Behoefte aan uniforme kwaliteitscyclus van coschappen

OBJECTIVE: To investigate how quality control of clinical placements in the Netherlands is organised, which tools are available for this purpose, and what Dutch clinical placement students think about current clinical placement assessment. DESIGN: Document analysis, literature search and questionnaire. METHOD: In 2017, we asked all 8 medical schools to share their procedures and tools for assessing clinical placement quality with us. We searched various databases to find all published tools developed to measure clinical placement quality. In the same year, we also conducted a survey of 15 clinical placement students per school with questions about current and desired clinical placement assessment. RESULTS: All 8 schools sent detailed information about clinical placement quality assessment contents and procedures. All schools indicated that they are cyclically measuring each clinical placement's quality using evaluations by the clinical placement students. Each school uses its own questionnaire, none of these questionnaires have been validated. Literature search only found two tools specifically developed for assessing clinical placement quality, none of which have been validated for the Dutch language and situation. Clinical placement students feel that not enough noticeable improvement actions are being taken as a result of their evaluations. They preferred a short, uniform questionnaire with questions about clinical placement content, atmosphere and organisation. CONCLUSION: The quality cycle of clinical placements in the Netherlands could be improved with respect to uniformity and implementation of actions for improvement. There is a need for standardisation of the clinical placement quality cycle and for development of a validated Dutch measuring tool for this

Need for a uniform clinical placement quality cycle

OBJECTIVE: To investigate how quality control of clinical placements in the Netherlands is organised, which tools are available for this purpose, and what Dutch clinical placement students think about current clinical placement assessment.DESIGN: Document analysis, literature search and questionnaire.METHOD: In 2017, we asked all 8 medical schools to share their procedures and tools for assessing clinical placement quality with us. We searched various databases to find all published tools developed to measure clinical placement quality. In the same year, we also conducted a survey of 15 clinical placement students per school with questions about current and desired clinical placement assessment.RESULTS: All 8 schools sent detailed information about clinical placement quality assessment contents and procedures. All schools indicated that they are cyclically measuring each clinical placement's quality using evaluations by the clinical placement students. Each school uses its own questionnaire, none of these questionnaires have been validated. Literature search only found two tools specifically developed for assessing clinical placement quality, none of which have been validated for the Dutch language and situation. Clinical placement students feel that not enough noticeable improvement actions are being taken as a result of their evaluations. They preferred a short, uniform questionnaire with questions about clinical placement content, atmosphere and organisation.CONCLUSION: The quality cycle of clinical placements in the Netherlands could be improved with respect to uniformity and implementation of actions for improvement. There is a need for standardisation of the clinical placement quality cycle and for development of a validated Dutch measuring tool for this.</p

Bacterial Contamination of Ultrasound and Stethoscope Surfaces in Low- and High-Resource Settings

Point-of-care ultrasound is an accurate diagnostic and monitoring tool. Its increasing affordability, portability, and versatility make it an excellent component of standard clinical evaluation alongside the stethoscope. However, like the stethoscope, ultrasound carries risks of surface contamination and potential cross-infection. In this international observational study, we compared the surface contamination of ultrasound equipment to stethoscopes in two medical centers: a tropical low-resource hospital and academic high-resource hospital. Ultrasound equipment and coupling gel had similar prevalence of microbial surface contamination compared with observed stethoscopes. Most microbes were commensal Gram-positive, but some were opportunistic and pathogenic microbes (such as Escherichia coli and Staphylococcus aureus). In conclusion, it is crucial to appreciate and reduce the risk of ultrasound device contaminations. When ultrasound is used bedside, similar to stethoscopes, conscientious hygiene measures are equally fundamental

Orthostatic blood pressure measurements are often overlooked during the initial evaluation of syncope in the emergency department

The renewed 2018 syncope guidelines published by the European Society of Cardiology (ESC) reiterate that the initial evaluation of syncope should include history taking, physical examination, an electrocardiogram, and orthostatic blood pressure measurements (OBPM). However, the importance of evaluating for orthostatic hypotension (OH) often remains underappreciated in clinical practice. In this study, we examine the initial evaluation of syncope on an ED. We retrospectively reviewed 2 years of consecutive medical records of patients presenting with a syncope to the ED of a university hospital. We collected patient demographics and data on initial syncope evaluation for further analysis. In a cohort of 289 patients, OBPM and ECG were performed in 16 and 89% of the cases, respectively. An OBPM was performed in only 52% of the patients who received a working diagnosis of OH. In the other 48%, the OH diagnosis was likely made on the basis of history taking and exclusion of other syncope causes. OBPM are infrequently used during the initial evaluation of syncope irrespective of its consistent inclusion in ESC syncope guidelines. The discordance between clinical practice and the ESC syncope guidelines calls for increased awareness of the role of OBPM in the initial evaluation of syncope by either stricter guideline adherence or reappraisal of clinical practice

Effects of Lung Ultrasonography-Guided Management on Cumulative Fluid Balance and Other Clinical Outcomes: A Systematic Review

Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung ultrasonography-guided management has an effect on cumulative fluid balances and other clinical outcomes remains unclear. In this systematic review, we included 12 studies using ultrasonography guided-management with a total of 2290 patients. Four in-patient studies found a reduced cumulative fluid balance (ranging from –0.3 L to –2.4 L), whereas three out-patient studies found reduction in dialysis dry weight (ranging from –2.6 kg to –0.2 kg) compared with conventionally managed patients. None of the studies found adverse effects related to hypoperfusion. The use of lung ultrasonography-guided management was not associated with other clinical outcomes. This systematic review shows that lung ultrasonography-guided management, exclusively or in concert with other diagnostic modalities, is associated with a reduced cumulative fluid balance. Studies thus far have not shown a consistent effect on clinical outcomes