Has “the ceiling” rendered the Readiness for Interprofessional Learning Scale (RIPLS) outdated?

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Supporting Clinical Perception : A multi-method approach to how technology may support clinical perception

BACKGROUND Patient care and management in hospitals is more difficult than ever before. Not only must clinicians perceive and interpret vast amounts of medical information related to single patient management, they are also expected to coordinate their own and their patients’ activities to achieve most health benefit per value spent. The overall objective of this thesis was to explore, develop and evaluate technology that may support perception and interpretation of information related to individual patient management and care coordination. METHODS The research has been conducted within the context of perioperative care, including operating theatres, post-anaesthesia care units, trauma team management of emergency patients and assessment of individual patients’ laboratory test results. Field work with focused interviews and in-depth interviews with perioperative staff were carried out to understand what information supports perioperative staff members in managing their own and their patients’ activities, and how that information is perceived. Patient status overviews were iteratively developed and evaluated through simulated ward work scenarios to understand what information supports surgical ward nurses in managing perioperative care, and how that information can be presented on a digital whiteboard without compromising patient privacy. An observational retrospective cohort study was conducted to evaluate the importance of projected perception of a care activity on patient management. Finally, we did a balanced, crossover experiment with medical students as participants to explore the effects of four laboratory test result presentation formats on the quality and efficiency of perception and interpretation of such results. RESULTS Perioperative activities unfold unpredictably, and perioperative care management relies heavily on ad hoc communication. Although schedules are perceived as important collaborative artefacts, they provide limited support for timely execution of individual work. A patient management status board including a continuously updated list of recent care events as well as a list of estimated onset of expected future events was welcomed by ward nurses. Such a status board was expected to facilitate perception and improve awareness on new care information as well as reduce the workload of coordinating care. Continuously updated estimated projections of expected future events were considered to be an effective means of interdepartmental communication. There was a significant association between the efficiency of the initial intrahospital trauma patient management and the time from trauma team activation until patient arrival (i.e. the amount of temporal projection). The descriptive data suggested that 10-20 minutes pre-arrival activation of the team was optimal timing. Pre-activation trauma team notification was not associated with the efficiency of patient management. The formats with which laboratory results were presented influenced both speed and quality of the assessment. Participants preferred different presentation formats for different kinds of patients. A table sufficed for sets of laboratory results consisting of few blood samples, but line graph visualisations seemed favourable for sets of laboratory results consisting of many samples. No single presentation format was superior in all respects. CONCLUSION Presenting proper information at the right place and right time is important, and for some information presentation format also may matter. Providing clinicians with timely updates on care activities and estimated onset of expected future events seems to be a fruitful technological solution to support coordination of hospital services. Furthermore, information visualisation has a potential of enhancing the perceptual and cognitive skills of clinicians – influencing the clinical assessment of patient data both qualitatively and quantitatively

Disease-associated reference intervals for twenty laboratory tests in patients with rheumatoid arthritis, Crohn's disease or ulcerative colitis

Background Population based reference intervals are fundamental for interpreting results for quantitative laboratory tests. In patients with a specific chronic disorder, however, results of various tests may regularly be different than in healthy individuals. Health-associated reference intervals may therefore have limited value in such patients. Instead, disease-associated reference intervals may be useful, as they describe the results distribution in populations resembling the specific patients. Few disease-associated reference ntervals are available in the literature. The aim of this study was to estimate reference intervals for common laboratory tests for patient populations with rheumatoid arthritis, Crohn’s disease or ulcerative colitis without significant comorbidity, using a novel algorithm. Material and methods Laboratory test results and hospital discharge diagnoses were collected for relevant patients. An algorithm was developed to identify discharge diagnoses significantly associated with high or low results for specific tests. After excluding patients with such diagnoses, reference intervals were estimated, representing results distributions in patients with each of the specific chronic disorders, but without significant comorbidity. Results Disease-associated reference intervals were estimated for 20 common laboratory tests. Most of the estimated reference limits were significantly different from corresponding health-associated reference limits. Thirty percent of the estimated reference intervals were different from estimates based on crude patient populations, indicating that the algorithm applied managed to exclude patients with relevant comorbidity. Conclusion Disease-associated reference intervals could be estimated for a number of tests in patients with rheumatoid arthritis, ulcerative colitis or Crohn’s disease using a highly automated algorithm based on routinely recorded patient data

Presentation of clinical laboratory results : an experimental comparison of four visualization techniques.

OBJECTIVE: To evaluate how clinical chemistry test results were assessed by volunteers when presented with four different visualization techniques. MATERIALS AND METHODS: A total of 20 medical students reviewed quantitative test results from 4 patients using 4 different visualization techniques in a balanced, crossover experiment. The laboratory data represented relevant patient categories, including simple, emergency, chronic and complex patients. Participants answered questions about trend, overall levels and covariation of test results. Answers and assessment times were recorded and participants were interviewed on their preference of visualization technique. RESULTS: Assessment of results and the time used varied between visualization techniques. With sparklines and relative multigraphs participants made faster assessments. With relative multigraphs participants identified more covarying test results. With absolute multigraphs participants found more trends. With sparklines participants more often assessed laboratory results to be within reference ranges. Different visualization techniques were preferred for the four different patient categories. No participant preferred absolute multigraphs for any patient. DISCUSSION: Assessments of clinical chemistry test results were influenced by how they were presented. Importantly though, this association depended on the complexity of the result sets, and none of the visualization techniques appeared to be ideal in all settings. CONCLUSIONS: Sparklines and relative multigraphs seem to be favorable techniques for presenting complex long-term clinical chemistry test results, while tables seem to suffice for simpler result sets.<p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode</p

Teambasert læring – en studentaktiviserende og lærerstyrt undervisningsform

Sammendrag Bakgrunn: Studentaktiviserende undervisning er viktig for å oppnå god læring. I teambasert læring (TBL) aktiviseres studentene individuelt, gruppevis og i plenum under ledelse av faglærer. TBL er i liten grad prøvd ut og evaluert i medisinsk utdanning i Norge. Vi ville derfor undersøke hvorvidt TBL kan være egnet som undervisningsform i grunnutdanningen av leger. Materiale og metode: Vi arrangerte TBL i generell patologi for andreårs medisinstudenter i 2013 og 2014. TBL-sesjonen varte i tre timer og inkluderte individuell og gruppevis oppvarmingstest, gruppearbeid, plenumsdiskusjon og oppsummering fra faglærer. Svarene på oppgavene ble samlet inn for å sammenlikne individuelle og gruppevise prestasjoner på testene. Studentene ble også bedt om å evaluere undervisningen. Resultater: Gruppenes prestasjoner var bedre enn eller like gode som 84 % (2013) og 72 % (2014) av de individuelle prestasjonene. TBL ble av studentene oppfattet som en engasjerende og lærerik undervisningsform som egner seg til oppsummering og som tilbakemelding på eget kunnskapsnivå. Til tross for at tidsbruken ble beskrevet som unødvendig lang, var studentene tydelige på at TBL burde integreres i medisinstudiet. Fortolkning: Vi anbefaler TBL som undervisningsform i grunnutdanningen i medisin

What is optimal timing for trauma team alerts? A retrospective observational study of alert timing effects on the initial management of trauma patients.

BACKGROUND: Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients. METHODS: Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification. RESULTS: In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003). Median time to chest X-ray for teams activated 15-20 minutes prearrival was 5 minutes, and 8 minutes for teams activated &lt;5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694). We found no effect of preactivation notification on time to chest X-ray (P = 0.474) or length of stay (P = 0.684). CONCLUSION: Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.<p>This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php</p

Express Team-Based Learning (eTBL): A Time-Efficient TBL Approach in Neuroradiology

Rationale and Objectives Team-based learning (TBL) is a student-centred, teacher-directed instructional method that promotes active learning. The application phase of TBL stimulates group discussion and critical thinking, which could be useful for learning radiology. We designed and evaluated two modified TBL-sessions on computed tomography and magnetic resonance imaging diagnostics in neuroradiology. Our aim was to examine what effects engaging students in in-class team application tasks had on student learning. Materials and Methods A cross-over study was conducted, including 105 third-year medical students using two modified TBL sessions as the active learning intervention compared with two traditional lectures as a control. Student learning was assessed by results on the neuroradiology part of the end-of-year written examination. Student engagement and perceptions were assessed using the Student Self-Report of Engagement Measure and an additional four Likert-type items. Results There were no statistically significant differences in student scores on the examination. Students reported high levels of engagement, and reported being more satisfied overall with the TBL sessions than traditional lectures. Students rated the TBL sessions higher than lectures on ability to make difficult material comprehensible, ability to engage students and to give them feedback. Conclusion The modified TBL sessions halved in-class teaching time and by omitting the readiness assurance tests, there was more in-class time to focus on problem-solving of real clinical cases. Moreover, shorter sessions may ease implementation of TBL in the curriculum and allow for more frequent sessions. Students were more satisfied with eTBL than lectures, and reported high levels of engagement