NL360+: A Multisource Feedback & Peer-Coaching Pilot Program: Final Evaluation Report

In November 2018, the Office of Professional & Educational Development (OPED), Faculty of Medicine, Memorial University received an unrestricted educational grant from the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) to design, develop, pilot, and evaluate a Quality Improvement (QI) program for Newfoundland and Labrador (NL) physicians - NL360+: A Multisource Feedback & Peer-Coaching Pilot Program. The purpose of this program was to provide physicians in the province with a voluntary opportunity to participate in, and evaluate, a pilot multisource feedback and peer-coaching experience. The initial timeline for completion of pilot program delivery and evaluation was December 2020. However, the COVID-19 public health emergency caused significant delays in the matching of participants and peer-coaches and subsequently, the coaching sessions. The process continued to move forward and a preliminary evaluation report was submitted to the CPSNL in December 2020. The NL360+ pilot program closed in June 2021

Examination of the Effect of Low versus High-Fidelity Simulation on Neonatal Resuscitation Program (NRP) Learning Outcomes: Final Report of Study Findings

The purpose of this study was to examine the effect of using low versus high-fidelity manikin simulators in Neonatal Resuscitation Program (NRP) instruction. Low and high-fidelity manikin simulators provide trainees with an opportunity to learn, practice and demonstrate neonatal resuscitation skills in a learning environment which simulates the experiences involved with real resuscitation emergencies. High-fidelity manikin simulator systems have been developed which approximate a full-term newborn in size and weight, possess a realistic airway that can be intubated, lungs that can be inflated with positive pressure ventilation, and an umbilical cord containing a single vein and 2 arteries that allow insertion of umbilical venous and arterial catheters. Integrated computer programs allow primary cues important for accurate assessment of the neonate (heart rate, respiratory rate, and skin color) to be controlled remotely. In 2003, the International Liaison Committee on Resuscitation (ILCOR) recommended that high-fidelity simulation-directed training should increasingly supplement instructor-directed training in advanced life support/advanced cardiac support (Chamberlain & Hazinski, 2003). Several studies have examined the use of simulation in resuscitation training and specifically compared the utility and effectiveness of low and high-fidelity simulation. However, few studies have compared low and high-fidelity simulation for NRP learning outcomes, and more specifically on team performance and confidence. This study was funded by a grant from the Janeway Children’s Hospital Foundation, Research Advisory Committee. It was led and managed by Professional Development & Conferencing Services (PDCS), Faculty of Medicine, Memorial University, as well as a team of study investigators (see Section 1.1). Ethics approval was received from the Interdisciplinary Committee on Ethics in Human Research (ICEHR), Memorial University

A Survey Study of Resuscitation Skills Retention Amongst Health Providers in Newfoundland and Labrador: Final Report of Study Findings

The purpose of this report is to summarize the findings of a research study conducted between July 2010 and June 2011. The objectives of this study were threefold: 1. To examine the perceptions and attitudes of certified resuscitation providers towards the retention of resuscitation skills and regular skills updating. 2. To examine resuscitation providers’ self-efficacy beliefs towards resuscitation skills. 3. To explore resuscitation provider’s perceptions of methods and modalities for enhancing resuscitation skills retention

The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis

Introduction: Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? Methods and analysis: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural. Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women’s confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting. Comparator: standard care alone in hospital-based maternity units. Outcomes: Primary: CS. Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being. Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. Study design: An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. Ethics and dissemination: Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. Trial registration number: CRD42020103857

A comparative evaluation of the effect of internet-based CME delivery format on satisfaction, knowledge and confidence

<p>Abstract</p> <p>Background</p> <p>Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes.</p> <p>Methods</p> <p>Evaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted.</p> <p>Results</p> <p>Participants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity.</p> <p>Conclusions</p> <p>The findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.</p

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Ceilings (Or in Defense of the Chandelier)

Graduate student. Year of Graduation: 2016. Major: Graphic Design. Class: . Faculty: Bethany Johns and Lucy Hitchcock.https://digitalcommons.risd.edu/bookcontest1st2015/1091/thumbnail.jp

Evaluation of The Electronic Rural Medicine Strategy (TERMS): Final Report

The provision of an equitable and sustainable level of health care in rural communities has been a challenge to the Canadian health care system for some time (Tepper & Rourke, 1999; Rourke, 1997; Hutten-Czapski, 1998). Rural communities have suffered from a shortage of primary care physicians for many years and have felt the chronic shortage longer and more severely than urban areas (Ramsey, Coombs, Hunt, Marshall & Wenrich, 2001). It has been argued that one of the main challenges to a sustainable rural health care system is the ongoing maldistribution of physicians (Rourke, 1997). Some rural hospitals have been at risk of closing because of a lack of physicians, while others have experienced a drastic decrease in the level of health care they can provide (Rourke, 1998; Rourke & Rourke, 1998)

Lenticularis Typographic Abecedarium

Graduate student, year of graduation 2016. Major: Graphic Design. Class: Graduate Thesis I. Faculty: Bethany Johns, Clement Valla.https://digitalcommons.risd.edu/bookcontest2nd2016/1184/thumbnail.jp

Lenticularis Typographic Abecedarium

Graduate student, year of graduation 2016. Major: Graphic Design. Class: Graduate Thesis I. Faculty: Bethany Johns, Clement Valla.https://digitalcommons.risd.edu/bookcontest2nd2016/1185/thumbnail.jp