Displaying all 11 publications

  1. Sinha NK, Bhardwaj A
    Clin Orthop Surg, 2019 12;11(4):495.
    PMID: 31788175 DOI: 10.4055/cios.2019.11.4.495
    Matched MeSH terms: Learning Curve
  2. Foo, Sze-yeng, Raja Maznah Raja Hussain
    To help adults learners stay competitive in the changing work environments of the 21st century, the teaching and learning of adult learners ought to transition from the traditional didactic school of education to embrace self-directed and social forms of learning. This study proposes a conceptual framework of a mediated activity system in developing the e-socioconstructivist learning environment (eSCLE); which is a learner-centred environment incorporating the design of a physical and virtual learning space conducive for constructing knowledge and building upon existing knowledge in collaboration with others. The design of the eSCLE is a preliminary research attempt to develop instructional learning environments that reflect the unstructured seamless nature of lifelong self-directed learning. It was conducted among a cohort of Master of Instructional Technology (MIT) students enrolled in the Instructional Design and Development (IDD) Course in a local Higher Institution of Learning. Findings from survey questionnaires, content analysis, observation and interview reveal systemic tensions faced by learners in self-directing their learning in the eSCLE where it is suggested that appropriate balance and discretion in managing conflicting situations is needed. The integration of web-based technology is found to be able to scaffold self-directed learning as collaborative mediating tools where functional roles of both instructor and learner-determined web tools enable self-directed actions. Finally, the designed eSCLE is able to facilitate the development of self-directed learning as learners transition through various self-directed learning phases in a steep learning curve, towards continuous lifelong learning.
    Matched MeSH terms: Learning Curve
  3. Adlin Dasima, A.K., Nadia Hanom, I., Siti Aznida, A.K., Rusnaini, M.K., Mohd Fahmi, Z., Mohd Nazir, M.S., et al.
    This is our first experience in providing general anaesthesia for robotic-assisted thyroidectomy (RAT). It is rather a
    new experience for our anaesthetic team and few issues should be addressed. The conduct of RAT must be fully
    understood and familiarized as it may present with few challenges for the anaesthesiologists. The key point of
    success during this learning curve period is the importance of teamwork between the anaesthesiologists and the
    operating surgeons. The specific anaesthetic challenges include limited access to the patient post-docking of the
    robot, the need of extra precautions of the anaesthetic circuit and IV line connections, a vigilant anaesthesiologists
    and options for postoperative pain relief.
    Matched MeSH terms: Learning Curve
  4. Teoh JY, Cho CL, Wei Y, Isotani S, Tiong HY, Ong TA, et al.
    Andrologia, 2020 Sep;52(8):e13708.
    PMID: 32557751 DOI: 10.1111/and.13708
    Anatomical endoscopic enucleation of the prostate has been proposed as a potentially superior benign prostatic hyperplasia surgery than conventional transurethral resection of prostate. However, the learning curve of the procedure is steep, hence limiting its generalisability worldwide. In order to overcome the learning curve, a proper surgical training is extremely important. This review article discussed about various aspects of surgical training in anatomical endoscopic enucleation of the prostate. In summary, no matter what surgical technique or energy modality you use, the principle of anatomical enucleation should be followed. When one starts to perform prostate enucleation, a 50 to 80 g prostate appears to be the 'best case' to begin with. Mentorship is extremely important to shorten the learning curve and to prevent drastic complications from the procedure. A proficiency-based progression training programme with the use of simulation and training models should be the best way to teach and learn about prostate enucleation. Enucleation ratio efficacy is the preferred measure for assessing skill level and learning curve of prostate enucleation. Morcellation efficiency is commonly used to assess morcellation performance, but the importance of safety rather than efficiency must be emphasised.
    Matched MeSH terms: Learning Curve
  5. Salowi MA, Choong YF, Goh PP, Ismail M, Lim TO
    Br J Ophthalmol, 2010 Apr;94(4):445-9.
    PMID: 19951939 DOI: 10.1136/bjo.2009.163063
    AIMS: To apply cumulative sum (CUSUM) in monitoring performance of surgeons in cataract surgery and to evaluate the response of performance to intervention.
    METHOD: A CUSUM analysis was applied to 80 phacoemulsification performed by three ophthalmic trainees and one consultant, for the occurrence of posterior capsular rupture and postoperative refracted vision of worse than 6/12 among patients without pre-existing ocular comorbidity. The CUSUM score of each consecutive procedure performed by an individual surgeon was calculated and charted on CUSUM chart. When trainees' CUSUM charts showed an unacceptable level of performance, their supervisors would give feedback and impose closer monitoring of subsequent surgeries.
    RESULTS: CUSUM charts of the trainees demonstrated an initial upward followed by flattening trend. This reflects learning curves in their process of acquiring competency in phacoemulsification. In contrast, the consultant showed a flat curve indicating an ongoing maintenance of competence.
    CONCLUSION: The CUSUM analysis is able to monitor and promptly detect adverse events and trends of unacceptable outcomes in cataract surgery. This objective and dynamic monitoring makes CUSUM a useful audit tool for individual surgeons, but more so for busy consultants who need to supervise trainees.
    Matched MeSH terms: Learning Curve*
  6. Waran V, Narayanan V, Karuppiah R, Pancharatnam D, Chandran H, Raman R, et al.
    J Surg Educ, 2014 Mar-Apr;71(2):193-7.
    PMID: 24602709 DOI: 10.1016/j.jsurg.2013.08.010
    The traditionally accepted form of training is direct supervision by an expert; however, modern trends in medicine have made this progressively more difficult to achieve. A 3-dimensional printer makes it possible to convert patients imaging data into accurate models, thus allowing the possibility to reproduce models with pathology. This enables a large number of trainees to be trained simultaneously using realistic models simulating actual neurosurgical procedures. The aim of this study was to assess the usefulness of these models in training surgeons to perform standard procedures that require complex techniques and equipment.
    Matched MeSH terms: Learning Curve
  7. Siow, LR, Naresh G, Nik Ritza Kosai, Harunarashid H, Sutton, PA, Zainal AA
    The incidence of varicose veins and the need for treatment has shown a tremendous increase over the years. Debilitating venous ulcers and dragging edemas of the lower limb with overall improvement in cosmetic results and availability of endovenous procedures has brought many patients forward for treatment. Continuous-wave handheld Doppler usage is limited by its diagnostic capabilities, thus the need to determine its real effectiveness. Benefits of using hand-held dopplers lies in its rapidity in assessment of patients, it's low running cost and short learning curve. This is important as duplex ultrasounds are not readily available in district hospitals. This study aims to determine the clinical effectiveness of hand-held continuous wave dopplers in the local setting especially in primary uncomplicated varicose articles veins. All electively referred patients with primary uncomplicated varicose veins who were referred to the Varicose Vein Clinic were evaluated with continuous-wave handheld Doppler (CWD) and duplex ultrasound (DUS) examination. The study duration was from the 1st of July to 31st of August 2013 (2 months). All patients in the study were independently evaluated with CWD and DUS in the clinic on the same day after adequate rest time. DUS was taken as the gold standard for evaluation of CWD specificity and sensitivity. The Chi-square and T-test was used to test for statistical significance. A total of 41 patients were evaluated in this study. The specificity of CWD when compared to DUS for diagnosing Sapheno-femoral junction (SFJ) was 100% and at the Sapheno-popliteal junction (SPJ) was 87%. Meanwhile sensitivity of CWD for SFJ was 75% and SPJ was 60%. The examination time with CWD was significantly faster than when compared with DUS examination with significant faster tracing times that can be achieved with CWD. CWD also significantly shorter reflux times when compared to DUS. Continuous-wave handheld doppler proves to be an indispensable clinical tool in the evaluation of SFJ and SPJ reflux in varicose veins. CWD assessment in this study was shown to be equal if not better for evaluating reflux when compared to DUS assessment for SFJ reflux. Main advantages for CWD also lie in its low running cost, rapidity in assessment and short learning curve when compared to duplex ultrasound examinations.
    Matched MeSH terms: Learning Curve
  8. Ariffin MHM, Ibrahim K, Baharudin A, Tamil AM
    Asian spine journal, 2019 Oct 15.
    PMID: 31608611 DOI: 10.31616/asj.2019.0075
    Study Design: Prospective observational study (n=74).

    Purpose: To evaluate the learning curve for exoscope and three-dimensional (3D) 4K hybrid visualization in terms of operating time, advantages, disadvantages, and surgical complications in tubular-access minimally invasive spine surgery (MISS) and to assess surgeon satisfaction with image quality, ergonomics, and ability to perform target site treatment.

    Overview of Literature: Working through tubular retractors poses a challenge. The extreme angulations during microsurgical decompression, especially contralateral decompression, require surgeons to work non-ergonomically. An exoscope allows surgeons to work ergonomically and independently of the microscope oculars as visualizations are now provided by large 3D 4K monitors. However, the value and efficacy of solely depending on an exoscope and 3D 4K monitors during microsurgical work are still unknown.

    Methods: Seventy-four patients (99 levels) underwent trans-tubular MISS between March 2018 and January 2019. Five patients were excluded: one had pyogenic discitis, two had revisions, and two were trans-tubular transoral. In total, we analyzed 69 for operating time, blood loss, and complications. The learning curve graph was plotted using the surgical time for each procedure. Surgeons were asked to rate their satisfaction with image quality, ability to maintain ergonomic posture, and efficient target site treatment.

    Results: For tubular microdiscectomy, the operating time plateaued after six cases, and for tubular decompression and minimally invasive transforaminal lumbar interbody fusion, the operating time plateaued after nine cases. Mean operating time was significantly reduced after the plateau. Complications included four cases of dural tear. All patients improved symptomatically, and there were no postoperative neurological deficits.

    Conclusions: Use of the exoscope has a short learning curve. Surgeons benefit from improved ergonomic posture during surgery, and resident teaching appears to be good. The only drawback is the need to rearrange the operating table setup. Complications were comparable to those when using the surgical microscope. An exoscope with hybrid digital visualization provides excellent visualization, depth perception, clarity, and precision target site treatment.

    Matched MeSH terms: Learning Curve
  9. Park JH, Lee J, Hakim NA, Kim HY, Kang SW, Jeong JJ, et al.
    Head Neck, 2015 Dec;37(12):1705-11.
    PMID: 24986508 DOI: 10.1002/hed.23824
    This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.
    Matched MeSH terms: Learning Curve*
  10. Leow VM, Faizah MS, Mohd Sharifudin S, Letchumanan VP, Yang KF, Manisekar KS
    Med J Malaysia, 2014 Jun;69(3):129-32.
    PMID: 25326354 MyJurnal
    OBJECTIVE: Conventional laparoscopic cholecystectomy (LC) involves the use of four ports, but the number of ports has gradually been reduced to one for cosmetic reasons. however, single-incision LC is technically demanding, and there is a substantial learning curve associated with its successful application. The aim of this clinical study was to evaluate the safety and feasibility of a less demanding alternative LC technique with a faster learning curve.

    METHODS: This prospective descriptive study was performed from September 2009 to February 2011 at Sultanah Bahiyah hospital in Kedah, Malaysia. A total of 58 patients underwent two-incision threeport laparoscopic cholecystectomy (TILC), which was performed by the senior consultant hepato-pancreato-biliary surgeon and two hepato-pancreato-biliary trainees. Study end points included operative time, postoperative pain, length of hospital stay and early postoperative complications. The follow-up period was 4 weeks.

    RESULTS: The overall operative time taken was 44 ± 18 minutes. none of the patients had major complication or incisional hernia postoperatively. All but one of the patients were discharged within 24 h. nonsteroidal anti-inflammatory drugs were the main postoperative analgesic used.

    CONCLUSION: TILC is feasible and safe cholecystectomy technique.
    Matched MeSH terms: Learning Curve
  11. Vaiyapuri GR, Han HC, Lee LC, Tseng LA, Wong HF
    Int Urogynecol J, 2011 Jul;22(7):869-77.
    PMID: 21479713 DOI: 10.1007/s00192-011-1400-9
    INTRODUCTION AND HYPOTHESIS: This retrospective study reports the 1-year outcome in women who underwent mesh-augmented Prolift surgery performed from 2006 to 2008. There were a total of 254 patients, with 128, 106 and 20 patients receiving total, anterior and posterior Prolift, respectively.

    METHODS: Incidence of thigh pain was lower in 2008 compared to 2006 and 2007 (p < 0.0001). The percentage of patients requiring blood transfusions (p = 0.09), duration of IDC ≥ 7 days (p = 0.27), wound dehiscence and re-operation rate were lower in 2008 in contrast to 2006 and 2007 (p = 0.43). Only 209 patients (82.3%) were available for review at 1 year. There were two (1.0%) cases of recurrent vault prolapse.

    RESULTS: The subjective and objective cure rates at 1 year after this mesh implant surgery in 2006, 2007 and 2008 were 92.1% and 92.1%; 97.0% and 92.4% and 100% and 97%, respectively. The mesh erosion rate was remarkably lower in 2008 as compared to 2007 and 2006 (p < 0.001).

    CONCLUSIONS: This synthetic mesh-augmented implant surgery is effective and safe, and surgical outcome appears related to the learning curve of the surgeon.

    Matched MeSH terms: Learning Curve
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