Virtual reality training compared with apprenticeship training in laparoscopic surgery: a meta-analysis.

INTRODUCTION: Since its inception, laparoscopic surgery has evolved and new techniques have been developed due to technological advances. This requires a different and more complex skill set in comparison with open surgery. Reduced working hours, less training time and patient safety factors demand that such skills need to be achieved outside the operating theatre environment. Several studies have been published and have determined the effectiveness of virtual reality training. We aimed to compare virtual reality training with the traditional apprenticeship method of training and determine whether it can supplement or replace the traditional apprenticeship model. We also aimed to perform a meta-analysis of the literature and develop conclusions with respect to the benefits achieved by adding virtual reality training on a regular basis to surgical training programmes. METHODS: A literature search was carried out on PubMed, MEDLINE, EMBASE and Google Scholar academic search engines using the MESH terms 'randomised controlled trials', 'virtual reality', 'laparoscopy', 'surgical education' and 'surgical training'. All randomised controlled trials published to January 2018 comparing virtual reality training to apprenticeship training were included. Data were collected on improved dexterity, operative performance and operating times. Each outcome was calculated with 95% confidence intervals and with intention-to-treat analysis; 24 randomised controlled trials were analysed. FINDINGS: Meta-analytical data were extracted for time, path length, instrument handling, tissue handling, error scores and objective structure assessment of technical skills scoring. There was significant improvement in individual trainee skill in all meta-analyses (p < 0.0002). CONCLUSION: This meta-analysis shows that virtual reality not only improves efficiency in the trainee's surgical practice but also improves quality with reduced error rates and improved tissue handling.

Cognitive vulnerability to depressive symptoms in children: the protective role of self-efficacy beliefs in a multi-wave longitudinal study.

The current multi-wave longitudinal study on childhood examined the role that social and academic self-efficacy beliefs and cognitive vulnerabilities play in predicting depressive symptoms in response to elevations in idiographic stressors. Children (N = 554; males: 51.4 %) attending second and third grade completed measures of depressive symptoms, negative cognitive styles, negative life events, and academic and social self-efficacy beliefs at four time-points over 6 months. Results showed that high levels of academic and social self-efficacy beliefs predicted lower levels of depressive symptoms, whereas negative cognitive styles about consequences predicted higher depression. Furthermore, children reporting higher social self-efficacy beliefs showed a smaller elevation in levels of depressive symptoms when reporting an increases in stress than children with lower social self-efficacy beliefs. Findings point to the role of multiple factors in predicting children's depression in the long term and commend the promotion of self-efficacy beliefs and the modification of cognitive dysfunctional styles as relevant protective factors.

Differential susceptibility in youth: evidence that 5-HTTLPR x positive parenting is associated with positive affect 'for better and worse'.

Positive affect has been implicated in the phenomenological experience of various psychiatric disorders, vulnerability to develop psychopathology and overall socio-emotional functioning. However, developmental influences that may contribute to positive affect have been understudied. Here, we studied youths' 5-HTTLPR genotype and rearing environment (degree of positive and supportive parenting) to investigate the differential susceptibility hypothesis (DSH) that youth carrying short alleles of 5-HTTLPR would be more influenced and responsive to supportive and unsupportive parenting, and would exhibit higher and lower positive affect, respectively. Three independent studies tested this gene-environment interaction (GxE) in children and adolescents (age range 9-15 years; total N=1874). In study 1 (N=307; 54% girls), positive/supportive parenting was assessed via parent report, in study 2 (N=197; 58% girls) via coded observations of parent-child interactions in the laboratory and in study 3 (N=1370; 53% girls) via self report. Results from all the three studies showed that youth homozygous for the functional short allele of 5-HTTLPR were more responsive to parenting as environmental context in a 'for better and worse' manner. Specifically, the genetically susceptible youth (that is, S'S' group) who experienced unsupportive, non-positive parenting exhibited low levels of positive affect, whereas higher levels of positive affect were reported by genetically susceptible youth under supportive and positive parenting conditions. These GxE findings are consistent with the DSH and may inform etiological models and interventions in developmental psychopathology focused on positive emotion, parenting and genetic susceptibility.

Incarcerated small bowel within a spontaneous lumbar hernia.

Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.

Chemotherapy induced carcinoma-adenoma regression in the caecum.

The case of a male patient with synchronous oesophago-gastric junction (OGJ) and caecal adenocarcinomas is reported. His management is described, particularly the administration of neoadjuvant chemotherapy targeting his upper gastrointestinal cancer. Synchronous gastrectomy and hemicolectomy were performed. Histopathological examination of the surgical specimen confirmed the OGJ cancer but only identified a caecal adenoma. This is believed to be the first description of chemotherapy induced reversal of the adenoma-carcinoma sequence.

The hopelessness theory of depression: a test of the diathesis-stress and causal mediation components in third and seventh grade children.

The goal of the current study was to test the diathesis-stress and causal mediation components of the hopelessness theory of depression in third- and seventh-grade children. The procedure involved an initial assessment of depressive symptoms, hopelessness, and the 3 cognitive styles posited as vulnerability factors by hopelessness theory. The procedure also involved a series of 6 weekly follow-up assessments in which depressive symptoms, hopelessness, and the occurrence of negative events were assessed. A depressogenic attributional style interacted with negative events to predict increases in depressive symptoms in seventh-grade children but not in third-grade children. A depressogenic inferential style about consequences interacted with negative events to predict increases in depressive symptoms in both third- and seventh-grade children. Last, a depressogenic inferential style about the self interacted with negative events to predict increases in depressive symptoms in third- and seventh-grade girls but not boys. None of these interactions were mediated by hopelessness.

Attributional style and life events: a diathesis-stress theory of alcohol consumption.

The role of a cognitive diathesis-stress model in predicting changes in alcohol consumption was examined. This study evaluated the interaction of attributional style with negative life events in predicting changes in beer, wine, spirits, and overall alcohol consumption. 93 undergraduate participants completed the Khavari Alcohol Test, Negative Life Events Questionnaire, and Attributional Style Questionnaire. The interaction of attributional style with negative life events predicted increases in spirits consumption between Time 1 and Time 2.