Redefining Simulation Fidelity for Healthcare Education

Background. Fidelity - an intrinsic property of simulation is crucial to simulation design and to educational effectiveness. Yet the term fidelity is inconsistently used, which makes it difficult to draw inferences from current literature and translate research into practice. Aim. In this article, we attempt to bring some clarity to the term simulation fidelity in healthcare education. Method. We are opposed to the notion that high-fidelity simulation requires complete and faithful replication of reality, and instead argue for an accurate representation of real-world cues and stimuli. We address a number of issues surrounding the term fidelity and how it is currently used in the literature. Result. In recognising the limitations of current methods of describing fidelity in the literature, we propose an alternative 3-dimensional framework for fidelity along the axes of the patient, clinical scenario, and healthcare facilities as a means for more precise and practical positioning of current healthcare simulation activities. Conclusion. All aspects of fidelity significantly hinge on the learners’ perceived realism of the context of the learning episode as opposed to any one particular element such as the technology used.Peer reviewe

What is the role of imaging in acute low back pain?

In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4–6 weeks. The natural history of low back pain is favorable with improvement over time, thus reassurance to such patients is very important. However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits. There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms

Validation of the SCID-hu Thy/Liv mouse model with four classes of licensed antiretrovirals.

BackgroundThe SCID-hu Thy/Liv mouse model of HIV-1 infection is a useful platform for the preclinical evaluation of antiviral efficacy in vivo. We performed this study to validate the model with representatives of all four classes of licensed antiretrovirals.Methodology/principal findingsEndpoint analyses for quantification of Thy/Liv implant viral load included ELISA for cell-associated p24, branched DNA assay for HIV-1 RNA, and detection of infected thymocytes by intracellular staining for Gag-p24. Antiviral protection from HIV-1-mediated thymocyte depletion was assessed by multicolor flow cytometric analysis of thymocyte subpopulations based on surface expression of CD3, CD4, and CD8. These mice can be productively infected with molecular clones of HIV-1 (e.g., the X4 clone NL4-3) as well as with primary R5 and R5X4 isolates. To determine whether results in this model are concordant with those found in humans, we performed direct comparisons of two drugs in the same class, each of which has known potency and dosing levels in humans. Here we show that second-generation antiretrovirals were, as expected, more potent than their first-generation predecessors: emtricitabine was more potent than lamivudine, efavirenz was more potent than nevirapine, and atazanavir was more potent than indinavir. After interspecies pharmacodynamic scaling, the dose ranges found to inhibit viral replication in the SCID-hu Thy/Liv mouse were similar to those used in humans. Moreover, HIV-1 replication in these mice was genetically stable; treatment of the mice with lamivudine did not result in the M184V substitution in reverse transcriptase, and the multidrug-resistant NY index case HIV-1 retained its drug-resistance substitutions.ConclusionGiven the fidelity of such comparisons, we conclude that this highly reproducible mouse model is likely to predict clinical antiviral efficacy in humans

Influence of national culture on the adoption of integrated medical curricula

Integrated curricula have been implemented in medical schools all over the world. However, among countries different relative numbers of schools with integrated curricula are found. This study aims to explore the possible correlation between the percentage of medical schools with integrated curricula in a country and that country’s cultural characteristics. Curricula were defined as not integrated if in the first 2 years of the program at least two out of the three monodisciplinary courses Anatomy, Physiology and Biochemistry were identified. Culture was defined using Hofstede’s dimensions Power distance, Uncertainty avoidance, Masculinity/Femininity, and Individualism/Collectivism. Consequently, this study had to be restricted to the 63 countries included in Hofstede’s studies which harbored 1,195 medical schools. From each country we randomly sampled a maximum of 15 schools yielding 484 schools to be investigated. In total 91% (446) of the curricula were found. Correlation of percent integrated curricula and each dimension of culture was determined by calculating Spearman’s Rho. A high score on the Power distance index and a high score on the Uncertainty avoidance index correlated with a low percent integrated curricula; a high score on the Individualism index correlated with a high percent integrated curricula. The percentage integrated curricula in a country did not correlate with its score on the Masculinity index. National culture is associated with the propensity of medical schools to adopt integrated medical curricula. Consequently, medical schools considering introduction of integrated and problem-based medical curricula should take into account dimensions of national culture which may hinder the innovation process

Chronic pain in primary care. German figures from 1991 and 2006

<p>Abstract</p> <p>Background</p> <p>Until now only limited research has been done on the prevalence of chronic pain in primary care. The aim of this investigation was to study the health care utilisation of patients suffering from pain. How many patients visit an outpatient clinic because of the symptom of pain? These data were compared with data from a similar study in 1991, to investigate whether improvements had been achieved.</p> <p>Methods</p> <p>A total of 1201 consecutive patients visiting outpatient clinics were surveyed in six practices in the western part of Germany on randomly selected days by means of questionnaires. Topics were the point prevalence of pain and the period prevalence of chronic pain, its characteristics and its impact on daily life, as well as data on previous therapies for pain. A retrospective comparison was made with the data from a similar study with same design surveying 900 patients that took place in five practices during 1991.</p> <p>Results</p> <p>In 2006, pain was the main reason for consulting a doctor in 42.5% of all patients (1991: 50.3%). Of all respondents, 62% suffered from pain on the particular day of the consultation, and 40% reported that they had been suffering from pain for more than six months (1991: 36.4%). As many as 88.3% of patients with chronic pain reported a negative impact on their daily life due to this pain (1991: 68%), and 88.1% reported impairment of their working life because of chronic pain (1991: 59.1%).</p> <p>Conclusion</p> <p>Pain, and chronic pain in particular, is a central problem in primary care. Over the last 15 years, the number of patients suffering from chronic pain has not decreased. In nearly half of all cases, pain is still the reason for health care utilisation in outpatient clinics. Pain represents a major primary health care problem with enormous impact on public health. Improvements can only be achieved by improving the quality of health care at the primary care level.</p