Virtual reality simulation training in laparoscopic surgery - does it really matter, what simulator to use? Results of a cross-sectional study.

BACKGROUND: Virtual reality simulation training plays a crucial role in modern surgical training, as it facilitates trainees to carry out surgical procedures or parts of it without the need for training "on the patient". However, there are no data comparing different commercially available high-end virtual reality simulators. METHODS: Trainees of an international gastrointestinal surgery workshop practiced in different sequences on LaparoS® (VirtaMed), LapSim® (Surgical Science) and LapMentor III® (Simbionix) eight comparable exercises, training the same basic laparoscopic skills. Simulator based metrics were compared between an entrance and exit examination. RESULTS: All trainees significantly improved their basic laparoscopic skills performance, regardless of the sequence in which they used the three simulators. Median path length was initially 830 cm and 463 cm on the exit examination (p < 0.001), median time taken improved from 305 to 167 s (p < 0.001). CONCLUSIONS: All Simulators trained efficiently the same basic surgery skills, regardless of the sequence or simulator used. Virtual reality simulation training, regardless of the simulator used, should be incorporated in all surgical training programs. To enhance comparability across different types of simulators, standardized outcome metrics should be implemented.

Sources of occupational stress amongst dentistry academics.

BACKGROUND: Dentistry professionals may experience significantly higher occupational stress than other health professionals and dentistry academics may have specific work content and context sources of stress. AIMS: The aim of this study is to identify common sources of occupational stress, and how these are associated with wellbeing, in dentistry academics. MATERIALS & METHODS: A cross-sectional online survey with staff in Dentistry departments in Australia and New Zealand. Assessment included 23 items from five general domains of occupational stress from the NIOSH-Generic Job Stress Questionnaire, a 23-item list of sources of stress and the 22-item Psychological General Well-Being Index. Analyses used descriptive statistics and multiple linear regression. RESULTS: A total of 107 respondents (average age 50 ± 11.7 years, 56.8% men) completed the survey. Leading sources of occupational stress were job future, time pressure at work, work overload, and administration demands. A multiple linear regression model significantly predicted wellbeing, F(8,77) = 13.141, p = .000, adj.R2  = .53, but there were no significant associations for any of the specific sources of stress. CONCLUSION: The combination of time pressure, workload and responsibility, job dissatisfaction, low social support, and uncertain job future was inversely associated with wellbeing amongst these dentistry academics. Future studies should consider the development and evaluation of interventions to address these concerns.

Transition from a circular to a linear stapling protocol in laparoscopic Roux-en-Y gastric bypass surgery and its impact on quality of life: a 5-year outcome study.

PURPOSE: Surgical technique in bariatric surgery has been refined over the past decades. This study analysed the effect of changing the stapling protocol on the quality of life (QoL) at a midterm follow-up. METHODS: The retrospective cohort study included patients undergoing Roux-en-Y gastric bypass between June 2012 and March 2016. Patients were stratified into the circular stapling protocol (CSP, n = 117) or the linear stapling protocol (LSP, n = 118). QoL was quantified by the Moorehead score at 12, 24 and 60 months. Multivariate testing was used to identify confounders. RESULTS: The age was 42.8 ± 11.5 years and the body mass index (BMI) was 43.8 ± 6.2 kg/m2, with no baseline intergroup differences. Overall baseline Moorehead score was 0.42 ± 1.1 and improved in both groups after 12 months (1.97 ± 0.74, p < 0.001), 24 months (1.86 ± 0.79, p < 0.001) and 60 months (1.71 ± 0.9, p < 0.001). LSP was associated with improved Moorehead score after 60 months (odds ratio [OR] 1.251, 95% confidence interval [CI] 1.06-1.48, p = 0.010). Overall, a drop of mean BMI occurred and this effect lasted throughout the observation period (- 12.48 kg/m2, p < 0.001). More profound BMI reduction was further positively associated with Moorehead scores after 24 and after 60 months (OR 0.97, p = 0.028; OR 0.96, p = 0.007). Complications, rehospitalisations and reoperations were more frequent in the CSP group (50% vs 23.7%, p < 0.001; 39.7% vs 22.9%, p = 0.009; 37.1% vs 18.6%, p = 0.003). CONCLUSION: The CSP and LSP achieve a long-lasting increase in QoL, although the LSP is associated with fewer complications, persistent weight loss and improved Moorehead score. Therefore, the LSP might be considered the favourable protocol in Roux-en-Y gastric bypass.

Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study.

BACKGROUND: PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive approach relying on physical principles for improving intraperitoneal drug delivery, including optimizing the homogeneity of drug distribution through an aerosol. Feasibility and safety of the new approach are now consolidated and data on its effectiveness are continuously increasing. Although any surgical procedure associated with PIPAC had always been discouraged due to the high risk of complications, surgical practice is constantly changing: with growing expertise, more and more surgical teams associate PIPAC with surgery. METHODS: PLUS study is part of the retrospective international cohort studies including 10 centers around the world (India, Italy, France, Germany, Belgium, Russia, Saudi Arabia, Switzerland) and 96 cases of combined approaches evaluated through a propensity score analysis. RESULTS: the procedures most frequently associated with PIPAC were not only adhesiolysis, omentectomy, adnexectomy, umbilical/inguinal hernia repairs, but also more demanding procedures such as intestinal resections, gastrectomy, splenectomy, bowel repair/stoma creation. Although the evidence is currently limited, PLUS study demonstrated that PIPAC associated with additional surgical procedures is linked to an increase of surgical time (p < 0.001), length of stay (p < 0.001) and medical complication rate (p < 0.001); the most frequently reported medical complications were mild or moderate in severity, such as abdominal pain, nausea, ileus and hyperthermia. No difference in terms of surgical complications was registered; neither reoperation or postoperative deaths were reported. CONCLUSIONS: these results suggest that PIPAC can be safely combined in expert centers with additional surgeries. Widespread change of practice should be discouraged before the results of ongoing prospective studies are available.

An ileo-colic intussusception reaching down to the descending colon - A case report.

INTRODUCTION AND IMPORTANCE: Intussusception in healthy adults is rare and often associated with oncologic diseases. This case report presents a case of an ileo-colic intussusception reaching down to the descending colon in a healthy adult that required ileo-colic resection. CASE PRESENTATION: We present a case of a 78-year-old male patient with acute onset unspecific abdominal pain. The medical history was unremarkable. Preoperative radiologic assessments showed an invagination of the small intestine into the colon without any signs of polyps or tumours. An emergency laparotomy with resection of the affected intestine was performed. The pathologist described a 49 cm length of intussuscepted colon and an additional 7 cm intussusception of the terminal ileum. A circular area with multiple polyps extending over 8 cm in the colon could be identified. The microscopic findings showed a low-grade dysplasia within this area. Following surgery, the patient was discharged to rehabilitation after a ten-day hospitalization. CLINICAL DISCUSSION: Intussusception in adults is rare and the clinical presentation includes unspecific symptoms making the diagnosis challenging. In 90% of the cases, a pathologic lesion is found (two-thirds are neoplasms). An intussusception involving the colon should be treated surgically without prior reduction due to the high incidence of a neoplasm and the risk for perforation and tumour dissemination. CONCLUSION: In the literature, neoplastic disease represents the major cause for intussusception in adults. This report presents a rare case of an ileo-colic intussusception reaching down to the descending colon treated successfully with a subtotal colectomy.

Spatial Patterns in Hospital-Acquired Infections in Portugal (2014-2017).

BACKGROUND: Hospital-Acquired Infections (HAIs) represent the most frequent adverse event associated with healthcare delivery and result in prolonged hospital stays and deaths worldwide. AIM: To analyze the spatial patterns of HAI incidence from 2014 to 2017 in Portugal. METHODS: Data from the Portuguese Discharge Hospital Register were used. We selected episodes of patients with no infection on admission and with any of the following HAI diagnoses: catheter-related bloodstream infections, intestinal infections by Clostridium difficile, nosocomial pneumonia, surgical site infections, and urinary tract infections. We calculated age-standardized hospitalization rates (ASHR) by place of patient residence. We used empirical Bayes estimators to smooth the ASHR. The Moran Index and Local Index of Spatial Autocorrelation (LISA) were calculated to identify spatial clusters. RESULTS: A total of 318,218 HAIs were registered, with men accounting for 49.8% cases. The median length of stay (LOS) was 9.0 days, and 15.7% of patients died during the hospitalization. The peak of HAIs (n = 81,690) occurred in 2015, representing 9.4% of the total hospital admissions. Substantial spatial inequalities were observed, with the center region presenting three times the ASHR of the north. A slight decrease in ASHR was observed after 2015. Pneumonia was the most frequent HAI in all age groups. CONCLUSION: The incidence of HAI is not randomly distributed in the space; clusters of high risk in the central region were seen over the entire study period. These findings may be useful to support healthcare policymakers and to promote a revision of infection control policies, providing insights for improved implementation.

The Motivational Thought Frequency Scales for increased physical activity and reduced high-energy snacking.

OBJECTIVES: The Motivational Thought Frequency (MTF) Scale has previously demonstrated a coherent four-factor internal structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) in control of alcohol and effective self-management of diabetes. The current research tested the factorial structure and concurrent associations of versions of the MTF for increasing physical activity (MTF-PA) and reducing high-energy snacks (MTF-S). DESIGN: Study 1 examined the internal structure of the MTF-PA and its concurrent relationship with retrospective reports of vigorous physical activity. Study 2 attempted to replicate these results, also testing the internal structure of the MTF-S and examining whether higher MTF-S scores were found in participants scoring more highly on a screening test for eating disorder. METHODS: In Study 1, 626 participants completed the MTF-PA online and reported minutes of activity in the previous week. In Study 2, 313 participants undertook an online survey that also included the MTF-S and the Eating Attitudes Test (EAT-26). RESULTS: The studies replicated acceptable fit for the four-factor structure on the MTF-PA and MTF-S. Significant associations of the MTF-PA with recent vigorous activity and of the MTF-S with EAT-26 scores were seen, although associations were stronger in Study 1. CONCLUSIONS: Strong preliminary support for both the MTF-PA and MTF-S was obtained, although more data on their predictive validity are needed. Associations of the MTF-S with potential eating disorder illustrate that high scores may not always be beneficial to health maintenance.

Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010 / Efeitos da composição regional da água potável no risco de fratura do fêmur: uma análise espacial das admissões hospitalares em Portugal, de 2000 a 2010

Abstract Geographical variation on hip fractures (HF) may be related to the geographical variation of drinking water composition (DWC); minerals in drinking water may contribute to its fragility. We aim to investigate the effects of DWC on HF risk in Portugal (2000-2010). From National Hospital Discharge Register we selected admissions of patients aged ≥50 years, diagnosed with HF caused by low/moderate energy traumas. Water components and characteristics were selected at the municipality level. A spatial generalized additive model with a negative binomial distribution as a link function was used to estimate the association of HF with variations in DWC. There were 96,905HF (77.3% in women). The spatial pattern of HF risk was attenuated after being adjusted for water parameters. Results show an indirect association between calcium, magnesium, and iron and HF risk but no clear relation between aluminum, cadmium, fluoride, manganese, or color and HF risk. Regarding pH, the 6.7pH and 7pH interval seems to pose a lower risk. Different dose-response relationships were identified. The increase of calcium, magnesium, and iron values in DWC seems to reduce regional HF risk. Long-term exposure to water parameters, even within the regulatory limits, might increase the regional HF risk.

Resumo A variabilidade espacial existente na fratura do colo do fêmur (FCF) pode estar relacionada com a variabilidade geográfica da composição da água para consumo (CAC), devido à ação dos minerais na fragilidade óssea. O objetivo do artigo foi investigar o efeito da CAC no risco de FCF em Portugal (2000-2010). Do registo nacional de altas hospitalares, foram selecionadas todas as admissões em indivíduos ≥50, com diagnóstico de FCF causado por trauma de baixo/moderado impacto. Os componentes e características da água foram usados ao nível do município. Um modelo espacial aditivo generalizado, com a distribuição binomial negativa como função de ligação, foi usado para estimar a associação de FCF e as variações da CAC. Foram selecionadas 96.905 FCF (77,3% em mulheres). O padrão espacial de risco de FCF foi atenuado após ser ajustado pelos parâmetros da CAC. Os resultados mostraram uma associação indireta com cálcio, magnésio e ferro. No entanto, com alumínio, cádmio, fluoreto, manganês e cor, a associação com o risco não foi clara. O intervalo de pH de 6,7 a 7 parece apresentar um menor risco. Foram identificadas diferentes dose-resposta. O aumento do cálcio, magnésio e ferro na CAC parece reduzir o risco regional de FCF. Uma exposição a longo prazo, mesmo obedecendo aos limites impostos por lei, parece aumentar o risco regional de FCF.

The influence of socioeconomic, biogeophysical and built environment on old-age survival in a Southern European city.

Old-age survival is a good indicator of population health and regional development. We evaluated the spatial distribution of old-age survival across Porto neighbourhoods and its relation with physical (biogeophysical and built) and socioeconomic factors (deprivation). Smoothed survival rates and odds ratio (OR) were estimated using Bayesian spatial models. There were important geographical differentials in the chances of survival after 75 years of age. Socioeconomic deprivation strongly impacted old-age survival (Men: least deprived areas OR=1.31(1.05-1.63); Women OR=1.53(1.24-1.89)), explaining over 40% of the spatial variance. Walkability and biogeophysical environment were unrelated to old-age survival and also unrelated to socioeconomic deprivation, being fairly evenly distributed through the city.

[PIPAC--Pressurized intraperitoneal aerosol chemotherapy. A novel treatment for peritoneal carcinomatosis]. / PIPAC--Chimiothérapie intrapéritonéale vaporisée. Un traitement innovateur de la carcinose péritonéale.

Peritoneal carcinomatosis remains a diagnostic challenge with sparse treatment options. The effect of systemic chemotherapy remains limited inside the peritoneum due to low penetration and a relative resistance of peritoneal nodules. Heated IntraPeritoneal Chemotherapy (HIPEC) improves survival in selected patients but entails a high incidence of complications. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) allows to disperse the active agents inside the peritoneal cavity by laparoscopy. Distribution and tissue penetration of chemotherapy by PIPAC are superior to HIPEC and systemic chemotherapy despite of lower doses. Systemic side effects are uncommon and surgical trauma is limited. Histological and clinical response rates in platinum-resistant patients approach 70% and survival data appear to be favorable compared with standard therapy.

Tools for address georeferencing - limitations and opportunities every public health professional should be aware of.

Various address georeferencing (AG) tools are currently available. But little is known about the quality of each tool. Using data from the EPIPorto cohort we compared the most commonly used AG tools in terms of positional error (PE) and subjects' misclassification according to census tract socioeconomic status (SES), a widely used variable in epidemiologic studies. Participants of the EPIPorto cohort (n = 2427) were georeferenced using Geographical Information Systems (GIS) and Google Earth (GE). One hundred were randomly selected and georeferenced using three additional tools: 1) cadastral maps (gold-standard); 2) Global Positioning Systems (GPS) and 3) Google Earth, single and in a batch. Mean PE and the proportion of misclassified individuals were compared. Google Earth showed lower PE than GIS, but 10% of the addresses were imprecisely positioned. Thirty-eight, 27, 16 and 14% of the participants were located in the wrong census tract by GIS, GPS, GE (batch) and GE (single), respectively (p<0.001). Misclassification according to SES was less frequent but still non-negligible -14.4, 8.1, 4.2 and 2% (p<0.001). The quality of georeferencing differed substantially between AG tools. GE seems to be the best tool, but only if prudently used. Epidemiologic studies using spatial data should start including information on the quality and accuracy of their georeferencing tools and spatial datasets.

Pesquisa e produção científica em economia da saúde no Brasil

Este artigo elabora um diagnóstico sobre a área de economia da saúde (ES) no Brasil, a partir de inquérito enfocando os grupos de pesquisa em ES cadastrados no Conselho Nacional de Desenvolvimento Científico e Tecnológico e de um levantamento da produção científica brasileira em ES disponibilizado na Biblioteca Virtual em Saúde Bireme.

Pesquisa e produção científica em economia da saúde no Brasil / Research and scientific production in health economics in Brazil

Este artigo elabora um diagnóstico sobre a área de economia da saúde (ES) no Brasil, a partir de inquérito enfocando os grupos de pesquisa em ES cadastrados no Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) e de um levantamento da produção científica brasileira em ES, publicado entre janeiro de 1999 e junho de 2004 e disponibilizado na Biblioteca Virtual em Saúde Bireme (Paho/WHO). Os dados foram descritos considerando regiões geográficas, tipos de instituições e áreas temáticas de pesquisa. Dos grupos de pesquisa com trabalhos relacionados às áreas temáticas em ES, 48 apresentam ampla diversidade de atuação e concentram-se na região Sudeste do país. Apenas 14 por cento (376) das 2.617 publicações avaliadas se relacionam à ES. A maioria dos estudos foi publicada em 2002 e apresenta como principais temas: gestão, financiamento, eficiência alocativa e eqüidade na distribuição de recursos de saúde. A análise permite identificar aspectos importantes para compreender o desenvolvimento do campo da ES no Brasil, entre 1999 e 2004.

This article presents a diagnosis of the health economics (HE) in Brazil, based on a survey of HE research groups currently registered in the National Council for Scientific and Technological Development (CNPq), as well as an inventory of the Brazilian scientific production in HE, published between January 1999 and June 2004, available in the Bireme Virtual Health Library (Paho/WHO). It describes the data considering geographic regions, types of institution and topics of research. Of the research groups with works related to HE subject matters, 48 have very diversified activities, concentrated in the Southeastern region of the country. Only 14 percent (376) of the 2.617 publications that had been evaluated were related to HE. Most of the studies were published in 2002 and their main topics were management, financing, allocative efficiency and equity in the distribution of health resources. The diagnosis allows the identification of important aspects that help understand the development of the HE field in Brazil between 1999 and 2004.

Financiamento da saúde pública no Brasil: a experiência do Siops / Public health financing in Brazil: the Siops experience

Este artigo apresenta características do Sistema de Informaçöes sobre Orçamentos Públicos de Saúde (Siops), tece breves comentários sobre a estratégia de coleta e os dados coletados, e exemplifica algumas de suas potencialidades como instrumento de apoio à gestäo. O Siops reúne informaçöes sobre o financiamento e o gasto com saúde pública dos municípios, dos estados e da Uniäo, constituindo-se em banco de dados único no âmbito das políticas sociais no Brasil. Produzindo informaçöes com regularidade e com qualidade crescente, o sistema conforma-se como uma importante fonte de dados para a realizaçäo de estudos pelas instituiçöes de pesquisa, para o exercício do acompanhamento e fiscalizaçäo pelos órgäos de controle e para a gestäo e avaliaçäo das açöes no âmbito do Sistema Unico de Saúde. Tais informaçöes podem viabilizar o aprimoramento da gestäo, a disseminaçäo de experiências bem-sucedidas entre os entes federados, e a adequada distribuiçäo dos gastos entre investimento e custeio e entre as esferas governamentais, tendo em vista o dimensionamento das redes de atençäo, dentre outras questöes