Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

Background: Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation. Aims: To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model. Materials and Methods: One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation. Results: A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined. Conclusion: The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described. © Indian Journal of Dermatology 2013.

Dissection of the Appendix with Ultrasound-Activated Scalpel: An Experimental Study in Pediatric Laparoscopic Appendectomy

Abstract Background: The aim of this study was to examine mechanical, microbiologic, and morphologic changes of the appendicle rim to assess if it is appropriate to dissect the appendix with the ultrasound-activated scalpel (UAS) during laparoscopic appendectomy. Materials and Methods: After laparoscopic resection of the appendix, using conventional Roeder slings, we investigated 50 appendicle rims with an in vitro procedure. The overall time of dissection of the mesoappendix with UAS was noted. Following removal, the appendix was dissected in vitro with the UAS one cme from the resection rim. Seal-burst pressures were recorded. Bacterial cultures of the UAS-resected rim were compared with those of the scissors resected rim. Tissue changes were quantified histologically with hematoxylin and eosin (HE) stains. Results: The average time to dissect the mesoappendix was 228 seconds (25-900). Bacterial culture growths were less in the UAS-resected probes (7 versus 36 positive probes; (p > 0.01). HE-stained tissues revealed mean histologic changes in the lamina propria muscularis externa of 2 mm depth. The seal-burst pressure levels of the appendicle lumen had a mean of 420 mbar. Seal-burst pressures and depths of histologic changes were not dependent on the different stages of appendicitis investigated, gender, or age groups. Seal-burst pressure levels were not related to different depths of tissue changes (P = 0.64). Conclusions: The UAS is a rapid instrument for laparoscopic appendectomy and appears to be safe with respect to stability, sterility and tissue changes. It avoids complex time consuming instrument change manoeuvres and current transmission, which may induce intra- and postoperative complications. Our results suggest that keeping a safety margin of at least 5 mm from the bowel would be sufficient to avoid thermal damage.

Frock paper scissors : a comparative case study

This paper discusses the ways in which synergies across design disciplines can be developed through student engagement on authentic design projects. The paper focuses on a comparative case study where students from the Fashion, and Communication Design discipline areas in the Creative Industries Faculty at Queensland University of Technology (QUT) work on the production of the Frock Paper Scissors magazine and web site. The Frock Paper Scissors magazine has been the focus of assessment in a Fashion and Style Journalism class for the last three years, and for the last two years, students from an Advanced Web Design class have been involved in the production of the accompanying web site, http://frockpapersissors.com/. In this paper we focus on how this authentic assessment task has been integrated into the two design (and communication) classes; discussing the different approaches taken by teaching staff, the challenges faced, and the ways in which student learning outcomes have been improved through interactions between design disciplines. The paper concludes by outlining a set of observations on how to successfully engage students from different design (and creative industries) fields on an authentic design project within their studies.

Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE) : a randomised trial

Background: The two-stage Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) for stage I endometrial cancer (LACE) randomised controlled trial was initiated in 2005. The primary objective of stage 1 was to assess whether TLH results in equivalent or improved QoL up to 6 months after surgery compared to TAH. The primary objective of stage 2 was to test the hypothesis that disease-free survival at 4.5 years is equivalent for TLH and TAH. Results addressing the primary objective of stage 1 of the LACE trial are presented here. Methods: The first 361 LACE participants (TAH n= 142, TLH n=190) were enrolled in the QoL substudy at 19 centres across Australia, New Zealand and Hong Kong, and 332 completed the QoL analysis. Randomisation was performed centrally and independently from other study procedures via a computer generated, web-based system (providing concealment of the next assigned treatment) using stratified permuted blocks of 3 and 6, and assigned patients with histologically confirmed stage 1 endometrioid endometrial adenocarcinoma and ECOG performance status <2 to TLH or TAH stratified by histological grade and study centre. No blinding of patients or study personnel was attempted. QoL was measured at baseline, 1 and 4 weeks (early), and 3 and 6 months (late) after surgery using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The primary endpoint was the difference between the groups in QoL change from baseline at early and late time points (a 5% difference was considered clinically significant). Analysis was performed according to the intention-to-treat principle using generalized estimating equations on differences from baseline for the early and late QoL recovery. The LACE trial is registered with clinicaltrials.gov (NCT00096408) and the Australian New Zealand Clinical Trials Registry (CTRN12606000261516). Patients for both stages of the trial have now been recruited and are being followed up for disease-specific outcomes. Findings: The proportion of missing values at the 5%, 10% 15% and 20% differences in the FACT-G scale was 6% (12/190) in the TLH and 14% (20/142) in the TAH group. There were 8/332 conversions (2.4%, 7 of which were from TLH to TAH). In the early phase of recovery, patients undergoing TLH reported significantly greater improvement of QoL from baseline compared to TAH in all subscales except the emotional and social well-being subscales. Improvements in QoL up to 6 months post-surgery continued to favour TLH except for the emotional and social well-being of the FACT and the visual analogue scale of the EuroQoL five dimensions (EuroQoL-VAS). Length of operating time was significantly longer in the TLH group (138±43 mins), than in the TAH group at (109±34 mins; p=0.001). While the proportion of intraoperative adverse events was similar between the treatment groups (TAH 8/142, 5.6%; TLH 14/190, 7.4%; p=0.55), postoperatively, twice as many patients in the TAH group experienced adverse events of CTC grade 3+ than in the TLH group (33/142, 23.2% and 22/190, 11.6%, respectively; p=0.004). Postoperative serious adverse events occurred more frequently in patients who had a TAH (27/142, 19.0%) than a TLH (15/190, 7.9%) (p=0.002). Interpretation: QoL improvements from baseline during early and later phases of recovery, and the adverse event profile significantly favour TLH compared to TAH for patients treated for Stage I endometrial cancer.

Frock Paper Scissors [website]

Frock Paper Sissors (http://www.frockpaperscissors.com): curated web based fashion work. Research has focussed on creating a professional and ‘real world’ website (available in the international/public arena) while producing a high quality design and journalistic fashion medium. The hard copy Frock Paper Scissors magazine has been the focus of assessment in a Fashion and Style Journalism class for the last five years, and for the last three years, students from an Advanced Web Design class have been involved in the production of the accompanying web site, http://www.frockpapersissors.com. This project researches the ways in which synergies across design disciplines can be developed through student engagement on authentic design projects. The Frock Paper Scissors website is a curated collaboration of work from the Fashion,Journalism, Creative Industries and Communication Design discipline areas in the Creative Industries Faculty at Queensland University of Technology (QUT). Research focusses on how this authentic assessment task has been integrated into the two design (and communication)classes; discussing the different approaches taken by teaching staff, the challenges faced, and the ways in which student learning outcomes have been improved through interactions between design disciplines. The final curated work is a public/international website which successfully displays student work and engages students from different design (and creative industries) fields on an authentic design project within their studies.

Frock Paper Scissors [annual hard copy fashion magazine editions]

The Frock Paper Scissors magazine (and accompanying web site, www.frockpapersissors.com ) has been the focus of assessment in a Fashion and Style Journalism unit from 2006 to 2011 (current). The research has focused on the ways in which synergies across disciplines can be developed through student engagement on authentic projects (with a public audience). Up to 80 students from the Fashion Design, Journalism, Media Communication, Creative Industries, Business, Creative Writing and Communication Design discipline areas in the Creative Industries Faculty at Queensland University of Technology (QUT) work on the content, production, layout and funding for the Frock Paper Scissors magazine (and web site). Research focusses on how this authentic assessment task has been integrated into the classes; discussing the approaches taken by teaching staff, the challenges faced, and the ways in which student learning outcomes have been improved and their career outcomes enhanced. The final output requires staff to curate a professional hard copy fashion magazine(and website) where 5,000 copies are distributed annually throughout south east Queensland, Sydney, Melbourne, London, New York and Amsterdam.

Pass the scissors : consumers close in on the fashion industry

The fashion ecosystem is at boiling point as consumers turn up the heat in all areas of the fashion value, trend and supply chain. While traditionally fashion has been a monologue from designer brand to consumer, new technology and the virtual world has given consumers a voice to engage brands in a conversation to express evolving needs, ideas and feedback. Product customisation is no longer innovative. Successful brands are including customers in the design process and holding conversations ‘with’ them to improve product, manufacturing, sales, distribution, marketing and sustainable business practices. Co-creation and crowd sourcing are integral to any successful business model and designers and manufacturers are supplying the technology or tools for these creative, active, participatory ‘prosumers’. With this collaboration however, there arises a worrying trend for fashion professionals. The ‘design it yourself’, ‘indiepreneur’ who with the combination of technology, the internet, excess manufacturing capacity, crowd funding and the idea of sharing the creative integrity of a product (‘copyleft’ not copyright) is challenging the notion that the fashion supply chain is complex. The passive ‘consumer’ no longer exists. Fashion designers now share the stage with ‘amateur’ creators who are disrupting every activity they touch, while being motivated by profit as well as a quest for originality and innovation. This paper examines the effects this ‘consumer’ engagement is having on traditional fashion models and the fashion supply chain. Crowd sourcing, crowd funding, co-creating, design it yourself, global sourcing, the virtual supply chain, social media, online shopping, group buying, consumer to consumer marketing and retail, and branding the ‘individual’ are indicative of the new consumer-driven fashion models. Consumers now drive the fashion industry - from setting trends, through to creating, producing, selling and marketing product. They can turn up the heat at any time _ and any point _ in the fashion supply chain. They are raising the temperature at each and every stage of the chain, decreasing or eliminating the processes involved: decreasing the risk of fashion obsolescence, quantities for manufacture, complexity of distribution and the consumption of product; eliminating certain stages altogether and limiting the brand as custodians of marketing. Some brands are discovering a new ‘enemy’ – the very people they are trying to sell to. Keywords: fashion supply chain, virtual world, consumer, ‘prosumers’, co-creation, fashion designers

Multisensory integration weightings underlying haptic feedback laparoscopic surgery

"This letter aims to highlight the multisensory integration weighting mechanisms that may account for the results in studies investigating haptic feedback in laparoscopic surgery. The current lack of multisensory theoretical knowledge in laparoscopy is evident, and “a much better understanding of how multimodal displays in virtual environments influence human performance is required” ...publisher website

Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial

Aims: To identify risk factors for major Adverse Events (AEs) and to develop a nomogram to predict the probability of such AEs in individual patients who have surgery for apparent early stage endometrial cancer. Methods: We used data from 753 patients who were randomized to either total laparoscopic hysterectomy or total abdominal hysterectomy in the LACE trial. Serious adverse events that prolonged hospital stay or postoperative adverse events (using common terminology criteria 3+, CTCAE V3) were considered major AEs. We analyzed pre-surgical characteristics that were associated with the risk of developing major AEs by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The six most significant or clinically important variables were included in the nomogram to predict the risk of major AEs within 6 weeks of surgery and the nomogram was internally validated. Results: Overall, 132 (17.5%) patients had at least one major AE. An open surgical approach (laparotomy), higher Charlson’s medical co-morbidities score, moderately differentiated tumours on curettings, higher baseline ECOG score, higher body mass index and low haemoglobin levels were associated with AE and were used in the nomogram. The bootstrap corrected concordance index of the nomogram was 0.63 and it showed good calibration. Conclusions: Six pre-surgical factors independently predicted the risk of major AEs. This research might form the basis to develop risk reduction strategies to minimize the risk of AEs among patients undergoing surgery for apparent early stage endometrial cancer.

Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer : results from a randomised controlled trial

AIM: To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. METHODS: Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6 weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. RESULTS: The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107 min, and median length of hospital stay was 2 and 5 days in the TLH and TAH group, respectively (p<0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006). CONCLUSIONS: Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.

Rock, paper, scissors : reflective practice for design process in the novice landscape architect

We describe a pedagogical approach that addresses challenges in design education for novices. These include an inability to frame new problems and limited-to-no design capability or domain knowledge. Such challenges can reduce student engagement with design practice, cause derivative design solutions as well as the inappropriate simplification of design assignments and assessment criteria by educators. We argue that a curriculum that develops the student’s design process will enable them to deal with the uncertain and dynamic situations that characterise design. We describe how this may be achieved and explain our pedagogical approach in terms of methods from Reflective Practice and theories of abstraction and creativity. We present a landscape architecture unit, recently taught, as an example. It constitutes design exercises that require little domain or design expertise to support the development of conceptual thinking and a design rationale. We show how this approach (a) leveraged the novice’s existing spatial and thinking skills while (b) retaining contextually-rich design situations. Examples of the design exercises taught are described along with samples of student work. The assessment rationale is also presented and explained. Finally, we conclude by reflecting on how this approach relates to innovation, sustainability and other disciplines.