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Marks J.M.,University Hospitals | Dunkin B.J.,Methodist Institute for Technology
Principles of Flexible Endoscopy for Surgeons | Year: 2013

Written entirely by surgical endoscopists, Principles of Flexible Endoscopy for Surgeons presents a comprehensive overview of past, present, and future flexible gastrointestinal endoscopic techniques, with a focus on educating surgeons who may or may not already have the skills to perform flexible endoscopy. In addition to the endoscopic management of surgical issues, the volume describes the role of surgery in the management of endoscopic complications. Basic as well as advanced flexible endoscopic techniques are presented in both a didactic and visual mode, with representative endoscopic images and video clips. Recent endoscopic advancements which are not routinely a core component of surgical training programs are also covered in detail. Extensively illustrated with endoscopic images and accompanied by a DVD, Principles of Flexible Endoscopy for Surgeons is a valuable resource for surgeons on all facets of flexible endoscopy. © 2013 Springer Science+Business Media New York. All rights reserved.

Aghazadeh M.A.,Baylor College of Medicine | Mercado M.A.,Baylor College of Medicine | Pan M.M.,Baylor College of Medicine | Goh A.C.,Methodist Institute for Technology
BJU International | Year: 2016

Objective: To compare user performance of four fundamental inanimate robotic skills tasks (FIRST) as well as eight da Vinci Skills Simulator (dVSS) virtual reality tasks with intra-operative performance (concurrent validity) during robot-assisted radical prostatectomy (RARP) and to show that a positive correlation exists between simulation and intra-operative performance. Materials and Methods: A total of 21 urological surgeons with varying robotic experience were enrolled. Demographics were captured using a standardized questionnaire. User performance was assessed concurrently in simulated (FIRST exercises and dVSS tasks) and clinical environments (endopelvic dissection during RARP). Intra-operative robotic clinical performance was scored using the previously validated six-metric Global Evaluative Assessment of Robotic Skills (GEARS) tool. The relationship between simulator and clinical performance was evaluated using Spearman's rank correlation. Results: Performance was assessed in 17 trainees and four expert robotic surgeons with a median (range) number of previous robotic cases (as primary surgeon) of 0 (0-55) and 117 (58-600), respectively (P = 0.001). Collectively, the overall FIRST (ρ = 0.833, P < 0.001) and dVSS (ρ = 0.805, P < 0.001) simulation scores correlated highly with GEARS performance score. Each individual FIRST and dVSS task score also demonstrated a significant correlation with intra-operative performance, with the exception of Energy Switcher 1 exercise (P = 0.063). Conclusions: This is the first study to show a significant relationship between simulated robotic performance and robotic clinical performance. Findings support implementation of these robotic training tools in a standardized robotic training curriculum. © 2016 BJU International.

Desai R.J.,University of North Carolina at Chapel Hill | Ashton C.M.,Methodist Institute for Technology | Deswal A.,Michael bakey Va Medical Center | Deswal A.,Baylor College of Medicine | And 8 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2012

Objective: There is little evidence on comparative effectiveness of individual angiotensin receptor blockers (ARBs) in patients with chronic heart failure (CHF). This study compared four ARBs in reducing risk of mortality in clinical practice. Methods: A retrospective analysis was conducted on a national sample of patients diagnosed with CHF from 1 October 1996 to 30 September 2002 identified from Veterans Affairs electronic medical records, with supplemental clinical data obtained from chart review. After excluding patients with exposure to ARBs within the previous 6months, four treatment groups were defined based on initial use of candesartan, valsartan, losartan, and irbesartan between the index date (1 October 2000) and the study end date (30 September 2002). Time to death was measured concurrently during that period. A marginal structural model controlled for sociodemographic factors, comorbidities, comedications, disease severity (left ventricular ejection fraction), and potential time-varying confounding affected by previous treatment (hospitalization). Propensity scores derived from a multinomial logistic regression were used as inverse probability of treatment weights in a generalized estimating equation to estimate causal effects. Results: Among the 1536 patients identified on ARB therapy, irbesartan was most frequently used (55.21%), followed by losartan (21.74%), candesartan (15.23%), and valsartan (7.81%). When compared with losartan, after adjusting for time-varying hospitalization in marginal structural model, candesartan (OR=0.79, 95%CI=0.42-1.50), irbesartan (OR=1.17, 95%CI=0.72-1.90), and valsartan (OR=0.98, 95%CI=0.45-2.14) were found to have similar effectiveness in reducing mortality in CHF patients. Conclusion: Effectiveness of ARBs in reducing mortality is similar in patients with CHF in everyday clinical practice. © 2011 John Wiley & Sons, Ltd.

Garbey M.,University of Houston | Garbey M.,Methodist Institute for Technology | Bass B.L.,Methodist Institute for Technology | Berceli S.,University of Florida
Acta Mechanica Sinica/Lixue Xuebao | Year: 2012

This paper discusses some of the concept of modeling surgery outcome. It is also an attempt to offer a road map for progress. This paper may serve as a common ground of discussion for both communities i.e surgeons and computational scientist in its broadest sense. Predicting surgery outcome is a very difficult task. All patients are different, and multiple factors such as genetic, or environment conditions plays a role. The difficulty is to construct models that are complex enough to address some of these significant multiscale elements and simple enough to be used in clinical conditions and calibrated on patient data. We will provide a multilevel progressive approach inspired by two applications in surgery that we have been working on. One is about vein graft adaptation after a transplantation, the other is the recovery of cosmesis outcome after a breast lumpectomy. This work, that is still very much in progress, may teach us some lessons. We are convinced that the digital revolution that is transforming the working environment of the surgeon makes closer collaboration between surgeons and computational scientist unavoidable. We believe that "computational surgery" will allow the community to develop predictive model of the surgery outcome and greatprogresses in surgery procedures that goes far beyond the operating room procedural aspect. © The Chinese Society of Theoretical and Applied Mechanics and Springer-Verlag Berlin Heidelberg 2012.

Wilcox V.,Methodist Institute for Technology | Trus T.,Dartmouth Hitchcock Medical Center | Salas N.,Methodist Institute for Technology | Martinez J.,University of Miami | Dunkin B.J.,Methodist Institute for Technology
Journal of Surgical Education | Year: 2014

IntroductionIntroduction The surgical training for endoscopic proficiency program is a collaborative project between Society of American Gastrointestinal and Endoscopic Surgeons and Olympus America Inc. dedicated to providing flexible endoscopy training to surgery residency programs. Currently it lacks models for proficiency-based training. This study developed 2 novel flexible endoscopy simulators, purchased a third, and established face and content validity as well as proficiency metrics for all 3. Methods Three simulators were tested - a foam and cardboard upper gastrointestinal tract model, a commercially available colonoscopy model (CM-15, Olympus, Japan), and an endoscopic targeting model created from the Operation Game (Hasbro). Time and errors for the performance of 12 expert surgical endoscopists on each model were used to calculate proficiency scores. Face validity and content validity were established through posttest questionnaires using a 5-point Likert scale. Results Experts had a mean of 8 years of endoscopic practice (range: 1-24 y). Among them, 83% teach residents or fellows using simulation. Most perform more than 50 upper endoscopies (51 to >500) and 100 colonoscopies (101 to >500) per year. The average time for completing the upper gastrointestinal tract model with correct identification of all targets was 133 ± 56 seconds. Complete navigation of the colonoscopy model averaged 325 ± 156 seconds. Proper orientation and targeting using the Operation Game model averaged 273 ± 109 seconds with 3 errors. Conclusions This study proves face and content validity for 3 physical flexible endoscopy simulators that can be used to train upper and lower endoscopy as well as instrument targeting. It also establishes expert proficiency metrics that can be used by trainees for structured rehearsal. These relatively inexpensive models will be incorporated into the surgical training for endoscopic proficiency curriculum. © 2014 Association of Program Directors in Surgery.

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