OBJECTIVE:To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign ...indication.
DATA SOURCES:A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted.
METHODS OF STUDY SELECTION:Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data.
TABULATION, INTEGRATION, AND RESULTS:A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30–0.36). Bladder injury (0.24%, 95% CI 0.22–0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07–0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2–2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9–1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3–45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7–29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47–76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3–61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75–95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2–41.7).
CONCLUSION:The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively counseling their patients preoperatively concerning the risks of lower urinary tract injury.
Massive Open Online Courses (MOOCs) allow learning to take place anytime and anywhere with little external monitoring by teachers. Characteristically, highly diverse groups of learners enrolled in ...MOOCs are required to make decisions related to their own learning activities to achieve academic success. Therefore, it is considered important to support self-regulated learning (SRL) strategies and adapt to relevant human factors (e.g., gender, cognitive abilities, prior knowledge). SRL supports have been widely investigated in traditional classroom settings, but little is known about how SRL can be supported in MOOCs. Very few experimental studies have been conducted in MOOCs at present. To fill this gap, this paper presents a systematic review of studies on approaches to support SRL in multiple types of online learning environments and how they address human factors. The 35 studies reviewed show that human factors play an important role in the efficacy of SRL supports. Future studies can use learning analytics to understand learners at a fine-grained level to provide support that best fits individual learners. The objective of the paper is twofold: (a) to inform researchers, designers and teachers about the state of the art of SRL support in online learning environments and MOOCs; (b) to provide suggestions for adaptive self-regulated learning support.
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BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To examine the effect of transversus abdominis plane (TAP) block timing (preoperative or postoperative) on postoperative opioid use (quantified via morphine milligram equivalents; MME) and pain ...scores in patients undergoing minimally invasive hysterectomy for benign indications.
Retrospective, single-institution cohort study SETTING: Academic-affiliated community hospital PATIENTS: A total of 2982 patients were included who underwent a minimally invasive total hysterectomy between January 2018 and December 2022, excluding patients with a malignancy diagnosis, concurrent urogynecological procedure, vaginal hysterectomy, supracervical hysterectomy, or those with baseline narcotic use (opioid use within the 3 months before surgery). Patients were separated into 3 groups: no TAP blocks (n = 1966, 65.9%), preoperative TAP blocks (854, 28.6%), and postoperative TAP blocks (162, 5.4%).
Summary statistics and mixed-effects regression methods were used for data analysis.
There was a statistically significant lower mean use of opioids (MME 43.2 vs 53.9, p = .002) among patients who received a TAP block (either pre or postoperatively) than those who did not receive a block. However, when comparing preoperative vs postoperative patients with TAP block, there was no statistically significant difference in mean opioid use (MME 43.4 vs 42.1, p = .752). There were no differences in postoperative pain scores between patients with and without a TAP block, however, more opioids were required in patients who did not receive a TAP block to achieve the same pain scores as those who did receive a TAP block. There was a statistically significant shorter time to discharge for TAP versus patients without TAP block(median 5.5 vs 6.3 hours, p ≤ .001) as well as preoperative versus postoperative patients with TAP block (median 5.3 vs 6.2 hours, p = .001).
While TAP block use at the time of minimally invasive hysterectomy reduced use of postoperative opioids, the timing of TAP block, either preoperatively or postoperatively, did not significantly affect opioid use. Preoperative compared with postoperative TAP block administration significantly shortened the time to discharge.
International travel can expose travelers to a number of health risks. Pretravel consultation (PC) helps mitigate risk and prepare travelers for health concerns that might arise. The assessment of ...risk, mitigation strategies, and relevance of pretravel advice is dependent on how closely travelers adhere to their planned travel itinerary and activities. We determined the proportion of returned travelers whose completed travel experiences differed from their stated travel itineraries, and identified discrepancies that significantly altered the traveler's health risk and would have required alternative counseling during their PC.
We conducted a prospective cohort study at the SickKids' Family Travel Clinic between October 2014 and November 2015. Returned travelers who completed a post-travel survey were included. Pretravel consultation assessments and post-trip surveys were compared to identify discrepant trip experiences.
A total of 389 travelers presented to the clinic for a PC during the study period and 302 (77.6%) were enrolled. Post-travel surveys were received from 119 (39.4%) participants, representing 101 unique itineraries. The median participant age was 36.3 years (IQR 26.6-47.5) and there were 73 female travelers (61%). Most participants (n = 87,73%) were healthy as well as Canadian born (n = 84, 71%). A quarter of travelers were visiting friends and relatives (VFR) (n = 30, 25.2%). The vast majority of returned travelers (n = 109, 92%) reported discrepant trip experiences involving trip duration, countries visited, accommodations, environmental surroundings and/or activities. Almost two thirds of these individuals (n = 68, 62%) would have required alternative pretravel counseling. We did not identify any demographic or planned trip characteristics that predicted discrepant trip experiences requiring alternative pretravel counseling.
The majority of travelers reported discrepant trip experiences and the discrepancies often affected health risk. Therefore, clinicians should consider providing broader counselling during the PC as discrepancies from planned travel are common.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications.
A systematic review of PubMed, EMBASE, Cochrane Library, ...ClinicalTrials.gov, and MEDLINE was conducted.
One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts.
Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004).
The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
To evaluate whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with laparoscopic advanced energy devices.
Prospective cohort study.
Ergonomic ...simulation at an academic tertiary care site and the Society of Gynecologic Surgeons 47th Annual Meeting.
Thirty-eight participants (19 women and 19 men) were recruited.
Surgeon anthropometric measurements were collected. Each participant completed a 120-second trial of maximum voluntary effort with 3 laparoscopic advanced energy devices (LigaSure, HALO PKS, and ENSEAL). Grip strength was measured using a handheld dynamometer. Subjects completed the NASA Raw Task Load Index scale after each device trial. Grip strengths and ergonomic workload scores were compared using Student t tests and Wilcoxon rank sum tests where appropriate. Univariate and multivariate models analyzed hand size and ergonomic workload.
Women had lower baseline grip strength (288 vs 451 N) than men, as did participants with glove size <7 compared with ≥7 (231 vs 397 N). Normalized grip strength was not associated with surgeon sex (p = .08), whereas it was significantly associated with surgeon glove size (p <.01). Grip strength decline was significantly greater for smaller compared to larger handed surgeons for LigaSure (p = .02) and HALO PKS devices (p <.01). The ergonomic workload of device use was significantly greater for smaller compared to larger handed surgeons (p <.01). Surgeon handspan significantly predicted grip strength decline with device use, even after accounting for potential confounders (R
= .23, β = .8, p <.01).
Surgeons with smaller hand size experienced a greater grip strength decline and greater ergonomic workload during repetitive laparoscopic device use. No relationship was found between surgeon sex and grip strength decline or ergonomic workload. Laparoscopic device type was also identified as a significant main effect contributing to grip strength decline. These findings point toward ergonomic strain stemming from an improper fit between the laparoscopic device and the surgeon's hand during device use.
The limited instructional support in Massive Open Online Courses (MOOCs) inherently demands learners to self-regulate their learning. MOOC research shows that learners are more successful when they ...engage in self-regulated learning (SRL) behaviors such as planning what to study and reviewing study materials. However, many learners struggle with SRL. In this study, we examined the effect of two types of SRL prompts (i.e., questions or a combination of questions and recommendations) on SRL activities, course engagement, and performance in MOOCs. Learners either received questions supporting SRL, questions supporting SRL followed by recommendations, or neither questions supporting SRL nor recommendations. Log data was used to examine learners’ behavior in the MOOCs. Results showed the SRL prompts, in general, are effective in enhancing SRL-related activities and course engagement. However, the effectiveness of the SRL prompts may be influenced by the complexity of the MOOCs. The current study adds to the field of SRL by examining prompting as an approach to enhance SRL in MOOCs.
•Prompts supporting self-regulated learning (SRL) were examined in MOOCs.•SRL prompts are especially beneficial for learners in more complex MOOCs.•Prompted learners completed more course items on time indicative of time-management.•No significant effect was found for SRL activities indicative of self-monitoring.•Log file analysis and process mining provide insight in SRL-related behavior.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
...it would be difficult for SIOP or APA to be responsible for the on-the-ground education around ethics, beyond perhaps developing curricula. ...it would be irresponsible and challenging (if not ...impossible) to expect supervisors or employers to be responsible for sufficiently educating I-O psychologists about ethics (e.g., Do supervisors have a foundational understanding of ethics that they can teach their employees? How to teach I-O graduate students about ethics We provide specific ideas for how I-O graduate programs can incorporate ethics-related training and present several questions to prompt critical thinking surrounding ethics in core areas of I-O psychology (i.e., research, teaching, practice, and professional development). Provide opportunities for I-O faculty members to further develop their understanding of ethics. ...as more students take ethics courses, more incoming I-O faculty members will have these qualifications to teach future courses (or serve as role models/mentors in applied settings).
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