Dankelman, J.

A literature review on flow-rate variability in neonatal IV therapy (Article)

2012-10-16T00:00:00Z

Aim: To provide an overview of factors influencing the flow rate in intravenous (IV) therapy for newborns. Methods: We conducted a review of the literature from 1980 to 2011 in PubMed and Web of Knowledge. Articles focusing on flow-rate variability and possible complications due to flow-rate variability were included. Results: Forty-one articles were selected for this review. IV therapy in (preterm) neonates is prone to significant start-up delays and flow-rate variability. The sudden changes in the volume delivered to (preterm) neonates may have serious consequences. Low preprogrammed flow rates, total compliance, and volume of the IV administration set, the presence or absence of antisiphon valves or inline filters and the vertical displacement of syringe pumps all contribute to flow-rate variability in IV therapy for neonates. Conclusions: Flow-rate variability in IV therapy and its clinical relevance are due to the preprogrammed flow rate, the hydrostatic pressure changes, the complete IV administration set compliance and the type of substances supplied to the patient. To improve IV therapy, the internal compliance of the complete IV administration set should be minimized and the highest possible preprogrammed flow rate should be used in combination with small syringes and low-resistance valves.

Implications of the law on video recording in clinical practice (Article)

2012-10-01T00:00:00Z

Background: Technological developments allow for a variety of applications of video recording in health care, including endoscopic procedures. Although the value of video registration is recognized, medicolegal concerns regarding the privacy of patients and professionals are growing. A clear understanding of the legal framework is lacking. Therefore, this research aims to provide insight into the juridical position of patients and professionals regarding video recording in health care practice. Methods: Jurisprudence was searched to exemplify legislation on video recording in health care. In addition, legislation was translated for different applications of video in health care found in the literature. Results: Three principles in Western law are relevant for video recording in health care practice: (1) regulations on privacy regarding personal data, which apply to the gathering and processing of video data in health care settings; (2) the patient record, in which video data can be stored; and (3) professional secrecy, which protects the privacy of patients including video data. Practical implementation of these principles in video recording in health care does not exist. Conclusion: Practical regulations on video recording in health care for different specifically defined purposes are needed. Innovations in video capture technology that enable video data to be made anonymous automatically can contribute to protection for the privacy of all the people involved.

An observational study to quantify manual adjustments of the inspired oxygen fraction in extremely low birth weight infants (Article)

2012-03-01T00:00:00Z

Aim: To quantify manual fraction of inspired oxygen (FiO2) adjustments performed by caregivers in extremely low birth weight (ELBW; ≤1000 g) infants, in relation to oxygen saturation (SpO) and bedside care. Methods: In a single-centre study, FiO, SpO and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO adjustments, was performed. Results: Twelve ELWB infants were included. Total recording time was 726 h. FiO was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and -3% (-1% to -65%), respectively. Wide variation of FiO adjustments for equal levels of SpO was observed in all included infants. One hundred and twenty-six of 136 FiO adjustments with a step size âyen 15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO was >21%, alarm limits for SpO were set according to protocol (88-94%) in 64% of the time. Within these periods, SpO was >94% for 30% and <88% for 16% of the time. Conclusions: Manual FiO adjustments varied widely in frequency and step size. Deep desaturations and large FiO adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device. © 2011 The Author(s)/Acta Pædiatrica

Evaluation of a new surgical light source for difficult visibility procedures (Article)

2011-09-01T00:00:00Z

A new lighting device for open surgery of difficult access wounds was designed: the Extender add-on. The performance of the Extender is evaluated and compared with the conventional solutions used in the operating room (OR) on illumination quality. A cylindrical setup was built to measure the distribution of light in a simulated pelvic wound. The light was provided by a head-mounted light, an OR light, and a pair of Extender prototypes. The results showed that the Extender prototypes provided 12.2 lumens inside the wound, whereas the head-mounted light gave 5.7 lumens. The Extenders provided smoothly angular distributed light from 0° to 180°, whereas the head-mounted light and OR light only provided light from 115° to 180°. The Extender prototypes had a promising performance in terms of light distribution. It is expected that a more accurately produced Extender will increase performance in terms of illumination quantity and illumination distribution smoothness even further.

Objective classification of residents based on their psychomotor laparoscopic skills (Article)

2010-03-01T00:00:00Z

Background From the clinical point of view, it is important to recognize residents' level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as "experienced," "intermediates," or "novices" according to their technical abilities. This study introduces a classification method for recognizing residents' level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone. Methods For this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10-100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out cross-validation. Results Of 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices. Conclusions The proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers.

Serious gaming and voluntary laparoscopic skills training: A multicenter study (Article)

2009-12-30T00:00:00Z

This study assesses the issue of voluntary training of a standardized online competition (serious gaming) between surgical residents. Surgical residents were invited to join a competition on a virtual reality (VR) simulator for laparoscopic motor skills. A final score was calculated based on the task performance of three exercises and was presented to all the participants through an online database on the Internet. The resident with the best score would win a lap-top computer. During three months, 31 individuals from seven hospitals participated (22 surgical residents, 3 surgeons and six interns). A total of 777 scores were logged in the database. In order to out-perform others some participants scheduled themselves voluntarily for additional training. More attempts correlated with higher scores. The serious gaming concept may enhance voluntary skills training. Online data capturing could facilitate monitoring of skills progression in surgical trainees and enhance (VR) simulator validation.

Incorporation of proficiency criteria for basic laparoscopic skills training: How does it work? (Article)

2008-12-01T00:00:00Z

Background: It is desirable that surgical trainees are proficient in basic laparoscopic motor skills (eye-hand coordination). The present study evaluated the use of predefined proficiency criteria on a basic virtual reality (VR) simulator in preparation for a laparoscopic course on animal models. Methods: Twenty-eight surgical trainees who enrolled for a basic laparoscopic course were trained on a basic (VR) simulator until their performance met predefined criteria. Two different criteria were defined, based on the performance of experienced laparoscopic surgeons on the simulator. In the first group (n = 10), the criteria were set at the 75th percentile of the laparoscopic surgeons' performance on the simulator and in the second group, at the 50th percentile (n = 18). Training time and number of attempts needed until the performance criteria were met were measured. Results: In the first group, training time needed to pass the test ranged from 29 to 77 min (median: 63 min) with a range of 43-90 attempts (median 61 attempts). In the second group, training time ranged from 38 to 180 min (median 80 min) with a range of 55-233 attempts (median 95 attempts). Experience with assisting or performing laparoscopic procedures varied widely and was not correlated with the training time and number of attempts needed to pass the criteria. Conclusions: The performance criteria for training laparoscopic motor skills on a (VR) simulator resulted in wide variation between surgical trainees in time and number of attempts needed to pass the criteria. This demands training courses with a flexible time span tailored to the individual level of the trainee.

Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial (Article)

2008-07-01T00:00:00Z

Background: Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery, requiring extensive training. The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality (VR) simulator to a realistic laparoscopic environment. Methods: Twenty surgical trainees underwent basic eye-hand coordination training on a VR simulator (SIMENDO, DelltaTech, Delft, the Netherlands) until predefined performance criteria were met. Then, they were randomized into two groups. Group A (the experimental group) received additional training with the knot-tying module on the simulator, during which they had to tie a double laparoscopic knot ten times. Group B (controls) did not receive additional manual training. Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model. Their performance was captured on digital video and coded. Objective analysis parameters were: time taken to tie the knot and number of predefined errors made. Subjective assessments were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale. Results: Trainees in group A (n = 9) were significantly faster than the controls (n = 10), with a median of 262 versus 374 seconds (p = 0.034). Group A made a significantly lower number of errors than the controls (median of 24 versus 36 errors, p = 0.030). Subjective assessments by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups. Conclusion: Surgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls. The VR module is a useful tool to train laparoscopic knot-tying. Opportunities arose to improve simulator-based instruction that might enhance future training.