Relevance of motion-related assessment metrics in laparoscopic surgery

INTRODUCTION: Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skills has not been fully explored. The purpose of this study is to investigate the relevance of motion-related metrics in the evaluation processes of basic psychomotor laparoscopic skills, as well as their correlation with the different abilities sought to measure. METHODS: A framework for task definition and metric analysis is proposed. An explorative survey was first conducted with a board of experts to identify metrics to assess basic psychomotor skills. Based on the output of that survey, three novel tasks for surgical assessment were designed. Face and construct validation study was performed, with focus on motion-related metrics. Tasks were performed by 42 participants (16 novices, 22 residents and 4 experts). Movements of the laparoscopic instruments were registered with the TrEndo tracking system and analyzed. RESULTS: Time, path length and depth showed construct validity for all three tasks. Motion smoothness and idle time also showed validity for tasks involving bi-manual coordination and tasks requiring a more tactical approach respectively. Additionally, motion smoothness and average speed showed a high internal consistency, proving them to be the most task-independent of all the metrics analyzed. CONCLUSION: Motion metrics are complementary and valid for assessing basic psychomotor skills, and their relevance depends on the skill being evaluated. A larger clinical implementation, combined with quality performance information, will give more insight on the relevance of the results shown in this study.

Modelo de gestión de costes medioambientales para el sector petroquímico venezolano

El crecimiento económico ha producido mejoras en el nivel de vida de la población que muchas veces tienen efectos medioambientales negativos en el largo plazo. Ante esta problemática, surge la necesidad a nivel empresarial de enmarcarse en un modelo de desarrollo sostenible que combine los objetivos de crecimiento económico con los de protección medioambiental. Esta situación puede representar altos costes para las empresas del sector petroquímico venezolano, debido al elevado riesgo de sus operaciones y al conjunto de regulaciones legales vigentes en materia medioambiental. Por lo tanto, el objetivo de la presente investigación ha sido proponer un modelo para la gestión de costes medioambientales de dicho sector fundamentado en la ecoeficiencia. Se planteó una investigación proyectiva, desde un enfoque holístico. Se utilizó un diseño de investigación univariable, transeccional contemporáneo, de fuente mixta. Univariable, porque se enfoca en la gestión de costes medioambientales como único evento a modificar. Transeccional contemporáneo, porque el evento se estudia en la actualidad y la medición de los datos se realiza en un solo momento. De fuente mixta, porque se combinó un diseño documental con un diseño de campo. Se utilizó un diseño documental para el análisis comparativo de las normativas de registro y control de costes medioambientales propuestas por organismos internacionales, mediante la aplicación de una matriz de análisis de categorías emergentes. Para el diagnóstico de la gestión de costes medioambientales en el sector petroquímico venezolano, se utilizó un diseño de campo en las empresas del sector que operan en la región zuliana. Para ello se aplicó un cuestionario con 100 ítems en escala Likert y 6 preguntas de opción múltiple. Dicho cuestionario fue validado mediante la revisión de expertos y se determinó su confiablidad a través del coeficiente alfa de Cronbach. Los resultados muestran que los principales asuntos tratados por las normativas analizadas pueden agruparse en seis temas: alcance de la contabilidad de gestión medioambiental, clasificación, tratamiento contable, asignación, informes de costes medioambientales e indicadores de gestión. Se evidenció que las guías de aplicación de la contabilidad de gestión medioambiental abordan todos los temas identificados pero no hay uniformidad en los criterios asumidos. Por el contrario, las normativas en el ámbito de la contabilidad financiera consideran principalmente los aspectos relacionados con el tratamiento contable de los costes medioambientales y su inclusión en los estados financieros. En cuanto a la gestión de costes medioambientales que realizan las empresas del sector petroquímico venezolano, se evidenció su limitación por la escasa consideración de criterios de ecoeficiencia y la poca aplicación de herramientas de contabilidad de gestión, que dificultan la determinación y el control de costes medioambientales. Tomando como base los resultados obtenidos, se diseñó el modelo de Gestión de Costes Medioambientales Ecoeficiente (GCME). Dicho modelo plantea como deben incorporarse los criterios de ecoeficiencia y las herramientas de contabilidad de gestión medioambiental para la planificación, coordinación y control en la gestión de costes medioambientales. Se plantea que estas etapas deben desarrollarse permanentemente para asegurar la mejora continua del proceso y su adaptación a los cambios tecnológicos y a las regulaciones legales. Se hace énfasis en las directrices que deben seguir las empresas del sector petroquímico venezolano para la aplicación del modelo GCME. Sin embargo, por su generalidad y adaptación a las Normas Internacionales de Contabilidad vigentes en Venezuela, dicho modelo es aplicable a diversos sectores industriales que requieran mejorar su desempeño económico-medioambiental. ABSTRACT Economic growth has led to improvements in the standard of living of the population that often have negative environmental effects over the long term. Faced with this problem, at the enterprise-level, the need to be framed in a sustainable development model that combines the goals of economic growth with environmental protection arises. This situation may represent high costs for the Venezuelan petrochemical companies due to the high risk of their operations and to all the applicable legal regulations on environmental matters. Therefore, this research aims to propose a model for the environmental costs management of these companies based on eco-efficiency. A projective research was performed from a holistic approach. An univariate, contemporary cross-sectional and mixed source research design was used. It is univariate, because it focuses on environmental costs management as the single event to change. It is contemporary cross-sectional, because the event is currently studied and the data measurement is performed in a single moment. It relies on mixed source, because it combines a documentary design with a field design. A documentary design was used for the comparative analysis of the standards of registration and control of environmental costs proposed by international organizations, by applying an analysis matrix of emerging categories. For the diagnosis of the environmental costs management in the Venezuelan petrochemical industry, a field design was applied in the companies that operate in the Zulia region. A questionnaire with 100 items on a Likert scale and 6 multiple-choice questions was used. The questionnaire was validated by peer review and internal consistency reliability was determined using Cronbach's alpha coefficient. The results show that the main issues addressed in the analyzed regulations can be grouped into six themes: scope of environmental management accounting, classification, accounting, allocation, reporting of environmental costs and performance indicators. It was evident that implementation guides of environmental management accounting address all issues identified but there is no uniformity in the assumed criteria. Meanwhile, regulations in the financial accounting field mainly consider aspects related to the accounting treatment of environmental costs and their inclusion in the financial statements. Regarding the environmental costs management performed by Venezuelan petrochemical companies, its limitations were made evident by the low status of eco-efficiency criteria and insufficient application of management accounting tools, which hinder the identification and control of environmental costs. Based on the results, the model of eco-efficient environmental costs management (EECM) was designed. This model indicates how eco-efficiency criteria and tools of environmental management accounting for planning, coordination and control in the environmental costs management should be incorporated. It argues that these stages must be continually developed to ensure a continuous process improvement and its adaptation to technological and legal regulatory changes. The guidelines which the Venezuelan petrochemical companies should follow for the EECM model application have been emphasized. However, due to its generality and adaptation to the International Accounting Standards enforced in Venezuela, this model is applicable to various industries that require an improvement of their economic and environmental performance.

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

Background The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons’ psychomotor skills. Methods Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand–eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach’s α test. Results Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. Conclusions EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons.