PubMed Health⌕ Search

Biomedical subjects

J Hance

Publications and source records attributed to J Hance.

8 recordsLinked to original sources
PubMed2006

Technical skills examination for general surgical trainees.

BACKGROUND: The technical skills of surgical trainees are difficult to assess and compare objectively. This study involved a structured, multistation, technical skills examination that enables the stratification of surgical trainees. METHODS: Twenty-two surgeons (five basic surgical trainees, eight junior specialist trainees, four senior specialist trainees and five consultants) participated in the study. All undertook a five-station technical skills examination consisting of three synthetic simulations (bowel anastomosis, vascular anastomosis, saphenofemoral dissection) and two virtual reality-based (flexible sigmoidoscopy and laparoscopy) assessment stations. Video-based analyses and in-built computer scoring were used to measure each surgeon's performance. The mean rank was determined for each variable, and the sum of the mean ranks produced a total score. RESULTS: There was a significant improvement in overall performance with increasing seniority (P<0.001). Significant differences were observed between basic surgical trainees and junior specialist trainees (P=0.019), and between junior and senior specialist trainees (P=0.048), but not between senior trainees and consultants. CONCLUSION: This examination successfully differentiated surgical skill, both between surgeons with different grades of experience and within the target study group of specialist trainees. The examination is feasible in terms of the timeframe needed to complete tasks, cost, and efficiency in performing video-based assessments.

Clinical Competence↗
PubMed2004

Robot-assisted laparoscopic Heller cardiomyotomy: preliminary UK results.

BACKGROUND/AIM: Laparoscopic Heller cardiomyotomy is an established modality in the surgical treatment of patients having achalasia cardia. We present our initial experience in robot-assisted laparoscopic Heller cardiomyotomy without addition of an antireflux procedure and discuss the relative merits and disadvantages of the procedure. PATIENTS AND METHODS: Five patients underwent robot-assisted laparoscopic Heller cardiomyotomy between August 2001 and October 2002. The diagnosis had been confirmed by radiology and manometry in all patients prior to surgery. RESULTS: All procedures were completed successfully using the robotic system, without conversion to open procedure. Mucosal perforation occurred in 1 patient and was sutured robotically. The average operative time was 114.8 (range 65-160) min which is comparable to laparoscopic procedures. After a mean follow-up period of 9.4 (range 3-17) months, 4 patients remained completely asymptomatic, and 1 patient has benefited from symptomatic improvement. CONCLUSIONS: The enhanced dexterity and the high-quality three-dimensional vision available with robot-assisted surgery make the application of this technology highly suitable for Heller cardiomyotomy. The minimal lateral and posterior dissection due to the wristed instruments avoids the need for an antireflux procedure.

Adult↗
PubMed2004

Robotics in colorectal surgery.

Minimally invasive surgery has been shown to offer many advantages to general surgical patients but has not been widely adopted for colorectal disease. Initial fears surrounding the oncological safety of laparoscopic colectomies have largely subsided but the technical challenges still remain. Surgical robots or telemanipulators present the laparoscopic surgeon with unrivaled dexterity and vision, which may allow colonic resections to be completed with greater ease. Although initial studies suggest promising results using currently available systems, it will take further time for patient benefits to be proven, therefore justifying the greater expense of operating with this new technology.

Colonic Diseases↗
PubMed2004

Evaluation of the benefit of VR simulation in a multi-media web-based educational tool.

WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality multimedia learning materials with VR simulation. The aim of this study was to evaluate the benefit of the VR simulation on the learning of procedure based psychomotor skills. Subjects were divided into three groups. The group that used the entire package including the VR simulation were superior to the group that used only the multimedia component in terms of the their procedural skills in the post-training assessment. Both groups performed better than the controls.

Computer-Assisted Instruction↗
PubMed2000

The influence of early and frequent use of marijuana on the risk of desistance and of progression to marijuana-related harm.

BACKGROUND: A significant minority of lifetime marijuana users will eventually receive a diagnosis of abuse or dependence. Yet little is known regarding the effect of age at onset and frequency of lifetime marijuana use on desistance from use and on progression to marijuana disorders. METHODS: To address this issue, data were obtained from a community sample of 2,729 lifetime marijuana users participating in the Ontario Mental Health Supplement. RESULTS: Early and frequent lifetime marijuana use was associated with highly persistent use and rapid progression to marijuana-related harm. Multivariate analyses revealed a monotonic increase in the risk of desistance with less frequent categories of use and later ages of onset. Results also indicated a threshold of use (100-199 times) associated with an elevated risk of developing marijuana disorders. A lower threshold of risk for marijuana problems was observed for females (50-99 times). CONCLUSIONS: Early and frequent marijuana use are potent risk factors for prolonging desistance and hastening marijuana-related harm. Required are prevention programs aimed at delaying the onset of first use as well as harm reduction strategies that encourage cessation or reduced levels of consumption among those already using.

Adolescent↗