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Max Olesevich

Publications and source records attributed to Max Olesevich.

2 recordsLinked to original sources
PubMed2005

Validation of a flexible endoscopy simulator.

BACKGROUND: Virtual reality (VR) simulation is a rapidly proliferating adjunct of surgical training. Numerous devices have evolved as educational tools in a variety of fields. Whether these tools can be used for validation of physicians' skills has yet to be determined. The objective of this study was to determine whether the GI Mentor (Simbionix, Lod, Israel) flexible endoscopy simulator construct could distinguish experienced endoscopists from beginners. METHODS: Seventy-five surgical attendings, fellows, and residents were recruited for participation in the study. Two cohorts were used and these groups were selected from 2 separate scientific sessions. Participants completed a standardized questionnaire documenting their endoscopic training and experience. Physicians subsequently were designated as experienced or beginner after their endoscopic training and experience were evaluated. All participants completed 1 of 2 colonoscopic simulations. The GI Mentor objectively evaluated performance on the basis of programmed data points, including the time to reach the cecum, the percentage of mucosa visualized, the completed polypectomy rate, the percentage of time spent in clear view through the lumen, the percentage of time that the patient was in pain, and overall efficiency. RESULTS: In both simulations, experienced endoscopists were more efficient than beginners (.32%/s vs. .26%/s, P=.02; and .53%/s vs. .37%/s, P=.03) and achieved a greater polypectomy rate (78% vs. 43%, P=.03; and 87% vs. 48%, P=.01). Furthermore, experienced endoscopists visualized more of the colonic surface (86% vs. 82%, P=.02) and spent a greater proportion of the time in clear view of the lumen (55% vs. 47%, P=.05) than beginners completing the first simulation. In the second simulation, experienced participants reached the cecum more rapidly than beginners (175 vs. 262 s, P=.01). CONCLUSIONS: The G1 Mentor VR colonoscopy construct appears valid. Significant performance differences were shown between the experienced and beginner cohorts. The beginner participants in this study were all physicians with some degree of endoscopic experience. Therefore, the G1 Mentor distinguished endoscopists of varying experience and exposure. Further validation studies are needed to evaluate the breadth of programs inherent to this simulator and to determine whether it may be used in the future for qualification and certification purposes.

Clinical Competence↗
PubMed2005

Gastroschisis revisited: role of intraoperative measurement of abdominal pressure.

BACKGROUND: Animal studies have shown that visceral circulation is well preserved when intraabdominal pressure does not exceed 20 mm Hg. Our aim was to analyze the outcomes of a series of infants with gastroschisis whose surgical management was directed by the intraoperative measurement of bladder pressure. METHODS: Forty-two neonates with gastroschisis were surgically managed using intraoperative measurement of bladder pressure at a tertiary care center between July 31, 1992, and March 20, 2004, and their outcome was evaluated. Primary closure with or without prosthetic material was performed when pressures measured 20 mm Hg or less. Delayed closure using a silon pouch was performed when pressures measured more than 20 mm Hg. Categorical variables were analyzed including mode of delivery, associated anomalies, type of closure, complications, and mortality. Continuous variables were analyzed including gestational age, birth weight, bladder pressure, time to full feeds, and length of hospital stay. Categorical and continuous variables for both groups were compared using Fisher's Exact and Wilcoxon's rank-sum tests, respectively, and a significance level of .05 was used. Preapproval of this study was obtained from the Institutional Review Board (No. 6690). RESULTS: Thirty-three (79%) neonates with a mean bladder pressure of 16 mm Hg underwent primary closure and 9 neonates with a mean bladder pressure of 27 mm Hg underwent delayed closure with a silon pouch that was not spring loaded ( P < .03). Patients treated with primary closure had faster return to full feeds and significantly shorter hospital length of stay compared with patients treated by delayed closure ( P = .04). Surgical morbidity and mortality was nil in patients after primary closure. One patient with total abdominal evisceration died during attempted delayed closure and another patient required reoperation for bowel necrosis after delayed closure. CONCLUSION: Primary closure was safely accomplished in 100% of neonates with gastroschisis whose bladder pressure measured 20 mm Hg or less. Further, this group of patients had a faster return to full feeds and a significantly shorter hospital length of stay compared with neonates who required delayed closure.

Abnormalities, Multiple↗