Lapnurse-A Blended Learning Course for Nursing Education in Minimally Invasive Surgery: Design and Experts' Preliminary Validation of Its Online Theoretical Module.

BACKGROUND: The implantation of Minimally Invasive Surgery (MIS) leads to the specialization of nurses in this surgical field. However, there is no standard curriculum of MIS Nursing in Europe. Spanish and Portuguese nurses are inexperienced and have poor training in MIS. For that, a blended learning course for nursing education in MIS (Lapnurse) has been developed. This work aims to detail the course design and to preliminary validate by experts its online theoretical module. METHODS: Lapnurse consists of an online module with nine theoretical lessons and a face-to-face module with three practical lessons. The e-learning environment created to provide the online module, with didactic contents based on surgical videos and innovative 3D designs, has been validated by two technicians (functionality) and four nurses with teaching experience in MIS (usability and content). RESULTS: The E-learning platform meets all technical requirements, provides whole and updated multimedia contents correctly applied for educational purposes, incorporates interactivity with 3D designs, and has an attractive, easy-to-use and intuitive design. CONCLUSIONS: The lack of knowledge in MIS of Spanish and Portuguese nurses could be addressed by the blended learning course created, Lapnurse, where the e-learning environment that provides theoretical training has obtained a positive validation.

Validation of the online theoretical module of a minimally invasive surgery blended learning course for nurses: A quantitative research study.

BACKGROUND: The progressive development of Minimally Invasive Surgery (MIS) implies the need to train health professionals in such field, for which e-learning and blended learning methods are increasingly been used. Most nurses lack experience and training in MIS, so a laparoscopic blended learning course for nursing has been created. OBJECTIVES: To perform the validation of the online theoretical module of such course to evaluate student perception and satisfaction, sociability and usability metrics, and also the interest of nurses in blended learning. DESIGN: A quantitative design has been used. PARTICIPANTS: 24 nurses participated in the validation tests performing the online module of the course. METHODS: Subjective (questionnaires) and objective (performance statistics) metrics were analysed. RESULTS: The e-learning environment has ease of access, good layout, consistency and intuitive navigation. Chat and forums have not been used and nurses miss a moderator. Participants consider that videos provide added value to the course, and contents are easily understandable and of high quality. However, questionnaires are not well balanced in difficulty and few interactive 3D designs have been viewed. Participants consider blended learning as the most effective training method for its flexibility in time and place. CONCLUSIONS: This study suggests that a simple, easy-to-use and attractive e-learning environment has been developed to train nurses in MIS. However, installation of additional software should be avoided. A moderator/tutor should manage forums to encourage user participation, using conversational agents. But nevertheless, chats have no interest. Questionnaires for content evaluation should be designed with efficiency and equity. Videos designed according to micro-learning, with audio and interactivity, should be included. These courses should be designed to meet factors to promote the engagement of students. Blended learning is considered by nurses as ideal method for training, but further research to assess whether it improves learning outcomes is needed.

Changes on Adipose Tissue Distribution After Laparoscopic Roux-en-Y Gastric Bypass in Obese Göttingen Minipig. Effects on Glucose Metabolism.

BACKGROUND: The objective of the study was to assess Roux-en-Y independent-to-weight metabolic effects on an obese Gottingen minipig. METHODS: Eleven castrated Göttingen minipigs were enrolled. Minipigs became obese after a 9-month period of experimental diet. The animals were then subjected to a laparoscopic Roux-en-Y gastric bypass (period P1) followed by 4 months of follow-up (period P2). During this last period, they were fed to maintain similar body weight to that observed at the day of surgery. Registered parameters during each period included biometric variables; abdominal adipose tissue (AT) distribution; lipid profile; HOMA-IR; and fasting plasma leptin, adiponectin, glucose, insulin and fructosamine. RESULTS: Two pigs were unable to complete the study due to postoperative complications. Four months after surgery, the body weight (kg) was maintained (P1 51.90 ± 5.78 vs P2 51.47 ± 5.68). On the contrary, intraperitoneal AT (p < 0.0001), glucose (mmol/L) (P1: 5.53 ± 0.37 vs 4.66 ± 0.72, p = 0.019), fructosamine (µmol/L) (p = 0.0001) and insulin (pmol/L) (P1: 36.66 ± 13.94 vs P2: 21.42 ± 12.62, p = 0.001) significantly decreased after surgery. Lipid profile showed a significant increase after high-fat feeding period and a slight reduction at P2, which continued increasing. At the end of the study, leptin plasma levels (ng/mL) showed a significant reduction compared to basal value (p = 0.001). CONCLUSIONS: The improvement in glucose metabolism seems to occur by means of the redistribution of body fat. In order to fully confirm this hypothesis, more studies including the evaluation of incretins and inflammatory molecules, as well as a glycaemia control study against glucose load, are needed.

Effects of pneumoperitoneum and body position on the morphology of abdominal vascular structures analyzed in MRI.

PURPOSE: To analyze the complications of laparoscopy in different vascular structures using magnetic resonance imaging (MRI). MRI has become a key tool in laparoscopic surgery. During these procedures, pneumoperitoneum creation and placing the patient in the surgical position provoke different changes in the splachnic circulation. MATERIALS AND METHODS: Ten pigs were included in the study. MRI studies of the abdominal area were carried out in four different situations of abdominal pressure and body position. RESULTS: Changes in the area of the lumen of the portal vein and the abdominal aorta were analyzed in all situations. A significant reduction in the area of the abdominal aorta was observed after the pneumoperitoneum in supine and anti-Trendelemburg position. The lumen of the portal vein was significantly reduced in all analyzed situations except when placing the patient in anti-Trendelemburg without pneumoperitoneum, in which case the area was increased. CONCLUSION: The creation of pneumoperitoneum provokes morphological changes in the lumen of different abdominal vessels as a consequence of the increase of pressure. Furthermore, the combination of pneumoperitoneum together with the anti-Trendelemburg position results in a more significant reduction of the lumen of the portal vein and the abdominal aorta.