The Effect of a Multimedia Health Educational Program on the Postoperative Recovery of Patients undergoing Laparoscopic Cholecystectomy Extended preoperative patient education using a multimedia DVD—impact on patients receiving a laparoscopic cholecystectomy: a randomised controlled trial The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. The informed consent: a study of the efficacy of informed consents and the associated role of language barriers. The effect of pre-admission education on domiciliary recovery following laparoscopic cholecystectomy. Warm-up in a Virtual Reality Environment Improves Performance in the Operating Room Altering patients' responses to surgery: an extension and replication. The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum Assessment of medical student laparoscopic camera skills and the impact of formal camera training. Virtual reality training improves simulated laparoscopic surgery performance in laparoscopy naïve medical students. Preoperative oral feeding reduces stress response after laparoscopic cholecystectomy. Improving Informed Consent of Surgical Patients Using a Multimedia-Based Program?: Results of a Prospective Randomized Multicenter Study of Patients Before Cholecystectomy A comparison of two methods of delivering presurgical instructions. Validation of laparoscopic surgical skills training outside the operating room: a long road Laparoscopic simulation training with proficiency targets improves practice and performance of novice surgeons. Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery. Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure.
Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program ( MHEP ) on patients undergoing elective Laparoscopic Cholecystectomy ( LC ) for cholelithiasis , preoperative anxiety and postoperative pain and nausea . Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial . Patients were assigned r and omly to four groups : Group A included 15 patients , preoperatively informed regarding LC through the MHEP presented by a Registered Nurse ( RN ) . Group B included 15 patients  preoperatively informed through a leaflet ( design ed and developed using the exact contents of the MHEP ) . In Group C , there were 15 patients who were being informed verbally from the RN . Finally , the control Group D included 15 patients , who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist , as every other patient included in groups A , B , C. Preoperative assessment of patient 's knowledge about cholelithiasis and LC was performed after informative session , and was based on a specifically developed " closed , true-false " question naire . Preliminary results suggest that conventional information provided by the attending surgeon ( Group D ) is inadequate . Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain , in patients undergoing elective LC Purpose The informed consent is a legal requirement prior to surgery and should be based on an extensive preoperative interview . Multimedia productions can therefore be utilised as supporting tool . In a prospect i ve r and omised trial , we evaluated the impact of an extended education on patients undergoing cholecystectomy . Material s and methods For extended patient information , a professionally built DVD was used . After r and omisation to either the DVD or the control group , patients were informed with or without additional presentation of the DVD . The quality of education was evaluated using a purpose -built question naire . Results One hundred fourteen patients were included in the DVD and 98 in the control group .  Patient characteristics did not differ significantly despite a higher educational level in the DVD group . The score of correctly answered questions was higher in the DVD group ( 19.88 vs. 17.58 points , p < 0.001 ) . As subgroup analysis revealed , particular patient characteristics additionally impacted on results . Conclusion Patients should be informed the most extensively prior to any surgical procedure . Multimedia productions therefore offer a suitable instrument . In the presented study , we could prove the positive impact of an information DVD on patients knowledge . Nevertheless , multimedia tools can not replace personal interaction and should only be used to support daily work OBJECTIVES Aim of this study is the evaluation of the impact of a multimedia CD ( MCD ) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy ( LC ) . METHODS Sixty consecutive c and i date s for elective LC were r and omly assigned to four groups . Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse ( RN ) . Patients in group B ( n = 15 ) were informed through a leaflet . Patients in group C ( n = 15 ) were informed verbally from a RN . Finally , the control Group D included 15 patients  informed conventionally by the attending surgeon and anesthesiologist , as every other patient included in groups A , B , and C. Preoperative assessment of knowledge about LC was performed after each informative session through a question naire . Evaluation of preoperative anxiety was conducted using APAIS scale . Postoperative pain and nausea scores were measured using an NRS scale , 16 hours after the patient had returned to the ward . RESULTS Statistical processing of the results ( single linear regression ) showed that patients in groups A , B , and C achieved a higher knowledge score , less preoperative anxiety score and less postoperative pain and nausea , compared to Group D. In multiple regression analysis , group A had a higher knowledge score compared to the four groups ( p < 0.001 r(2 ) = 0.41 ) . CONCLUSION Informative sessions using MCD is an effective means of improving patient 's preoperative knowledge , especially in day-surgery cases , like LC BACKGROUND Obtaining informed consent before performing invasive procedures and operations has become a st and ard practice at all medical institutions in the United States . All agree that patients should be both conscious of and in agreement with their medical care . Though patients routinely sign consent forms with numerous risks and complications detailed , there are only a limited amount of reports that study if these patients have a thorough underst and ing of those risks and complications . Confounding the issue of the efficacy of informed consents is the growing population of patients who do not speak English . To obtain objective data on the efficacy of informed consents and the role of language barriers we looked at how well patients who consented to have a laparoscopic cholecystectomy  understood the complications associated with this procedure . METHODS We conducted a r and omized prospect i ve study of all patients seen in the General Surgery Resident Outpatient Clinic who presented for an elective cholecystectomy . Fifty patients agreed to participate in our study . Participants were split into two groups . In the first group ( the control group ) surgical benefits , risks and complications were explained in the usual fashion . In the second group , after hearing the st and ard explanation of surgical risks , complications and benefits , patients watched a PowerPoint presentation with illustrations on laparoscopic cholecystectomy . Patients from both groups then took a ten question assessment based on the presentations that they encountered . Spanish speaking patients were addressed with an interpreter and given a Spanish PowerPoint presentation with a Spanish assessment . The patients ' age , education level , income , and birth country were also studied . RESULTS Fifty-two percent of the patients in the study were born outside of the United States . All of the non-US born patients were Hispanic and their primary language was Spanish . The average age of the studied patients was 38 . Sixty-eight percent of the patients reported an education level no higher than high school . The majority of the studied patients noted an  income of less than $ 40,000 . Differences were seen between patient native to the US and those born outside the United States . US born patients had an 80 % correct response rate versus non-US born patients who had only a 63 % correct response . Differences were seen between US born patient and non-US born patients concerning the topics of the severity of a common bile duct injury , gastrointestinal changes after cholecystectomy and the safety concerning conversion from laparoscopic to open cholecystectomy . No difference was appreciated in the PowerPoint group versus the non-PowerPoint group . CONCLUSION The addition of a PowerPoint presentation did not increase underst and ing of the risks and benefits associated with a laparoscopic cholecystectomy . This study did however highlight the problem of obtaining consent from foreign born patients . Patients who were not US natives showed a decreased underst and ing of the surgical procedure and the severity of the complications in both the control group and the PowerPoint group . Better methods of educating foreign patients should be investigated to truly obtain informed consents from this patient population OBJECTIVES The objectives of this r and omised controlled study were to determine if pre-admission patient education affects post-operative pain levels , domiciliary self-care capacity and patient recall following a laparoscopic cholecystectomy ( LC ) . Participants were r and omised to receive the st and ard preadmission program ( SP ) or an individualised , education intervention ( El ) . DESIGN A pre-operative question naire was administered in the pre-admission clinic to determine participants ' knowledge of LC and post-operative management . Telephone follow-up and post-operative question naire were conducted approximately 14 days post discharge . SETTING Preadmission clinic of a Sydney , Australia , tertiary referral hospital . SAMPLE Ninety-three elective LC patients . RESULTS EI participants experienced lower pain levels and had significantly greater recall of provided information . However , no significant differences were found between the control and intervention groups for domiciliary self-care . CONCLUSION Pre-admission education intervention helps reduce post-operative pain levels following LC and significantly increases patients ' knowledge of self-care and complication management Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources This study of 58 cholecystectomy and 57 herniorrhaphy patients was design ed to determine the reliability of the effects of preoperative preparation on postoperative recovery that were observed in a previous study . The preoperative preparation consisted of information that focused on the typical subjective sensory experiences of surgical patients in combination with instruction in postoperative exercises . The effects of prehospital admission preparation , restatement postoperatively of preparatory information , and adding temporal orienting information to the preparatory information on postoperative course were also examined . The main results of the original study were replicated . In the cholecystectomy sample , the preoperative information intervention significantly reduced length of postoperative hospitalization and length of time posthospital discharge before patients ventured from home . Temporal orienting information reduced feelings of helplessness postoperatively in the cholecystectomy sample . Consistent with the original study , only trends for effects were observed in the herniorrhaphy sample Background : This study was undertaken to investigate operating room performance of surgical residents , after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course . This course is the first formal surgical resident trainings course , using a variety of complementary virtual reality ( VR ) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy . The course was granted EAES certification . Methods : The four-day course is based on multimedia and multimodality approach . A variety of increasingly difficult simulation training sessions , next to intimate focus-group “ knowledge sessions ” are included . Both basic and procedural VR simulation is featured , using MIST-VR and the Xitacts ' LapChol simulation software . The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared . The case-control grup was matched for clinical number laparoscopic cholecystectomy performance ( maximum of 4 procedures ) . Two observers analyzed a r and omly mixed videotape , featuring the part of the “ clip- and -cut ” procedure of the laparoscopic cholecystectomy , and were blinded for participants ' group status . Structured question naires including multiple observation scales were used to assess performance . Results : Residents of both the experimental and control group did not differ in demographic parameters , except for number of laparoscopic cholecystectomies in favor of the control group ( p-value 0.008 ) . Both observers judge the experimental group to perform significantly better ( p-value 0.004 and 0.013 ) . Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curiculum . Conclusions : The Eindhoven Virtual Reality laparoscopic cholecyctectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods BACKGROUND In laparoscopic surgery , the role of camera holder often falls to untrained medical students . Laparoscopic-naive students can easily acquire laparoscopic camera navigation ( LCN ) skills , yet it is unclear whether this translates into improved LCN performance in the operating room and whether students retain these skills over time . The purpose of this study was to evaluate whether pre clinical laparoscopic camera simulator training would result in improved LCN skills , efficiency , and comfort level over the course of a 6-week surgery clerkship . METHODS A r and omized , controlled study was design ed to compare students ' preclerkship and postclerkship LCN skills on a previously vali date d box trainer model . The students ( n = 70 ) were r and omized via a computer-generated table of r and om numbers into study and control groups . The study group ( n = 36 ) received a brief laparoscope training session before the clerkship , while the control group ( n = 36 ) did not . All students also completed a preclerkship and postclerkship question naire detailing their experience and comfort level . RESULTS Statistical analysis using Wilcoxon 's signed-rank test demonstrated that all students improved in skill level ( total score , 4 vs 7 ; P < .0001 ) , efficiency ( time , 76 vs 33 seconds ; P < .0001 ) , and comfort level ( Likert scale score , 2 vs 4 ; P < .0001 ) , with no statistically significant difference between the control and study groups . CONCLUSIONS This study demonstrates that novice medical students are able to gain laparoscopic camera skills from " h and s-on " experience , with no added benefit or retention of skills learned in a pre clinical camera simulator training session PURPOSE With the exp and ing role of laparoscopy in urologic practice , efficient and safe training has become paramount . Virtual reality simulation may potentially aid training , but it requires validation before it can be incorporated into training programs . The objective of this study was to assess whether training on a virtual reality ( VR ) laparoscopy simulator ( LAP Mentor ) can improve performance of virtual laparoscopic procedures . MATERIAL S AND METHODS After a basic introduction to the LAP Mentor , 32 inexperienced medical students performed a baseline VR cholecystectomy  that was observed and scored by two observers using the Objective Structured Assessment of Technical Skills ( OSATS ) . The students were then r and omized to two groups : Group 1 trained on the simulator without supervision during a total of six 30-minute sessions , and group 2 received no training . Students were then reevaluated on a second VR cholecystectomy by the same observers . RESULTS All 32 students completed the study . The two groups were comparable with regard to baseline OSATS scores ( group 1 , 16.6+/-4.3 v group 2 , 15.67+/-6.3 , P=0.2 ) . On the second evaluation , the trained students ( group 1 ) performed significantly better than the control group ( group 2 ) ( 27.9+/-7.2 v 17.6+/-6.2 , P<0.001 ) . Group 1 students outperformed group 2 students in each category of the OSATS . Moreover , trained students improved their scores by at least 20 % ( P<0.001 ) in each category , while the untrained students improved only in the " knowledge of procedure " category by 25 % ( P=0.03 ) . CONCLUSION Skills training on a LAP Mentor VR simulator improved VR surgical performance . Before incorporating this simulator into resident education , the LAP Mentor will have to undergo testing for predictive and construct validity BACKGROUND / AIMS Fasting period before surgery may change metabolic status of the patient and have influence on perioperative stress response . The aim of the study was to investigate effects of preoperative carbohydrate-rich beverage on stress response after laparoscopic cholecystectomy . METHODOLOGY Patients admitted for laparoscopic cholecystectomy were included into study and they were r and omized into a group that was fed prior to surgery and in a group that was in the regime of nothing by mouth from the evening one day before surgery .  Concentrations of C-reactive protein and cortisol , were measured before and subsequently up to 48 h postoperatively . RESULTS Postoperative serum C-reactive protein increased significantly in both groups , but the increase was more evident in the group with fasting protocol both 24 and 48 hours postoperatively . In fed patients cortisol concentration measured in the afternoon immediately after the operation showed physiological decline . In patients with fasting protocol postoperative cortisol values rise above the values measured in the morning . CONCLUSIONS Preoperative feeding has advantage over overnight fasting by reducing preoperative discomfort in patients after laparoscopic cholecystectomy . In fed patients , smaller increase in C-reactive protein and better regulation of cortisol levels are an indicator of decreased perioperative stress response Objective : The term “ informed consent ” explains the process by which a patient , before treatment , is provided comprehensive and impartial information regarding a planned operative procedure so that he/she underst and s the implication s of the procedure before consenting . The goal of the current study was to investigate whether st and ard methods of consenting can be improved using a multimedia-based information program ( MM-IP ) . Patients and Methods : In a prospect i ve multicenter study , 80 patients undergoing laparoscopic cholecystectomy went through the st and ard informed consent process . One group of patients was also given access to a MM-IP . Question naires were completed before surgery . These evaluated how patients perceived their own underst and ing of important aspects of their illness ( ie , disease , therapeutic alternatives , operation , risks ) and satisfaction with the consenting process . Patients ’ anxiety levels were also assessed . These question naires were used to evaluate the effectiveness of the MM-IP for improving the consent process . Results : Seventy-six patients ( 47 women , 29 men , median age 54 years ) were included . There was no significant age or gender variation between the groups ( st and ard n = 41 and MM-IP n = 35 ) . Eighty-two percent of all respondents were satisfied with the st and ard informed consent process . However , perceived underst and ing of the material was significantly improved in the MM-IP group ( P < 0.001 ) . Patients with less formal education profited particularly from the MM-IP .  Preoperative anxiety did not vary between the groups . Conclusion : Use of the multimedia-based program was positively evaluated by patients , and significantly improved patients ’ perceived underst and ing of their disease and its treatment . It is , therefore , valuable in the informed consent process A 2 x 2 factorial design was employed to test the effects on various indicators of postoperative recovery of surgical patients who had received preoperative instructions . A pamphlet and /or a nurse visit were used as delivery methods . The study population consisted of 50 patients who were scheduled for cholecystectomies . Patients were given information on the expected sequence of events on the day of surgery and instructions in postoperative self-care activities . Findings indicate that a differential effect of providing information was dependent on the patient 's level of preoperative fear , with high-fear patients benefiting most from information . Patients in the high preoperative-fear group who received either the pamphlet or the pamphlet and a nurse visit had shorter postoperative hospitalizations , switched from injected to oral medication sooner , scored higher on an index of energy and movement , and rated their appetites as better when compared with patients in either the nurse-visit or control groups . However , among those who scored low in preoperative fear , patients in the control group had better recoveries from surgery than patients who received preoperative information . The study points out the need to perform an educational assessment of patients before information is provided Background  Surgical skills training outside the operating room is beneficial . The best methods have yet to be identified . The authors aim ed to document the predictive validity of simulation training in three different studies . Methods Study 1 was a prospect i ve , r and omized , multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training . The Global Operative Assessment of Laparoscopic Skills ( GOALS ) was used to evaluate operative performance . Study 2 retrospectively review ed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum .  Operative time was the variable used to determine resident improvement . Study 3 was a prospect i ve , r and omized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator .  Operative performance was assessed using GOALS . Results All three studies failed to demonstrate predictive validity . With GOALS used as the assessment tool , no difference was found between trained and untrained residents in studies 1 and 3 . In study 2 , the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group . Conclusions No correlation was found between the three types of training outside the operating room , and no improved operative performance was observed . Possible explanations include too few subjects , training introduced too late in the learning curve , and training criteria that were too easy . Additionally , simulator training focuses on precision , which may actually increase task time . Awareness of these issues can improve the design of future studies BACKGROUND This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress . METHODS Fourteen surgery interns were r and omized into 2 groups . The intervention group received task-specific proficiency criteria to guide practice . The control group did not . After training , participants were evaluated by blinded faculty during laparoscopic cholecystectomy . RESULTS The control group met significantly fewer of the 7 LapSim ( Surgical Science Sweden AB , Gotëborg ) targets ( mean = 1.14 ) than the intervention group ( mean = 7.00 ; P = .001 ) and significantly fewer of the 5 video trainer targets ( mean = .86 ) than the intervention group ( mean = 5.00 ; P = .001 ) . Ratings of depth perception , bimanual dexterity , efficiency , tissue h and ling , autonomy , and overall competence were higher for the intervention group . Effect sizes ranged from medium to large ( .394-.981 ) , indicating an impact of the proficiency-based training protocol . CONCLUSIONS Delineation of proficiency targets with reporting of progress improves interns ' practice results , and appears to have a positive effect on their early operating room ( OR ) performance of laparoscopic cholecystectomy BACKGROUND AND PURPOSE Surgery is a high-stakes " performance . " Yet , unlike athletes or musicians , surgeons do not engage in routine " warm-up " exercises before " performing " in the operating room . We study the impact of a preoperative warm-up exercise routine ( POWER ) on surgeon performance during laparoscopic surgery .  MATERIAL S AND METHODS Serving as their own controls , each subject performed two pairs of laparoscopic cases  , each pair consisting of one case with POWER ( + POWER ) and one without ( -POWER ) . Subjects were r and omly assigned to + POWER or -POWER for the initial case of each pairing , and all cases were performed ≥ 1 week apart . POWER consisted of completing an electrocautery skill task on a virtual reality simulator and 15 minutes of laparoscopic suturing and knot tying in a pelvic box trainer . For each case , cognitive , psychomotor , and technical performance data were collected during two different tasks : mobilization of the colon ( MC ) and intracorporeal suturing and knot tying ( iSKT ) . Statistical analysis was performed using SYSTAT v11.0 . RESULTS A total of 28 study cases ( 14+POWER , 14-POWER ) were performed by seven different subjects . Cognitive and psychomotor performance ( attention , distraction , workload , spatial reasoning , movement smoothness , posture stability ) were found to be significantly better in the + POWER group ( P ≤ 0.05 ) and technical performance , as scored by two blinded laparoscopic experts , was found to be better in the + POWER group for MC ( P=0.04 ) but not iSKT ( P=0.92 ) . Technical scores demonstrated excellent reliability using our assessment tool ( Cronbach ∝=0.88 ) . Subject performance during POWER was also found to correlate with intraoperative performance scores . CONCLUSIONS Urologic trainees who perform a POWER  approximately 1 hour before laparoscopic renal surgery demonstrate improved cognitive , psychomotor , and technical performance PURPOSE Virtual reality simulators provide a safe and efficient means of acquiring laparoscopic skills . We evaluated whether training on a virtual reality laparoscopic cholecystectomy simulator ( Lap Mentor ) improves the performance of a live , unrelated laparoscopic urological procedure . MATERIAL S AND METHODS A total of 32 medical students with no previous laparoscopic experience were oriented to the Lap Mentor , and then performed virtual reality laparoscopic cholecystectomy which was assessed by 2 experienced laparoscopists using the previously vali date d Objective Structured Assessment of Technical Skills scoring . Subjects were r and omized to group 1 , in which participants completed 6 , 30-minute virtual reality training sessions within 3 weeks , or group 2 , in which participants received no training . All participants then performed live laparoscopic nephrectomy in a porcine model  and performance was evaluated using Objective Structured Assessment of Technical Skills by 2 experts blinded to training status . RESULTS Mean total pretraining laparoscopic cholecystectomy Objective Structured Assessment of Technical Skills scores were comparable between the groups ( 16.9 + /- 4.3 for group 1 vs 15.4 + /- 6.2 for group 2 , p = 0.4 ) . After training total Objective Structured Assessment of Technical Skills scores for live porcine laparoscopic nephrectomy were significantly higher in group 1 compared to group 2 ( 21.0 + /- 6.8 vs 15.7 + /- 6.6 , respectively , p = 0.03 ) . Likewise , individual subcategory Objective Structured Assessment of Technical Skills scores were higher in group 1 than in group 2 , although significant differences were noted only in the categories of instrument h and ling and knowledge of the procedure . CONCLUSIONS Surgical skills acquired as a result of training on a virtual reality laparoscopic simulator are not procedure specific but improve overall surgical skills , thereby translating into superior performance of an unrelated live laparoscopic urological procedure
Due to the very low quality of the current evidence , the effects of formal patient education provided in addition to the st and ard information provided by doctors to patients compared with st and ard care remain uncertain .
BACKGROUND Generally , before being operated on , patients will be given informal information by the healthcare providers involved in the care of the patients ( doctors , nurses , ward clerks , or healthcare assistants ) .
This information can also be provided formally in different formats including written information , formal lectures , or audio-visual recorded information .
OBJECTIVES To compare the benefits and harms of formal preoperative patient education for patients undergoing laparoscopic cholecystectomy .