere with acquisition of skills during training. The purpose of this study was to compare stress biomarkers in the saliva of trainees before and after familiarisation with ERCP exercises on a virtual simulator.Methods: Altogether 26 endoscopists under training, 14 women and 12 men, completed the three phases of this study: Phase 1. Three different ERCP procedures were performed on the simulator. Saliva for α-amylase (sAA), Chromogranin A (sCgA), and Cortisol (sC) were collected before (baseline), halfway through the exercise (ex.), and 10 min after completion of the exercise (comp.); Phase 2. A three-week familiarisation period where at least 30 different cases were performed on the virtual ERCP simulator; and Phase 3. Identical to Phase 1 where saliva samples were once again collected at baseline, during, and after the exercise. Percentage differences in biomarker levels between baseline and exercise (Diffex) and between baseline and completion (Diffcomp) during Phase 1 and Phase 3 were calculated for each stress marker.Results: Mean % changes, Diffex and Diffcomp, were significantly positive (p < 0.05) for all markers in both Phase 1 and Phase 3. Diffex in Phase 1 was significantly greater than Diffex in Phase 3 (p < 0.05) for sAA and sCgA. Diffcomp for sAA in Phase 1 was significantly greater than Diffcomp in Phase 3 (p < 0.05). No significant differences were found in sC concentration between Phases 1 and 3.Conclusion: This study shows that familiarisation with the ERCP simulator greatly reduced stress as measured by the three saliva stress biomarkers used with sAA being the best. It also suggests that familiarisation with an ERCP simulator might reduce stress in the clinical setting.
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| 17. |
- Georgiou, Konstantinos, et al.
(författare)
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The use of simulators to acquire ERCP skills : a systematic review
- 2023
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Ingår i: Annals of Medicine and Surgery. - : Wolters Kluwer. - 2049-0801. ; 85:6, s. 2924-2931
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Forskningsöversikt (refereegranskat)abstract
- Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding diagnostic and therapeutic endoscopic procedure with a high risk for adverse events such as post-ERCP pancreatitis and bleeding. Since endoscopists with less experience have higher adverse event rates, the training of new residents on ERCP simulators has been suggested to improve the resident's technical skills necessary for ERCP. However, there is a lack of consensus on whether the training program should focus on a threshold number of procedures or be more tailored to the individual's performance. Furthermore, there is also disagreement on which form of simulator(s) should be used. Therefore, the primary outcome of this systematic review was to study the extent to which simulators used for ERCP training are correctly validated.Methods: In 2022, a systematic search of the literature was conducted on MEDLINE and SCOPUS under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 protocol seeking articles with the MeSH terms 'Endoscopic Retrograde Cholangiopancreatography' OR 'ERCP' in combination with 'simulation' OR 'simulator'.Results: The search resulted in 41 references. A total of 19 articles met the inclusion criteria and were included in the qualitative analysis. Only one of the articles fulfilled the criteria of a robust validation study.Conclusions: Since only one of the 19 articles met the requirements for a thorough and correct validation, further studies with sufficient numbers of subjects, that evaluate complete preclinical training programs based on validated ERCP simulators are warranted.
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| 18. |
- Georgiou, Konstantinos, et al.
(författare)
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Validity of a virtual reality endoscopic retrograde cholangiopancreatography simulator : can it distinguish experts from novices?
- 2023
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Ingår i: Frontiers in Surgery. - : Frontiers Media S.A.. - 2296-875X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of evidence regarding the effectiveness of virtual simulators as a means to acquire hands-on exposure to endoscopic retrograde cholangiopancreatography (ERCP). The present study aimed to assess the outcome and construct validity of virtual ERCP when training on the GI II Mentor simulator.Methods: A group of seven experienced endoscopists were compared with 31 novices. After a short introduction, they were requested to carry out three virtual ERCP procedures: diagnosing and removing a common bile duct (CBD) stone; diagnosing and taking brush cytology from a hilar stenosis; and, finally, diagnosing and treating a cystic leakage with a BD stent. For each task, the total time required to complete the task, time required to correctly view the papilla, total time of irradiation, time to deep cannulation, time to define diagnosis, time to complete sphincterotomy, and time to complete the respective intervention were measured. Cannulation of the BD, correct diagnosis, sphincterotomy, and time to complete intervention were assessed by an assessor blinded to the status of the endoscopist who performed the virtual ERCP.Results: The time required to visualize the papilla and to cannulate deeply when removing the BD stone was significantly shorter for the experts (both p < 0.05). The time to visualize the papilla, cannulate deeply, reach a diagnosis, complete sphincterotomy, and complete the intervention was significantly shorter for the experts when managing cystic leakage (all p < 0.05). In diagnosing and taking brush cytology from a hilar stenosis, there was only a trend toward the experts needing less time for the deep cannulation of the BD (p = 0.077).Conclusion: The performance differed between experts and novices, especially in the management of cystic leakage. This corroborates the construct validity of the GI II Mentor simulator.
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| 19. |
- Georgiou, Nikos, et al.
(författare)
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Spatio-Seasonal Hypoxia/Anoxia Dynamics and Sill Circulation Patterns Linked to Natural Ventilation Drivers, in a Mediterranean Landlocked Embayment : Amvrakikos Gulf, Greece
- 2021
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Ingår i: Geosciences. - : MDPI. - 2076-3263. ; 11:6
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Tidskriftsartikel (refereegranskat)abstract
- Amvrakikos Gulf is a Mediterranean landlocked, fjord-like embayment and marine protected area suffering from natural, human-induced hypoxia/anoxia and massive fish mortality events. Seasonal marine geophysical and oceanographic surveys were conducted focusing on the water-circulation patterns at the sill and the spatial-seasonal distribution of dissolved oxygen (DO) in the gulf. Detailed surveys at the sill, the only communication route between the gulf and the open sea, revealed a two-layer water circulation pattern (top brackish outflow-bottom seawater inflow) and the role of the tide in the daily water exchange. Statistical analysis of the known natural drivers of DO distribution (density difference between the Ionian Sea and Amvrakikos, river inflow, wind) revealed that horizontal density gradients strongly affect anoxia reduction and seafloor oxygenation, while river inflow and wind mainly oxygenate volume/areas located above or within the pycnocline range, with DO concentrations > 2 mg/L. Complex geomorphology with well-formed internal basins contributes to the development and preservation of low DO conditions below the pycnocline. Finally, 43% of the seafloor and 36% of the gulf's total water volume are permanently hypoxic, and reach a maximum of 70% and 62%, respectively, in September and July. This work is tailored to future ecosystem management plans, decisions, and future research on coastal ecosystems.
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| 20. |
- Oussi, Ninos, et al.
(författare)
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Baseline characteristics in laparoscopic simulator performance : the impact of personal computer (PC)–gaming experience and visuospatial ability
- 2021
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Ingår i: Surgery Open Science. - : Elsevier. - 2589-8450. ; 4, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- Background: Learning via simulators is under constant development, and it is important to further optimize simulator training curricula. This study investigates the impact of personal computer–gaming experience, visuospatial skills, and repetitive training on laparoscopic simulator performance and specifically on the constituent parameters of the simulator score.Methods: Forty-seven medical students completed 3 consecutive Minimally Invasive Surgical Trainer–Virtual Reality simulator trials. Previously, they performed a visuospatial test and completed a questionnaire regarding baseline characteristics and personal computer–gaming experience. Linear regression was used to analyze the relationship between simulator performance and type of personal computer–gaming experience and visuospatial ability.Results: During the first 2 Minimally Invasive Surgical Trainer–Virtual Reality simulation tasks, there was an association between personal computer–gaming experience and the coordination parameters of the score (eg, EconDiath task 1: P = .0047; EconDiath task 2: P = .0102; EconDiath task 3: P = .0836). The type of game category played seemed to have an impact on the coordination parameters (eg, EconDiath task 1–3 for sport games versus no-sport games: P = .01, P = .0013, and P = .01, respectively). In the first Minimally Invasive Surgical Trainer task, visuospatial ability correlated with Minimally Invasive Surgical Trainer simulator performance but was abolished with repetitive training (overall Minimally Invasive Surgical Trainer score task 1–3: P = .0122, P = .0991, and P = .3506, respectively). Sex-specific differences were noted initially but were abolished with training.Conclusion: Sport games versus no-sport games demonstrated a significantly better Minimally Invasive Surgical Trainer performance. Furthermore, repetitive laparoscopic simulator training may compensate for a previous lack of personal computer–gaming experience, low visuospatial ability, and sex differences.
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- Österberg, Johanna, et al.
(författare)
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Can 3D Vision Improve Laparoscopic Performance in Box Simulation Training when Compared to Conventional 2D Vision?
- 2019
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Ingår i: Folia Medica. - : Plovdiv Medical University. - 0204-8043 .- 1314-2143. ; 61:4, s. 491-499
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Three-dimensional (3D) imaging systems have been introduced in laparoscopic surgery to facilitate binocular vision and dexterity to improve surgical performance and safety. Several studies have shown the benefits of 3D imaging in laparoscopy, but until now only a few studies have assessed the outcome by using objective variables. Box trainers are affordable alternatives to virtual laparoscopic surgical training, and the possibility of using real surgical instruments makes them more realistic to use. However, the data and feedback by a virtual simulator have not, until now, been able to assess. Simball Box®, equipped with G-coder sensors®, registers the instrument movements during training and gives the same feedback like a virtual simulator.AIM: The aim of this study was to objectively evaluate the laparoscopic performance in 3D compared to conventional 2D vision by using a box simulation trainer.MATERIALS AND METHODS: Thirty surgeons, residents and consultants, participated in the study. Eighteen had no, or minimal, laparoscopic experience (novices) whereas 12 were experts. They all performed three standard box training exercises (rope race, precision cutting, and basic suturing) in Simball Box. The participants were randomized and started with either 3D HD or traditional 2D HD cameras. The exercises were instructed and supervised. All instrument movements were registered. Variations in time, linear distance, average speed, and motion smoothness were analyzed.RESULTS: The parameters time, distance, speed, and motion smoothness were significantly better when the 3D camera was used.CONCLUSION: All individuals of both subgroups achieved significantly higher speed and better motion smoothness when using 3D.
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