Systematic review of the current status of cadaveric simulation for surgical training.

BACKGROUND: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. METHODS: A PRISMA-compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. RESULTS: A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). CONCLUSION: There is an abundance of relatively low-quality evidence showing that cadaveric simulation induces short-term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre.

ANTECEDENTES: Existe un interés creciente en los cursos de simulación con cadáveres para la formación de residentes en cirugía, así como en aumentar la disponibilidad de dichos cursos. Ello es debido a la necesidad de modernizar y mejorar la eficiencia del entrenamiento en el marco actual del reto que supone la formación quirúrgica. El objetivo de esta revisión sistemática era describir y evaluar la evidencia del uso de la simulación con cadáveres en la formación quirúrgica de posgrado. MÉTODOS: Siguiendo la normativa PRISMA, se realizó una revisión sistemática de la literatura de estudios que evaluaban prospectivamente el entrenamiento quirúrgico mediante la simulación con cadáveres. Se realizaron búsquedas en todas las bases de datos relevantes y en registros de ensayos clínicos hasta enero de 2019. Se evaluó el rigor metodológico utilizando la herramienta MERSQI (Medical Education Research Quality Index), ampliamente validada. RESULTADOS: Se incluyeron 51 estudios, con un total de 2.002 residentes de cirugía y 69 intervenciones de formación con simulación con cadáveres. Del total de dichos estudios, 22 evaluaron el impacto de la cirugía con cadáver utilizando solo medidas subjetivas, 5 midieron el impacto por el cambio en el conocimiento del alumno y 23 utilizaron herramientas objetivas para evaluar el cambio en el comportamiento del alumno después de la formación. Solo un estudio evaluó el resultado en pacientes, demostrando la transferencia de habilidades del entorno simulado al lugar de trabajo. De los estudios incluidos, el 55% tenía una metodología débil (puntuación MERSQI < 10,7). CONCLUSIÓN: Existe amplia evidencia, pero de baja calidad, referente a la simulación con cadáveres en la formación quirúrgica, demostrando que esta popular herramienta puede ser útil para adquirir habilidades a corto plazo, tal como indican los resultados derivados de medidas objetivas. Actualmente hay una falta de evidencia basada en estudios longitudinales respecto a la retención de habilidades y de cómo estas se transfieren al quirófano real una vez finalizada la formación. Se requieren futuros ensayos aleatorizados de alta calidad para abordar este punto.

Effectiveness of Canine Hip Dysplasia and Elbow Dysplasia Improvement Programs in Six UK Pedigree Breeds.

Hip and elbow dysplasia are common disorders in larger dog breeds and crosses, and a known contributory factor to osteoarthritis, lameness and reduced mobility. Screening schemes evaluating the severity of hip and elbow dysplasia in the UK are administered by the British Veterinary Association (BVA) and the Kennel Club (KC). The BVA/KC Hip Dysplasia scoring scheme is over 50 years old, having originated in 1965, and has operated in its current form since 1983. The BVA/KC Elbow Dysplasia grading scheme commenced more recently in 1998 and is based on the International Elbow Working Group guidelines. Hip score and elbow grade data on a considerable number of dogs in the UK have been generated from these two screening schemes. This study analyses data from dogs of six breeds scored from 1990 to present, to establish any determinable trends in hip score and elbow grade parameters, and to examine whether the implementation of such schemes has had a positive influence on hip and elbow health. A range of criteria, including the rate of participation in the screening schemes, hip score and elbow grade parameters (e.g., median, mean, standard deviation), and estimated breeding values (EBVs) were analyzed, both in the overall population and also among breeding animals. The results show a general decline in hip score parameters (median, mean, standard deviation, and 75th percentile), revealing a reduction in the prevalence and severity of hip dysplasia. There was a more modest decline in mean elbow grade within breeds. The proportion of sires and dams (of dogs born per year) with no hip score or elbow grade fell substantially over time, demonstrating good participation in the screening schemes. In most breeds, the scores of sires and dams are demonstrably improving. There is a declining genetic trend as ascertained by EBVs for both hip scores and elbow grades in most breeds, implying that the improvement observed is due in part to selection for improvement in hip and elbow health as described by the respective screening schemes.

Learning anatomy of the foot and ankle using sagittal plastinates: A prospective randomized educational trial.

BACKGROUND: Foot and ankle anatomy is highly complex and presents a considerable educational challenge for the medical student or junior doctor. The successful interpretation of cross-sectional radiological images requires a detailed knowledge of anatomy and spatial relationships. Plastic-impregnated cadaveric prosection slices, known as 'sagittal plastinated slices', or 'SPS', are becoming popular as an adjunct to traditional anatomical teaching methods. OBJECTIVES: To compare the impact of SPS versus conventional anatomy teaching resources (dry bones and whole cadaveric feet) on learners' ability to correctly identify structures of the foot and ankle on sagittal MRI images. METHODS: Randomized educational study using sequential exploratory mixed-methods. RESULTS: The intervention group anatomy test scores were a mean of 1.2 higher after the educational intervention, compared to 0.7 for the control group (scores out of 14), but this was not statistically significant (p=0.41). Learners reported that the SPS intervention was most useful to augment and refine their knowledge after a teaching session using conventional resources. CONCLUSION: The qualitative results showed that SPS provide a valuable adjunct to traditional teaching methods in both anatomy and radiology of the foot and ankle, which should be used after teaching with traditional methods.

Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma.

A 73-year-old former smoker with previous occupational exposure to asbestos presented with a pneumothorax that was initially managed by simple aspiration. Despite this, it re-accumulated and a bronchopleural fistula was suspected. A video-assisted thoracoscopic procedure was performed and revealed an abnormally thickened pleura that turned out to be a mesothelioma. All persistent pneumothoraces should be investigated.

Exercise-induced bronchoconstriction in athletes-should we screen?

The fact that exercise-induced bronchoconstriction (EIB) may be both over- and underdiagnosed in athletes has led to calls for widespread screening for the condition. This article assesses such a strategy by employing the standard framework used when evaluating any screening policy. This approach highlights a number of concerns and allows recommendations to help optimize the success of such a strategy if it were to be implemented.

Nebulised DNase in the treatment of life threatening asthma.

A 25-year-old pregnant patient developed life-threatening asthma refractory to all standard treatment including anaesthetic agents. Ventilatory pressures continued to rise with impending cardio-respiratory arrest. The introduction of nebulised endotracheal DNase however resulted in a rapid and dramatic improvement with good clinical outcome.

Blood free morphine levels vary with concomitant alcohol and benzodiazepine use.

AIMS: To record the concentration of morphine in post-mortem blood samples from fatalities arising directly from illicit drug abuse in Grampian, Scotland and to explore whether there is any difference in the morphine levels with co-existent drugs especially alcohol and benzodiazepines. METHODS: Drug-related deaths that had positive blood toxicology for morphine from the beginning of January 1995 until the end of December 2001 were identified from the database of toxicological data held in the Department of Clinical Biochemistry, Aberdeen Royal Infirmary, and the data analysed in conjunction with the information in the files of the Forensic Medicine Unit, University of Aberdeen. RESULTS: One hundred and twenty-six cases were identified and consisted of 106 males and 20 females with an age range 17-51 (Median 26 years). Morphine was the single isolate in only 21 cases giving a median blood free morphine (BFM) of 0.19 mg/L. When morphine and benzodiazepines were the primary isolates [Formula: see text] the median BFM was 0.37 mg/L, and when morphine was in combination with alcohol [Formula: see text] the median BFM was 0.18 mg/L. Statistical significance was noted between these groups ( [Formula: see text] ). The remaining 59 cases had morphine combined with other drugs. CONCLUSIONS: In the studied cases, the concentrations of BFM were statistically higher when morphine was only isolated in conjunction with benzodiazepines than when combined only with alcohol. These results may be multi-factorial; user error while under drug influence, the individuals drug tolerance, or related to the pharmacokinetics of morphine and its interactions with alcohol and benzodiazepines. Our understanding of the interactions of these substances appears to be far from clear.