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Ara Darzi - One of the best experts on this subject based on the ideXlab platform.
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bimodal Assessment of laparoscopic suturing skills construct and concurrent validity
Surgical Endoscopy and Other Interventional Techniques, 2004Co-Authors: Krishna Moorthy, Avril Chang, Y Munz, Aristotelis Dosis, Fernando Bello, Ara DarziAbstract:Background: The Assessment of technical skills should provide objective feedback and judge suitability of progress during training. The aim of this study was to validate two objective Assessment techniques for laparoscopic suturing and demonstrate a correlation between them. Methods: Six experts, seven surgeons skilled in laparoscopic suturing, and 13 with no laparoscopic suturing skills were asked to place two or three intracorporeal sutures on a synthetic suture pad. The latter group was given video-based instructions prior to the execution of the sutures. Ergonomic conditions were standardized for all subjects. The procedures were recorded on videotape and two blinded observers rated the first suture of each subject on a 29-point checklist. A motion analysis system, Imperial College Surgical Assessment Device, was used to assess psychomotor skills. Results: There was a significant difference in the time taken (p = 0.000) and total path length (p = 0.000) per suture across the groups. There were also a significant difference in the total checklist score (p = 0.000) and its individual categories. The was a strong correlation between the total path length and the total checklist score (coefficient, 0.78; p < 0.001). Conclusions: A combination of the motion analysis system and the checklist would make the process of formative feedback during the learning of intracorporeal suturing objective and comprehensive.
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the relationship between motion analysis and surgical technical Assessments
American Journal of Surgery, 2002Co-Authors: Vivek Datta, Avril Chang, Sean Mackay, Ara DarziAbstract:Background: Recent attempts to gain a more objective measure of surgical technical skill include the use of structured checklists and motion analysis of surgeons’ hand movements. We aim to show whether a correlation exists between these two methods of Assessment. Methods: Fifty subjects were recruited from four experience groups in general surgery, ranging from basic surgical trainees to consultants and were assessed performing a standardized laboratory-based task. Motion analysis using the Imperial College Surgical Assessment Device (ICSAD), which measures hand movements and time taken, and the Objective Structured Assessment of Technical Skill (OSATS) technique were used to measure skill. Results: Number of movements made, time taken, and global rating score discriminated between performance and experience group (Kruskal-Wallis, P <0.001, P <0.01, P <0.001, respectively). There was a significant correlation between movements made and global rating score (Spearman coefficient 0.53, P <0.01). Checklist scoring was not an accurate predictor of experience. Conclusions: There is a strong correlation between hand motion analysis using ICSAD and OSATS global rating Assessments in this model.
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the use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory based model
Journal of The American College of Surgeons, 2001Co-Authors: Vivek Datta, Sean Mackay, Mirren Mandalia, Ara DarziAbstract:Abstract BACKGROUND: Technical performance has traditionally been assessed subjectively within the operating theater, with few successful attempts at objective analysis. The Imperial College Surgical Assessment Device (ICSAD) has already been shown to be a valid quantitative measure of dexterity in laparoscopic surgical simulation. We describe its application to the Assessment of open surgical procedures. STUDY DESIGN: Fifty-one participants were recruited from four different levels of general surgical experience: basic surgical trainees (n = 12), junior specialist registrars (n = 13), senior specialist registrars (n = 13), and consultants (n = 13). They completed two tasks: a small bowel anastomosis and a vein patch insertion into an artery. Surgical performance was measured with the Imperial College Surgical Assessment Device, a motion analysis system that measures the number of hand movements made and time taken to complete a task. The four groups were compared statistically using the Kruskal-Wallis test (K-W). Pairwise group comparisons used the Mann-Whitney U test and p values were adjusted for multiple comparisons to determine the statistical significance of these comparisons. RESULTS: Mean values for number of movements and time (secs) for small bowel anastomosis were 2,080/1,236 (basic surgical trainees), 1,673/1,016 (junior specialist registrars), 1,375/862 (senior specialist registrars), and 1,337/782 (consultants), respectively. Comparison of the medians by K-W revealed a p CONCLUSIONS: These findings suggest that hand motion analysis may be an effective objective measure of dexterity in open surgical simulation.
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skill transfer from virtual reality to a real laparoscopic task
Surgical Endoscopy and Other Interventional Techniques, 2001Co-Authors: Jared Torkington, S Smith, B I Rees, Ara DarziAbstract:Background: To validate the usefulness of virtual reality surgical simulators, we investigated the transfer of skills achieved by their use to real tasks. Methods: Thirty medical students underwent a pretest using a real laparoscopic trainer. They were then randomized to the following three groups: group I received no training; group II received training using the Minimal Invasive Surgical Trainer in Virtual Reality (MIST-VR); and group III received training using conventional training exercises. Each group then underwent a posttest. Using the Imperial College Surgical Assessment Device (ICSAD), scores were generated for time taken, distance traveled, number of movements made, and speed of instrument movement. Results: Significant changes between the MIST-VR group (group II) and the conventionally trained group (group III), were observed in the speed of movement of the left hand and the numbers of movements taken by each hand, when compared to the untrained group (group I). Conclusion: The training of novices using MIST-VR yields quantifiable changes in skill that are transferable to a simple real task and are similar to the results achieved with conventional training.
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the role of the basic surgical skills course in the acquisition and retention of laparoscopic skill
Surgical Endoscopy and Other Interventional Techniques, 2001Co-Authors: Jared Torkington, B I Rees, S G T Smith, Ara DarziAbstract:Background: This study assesses the transfer of laparoscopic skills to a group of Basic Surgical Trainees (BST) attending the Basic Surgical Skills (BSS) course. Methods: The virtual reality simulator MIST-VR was used to assess 13 trainees before and after the course and again 3 weeks and 3 months later. Analysis of kinematic data using the Imperial College Surgical Assessment Device gave measures of distance traveled, distance efficiency ratio, time taken, number of errors made, and number of movements made in completing a virtual laparoscopic task. The performance of the group was compared to a control group who underwent no training. Results: All parameters improved significantly after the course, with the exception of distance traveled by the instruments. All outcome measures were significantly improved at 3 weeks. The control group showed a nonsignificant trend toward improvement in all parameters. Conclusions: The Basic Surgical Skills course produces quantifiable improvements in laparoscopic skill that are measurable by MIST-VR. There is a learning effect associated with using MIST-VR alone.
Gabor I Keitner - One of the best experts on this subject based on the ideXlab platform.
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the family Assessment Device an update
Family Process, 2015Co-Authors: Abigail K Mansfield, Gabor I Keitner, Jennifer DealyAbstract:The current study set out to describe family functioning scores of a contemporary community sample, using the Family Assessment Device (FAD), and to compare this to a currently help-seeking sample. The community sample consisted of 151 families who completed the FAD. The help-seeking sample consisted of 46 families who completed the FAD at their first family therapy appointment as part of their standard care at an outpatient family therapy clinic at an urban hospital. Findings suggest that FAD means from the contemporary community sample indicate satisfaction with family functioning, while FAD scores from the help-seeking sample indicate dissatisfaction with family functioning. In addition, the General Functioning scale of the FAD continues to correlate highly with all other FAD scales, except Behavior Control. The cut-off scores for the FAD indicating satisfaction or dissatisfaction by family members with their family functioning continue to be relevant and the FAD continues to be a useful tool to assess family functioning in both clinical and research contexts.
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the evaluation of family functioning by the family Assessment Device a systematic review of studies in adult clinical populations
Family Process, 2015Co-Authors: Laura Staccini, Elena Tomba, Silvana Grandi, Gabor I KeitnerAbstract:A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.
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impact of family functioning on quality of life in patients with psychogenic nonepileptic seizures versus epilepsy
Epilepsia, 2011Co-Authors: Curt W Lafrance, Michael L Alosco, Jennifer D Davis, Geoffrey Tremont, Christine E Ryan, Gabor I KeitnerAbstract:Summary Purpose: To evaluate different contributions of aspects of family functioning (FF) on health-related quality of life (HRQOL) in patients with psychogenic nonepileptic seizures (PNES) versus epileptic seizures (ES). Methods: Forty-five participants with PNES and 32 with ES completed self-report measures of FF (Family Assessment Device; FAD), HRQOL (Quality of Life in Epilepsy-31), and depression (Beck Depression Inventory-II; BDI-II). The FAD is a self-report questionnaire that assesses FF along six dimensions and general functioning. Regression analyses were used to evaluate the contribution of FF to HRQOL above and beyond the effects of disease severity and depression. Key Findings: Mean Family General Functioning fell in the unhealthy range in participants with ES or PNES. On further analysis, male participants in each group endorsed unhealthy levels of FF compared to female participants. Patients with PNES reported poorer HRQOL and greater depressive symptoms compared to ES participants; there were no gender differences in HRQOL. Regression analyses indicated that the FAD Roles subscale predicted reduced HRQOL in patients with PNES after controlling for illness duration, seizure frequency, and depression. After controlling for the same factors, Communication and Affective Involvement subscales scores predicted HRQOL in ES participants. Significance: Family dysfunction was reported in both ES and PNES participants, but greater family dysfunction was experienced by male participants in both groups. Aspects of FF predicted HRQOL in patients with PNES and ES differentially. FF may be an important treatment target to enhance coping in these groups, although the treatments may need to target different aspects of FF in PNES versus ES.
Sam D Hutchings - One of the best experts on this subject based on the ideXlab platform.
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the cytocam video microscope a new method for visualising the microcirculation using incident dark field technology
Clinical Hemorheology and Microcirculation, 2016Co-Authors: Sam D Hutchings, S Watts, E KirkmanAbstract:UNLABELLED We report a new microcirculatory Assessment Device, the Braedius Cytocam, an Incident Dark Field (IDF) video microscope, and compare it with a precursor Device utilising side stream dark field (SDF) imaging. METHODS Time matched measurements were made with both Devices from the sublingual microcirculation of pigs subjected to traumatic injury and hemorrhagic shock at baseline and during a shock phase. Images were analysed for vessel density, microcirculatory flow and image quality. RESULTS There were no differences in density or flow data recorded from the two Devices at baseline [TVD IDF 14.2 ± 2.4/TVD SDF 13.2 ± 2.0, p 0.17] [MFI IDF 3 (2.8-3.0)/MFI SDF 3 (2.9-3.0), p 0.36] or during the shock state [TVD IDF 11.64 ± 3.3/TVD SDF 11.4 ± 4.0 p = 0.98] [MFI IDF 1.9 (0.6-2.7)/MFI SDF 1.7 (0.3-2.6) p 0.55]. Bland and Altman analysis showed no evidence of significant bias. Vessel contrast was significantly better with the IDF Device for both capillaries [17.1 ± 3.9 (IDF) v 3.4 ± 3.6 (SDF), p = 0.0006] and venules [36.1 ± 11.4 (IDF) v 26.4 ± 7.1 (SDF) p 0.014] CONCLUSION The Braedius Cytocam showed comparable vessel detection to a precursor Device during both baseline and low flow (shock) states.
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the cytocam video microscope a new method for visualising the microcirculation using incident dark field idf technology
Intensive Care Medicine Experimental, 2015Co-Authors: Sam D Hutchings, Julia Wendon, S Watts, E KirkmanAbstract:Imaging the microcirculation provides valuable information regarding perfusion in a range of shock states. We report a new microcirculatory Assessment Device, the Braedius Cytocam, an Incident Dark Field (IDF) video microscope, and compare it with the most commonly used precursor Device, the Microvision Microscan which utilises side stream dark field (SDF) imaging.
Stephen R Zubrick - One of the best experts on this subject based on the ideXlab platform.
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reliability and validity of a short version of the general functioning subscale of the mcmaster family Assessment Device
Family Process, 2015Co-Authors: Katrina Boterhoven L De Haan, Jennifer Hafekost, David Lawrence, Michael G Sawyer, Stephen R ZubrickAbstract:The General Functioning 12-item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large-scale population-based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.
Katherine L Tucker - One of the best experts on this subject based on the ideXlab platform.
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family functioning parental psychological distress child behavioural problems socio economic disadvantage and fruit and vegetable consumption among 4 12 year old victorians australia
Health Promotion International, 2011Co-Authors: Andre M N Renzaho, Shiriki K Kumanyika, Katherine L TuckerAbstract:: The aim of this analysis was to assess relationships between family functioning, parental psychological distress, child behaviour difficulties and fruit and vegetable (FV level of family functioning was measured using the McMaster Family Assessment Device-General Functioning Scale and parental psychological distress was measured using the Kessler-6 scale. The mean number of servings consumed per day was 2.2 (95% CI: 2.1, 2.3) for fruit and 2.0 (95% CI: 1.9, 2.1) for vegetables. The proportion of children meeting the minimum daily age-specific recommendation was 87.8% (95% CI: 86.4, 89.1%) for fruit and 36.5% (95% CI: 34.5, 38.5) for vegetables. Children with behaviour difficulties, low levels of prosocial behaviours and from poorly functioning households consumed fewer servings of F&V than children who did not experience any environment stressors or behavioural problems. Although parental psychological distress was not associated with fruit intake, daughters of parents who reported higher levels of psychological distress consumed fewer servings of vegetables than daughters of parents who reported lower levels of psychological distress. Child behavioural problems and family functioning and to some extent parental psychological distress were associated with F&V consumption. Programmes aimed at promoting F&V consumption in children should target those families with children experiencing behavioural problems or poorly functioning households.
