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Constructing a Novel Simple LEEP Training Model.

ABSTRACT: BACKGROUND: Duty hour restrictions and enhanced focus on patient safety have prompted the development of new instruction models for practice of surgical techniques outside the operating room, including models for teaching loop electrosurgical excisional procedure (LEEP), a common procedure that gynecology residents perform to diagnose and manage cervical disease. OBJECTIVE: We sought to develop an inexpensive and reusable training model for guided practice opportunities that will improve gynecology residents' LEEP technique. METHODS: Polyvinyl chloride, foam, and a polish sausage are used to simulate the basic anatomy of the vagina and cervix. A 2-in-diameter polyvinyl chloride pipe and high-density foam are used to create a realistic representation with the sausage simulating the cervix. An electrosurgical pad is attached to the sausage and a standard operating room electrosurgical generator is used. RESULTS: After a brief lecture and demonstration of the LEEP procedure, gynecology residents are positioned at individual stations. Use of 2 to 3 instructors allows for the provision of directions and feedback to residents as they perform the simulated LEEP. During the last 6 years, this model has continued to improve residents' confidence and skills with the procedure. CONCLUSIONS: An anatomically accurate LEEP model can not only improve resident knowledge, skills, and confidence, but also improve quality and patient safety. This training model allows residents to refine their surgical skills through guided practice and instructors to monitor performance before residents to perform the procedure on patients.

SUBMITTER: Walters CL

PROVIDER: S-EPMC3693702 | biostudies-other | 2013 Jun

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:Uncovering the evolutionary principles of gene coexpression network is important for our understanding of the network topological property of new genes. However, most existing evolutionary models only considered the evolution of duplication genes and only based on the degree of genes, ignoring the other key topological properties. The evolutionary mechanism by which how are new genes integrated into the ancestral networks are not yet to be comprehensively characterized. Herein, based on the human ribonucleic acid-sequencing (RNA-seq) data, we develop a new evolutionary model of gene coexpression network which considers the evolutionary process of both duplication genes and de novo genes. RESULTS:Based on the human RNA-seq data, we construct a gene coexpression network consisting of 8061 genes and 638624 links. We find that there are 1394 duplication genes and 126 de novo genes in the network. Then based on human gene age data, we reproduce the evolutionary process of this gene coexpression network and develop a new evolutionary model. We find that the generation rates of duplication genes and de novo genes are approximately 3.58/Myr (Myr=Million year) and 0.31/Myr, respectively. Based on the average degree and coreness of parent genes, we find that the gene duplication is a random process. Eventually duplication genes only inherit 12.89% connections from their parent genes and the retained connections have a smaller edge betweenness. Moreover, we find that both duplication genes and de novo genes prefer to develop new interactions with genes which have a large degree and a large coreness. Our proposed model can generate an evolutionary network when the number of newly added genes or the length of evolutionary time is known. CONCLUSIONS:Gene duplication and de novo genes are two dominant evolutionary forces in shaping the coexpression network. Both duplication genes and de novo genes develop new interactions through a "rich-gets-richer" mechanism in terms of degree and coreness. This mechanism leads to the scale-free property and hierarchical architecture of biomolecular network. The proposed model is able to construct a gene coexpression network with comprehensive biological characteristics.

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Constructing a Novel Simple LEEP Training Model.

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