Improving Proficiency in Central Venous Catheter Insertion: Standardized Simulation Based Training for Internal Medicine House Staff

Objectives: The objectives of this study are to assess residents\u27 pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.https://jdc.jefferson.edu/patientsafetyposters/1063/thumbnail.jp

An assessment of growth and sex from mandibles of cadaver foetuses and newborns

The quantification of skeletal data is one way in which to demonstrate variation in human growth. In South Africa, few researchers have assessed patterns of growth in immature mandibles. The purpose of this study was to evaluate growth and sexual dimorphism in the mandible from the period of 31 gestational weeks to 36 months. A total of 74 mandibles were used, skeletal tissues were sourced from the Raymond A. Dart Collection (University of Witwatersrand), and cadaveric remains were obtained from the University of Pretoria and the University of Witwatersrand. The sources of cadaver materials (both bequeathment and unclaimed remains) included local provincial hospitals. The sample was divided into four groups, namely 31 to 40 gestational weeks (group1), 0 to 11 months (group 2), 12 to 24 months (group 3), and 25 to 36 months (group 4). Twenty-one osteological landmarks were digitized using a MicroScribe G2. Ten standard measurements were created and included: the longest length of mandible, mandibular body length and width, mandibular notch width and depth, mental foramen to inferior border of mandible, mandibular basilar widths bigonial and biantegonial, bigonial width of mental foramen and mental angle. Data were analyzed using PAST statistical software and Morphologika2 v2.5. For the linear measurements, no statistically significant difference between either the foetal and up to 12 month groups or the 2 to 3 years groups. However, statistically significant increases with age were noted between 12 and 24 months for nine variables. This can be associated with growth of the mandibular arch, development and eruption of the dentition and development of the masticatory structures. No evidence of sexual dimorphism was observed until age 3, where the mental angle and mandibular notch were significantly larger in females than males. In conclusion, the mandible develops and grows so as to accommodate development of the tongue, mastication and dental eruption. Future research that considers the influence of secular trends on mandibular growth is needed. AFRIKAANS : Die kwantifisering van skeletale data is ‘n betroubare metode om variasie in menslike groei aan te toon. Slegs enkele Suid-Afrikaanse navorsers, het groeipatrone in onvolwasse mandibulae nagevors. Die doel van hierdie studie was om groei en geslagsdimorfisme in die mandibula vanaf 31 gestasie weke tot 36 maande na geboorte te evalueer. ‘n Totaal van 74 mandibulae was gebruik. Skeletale weefsel uit die Raymond A. Dart Versameling (Universiteit van die Witwatersrand), en kadaweroorskot van die Universiteite van Pretoria en van die Witwatersrand was verkry. Die oorsprong van kadawermateriale (beide skenkings en onopgeëisde oorskot) het plaaslike provinsiale hospitale ingesluit. Die steekproef was verdeel in vier groepe, naamlik 31 to 40 gestasie weke (groep1), 0 tot 11 maande (groep 2), 12 tot 24 maande (groep 3), en 25 tot 36 maande (groep 4). MicroScribe, G2 is aangewend om 21 standaard antropometriese landmerke te digitiseer. Hieruit is 10 standaard antropometriese afmetings geskep o.a.: langste lengte van mandibula, lengte en breedte van corpus mandibula, afstand tussen foramen mentalis en inferior grens, basale wydte bigoniaal en biantegoniaal, bigoniale wydte van foramen mentalis asook mentale hoek. Inligting is d.m.v. PAST statistiese sagteware en Morphologika2 v2.5 ontleed. Volgens die Kruskal-Wallis-toets was die verskille tussen groepe 1 en 2, asook 3 en 4 statisties onbeduidend. Alle afmetings by groepe 2 en 3 het beduidende toenames getoon, behalwe dié van die afstand tussen foramen mentalis en inferior grens. Die veranderings mag die gevolg wees van die groei van die mandibula en koustrukture. Geslagsdimorfisme was aantoonbaar in groep 4, by die mentale hoeke (p=0.03) asook dimensies van die incisura mandibularis (p=0.0006), waar dié van vroulike individue groter was. Voor geboorte vergroot die arcus mandibularis om die ontwikkelende tong te huisves, terwyl dit na geboorte verander om die koustrukture te huisves. Gevolglik hermodelleer en groei die been as aanpassing vir die kouproses en om strukturele integreteit te behou. Geslagsdimorfisme word ook beïnvloed deur die kouproses. Die meeste veranderinge, veral dié van die koustrukture, was duideliker in vroulike individue. Toekomstige navorsing wat die invloed van sekulêre tendense op die groei van die mandibula oorweeg, is nodig.Dissertation (MSc)--University of Pretoria, 2011.Anatomyunrestricte

Do medical images aid understanding and recall of medical information? An experimental study comparing the experience of viewing no image, a 2D medical image and a 3D medical image alongside a diagnosis

Objective: This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis. Methods: We conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors. Results: Participants preferred to view 3D images alongside a diagnosis (p < .001) and reported greater understanding (p < .001), perceived accuracy (p < .001) and increased trust (p < .001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not. Conclusion: When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information. Practical Considerations: Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations

A qualitative study exploring the experience of viewing three‐dimensional medical images during an orthopaedic outpatient consultation from the perspective of patients, health care professionals, and lay representatives

Rationale, aims and objectives Three‐dimensional (3D) medical images are shown to patients during clinical consultations about certain health conditions. However, little is known about patients' experience of viewing them. The aim of this qualitative study was to explore the impact of sharing 3D medical images with patients during a clinical consultation about hip surgery, from the perspective of patients, health care professionals, and lay representatives. Method Interviews were conducted with 14 patients who were shown their own 3D medical images during their clinical consultation and four health care professionals conducting consultations within one orthopaedic outpatient clinic. In addition to interviews, 31 lay representatives participated in six focus groups. The focus groups aimed to gain a broader understanding of the advantages and concerns of showing patients their medical images and to compare 3D and two‐dimensional (2D) medical images. Interviews and focus groups were audio‐recorded, transcribed verbatim, and analysed using thematic analysis. Results Three themes were developed from the data: (a) the truthful image, (b) the empowering image, and (c) the unhelpful image. Focus group participants' preference for 3D or 2D images varied between conditions and groups, suggesting that the experience of viewing images may differ between individuals and conditions. Conclusions When shown to patients during an orthopaedic clinical consultation, 3D medical images may be an empowering resource. However, in this study, patients and focus group participants perceived medical images as factual and believed they could provide evidence of a diagnoses. This perception could result in overreliance in imaging tests or disregard for other forms of information

An assessment of early mandibular growth

Quantification of skeletal data has been shown to be an effective and reliable method of demonstrating variation in human growth as well as for monitoring and interpreting growth. In South Africa as well as internationally, few researchers have assessed mandibular growth in late fetal period and early childhood and therefore standards for growth and age determination in these groups are limited. The purpose of this study was to evaluate growth in the mandible from the period of 31 gestational weeks to 36 months postnatal. A total of 74 mandibles were used. Dried mandibles were sourced from the Raymond A. Dart Collection (University of Witwatersrand), and cadaveric remains were obtained from the Universities of Pretoria and the Witwatersrand. The sample was divided into four groups; 31–40 gestational weeks (group 1), 0–11 months (group 2), 12–24 months (group 3), and 25–36 months (group 4). Twenty-one osteological landmarks were digitized using a MicroScribe G2. Ten standard measurements were created and included: the maximum length of mandible, mandibular body length and width, mandibular notch width and depth, mental foramen to inferior border of mandible, mandibular basilar widths bigonial and biantegonial, bigonial width of mental foramen and mental angle. Data were analyzed using PAST statistical software and Morphologika2 v2.5. Statistically significant differences were noted in the linear measurements for all group comparisons except between groups 3 and 4. The mandible morphologically changed from a round, smooth contour anteriorly to adopt a more sharp and narrow adult shape. A progressive increase in the depth and definition of the mandibular arch was also noted. In conclusion, the mandible initially grows to accommodate the developing tongue (up to 11 months), progressive dental eruption and mastication from 12 to 36 months. Mastication is associated with muscle mass development; this would necessitate an increase in the dimensions of the mandibular notch and associated muscle attachment sites. These findings might be valuable in the estimation of age in unidentified individuals and to monitor prenatal growth of the mandible for the early diagnosis of conditions associated with stunted mandibular growth.http://www.elsevier.com/locate/forsciin

Preferences for portable ultrasound devices : a discrete choice experiment amongst abdominal aortic aneurysm surveillance patients and general ultrasound patients in England

Objective To undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA group); and (2) patients being scanned for general abdominal conditions (general group). Design A discrete choice experiment (DCE) questionnaire was administered to patients attending US appointments. Analysis of questionnaire responses used conditional logit models and included validity checks. Setting West Midlands, England. Participants 524 patients (223 in the AAA group and 301 in the general group) were recruited from the US outpatient department at University Hospital Coventry and Warwickshire. Outcome measures Coefficients for attributes in relation to their reference levels. Results The AAA group preferred to have their US performed in hospital while the general group had a preference for portable US at general practice surgeries. All patients had a strong preference for scanning by specialists, devices with a lower risk of underdiagnosis and receiving their results at the appointment where the scan takes place. The general group had a strong preference for the person performing the scan to know their medical history. Conclusions Patients being scanned for general abdominal conditions prefer to be scanned in a general practice by practitioners who know their medical history. Patients undergoing surveillance of AAA size prefer to be scanned in a hospital setting. Both groups would prefer to be informed of the scan results as soon as possible. Further research is required to explore the clinical scenarios in which targeted scanning by community practitioners would be of benefit to patients

Visual art-making as a resource for living positively with arthritis: An interpretative phenomenological analysis of older women’s accounts

This is the post-print version of the final paper published in Journal of Aging Studies. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.This study explored whether and how visual art-making, as a leisure activity, provided a coping resource for older women affected by arthritis. Twelve older women (aged 62–81) were interviewed. They had lived with arthritis for many years, and engaged in arts and crafts regularly. Transcripts were explored through Interpretative Phenomenological Analysis. Three main themes were identified. Firstly, most participants experienced art-making as a powerful means of controlling arthritis pain, through deep concentration, and through use of color and imagery. Secondly, participants experienced art-making as encouraging sustained attention to the outside world, offering psychological escape from the confines of the body and home. Thirdly, art-making protected and promoted identity, for example, through integrating current and former selves, enabling participants to express and re-experience certain valued memories, and engage in personal development. Some participants felt able to celebrate positive difference from others, on the basis of their art rather than their illness

Facet-joint injections for people with persistent non-specific low back pain (FIS) : study protocol for a randomised controlled feasibility trial

BACKGROUND: The role of injections of therapeutic substances into the back as treatment for low back pain is unclear. Facet joint injections are widely used despite the absence of evidence of sustained benefit. We hypothesise that facet joint injections might facilitate engagement with physiotherapist-led, best usual care (a combined physical and psychological programme) and is a clinically and cost-effective treatment for people with suspected low back pain of facet joint origin. METHODS/DESIGN: We present here the protocol for a randomised controlled feasibility trial for a main trial to test the above hypotheses. Patients referred to secondary care with persistent non-specific low back pain will be screened and invited to take part in the study. Those who meet the eligibility criteria will be invited for a physiotherapy assessment to confirm trial eligibility and for baseline data collection. All participants (n = 150) will be offered the best usual care package with physical and psychological components. Those randomised into the intervention arm (n = 75) will, in addition, receive intra-articular facet joint injections with local anaesthetic and steroids. Primary outcome data will be collected using daily and then weekly text messaging service for a pain score on a 0-10 scale. Questionnaire follow-up will be at 3, 6, and 12 months. Evaluation of trial processes and health economic analyses, including a value of information analysis, will be undertaken. The process evaluation will be mixed methods and will include the views of all stakeholders. DISCUSSION: Whilst this trial is a feasibility study it is currently one of the largest trials in this area. The outcomes will provide some evidence on the use of facet joint injections for patients with clinically diagnosed facet joint pain. TRIAL REGISTRATION: EudraCT identifier 2014-000682-50

Better Outcomes for Older people with Spinal Trouble (BOOST) Trial: a randomised controlled trial of a combined physical and psychological intervention for older adults with neurogenic claudication, a protocol

Introduction Neurogenic claudication due to spinal stenosis is common in older adults. The effectiveness of conservative interventions is not known. The aim of the study is to estimate the clinical and cost-effectiveness of a physiotherapist-delivered, combined physical and psychological intervention. Methods and analysis This is a pragmatic, multicentred, randomised controlled trial. Participants are randomised to a combined physical and psychological intervention (Better Outcomes for Older people with Spinal Trouble (BOOST) programme) or best practice advice (control). Community-dwelling adults, 65 years and over, with neurogenic claudication are identified from community and secondary care services. Recruitment is supplemented using a primary care-based cohort. Participants are registered prospectively and randomised in a 2:1 ratio (intervention:control) using a web-based service to ensure allocation concealment. The target sample size is a minimum of 402. The BOOST programme consists of an individual assessment and twelve 90 min classes, including education and discussion underpinned by cognitive behavioural techniques, exercises and walking circuit. During and after the classes, participants undertake home exercises and there are two support telephone calls to promote adherence with the exercises. Best practice advice is delivered in one to three individual sessions with a physiotherapist. The primary outcome is the Oswestry Disability Index at 12 months. Secondary outcomes include the 6 Minute Walk Test, Short Physical Performance Battery, Fear Avoidance Beliefs Questionnaire and Gait Self-Efficacy Scale. Outcomes are measured at 6 and 12 months by researchers who are masked to treatment allocation. The primary statistical analysis will be by ‘intention to treat’. There is a parallel health economic evaluation and qualitative study

Determining the role and responsibilities of the Australian epilepsy nurse in the management of epilepsy: a study protocol

Introduction Epilepsy is a common neurological condition affecting between 3% and 3.5% of the Australian population at some point in their lifetime. The effective management of chronic and complex conditions such as epilepsy requires person-centred and coordinated care across sectors, from primary to tertiary healthcare. Internationally, epilepsy nurse specialists are frequently identified as playing a vital role in improving the integration of epilepsy care and enhancing patient self-management. This workforce has not been the focus of research in Australia to date. Methods and analysis This multistage mixed-method study examines the role and responsibilities of epilepsy nurses, particularly in primary and community care settings, across Australia, including through the provision of a nurse helpline service. A nationwide sample of 30 epilepsy nurses will be purposively recruited via advertisements distributed by epilepsy organisations and through word-of-mouth snowball sampling. Two stages (1 and 3) consist of a demographic questionnaire and semistructured interviews (individual or group) with epilepsy nurse participants, with the thematic data analysis from this work informing the areas for focus in stage 3. Stage 2 comprises of a retrospective descriptive analysis of phone call data from Epilepsy Action Australia’s National Epilepsy Line service to identify types of users, their needs and reasons for using the service, and to characterise the range of activities undertaken by the nurse call takers. Ethics and dissemination Ethics approval for this study was granted by Macquarie University (HREC: 52020668117612). Findings of the study will be published through peer-reviewed journal articles and summary reports to key stakeholders, and disseminated through public forums and academic conference presentations. Study findings will also be communicated to people living with epilepsy and families