Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model.

OBJECTIVES: . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN: . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS: . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION: . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.

Videojuegos como método de entrenamiento para las habilidades quirúrgicas laparoscópicas básicas / Video games as a method of training basic laparoscopic skills

INTRODUCCIÓN: El uso de videojuegos ha sido propuesto como alternativa para acortar la curva de aprendizaje de las habilidades laparoscópicas básicas. Sin embargo, aún no está clara su real utilidad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Se identificaron tres revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales cuatro son ensayos aleatorizados. Se concluyó que el entrenamiento mediante el uso de videojuegos podría ayudar a acortar la curva de aprendizaje de habilidades visuoespaciales laparoscópicas básicas medido en una plataforma virtual, sin embargo la certeza de la evidencia disponible es baja.

INTRODUCTION: The use of video games has been proposed as an alternative to shorten the learning curve of basic laparoscopic skills. However, it is not yet clar how useful this practice is. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including eight primary studies, of which four were randomized trials. We concluded video games training could help shorten the learning curve of basic laparoscopic visuospatial skills measured in a virtual platform, but the certainty of the available evidence is low.

Psoriasis following bariatric surgery: clinical evolution and impact on quality of life on 10 patients.

Psoriasis is a chronic systemic disease with important skin manifestations, affecting 2 % of the population. It is more frequent and severe in obese patients, and both have been associated with a higher cardiovascular risk. Recent studies suggest that weight loss may improve psoriasis and metabolic comorbidities in obese patients. We reviewed our prospective electronic database for all patients with psoriasis who underwent bariatric surgery between 2008 and 2011. We assessed surgical complications, weight progression, and psoriasis-related outcomes. The Dermatology Life Quality Index was used retrospectively to assess quality of life (QoL) before and after the operation. Ten patients were included; body mass index was 38.8 ± 5.2 kg/m(2). Pre-surgical treatment for psoriasis was topical (50 %) and systemic (40 %). Eight patients underwent laparoscopic Roux-en-Y gastric bypass and two underwent laparoscopic sleeve gastrectomy. At follow-up, the mean percent excess weight loss 1, 6, and 12 months after surgery was 45 %, 80 %, and 88 %, respectively. Comorbidity resolution was 75 % for diabetes mellitus, 100 % for insulin resistance, and 57 % for hypertension. Related to psoriasis, 70 % of the patients stayed in remission 6 months after surgery and three of the four patients who were previously medicated with systemic drugs discontinued medication. The impact of psoriasis on QoL improved from 14.9 ± 6.8 before surgery to 5 ± 6.3 after surgery (p = 0.005). Bariatric surgery for positive metabolic, skin, and quality of life results should be considered as a useful adjuvant therapy for obese patients with psoriasis.