Training simulator efficacy in developing thoracic and general surgical skills in a residency programme: a pilot study.

OBJECTIVES: Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. METHODS: All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. RESULTS: No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P-value = 0.0015), left (P-value = 0.0017) and right (P-value = 0.0186) instrument path lengths, and in left (P-value = 0.0010) and right (P-value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. CONCLUSIONS: Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results.

The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient.

In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.

The relationship between self-observed and other-observed countertransference and session outcome.

For the psychodynamic approach, being aware of and managing countertransference is a core therapeutic competency. Research has demonstrated the negative effect of unmanaged countertransference on the outcomes of all kinds of psychotherapy. In this study, we focused on the relationship between countertransference when measured by therapists and external observers and its impact on session quality. We analyzed 69 counseling sessions, held by 23 in-training psychotherapists with 23 patients. We used the Therapist Response Questionnaire and three external observers (who used the Countertransference Behavior Measure) to measure psychotherapists' countertransference. We rated the session impact perceived by patients and psychotherapists using the Session Evaluation Questionnaire and by patients through the Session Impact Scale. Psychotherapists' and observers' ratings of countertransference correlated though on different dimensions. These results indicate that comparing external and internal evaluations can help to understand various aspects of countertransference since they have different associations with the session outcome. From a methodological point of view, it is necessary to adopt various perspectives to investigate countertransference. Future research should confirm these results on a sample of experienced psychotherapists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using Overt and Covert Items in Self-Report Personality Tests: Susceptibility to Faking and Identifiability of Possible Fakers.

Self-report personality tests widely used in clinical, medical, forensic, and organizational areas of psychological assessment are susceptible to faking. Several approaches have been developed to prevent or detect faking, which are based on the use of faking warnings, ipsative items, social desirability scales, and validity scales. The approach proposed in this work deals with the use of overt items (the construct is clear to test-takers) and covert items (the construct is obscure to test-takers). Covert items are expected to be more resistant to faking than overt items. Two hundred sixty-seven individuals were presented with an alexithymia scale. Two experimental conditions were considered. Respondents in the faking condition were asked to reproduce the profile of an alexithymic individual, whereas those in the sincere condition were not asked to exhibit a particular alexithymia profile. The items of the scale were categorized as overt or covert by expert psychotherapists and analyzed through Rasch models. Respondents in the faking condition were able to exhibit measures of alexithymia in the required direction. This occurred for both overt and covert items, but to a greater extent for overt items. Differently from overt items, covert items defined a latent variable whose meaning was shared between respondents in the sincere and faking condition, and resistant to deliberate distortion. Rasch fit statistics indicated unexpected responses more often for respondents in the faking condition than for those in the sincere condition and, in particular, for the responses to overt items by individuals in the faking condition. More than half of the respondents in the faking condition showed a drift rate (difference between the alexithymia levels estimated on the responses to overt and covert items) significantly larger than that observed in the respondents in the sincere condition.

A new means of assessing the quality of life of patients with obstructive sleep apnea: the MOSAS questionnaire.

BACKGROUND: The nightly use of continuous positive airway pressure (CPAP) increases the quality of life of patients affected by obstructive sleep apnea syndrome (OSAS). The aim of this study was to develop and validate a questionnaire to assess the psychological and physical impact of OSAS and adherence to the CPAP device. METHODS: Ninety-six patients underwent a polygraphic examination to establish a diagnosis of OSAS. They attended educational sessions concerning CPAP and completed the Maugeri Obstructive Sleep Apnea Syndrome (MOSAS) questionnaire before the adaptation phase to the device and after six months, when the number of hours of CPAP use was documented. RESULTS: Exploratory and confirmatory factor analysis of MOSAS section A revealed two factors with good internal consistency: "Sleep Apnea Psychological Impact" (α=0.77) and "Sleep Apnea Physical Impact" (α=0.75). Structural equation modeling confirmed the goodness of fit of the structure to the observed (RMSEA=0.034; GFI=0.95; AGFI=0.92; and CFI=0.96). MOSAS section B, which assesses the "discomfort and nuisance of CPAP," is mono-factorial with good internal consistency (α=0.663). The Psychological Impact factor positively correlated with the anxiety (r=0.44) and depression scores (r=0.49) and the physical impact factor positively correlated with daytime sleepiness (r=0.65). The discomfort and nuisance of CPAP negatively correlated with recorded CPAP use after six months (r=-0.52). CONCLUSIONS: The statistical quality of MOSAS is good, and it can be used to assess the psychological and physical impact of OSAS and subjective adherence to a CPAP device.

A revised short version of the depression questionnaire.

BACKGROUND: The Depression Questionnaire (QD) is an instrument designed to measure depression in an inpatient-rehabilitation setting. This study proposes a reduced version of the original 24-item QD, to make it better suited to the characteristics of patients in this setting. METHODS: The study population consisted of 801 individuals admitted to cardiac rehabilitation (564 males and 237 females) who had validly completed the original version of the QD. Data were analyzed first through confirmatory factor analysis and then using logistic models. RESULTS: Factor analysis of QD-24 items form, confirmed the plausibility of the monofactorial solution, both for males and females. Factor analysis combined with clinical observation suggested the possibility of reducing the QD to 17 items. Two further items were eliminated through use of simple logistic models. We thus obtained a shortened 15-item version of the QD (QD-R) that maintains a good index of separation (0.80), that is, good capacity to discriminate between individuals with different levels of depression, and a good item-trait interaction (chi(2)153=165.37, P>0.05). A second confirmatory factor analysis applied to the 15-item monofactorial model confirmed the validity of this shortened version of the instrument. The QD-R scores significantly correlated with metres walked during the 6 minute walking test (r=-0.316; P<0.01). CONCLUSION: Combined use of confirmatory factor analysis and simple logistic models together with observations drawn from clinical experience constitutes a valid method for shortening a questionnaire while at the same time maintaining, if not improving, its psychometric properties. The QD-R, seems adequate to how much is required in rehabilitation to point out the outcome, in case of variation of depression, easily to fill in by the debilitated individual or elderly, mainly because some item excessively influenced by the pathology or the hospital context were removed.