Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies

Background: Emergency medicine (EM) is a growing specialty in Colombia with five residency programs in the country. EM leadership is interested in incorporating point-of-care (POC) ultrasound into a standardized national EM residency curriculum. This study is a nationwide survey of Colombian EM residents designed to explore the current state of POC ultrasound use within EM residencies and examine specific barriers preventing its expansion. Methods: We conducted a mix-methodology study of all available current EM residents in the five EM residencies in Colombia. The quantitative survey assessed previous ultrasound experience, current use of various applications, desire for further training, and perceived barriers to expanded use. Focus group discussions (FGDs) were conducted with current EM residents to gather additional qualitative insight into their practice patterns and perceived barriers to clinician-performed ultrasound. Results: Sixty-nine EM residents completed the quantitative survey, a response rate of 85% of all current EM residents in Colombia; 52% of resident respondents had previously used ultrasound during their training. Of these, 58% indicated that they had performed 40 scans. The most frequently used applications indicated by respondents were trauma, obstetrics, and procedures including vascular access. A quarter indicated they had previously received some ultrasound training, but almost all expressed an interest in learning more. Significant barriers included lack of trained teachers (indicated by 78% of respondents), absence of machines (57%), and limited time (41%). In FGDs, the barriers identified were inter-specialty conflicts over the control of ultrasonography, both institutionally and nationally, and program-specific curriculum decisions to include POC ultrasound. Conclusion: While currently limited in their access, EM residents in Colombia have a strong interest in integrating POC ultrasound into their training. Current barriers to expanded use include traditional barriers such as a lack of equipment seen in many developing countries, as well as inter-specialty conflicts typical of developed countries. Further collaboration is underway to help overcome these obstacles and integrate POC ultrasound into Colombian EM residency training

Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies

Background: Emergency medicine (EM) is a growing specialty in Colombia with five residency programs in the country. EM leadership is interested in incorporating point-of-care (POC) ultrasound into a standardized national EM residency curriculum. This study is a nationwide survey of Colombian EM residents designed to explore the current state of POC ultrasound use within EM residencies and examine specific barriers preventing its expansion. Methods: We conducted a mix-methodology study of all available current EM residents in the five EM residencies in Colombia. The quantitative survey assessed previous ultrasound experience, current use of various applications, desire for further training, and perceived barriers to expanded use. Focus group discussions (FGDs) were conducted with current EM residents to gather additional qualitative insight into their practice patterns and perceived barriers to clinician-performed ultrasound. Results: Sixty-nine EM residents completed the quantitative survey, a response rate of 85% of all current EM residents in Colombia; 52% of resident respondents had previously used ultrasound during their training. Of these, 58% indicated that they had performed 40 scans. The most frequently used applications indicated by respondents were trauma, obstetrics, and procedures including vascular access. A quarter indicated they had previously received some ultrasound training, but almost all expressed an interest in learning more. Significant barriers included lack of trained teachers (indicated by 78% of respondents), absence of machines (57%), and limited time (41%). In FGDs, the barriers identified were inter-specialty conflicts over the control of ultrasonography, both institutionally and nationally, and program-specific curriculum decisions to include POC ultrasound. Conclusion: While currently limited in their access, EM residents in Colombia have a strong interest in integrating POC ultrasound into their training. Current barriers to expanded use include traditional barriers such as a lack of equipment seen in many developing countries, as well as inter-specialty conflicts typical of developed countries. Further collaboration is underway to help overcome these obstacles and integrate POC ultrasound into Colombian EM residency training

Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies

Background: Emergency medicine (EM) is a growing specialty in Colombia with five residency programs in the country. EM leadership is interested in incorporating point-of-care (POC) ultrasound into a standardized national EM residency curriculum. This study is a nationwide survey of Colombian EM residents designed to explore the current state of POC ultrasound use within EM residencies and examine specific barriers preventing its expansion. Methods: We conducted a mix-methodology study of all available current EM residents in the five EM residencies in Colombia. The quantitative survey assessed previous ultrasound experience, current use of various applications, desire for further training, and perceived barriers to expanded use. Focus group discussions (FGDs) were conducted with current EM residents to gather additional qualitative insight into their practice patterns and perceived barriers to clinician-performed ultrasound. Results: Sixty-nine EM residents completed the quantitative survey, a response rate of 85% of all current EM residents in Colombia; 52% of resident respondents had previously used ultrasound during their training. Of these, 58% indicated that they had performed <10 scans and 17% reported >40 scans. The most frequently used applications indicated by respondents were trauma, obstetrics, and procedures including vascular access. A quarter indicated they had previously received some ultrasound training, but almost all expressed an interest in learning more. Significant barriers included lack of trained teachers (indicated by 78% of respondents), absence of machines (57%), and limited time (41%). In FGDs, the barriers identified were inter-specialty conflicts over the control of ultrasonography, both institutionally and nationally, and program-specific curriculum decisions to include POC ultrasound. Conclusion: While currently limited in their access, EM residents in Colombia have a strong interest in integrating POC ultrasound into their training. Current barriers to expanded use include traditional barriers such as a lack of equipment seen in many developing countries, as well as inter-specialty conflicts typical of developed countries. Further collaboration is underway to help overcome these obstacles and integrate POC ultrasound into Colombian EM residency training. © 2014 Henwood et al.; licensee Springer

Superlattice structure in chalcogen square-net charge density wave phases.

Superstructures in materials with chalcogen square lattices are accounted for in terms of charge density waves associated with quasi-one-dimensional electronic structure. Two new compounds, DySe\sb{1.84} and Rb\sb{0.33}DySe\sb{2.67}, were grown in a RbCl/LiCl eutectic flux. Rb\sb{0.33}DySe\sb{2.67} has an orthorhombic subcell, space group Cmcm, a = 4.0579(6)A, b =26.47(1)A and c = 3.8909(6)A; the selenium square lattice has site occupancy waves and charge density waves. The average substructure of DySe\sb{1.84} is tetragonal, P4/nmm, but the complete modulated structure is better described in a 3 + 2 dimensional space group C\sbsp{c\"m\"m1}{Pm2\sb1n}. The basic cell is a = 3.9912(3)A, b = 3.9863(1)A, and c = 8.206(1)A, with modulation wave vectors at q\rm\sb1 = \alpha{\bf a}\sp* + \beta{\bf b}\sp* + 1/2{\bf c}\sp*,\ and\ {\bf q}\sb2 = \alpha{\bf a}\sp* - \beta{\bf b}\sp* + 1/2{\bf c}\sp* where $\alpha$ = 0.33338(12), and $\beta$ = 0.27284(6). Refinement on main reflections plus first and second order satellites produced four solutions that could not be differentiated by R-factors. An energy minimum structure is predicted by \mu\sb2-scaled Huckel theory, and the superstructures found in elemental selenium, and LnQ\sb2(Ln=La,Ce; Q=S,Se) phases are rationalized. The concept of an effective band filling is introduced as a means of generating a model for the Fermi surface of a defective lattice from that of an ideal non-defective lattice. By this method the superstructures of La\rm\sb{10}Se\sb{19},\ Cs\sb3Te\sb{22},\ RbDy\sb3Se\sb8\ and\ DySe\sb{1.84} are rationalized and predicted. The synthesis, structure and band structure analysis of the quaternary compound K\sb{0.33}\rm Ba\sb{0.67}AgTe\sb2 are reported. Crystals were obtained by reaction of K\sb2Te, BaTe, Ag and Te in a K\sb2Te/BaTe/Te flux cooling from 450\sp\circC. The substructure is tetragonal, 14/mmm, a\rm\sb{sub} = 4.624(2)\ \A,\ {\bf c}\sb{sub} = 23.326(4) A, 172 independent data, 13 variables, R/R\rm\sb{w} = 0.054/0.067. A (Te\sb2\rbrack\sp{4/3-} square net should be metallic, but transport measurements show semiconductor behavior. Electron diffraction reveals superstructures in accord with calculated Fermi surface nesting vectors. Superstructure predicted by \mu\sb2-scaled Huckel theory agrees with experimental diffraction data.Ph.D.ChemistryUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104938/1/9624607.pdfDescription of 9624607.pdf : Restricted to UM users only

Refractive errors in the adult pakistani population: the national blindness and visual impairment survey.

PURPOSE: To determine the prevalence of refractive error (RE) and spectacle wear and to explore the need for spectacle correction in adults (30 years or older) in Pakistan. METHODS: Multi-stage, cluster random sampling national survey. Each subject had their medical history taken, visual acuity measured, and underwent autorefraction, biometry and fundus examination. Those that presented with visual acuity of less than 6/12 in either eye underwent more detailed examination, including corrected distance visual acuity measurement (autorefraction results placed in a trial lens frame). Myopia was defined as a spherical equivalent of worse than -0.5D, hypermetropia as greater than +0.5D, and astigmatism as greater than 0.75D. Spectacle need (i.e., those that improved from unaided VA with spectacle correction) was determined along with the spectacle coverage, defined as the proportion of need that was met (by the participant's own spectacles). RESULTS: The crude prevalence of myopia, hypermetropia and astigmatism was 36.5%, 27.1%, and 37%, respectively. The prevalence of spectacle wear in phakic participants was 4.0%, significantly lower than for those who were pseudo/aphakic (41.7%). Just over a quarter (25.8%) of spectacle wearers presenting with visual impairment (< 6/12) were able to improve their vision when retested with their autorefraction prescription. The overall spectacle coverage (6/12 cutoff) was 15.1%. CONCLUSIONS: This survey provides the first reliable national estimates. RE services are not covering the majority of the population in need and the provision of spectacle correction, as a highly cost effective treatment for visual impairment, needs addressing within the country's national eye care program