Development of a virtual reality training curriculum for laparoscopic cholecystectomy
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Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology for development of a VR training curriculum for laparoscopic cholecystectomy.Inexperienced (had performed fewer than ten laparoscopic cholecystectomies), intermediate (20-50) and experienced (more than 100) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on simulator-derived metrics for nine basic skills, four procedural tasks and full laparoscopic cholecystectomy on a high-fidelity VR simulator. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on the performance of experienced surgeons.Thirty inexperienced, 11 intermediate and 16 experienced operators were recruited. Eight of nine basic skills and three of four procedural tasks were found to be construct valid. The full procedure revealed significant intergroup differences for time (1541, 673 and 816 s; P = 0.002), movements (1021, 595 and 638; P = 0.006) and path length (2038, 1235 and 1303 cm; P = 0.033). Learning curves plateaued between the second and ninth sessions.This study shows that it is possible to define and develop a whole-procedure VR training curriculum for laparoscopic cholecystectomy using structured scientific methodology.Keywords:
Learning curve
Learning curve is a curve of describing the learning effects of individuals or groups. Learning curve was based on three hypotheses. Learning curve may be applied to not only making plans, but also making competition strategies. Enterprises must pay attention to the influential factors and the requirements of our times and use the learning curve rationally.
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Treatment fidelity, or the application of an intervention as it is designed, is a critical issue for the successful implementation of evidence-based practices. Typically it is assumed that evidence-based practices implemented with high fidelity will result in improved outcomes, whereas low fidelity will lead to poorer outcomes. These assumptions presume agreement across researchers and practitioners on what fidelity is, how to measure it, and what level of fidelity optimizes outcomes; however, there is no widespread agreement on any of these issues. This article discusses the dimensions and nuances of treatment fidelity as well as the implications for measuring and analyzing it in relation to student outcomes. The authors review research demonstrating the differential relationship of fidelity across schools, program type, and impact on student outcomes that special educators should consider when designing intervention studies and implementing evidence-based practices. Special educators should prioritize practices and programs with clearly identified components that are empirically validated yet designed flexibly to match various contexts and student populations. Suggestions to support schools in implementing and sustaining evidence-based practices are provided.
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To provide a primer regarding treatment fidelity as it affects evidence-based practice (EBP) for speech-language pathologists.This tutorial defines treatment fidelity, examines the role of treatment fidelity for speech-language pathologists, provides examples of fidelity measurement, and describes approaches for assessing treatment fidelity.Treatment fidelity is a neglected construct in the EBP literature; however, fidelity is a crucial construct for documenting intervention effectiveness and engaging in EBP.
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Objective To analyse the adva nt ages and disadvantages of minilap cholecystectomy and laparospic cholecystectomy .Methods We compared and analysed minilap cholecystectomy in 53 4 cases and laparoscopic cholecytectomy in 225 cases.Results Bo th minilap cholecystectomy and laparoscopic cholecystectomy had the features of less injury and early recovery,but minilap cholecystectomy also had the advantag es of flexibility of manipulating,fewer complications,lower expense,and generali zing easily.Conclusion Less injury operation will act a very im portant role in surgery of 21 centure.Minilap cholecystectomy can popularize eas ily in some primary hospitals.However innovation of equipment and skillful opera tion,laparoscpic cholecystectomy will possess bright tomorrow.
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Abstract Treatment fidelity refers to the extent to which an intervention is implemented as planned. If researchers do not assess and report treatment fidelity, or if treatment fidelity is shown to be low, findings from intervention studies are difficult to interpret, because the intervention may not have been implemented as planned. In this article, our aim is to inform research consumers by discussing treatment fidelity and its primary dimensions, providing guidelines for interpreting treatment fidelity, considering implications of treatment fidelity for research and practice, and illustrating how fidelity is reported in two recent studies. Our take‐home message is that when one is interpreting intervention studies, it is important to consider whether the interventions were applied as planned, or with fidelity.
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A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy is associated with higher risk of bile leak compared to conventional cholecystectomy? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the rate of bile leak in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors found that the rates of bile leak in clipless laparoscopic cholecystectomy is comparable to conventional technique. Clipless cholecystectomy is feasible and safe.
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The concept of fidelity and seemed to be a paradox in literary translation.They were viewed as something rigidly opposite to each other.In fact,proper treason under the guidance of fidelity principle is a good way to achieve fidelity.That is:we can achieve fidelity by means of treason.
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Purpose Measuring fidelity of implementation in parent-child interaction therapy (PCIT) involves assessing the training delivered by clinicians and how parents implement the techniques with their children. The aim of this study was to determine the feasibility of measuring fidelity of implementation for a PCIT intervention designed for young children with Down syndrome.Method We applied a framework to measure dosage, adherence, quality, and participant responsiveness using a mixed methods approach with observational and interview data.Result Our results showed that clinicians delivered 94% of the planned dosage; they adhered to the goals of program and reached the quality criterion in 4/6 rated sessions. Parents described their ability to engage with the program and perceived that it changed how they interacted and communicated with their children. Parents were unable to collect dosage data, but did adhere to 7/9 of the targeted techniques and met the quality criterion on 6/9 of these. It was also possible to measure the children's responsiveness scores when interacting with parents during the intervention.Conclusion This study revealed the opportunities and challenges that occur when measuring fidelity of implementation. There is a need to refine definitions of fidelity measures and to develop appropriate measurement tools so that a more consistent and useful framework can be used by speech-language pathologists (SLPs) to measure fidelity.
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The use of laparoscopic surgery it is growing rapidly in Romania. We have tried to find if a learning curve for laparoscopic cholecystectomy exists and we have evaluated our training program to insure the quality of health care.There where analyzed 2585 procedures performed by 22 surgeons. The relationship between operative incidents/accidents and laparoscopic experience was evaluated. With a regression model we have find the tendency of these relationship.Surgeons appear to learn this procedure rapidly.Training curses with hands-on experience with animal models and proctoring from an experienced laparoscopist at the first 30 operations is needed, for each individual surgeon, to insure the quality of health care.
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