Using High-fidelity Medical Simulation to Assess Critical Thinking in Medical Students

Problem Graduating competent physicians is an imperative societal need. The development of critical thinking skills during medical school is important to meet this societal need and for the care of ill patients. Research shows this skill is key in decreasing medical errors, which in turn decreases cost. (Norman and Eva, 2010) Missing from the literature is a method to assess critical thinking in the setting of caring for the critically ill patient. This instrumental case study tests medical simulation as a method of assessing critical thinking, which incorporates all six competency domains, by looking at the assessment environment, summative patient experience, and participant\u27s reflection on the case and environment. Method A qualitative instrumental case study design was used to evaluate twelve senior medical students\u27 critical thinking skills in the setting of identified competency domains. A single simulation patient encounter was administered to each student and data collected from the videotape of the encounter, their written documentation, and oral presentation of the case, mimicking the real-life scenario. The participants were also asked five questions regarding this case. These data were analyzed and presented in narrative format. Results The analysis revealed six major themes: assessment environment, coalescence of knowledge and skills, decision-making and deep thinking/reasoning, integrative experience, lack of depth in thought process, and safe environment. This research identified gaps in the students\u27 knowledge, skill, and behaviors of competency domains as they apply to critical thinking. Despite all students successfully completing medical school, errors were made in their individual care of the simulated patient. Four cases ended in death of the patient. The documentation of their patient encounter also lacked sufficient detail to allow other medical professionals to understand the issues during the case. The students\u27 opinion of the patient encounter was positive. Several students noted they had not had similar encounters as the sole provider of patient care. The experience gave them the opportunity to apply what they had learned and reflect on their gaps in knowledge. Conclusions The ability for physicians to think critically is key in reducing medical errors. An effective instrument to assess critical thinking as it applies to competency is high-fidelity medical simulation. In addition, allowing senior medical students to manage the case as the physician in charge exposes knowledge, skills, and behaviors of critical thinking, making these processes accessible for assessment

Interventions for preventing hospital-acquired legionnaires' disease

Background Legionnaires’ Disease (LD) has been recognized as a significant source of morbidity and mortality in many hospitals worldwide. Legionella in the hospital water distribution system has been epidemiologically linked to hospital-acquired LD. Despite the several disinfection methods available the optimal method to control hospital-acquired LD has not been established yet. Objectives To assess the efficacy of interventions for preventing hospital-acquired LD in hospitalized patients at high risk of developing the disease and the effect on environmental colonization associated to the risk of developing hospital-acquired LD. Search Methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library and MEDLINE (PubMed). We also handsearched the reference lists of all primary studies identified by the initial search. Selection Criteria All controlled studies investigating the efficacy of interventions for the prevention of hospital-acquired LD, in hospitalized patients at high-risk for developing LD, were eligible for inclusion. Data collection and analysis Two authors independently assessed the trials and extracted data. Data was analysed using statistical software, Review Manager 5.2. Results Three controlled trials, two assessing copper-silver ionization and one assessing ultraviolet light (UVL), met the inclusion criteria. The meta-analysis showed a significant benefit in using copper-silver ionization rather than no intervention for Legionella positivity in distal sites, with RR = 0.04 (95% CI Fixed Effects 0.001, 0.29). One study demonstrated benefit of UVL versus no intervention with a RR = 0.03 (95% CI 0.00, 0.41) for Legionella positivity in water samples. Authors’ conclusions Our review demonstrates that copper-silver ionization and UVL are beneficial, compared with no treatment, to prevent hospital-acquired LD. However the quality of the body of evidence identified does not allow a robust conclusion regarding the effectiveness of interventions for preventing hospital-acquired LD. Further research with well design and high quality studies is needed

Protecting Privacy When Sharing and Releasing Data with Multiple Records per Person

This study concerns the risks of privacy disclosure when sharing and releasing a dataset in which each individual may be associated with multiple records. Existing data privacy approaches and policies typically assume that each individual in a shared dataset corresponds to a single record, leading to an underestimation of the disclosure risks in multiple records per person scenarios. We propose two novel measures of privacy disclosure to arrive at a more appropriate assessment of disclosure risks. The first measure assesses individual-record disclosure risk based upon the frequency distribution of individuals’ occurrences. The second measure assesses sensitive-attribute disclosure risk based upon the number of individuals affiliated with a sensitive value. We show that the two proposed disclosure measures generalize the well-known k-anonymity and l-diversity measures, respectively, and work for scenarios with either a single record or multiple records per person. We have developed an efficient computational procedure that integrates the two proposed measures and a data quality measure to anonymize the data with multiple records per person when sharing and releasing the data for research and analytics. The results of the experimental evaluation using real-world data demonstrate the advantage of the proposed approach over existing techniques for protecting privacy while preserving data quality

Increase in Pneumococcal Immunization in Adults over 65 Years of Age in a Federally Qualified Health Center

Pneumococcal disease is a healthcare concern with increasing financial and societal burden for adults over the age of 65 years and their caretakers. The Center for Disease Control and Prevention (CDC) recommends the use of pneumococcal vaccines in this population as a preventive measure helping minimize the mortality and morbidity. This project aimed at increasing the rate of pneumococcal vaccines in a Federally Qualified Health Center (FQHC). The interventions implemented included the use of audit, feedback and provider educational intervention aimed at increasing the knowledge and the intent to change and improve their practice. The key results indicated an increase in aggregate pneumococcal vaccines in the organization as well as an increase in individual and historical vaccination rates for the organization and individual providers. The implications for practice include the improvement in vaccination rates significantly impacting the health of the community, as well as an increase in education provided regarding vaccination. The questionnaire provided positive feedback on the intervention. Further research to determine vaccination availability and re-vaccination should be considered

Preventing disease and saving resources:the potential contribution of increasing breastfeeding rates in the UK

Two challenges stand out as we contemplate the future of health services in the United Kingdom. The first is the state of the public finances and therefore the pressure in real terms on health services funding. The second is the recurring and vexing problem of health inequalities. The state of health inequalities in Britain has been commented on by many, but we have seen precious little real change in the disproportionate burden of early death and illness among the most disadvantaged and indeed across the whole health gradient in recent years.This work was funded by UNICEF UK

Overview of Australian Indigenous health status 2014

This Overview of Australian Indigenous health status provides information about: Aboriginal and Torres Strait Islander populations; the context of Indigenous health; various measures of population health status; selected health conditions; and health risk and protective factors. This Overview of Australian Indigenous health status provides a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people in Australia (states and territories are: New South Wales (NSW), Victoria (Vic), Queensland (Qld), Western Australia (WA), South Australia (SA), Tasmania (Tas), The Australian Capital Territory (ACT) and The Northern Territory (NT)). It draws largely on previously published information, some of which has been re-analysed to provide clearer comparisons between Aboriginal and Torres Strait Islander peoples and non-Indigenous people (for more details of statistics and methods, readers should refer to the original sources). Very little information is available separately for Australian Aboriginal people and Torres Strait Islander people. It is often difficult to determine whether original sources that use the term ‘Indigenous\u27 are referring to Aboriginal people only, Torres Strait Islander people only or to both groups. In these instances the terms from the original source are used