Portfolios for longer-term learning in health professional education

University of Technology Sydney. Faculty of Arts and Social Sciences.Assessment practices in higher education for the professions are focused, not unreasonably, on student progress through their various subjects, culminating in testing of discipline entry standards and competencies. This can, however, neglect the considerable need for the new graduate to continue to learn independently following entry to the profession, judging the quality of their own work as they begin to demonstrate professional expertise. Understanding that assessment processes are a key incentive for generating student engagement in learning, this thesis asks how we might use assessment in university courses for the professions to foster longer-term learning into practice. The problem of identifying and facilitating those learning skills at university that best equip students’ ongoing learning and self-assessment as entry level professionals requires a methodology that recognises the contextual nature and complexity of pedagogical interventions. Educational design research was employed for its capacity to allow theoretical questions about learning in context to be addressed as the research unfolded. The vehicle for the investigation was a professional practice portfolio assembled throughout a course. The context of the health sciences and the setting of a two-year program for medical sonographers, allowed the study of three iterative cycles of portfolio design. In each cycle, interventions were implemented to foster self-assessment, independent learning, reflective practice, and the capacity for making judgments and evidencing competence. Analysis of data from participant focus groups, interviews and portfolio entries, drawn from three years of entry cohorts of students, contributed to ongoing design modifications for improvement of the portfolio process. Twelve months following course completion, the continuing learning practices of new graduates in their workplaces were investigated and reconceptualised through a practice theory lens, identifying both resonances with portfolio assessment, and further avenues for improvement in portfolio practices. This thesis provides empirical evidence, through iterative research of pedagogical strategies, that students’ engagement with a course-long portfolio can positively influence longer-term learning. This is particularly so when it is embedded with supported, scaffolded learning skills. Consideration of the socio-material practices of new graduates offers further insights into ways forward

A Neural Attention Model for Categorizing Patient Safety Events

Medical errors are leading causes of death in the US and as such, prevention of these errors is paramount to promoting health care. Patient Safety Event reports are narratives describing potential adverse events to the patients and are important in identifying and preventing medical errors. We present a neural network architecture for identifying the type of safety events which is the first step in understanding these narratives. Our proposed model is based on a soft neural attention model to improve the effectiveness of encoding long sequences. Empirical results on two large-scale real-world datasets of patient safety reports demonstrate the effectiveness of our method with significant improvements over existing methods.Comment: ECIR 201

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

Background. Competence in colonoscopy, which is a technically difficult procedure, requires adequate exposure to it and the maintenance of a detailed logbook. Without an electronic record this is difficult to  achieve. By implementing an electronic medical record system we aimed to perform a detailed quality assessment audit of colonoscopy, to benchmark our results and generate accurate logbooks for individual endoscopists.Methods. We reviewed the prospectively maintained Hybrid Electronic Medical Registry (HEMR).  Colonoscopies performed between March 2013 and March 2014 were reviewed, and for competency, quality metrics were derived from the guidelines of the American Society of Gastroenterology.Results. A total of 843 colonoscopies were performed. Seven hundred and seventy procedures were  performed by three staff endoscopists who each performed over the required 150 procedures annually (n=197, 338 and 235). The remaining 73 (8.7%) were performed by other staff. In 105 cases (12.5%), bowel preparation was deemed to be inadequate, which caused the procedure to be abandoned in 34 cases. A total of 64 cases were deemed to be incomplete because of obstructing lesions (n=26), extensive diverticulosis (n=4), technical difficulty (n=31) and patient discomfort (n=3). There were two complications recorded: perforation (n=1) and bleeding (n=1).Conclusions. The HEMR system enabled the audit of experiences with colonoscopy in our institution. Our results are broadly compatible with the international literature and with a number of guidelines. The  development of an electronic record system is a major advance, as it enables meaningful benchmarking and the generation of accurate procedural logbooks

Pan computed tomography for blunt polytrauma: Are we doing too many?

Background. Pan computed tomography (CT) is widely used in the evaluation of  patients with blunt polytrauma, but there is growing concern about the radiation risks imposed.Objectives. To ascertain whether we were possibly overutilising pan CT in our  trauma service, and whether we could safely cut down on scans without missing significant injuries.Methods. We audited all pan scans performed in the Metropolitan Trauma Service, Pietermaritzburg, South Africa, during the 12-month period 1 January - 31  December 2012. An analysis was done to determine what injuries were identified and how these findings influenced our management.Results. Of the 140 pan scans, 108 (77.1%) influenced management. These  included the following components: 62 brain scans (44.3%), 16 cervical spine scans (11.4%), 50 chest scans (35.7%) and 31 abdominal scans (22.1%). The remaining 32 pan scans (22.9%) did not influence management. However, it turned out that many of these ‘clinically negative’ scans were in fact clinically important, ruling out injury in patients in whom clinical assessment was regarded as unreliable: 3 patients (2.1%) were hypoxic and had to be sedated, intubated and ventilated; 14 (10.0%) had a Glasgow Coma Score (GCS) of <15; and 9 (6.4%) had major  distracting injuries. This left only 6 pan scans (4.3%) that were not regarded as clinically helpful.Conclusion. In our setting, the majority of pan scans influence management. By  ruling out significant injuries, clinically negative scans are valuable in patients who are obtunded, intubated and ventilated, or have major distracting injuries. In  patients with a GCS of 15, not sedated and ventilated and with no major distracting injuries, clinical assessment and alternative imaging modalities may suffice

Potassium, Calcium, and Magnesium Bridging of AOT to Mica at Constant Ionic Strength.

The bridging effect of a series of common cations between the anionic mica surface and the AOT anion has been studied in a condition of constant ionic strength and surfactant concentration. It was found that sodium ions did not show any bridging effect in this system; however, calcium, magnesium, and potassium all caused adsorption of the organic to the mica surface. The concentrations at which bridging occurred was probed, revealing that only a very low bridging cation concentration was required for binding. The bridged layer stability was also investigated, and the interaction was shown to be a weak one, with the bound layer in equilibrium with the species in the bulk and easily removed. Even maintaining ionic strength and bridging ion concentration was not sufficient to retain the layer when the free organic in solution was removed.We thank EPSRC and BP plc for the funding (RG8620) that made this work possible

Pathological and phylogenetic characterization of Amphibiothecum sp. infection in an isolated amphibian (Lissotriton helveticus) population on the island of Rum (Scotland)

Outbreaks of cutaneous infectious disease in amphibians are increasingly being attributed to an overlooked group of fungal-like pathogens, the Dermocystids. During the last 10 years on the Isle of Rum, Scotland, palmate newts (Lissotriton helveticus) have been reportedly afflicted by unusual skin lesions. Here we present pathological and molecular findings confirming that the pathogen associated with these lesions is a novel organism of the order Dermocystida, and represents the first formally reported, and potentially lethal, case of amphibian Dermocystid infection in the UK. Whilst the gross pathology and the parasite cyst morphology were synonymous to those described in a study from infected L. helveticus in France, we observed a more extreme clinical outcome on Rum involving severe subcutaneous oedema. Phylogenetic topologies supported synonymy between Dermocystid sequences from Rum and France and as well as their distinction from Amphibiocystidium spp. Phylogenetic analysis also suggested that the amphibian-infecting Dermocystids are not monophyletic. We conclude that the L. helveticusinfecting pathogen represents a single, novel species; Amphibiothecum meredithae

Hanging-related injury in Pietermaritzburg, South Africa

BACKGROUND: Hanging is a common form of self-harm, and emergency care physicians will not infrequently be called upon to manage a survivor.Despite the relative frequency of the injury, there is a paucity of literature on the topic and the spectrum and incidence of associated injuries are poorly described. OBJECTIVES: To review experience with management of victims of hanging at a major trauma centre in South Africa. METHODS: All patients treated by the Pietermaritzburg Metropolitan Trauma Service following a hanging incident between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry. Basic demographics were recorded, and the management and outcome of each patient were noted. RESULTS: During the 6-year period under review, a total of 154 patients were seen following a hanging incident. The mean age was 29.4 years. There were 24 females (15.6%) and 130 males (84.4%). The vast majority (n=150; 97.5%) had attempted suicide, and only 4 hangings (2.5%) were accidental. A total of 92 patients (60.9%) had consumed alcohol prior to the incident. There were 23 patients with a Glasgow Coma Score (GCS) 12 (mild TBI). A total of 7 patients (4.5%) required intensive care unit admission, and 25 (16.2%) required intubation. The following extracranial injuries were documented on computed tomography scans: hyoid bone fractures (n=2), cervical spine fracture (n=10), mandible fracture (n=4) and oesophageal injury (n=1). Intracranial pathology was evident on 27.0% of scans, with the most common finding being global cerebral ischaemia. The mortality rate was 2.5% (4/154). CONCLUSIONS: Hanging is a common mechanism of self-harm. It is associated with significant injuries and mortality. The acute management of hanging should focus on airway protection followed by detailed imaging of the head and neck. Further work must attempt to include mortuary data on hanging

Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience

INTRODUCTION: Discrepancy in outcomes between urban and rural trauma patients is well known. We reviewed our institutional experience with the management of gunshot wounds (GSWs) in the specific setting of car hijacking and focused on clinical outcome between rural and urban patients. METHODS: A retrospective review was conducted at a major trauma centre in South Africa over an 8-year period for all patients who presented with any form of GSWs in car hijacking settings. Specific clinical outcomes were compared between rural and urban patients. RESULTS: A total of 101 patients were included (74% male, mean age 34 years). Fifty-five per cent were injured in rural areas and the remaining 45% (45/101) were in the urban district. Mean time from injury to arrival at our trauma centre was 11 hours for rural and 4 hours for urban patients (p < 0.001). Seventy-six per cent (76/101) sustained GSWs to multiple body regions. Sixty-three of the 101 (62%) patients required one or more operative interventions. In individual logistic regressions adjusted for sex and number of regions injured, rural patients were 9 (95% CI: 1.9-44.4) and 7 (95% CI: 2.124.5) times more likely than urban patients to have morbidities or required admissions to intensive care respectively. The risk of death in rural patients was 36 (95% CI: 4.5-284.6) times higher than that of urban patients. CONCLUSIONS: Patients who sustained GSWs in carjacking incidents that occurred in rural areas are associated with significantly greater morbidity and mortality compared with their urban counterparts. Delay to definitive care is likely to be the significant contributory factor, and improvement in prehospital emergency medical service is likely to be beneficial in improving patient outcome