An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education

Automatic Colon Segmentation with Dual Scan CT Colonography

We present a fully automated three-dimensional (3-D) segmentation algorithm to extract the colon lumen surface in CT colonography. Focusing on significant-size polyp detection, we target at an efficient algorithm that maximizes overall colon coverage, minimizes the extracolonic components, maintains local shape accuracy, and achieves high segmentation speed. Two-dimensional (2-D) image processing techniques are employed first, resulting in automatic seed placement and better colon coverage. This is followed by near-air threshold 3-D region-growing using an improved marching-cubes algorithm, which provides fast and accurate surface generation. The algorithm constructs a well-organized vertex-triangle structure that uniquely employs a hash table method, yielding an order of magnitude speed improvement. We segment two scans, prone and supine, independently and with the goal of improved colon coverage. Both segmentations would be available for subsequent polyp detection systems. Segmenting and analyzing both scans improves surface coverage by at least 6% over supine or prone alone. According to subjective evaluation, the average coverage is about 87.5% of the entire colon. Employing near-air threshold and elongation criteria, only 6% of the data sets include extracolonic components (EC) in the segmentation. The observed surface shape accuracy of the segmentation is adequate for significant-size (6 mm) polyp detection, which is also verified by the results of the prototype detection algorithm. The segmentation takes less than 5 minutes on an AMD 1-GHz single-processor PC, which includes reading the volume data and writing the surface results. The surface-based segmentation algorithm is practical for subsequent polyp detection algorithms in that it produces high coverage, has a low EC rate, maintains local shape accuracy, and has a computational efficiency that makes real-time polyp detection possible. A fully automatic or computer-aided polyp detection system using this technique is likely to benefit future colon cancer early screening

A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions

Aims.  The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions. Background.  Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal. Design and methods.  Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis. Results.  Thirty-seven studies were appraised. Twenty-four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally. Conclusions.  Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non-compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice.  Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine, long-term application of standard precautions

Evidence-based management of non-tubal ectopic pregnancies

Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE