Analysis of financial risk protection indicators in Sri Lanka for pediatric surgery.

Purpose: To investigate the incidence of the Sri Lankan pediatric population who seek emergency surgical services and who are subsequently at risk of impoverishment and catastrophic expenditure.

Methods: Prospective data collection at a tertiary pediatric Sri Lankan hospital of direct out-of-pocket (OOP) medical and nonmedical expenses related to pediatric surgical interventions. Catastrophic expenditure and risk of impoverishment were respectively described as expenses superior to 10% of household income and falling below the impoverishment line due to income drop.

Simulation-Based Education of Health Workers in Low- and Middle-Income Countries: A Systematic Review.

Introduction: Simulation-based education (SBE) is increasingly used to improve clinician competency and patient care and has been identified as a priority by the World Health Organization for low- and middle-income countries (LMICs). The primary aim of this review was to investigate the global distribution and effectiveness of SBE for health workers in LMICs. The secondary aim was to determine the learning focus, simulation modalities, and additional evaluation conducted in included studies.

Simulation-based education in the Pacific Islands: educational experience, access, and perspectives of healthcare workers.

Background: The World Health Organization (WHO) recommends simulation-based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE.

An Objective Evaluation of Intraoperative and Postoperative Pain in Infants Undergoing Open Inguinal Herniotomy and Laparoscopic Inguinal Hernia Repair Using the Newborn Infant Parasympathetic Evaluation (NIPE™) Monitor.

Purpose: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor is an objective, non-invasive tool for the assessment of pain in children under 2 years of age. The aim of this study was to objectively compare pain in infants undergoing open and laparoscopic inguinal hernia surgery using the NIPE monitor.

Method: This prospective observational study included neonates and infants (<2 years of age) undergoing elective open inguinal herniotomy and laparoscopic inguinal hernia repair under general anaesthesia with a caudal block.

Incidence and risk factors of complications during central venous access devices removal in children.

Purpose: To quantify the rates and identify risk factors for the complications of central venous access devices (CVADs) removal in children.

Method: Retrospective (2018-2023) review of children undergoing CVADs removal at a single institution. Data are reported as frequency, percentages and median.

"I've yet to meet anyone who's not keen for simulation" - a qualitative study of simulation-based education in the Pacific Islands.

Background: Simulation-based education (SBE) has been increasingly used to train healthcare workers in low-resource settings and has been endorsed by the World Health Organization (WHO). Consideration of the educational and cultural context is important to maximize the effectiveness of SBE. Despite its demonstrable benefits, there have been no studies of the general approach in the Pacific Islands.

Using wearable technology for Posture Regulation to Improve Surgical Ergonomics in the paediatric operating room: the UPRISE trial: a pilot study.

Background: The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures.

Methods: Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained.

Dyadic practice for the acquisition of laparoscopic skills (DALS)-A randomized controlled trial.

Background: Laparoscopic simulation is integral to surgical education but requires significant resources. We aimed to compare the effectiveness of dyadic practice (DP), involving two individuals working together, to individual practice (IP) for novices acquiring laparoscopic skills and assess their learning experience.

Methods: We conducted a Randomized Controlled Trial comparing DP and IP for novice medical students who completed a laparoscopic simulation workshop.

A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries.

Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation.

Evaluation of a novel home-based laparoscopic and core surgical skills programme (Monash Online Surgical Training).

Introduction: Limitations to surgical education access were exacerbated during the COVID-19 Pandemic. In response, we created a national home-based comprehensive surgical skills course: Monash Online Surgical Training (MOST). Our aim was to evaluate the educational impact of this approach.

Newborn and Infant Parasympathetic Evaluation (NIPE™) Monitor for Assessing Pain During Surgery and Interventional Procedures: A Systematic Review.

Background: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor has been designed to be an objective, non-invasive tool for the assessment of pain and discomfort in children under 2 years of age. The aim of this systematic review was to evaluate the ability of NIPE to assess pain in neonates and infants during surgical and/or painful procedures.

Methods: A systematic review (2010-2023) was conducted using PRISMA guidelines.

Outcome following the surgical management of varicocele in children and adolescents: a systematic review and meta-analysis.

Background: The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification ( open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization/sclerotherapy.

Objectives: We aimed to appraise the clinical outcomes of these techniques in children and adolescents.

Eye-tracking in surgery: a systematic review.

Background: Surgery is constantly evolving with the assistance of rapidly developing novel technology. Eye-tracking devices provide opportunities to monitor the acquisition of surgical skills, gain insight into performance, and enhance surgical practice. The aim of this review was to consolidate the available evidence for the use of eye-tracking in the surgical disciplines.

Simulation-based education in urology - an update.

Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment.

Influence of foetal position on the degree of isolated antenatal hydronephrosis.

Backgrounds: The effect of foetal position on the degree of antenatal hydronephrosis (ANH) is unknown. We hypothesized that foetal position is an important contextual factor in ANH, with consequences on prenatal counselling and postnatal management. The current study aimed to investigate the effect of foetal position on the degree of ANH.

Effects of a Preoperative Carbohydrate Load on Postoperative Recovery in Children: A Randomised, Double-Blind, Placebo-Controlled Trial.

Background: Nausea and vomiting are common causes for prolonged postoperative length of hospital stay (LOS) in children. A preoperative carbohydrate load may reduce postoperative nausea and vomiting by improving the perioperative metabolic state. The aim of this study was to determine if a preoperative carbohydrate-containing drink would lead to an improvement in the perioperative metabolic state and consequently reduce the incidence of postoperative nausea, vomiting and LOS in children undergoing day-case surgical procedures.

The utility of sonographic signs to diagnose simple and complicated appendicitis in children.

Background: Acute appendicitis is classified into simple (SA) and complicated (CA). Ultrasound scans (USS) can be useful in clinically equivocal cases, by visualising primary and secondary signs. This study explores the utility of sonographic signs to diagnose and differentiate appendicitis in children.

The Newborn Infant Parasympathetic Evaluation (NIPE™) monitor predicts post-operative pain in children undergoing day-procedures: A prospective observational study.

Background: Pain assessment is essential for the administration of appropriate analgesia. Currently, clinicians use surrogate methods, such as heart rate or behavioural pain scales, to estimate pain in neonates and infants. The Newborn and Infant Parasympathetic Evaluation (NIPE™) monitor aims to provide an objective numeric value (NIPE index) of pain through a continuous assessment of the patient's parasympathetic activity.

Assessment of Core Surgical Skills Using a Mixed Reality Headset - The MoTOR Study.

Introduction: Surgical skill assessment utilises direct observation and feedback by an expert which is potentially subjective, therefore obtaining objective data for hand and eye tracking is essential. Our aim was to evaluate a wearable mixed reality (MR) headset in these domains.

Methods: Participants with differing levels of surgical expertise [novice (N), intermediate (I) & expert (E)] performed 4 simulated surgical tasks; 2 general dexterity (tasks 1&2) and 2 surgical skills (tasks 3&4) wearing the MR headset capturing their hand and eye movements (median & range).