CEVL interactive – Best surgical practices for Open Mitrofanoff Procedure

CEVL interactive – Best surgical practices for Open Mitrofanoff Procedure

Accepted Manuscript CEVL Interactive – Best Surgical Practices for Open Mitrofanoff Procedure Thomas de los Reyes, Max Maizels, Robert Dale, Kourosh A...

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Accepted Manuscript CEVL Interactive – Best Surgical Practices for Open Mitrofanoff Procedure Thomas de los Reyes, Max Maizels, Robert Dale, Kourosh Afshar, Patrick Meade, Andrew MacNeily PII:

S1477-5131(17)30186-9

DOI:

10.1016/j.jpurol.2017.04.006

Reference:

JPUROL 2531

To appear in:

Journal of Pediatric Urology

Received Date: 25 April 2017 Accepted Date: 26 April 2017

Please cite this article as: Reyes Tdl, Maizels M, Dale R, Afshar K, Meade P, MacNeily A, CEVL Interactive – Best Surgical Practices for Open Mitrofanoff Procedure, Journal of Pediatric Urology (2017), doi: 10.1016/j.jpurol.2017.04.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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CEVL Interactive – Best Surgical Practices for Open Mitrofanoff Procedure * * http://cevlforhealthcare.org/cevl/Products/Urology/JournalOfPediatricUrology/Menu/.

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Authors Thomas de los Reyes1, Max Maizels2, Robert Dale1, Kourosh Afshar1, Patrick Meade2 and Andrew MacNeily1 1

Division of Urology, Department of Urologic Sciences, BC Children's Hospital, University of British Columbia

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Division of Pediatric Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL

Key words Pediatrics, complex reconstruction, surgery

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Corresponding author Max Maizels [email protected]

This procedure strives to meet the need to provide a route by which intermittent bladder catheterization may be done expeditiously, by caregivers or patients themselves.

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INTRODUCTION AND OBJECTIVES Performing Pediatric Urological surgery effectively and efficiently requires a sufficient surgical caseload to maintain surgical skills. While this is possible for routine procedures with a high volume of cases, there is not yet a method by which Pediatric Urologists may be confident in their performance of unusual cases, such as complex reconstruction of the urinary tract. We believe this applies to surgery for children who require complex bladder reconstruction, for example by Mitrofanoff Procedure. Furthermore, we believe that “best practices” for this procedure have yet to be established. This is in part because there is not yet an established method to research developing such practices.

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To address this situation, the authors created this “CEV-ule” based on their belief that the presentation of a “stylized” method to perform the procedure would be enhanced by also including a blog instrument in which JPU readers may provide their unique insights in their performance of this surgery. We point out that while there is controversy in indications to perform diversion/undiversion, this communication does not address this controversy. Herein, we research to develop methods which our specialty could utilize in order to efficiently and effectively share surgical approaches which yield the best outcomes. We hypothesize that the provision of e-learning content with a companion blog application is an underutilized instrument to promote procedure consensus and thereby result in the establishment of “best practices.” As Mitrofanoff Procedure is not routinely performed by many Pediatric Urologists, we chose it as the index case to test this hypothesis in this communication. Herein, we present e-learning as a CEV-ule to show a stylized approach to perform Mitrofanoff Procedure. This content highlights critical points of the procedure, present them as hierarchical components and steps to their execution. A blog instrument provides users opportunity to provide their input as suggested update edits to these components and steps. Such inputs will be the basis for future iterations of this CEV-ule. METHODS Module Design: An online educational module, a CEV-ule, was created using the CEVL platform. The tabs are interactive and allow unrestricted navigation. The tabs are:

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1. Overview Tabs present background information, essential to understand decision making of this clinical problem and thus the surgery, such as principles and indications.

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2. CEVi Computer Exercise Virtual interactive presents a self-test so that the user may attain self-confidence in knowing their study of the content has prepared them to perform the procedure. 3. Surgery Open Mitrofanoff Procedure is presented as a series of hierarchical components with individual steps. This material is suitable for display in the real time operating room, utilizing overhead operating room monitors. By checking this display, the entire OR staff keeps in step with the surgery component being done in real time and may work seamlessly with each other.

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4. Extras Presents questions trainees commonly ask and their responses. In addition the tab “Feedback” links to provide Trainees/Attending Surgeons in Resident Programs to receive/give feedback on the surgical case.

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5. Survey Users may blog to input their views and experiences, such that this information would be the basis of updated future iterations of this CEV-ule. Highlights of the CEV-ule are presented in Figures 1-4.

Application Design: 1. This CEV-ule interactive is created as an online open source reference. Use your browser, works best with Chrome, to access www.jpurol.com and follow these steps:

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a. Desktop PC, MAC: Click on the main page CEVL icon, then navigate to view CEV-ule. The CEV-ule is fully compatible with desktop PC or MAC.

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b. iOS or Android mobile devices: Click your browser settings to “request desktop site.” You will now view the main page and CEVL icon; click the icon to navigate to view CEV-ule. You will be asked to download a free application (© 2016 Articulate Global, Inc.). The CEV-ule mobile version provides most but not all the functions of the desktop version. You may asked to set your device to provide screen rotation (i.e., auto-rotate) to enjoy the best experience.

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DISCUSSION We have created e-learning as an interactive module that provides a stylized method to repair high UGS and explores the possibility that information inputted into an embedded blog instrument may be a method to promote consensus on performance of infrequently performed cases. CONCLUSIONS The authors have created an online learning interactive (i.e., CEV-ule) showing a stylized method to perform Open Mitrofanoff Procedure. Information derived from input to a blog instrument will be the basis for future iterations of this CEV-ule. Explanation of Figures Figure 1. Surgery tab. Screenshot showing surgery presented as a series of components and steps, here specifically for exposing the bladder and appendix. The right most column presents to the “scrub tech” the instruments which will be required at the designated part of the surgery. The content is intended to present to the entire OR staff during real time case performance, so they all share in the flow of the procedure. The video icon (lower right) links to the video for this surgical component. Figure 2. Surgery video as a lightbox. The video presented as a lightbox so as to maintain users’

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orientation. The sequence of steps is shown on the left and annotations at the screen bottom provided additional information. This content is suitable to display in the real time operating room for all staff to view.

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Figure 3. Blog as a survey. The Survey tab provides users with opportunity to input their views of the CEVule, comment on the surgical practice shown, and to offer their views on their practices. This information is expected to be assimilated into future iterations of the CEV-ule.

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