Non-Invasive Method for the Rapid Assessment of Central Venous Pressure: Description and Validation by a Single Examiner

Objectives: This study describes a means of assessing the external jugular venous pressure (JVP) as an indicator of normal or elevated central venous pressure (CVP).Methods: Intensive care unit patients having CVP monitoring were examined. With patients in bed, the external jugular vein (EJV) was occluded at the base of the neck and observed to distend. The occlusion was then removed and the vein observed for collapse. Complete collapse was hypothesized to indicate a non-elevated CVP (≤8cm of water). In those patients whose EJV collapsed incompletely, the vein was then occluded with the finger near the angle of the jaw. With the occlusion maintained, the vein was milked downwards with the other hand to cause its emptying and was then observed for filling from below. Filling from below was hypothesized to indicate an elevated CVP (>8cm of water).Results: In 12 of the 40 patients examined, the EJV could not be assessed (EJV not seen at all: 5, and difficult to visualize: 7). For the remaining 28 patients, 11 had a CVP > 8 cm, while 17 had a CVP of < 8. EJV assessment was 100% accurate (95% Confidence Interval 88-100) in predicting whether or not a patient’s CVP was greater or less than 8 cm of water.Conclusion: EJV assessment, when visible, is accurate to clinically assess a patient’s CVP in the hands of the author. Further studies are needed to see if they are reproducible by other observer.[WestJEM. 2008;9:201-205.

Choosing Technologies to Facilitate Experiential, Creative, and Collaborative Online Learning

How can online instructors who are interested in engaging students in brainstorming activities, design thinking exercises, or other forms of creative collaboration do so, given the recognized limitations of standard learning management systems (LMS's), like Moodle, Blackboard, and D2L? Multiple free, online software options exist, but choosing between them can prove daunting. This presentation will compare the relative strengths and weaknesses of three virtual collaboration technologies--Linoit, Padlet, and Mural--with which the workshop facilitator has had success

Creative Problem Solving (CPS) in Practice: A Case Study

Creative Problem Solving (CPS) is a structured process for navigating complex, open-ended problems and achieving creative results (Puccio, Murdock, & Mance, 2011). Although CPS has been the subject of significant scholarly attention (e.g. Parnes, 1987; Puccio et al., 2006; Isaksen & Treffinger, 2004; Puccio & Cabra, 2010), there is a paucity of research exploring the multiple outcomes that might emerge from a CPS. There is also a dearth of research that considers the context in which a CPS session occurs. This study addresses these gaps. This study is guided by the question, “What happens when employees operating within an organizational setting engage in CPS?” It draws its theoretical foundation from workplace learning theory and practice theory. Methodologically, it uses a single, interpretive case. Generating data through onsite observation, interviews, and document analysis, the researcher considered what happened before, during, and after a vice president in a global, publicly traded aviation company facilitated a CPS session for other members of the company’s executive team. The study found that the facilitator faced multiple struggles in introducing CPS; that participants adapted and innovated the process; that participants assessed the success of the CPS session based on criteria other than whether it achieved creative outcomes; and that contextual factors influenced what was deemed a successful solution. This study suggests that those responsible for guiding employees in introducing and facilitating CPS should consider the following: • Practitioner resources should further emphasize the political skills needed to introduce and facilitate CPS. • Proponents of CPS should highlight its multiple potential benefits—as opposed to focusing on the achievement of creative results. • Proponents should consider linking CPS to the process of strategic planning, since the two practices are compatible. • CPS-focused scholars should develop a version of CPS that might be more easily integrated into existing organizational practices. This study contributes to academic knowledge by pioneering a new methodological approach to studying CPS, advancing the empirical application of practice theory, and providing empirical substantiation for theoretical scholarly discussions around the strengths and limitations of community of practice (CoP) theories

Polyarteritis Nodosa and Bronchiolitis Obliterans with Organizing Pneumonia, an Unusual Association

Bronchiolitis obliterans and organizing pneumonia (BOOP) is an inflammatory, fibrotic disorder of the small airways, alveoli and pulmonary intersitium. Often idiopathic and usually benign, this condition may cause dyspnea and influenza-like symptoms. Polyarteritis nodosa (PAN) is a small and medium vessel vasculitis, which usually involves the kidney and other viscera but rarely results in vasculitis of the lungs. This is the second case of BOOP associated with PAN reported in the literature. Knowledge of this association is likely to be of value because an undiagnosed vasculitis can rapidly become fatal

Use of continuous negative pressure around the chest increases exercise performance in chronic obstructive pulmonary disease patients: A pilot study

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) often have intrinsic positive end-expiratory pressure. Continuous positive airway pressure has been shown to decrease the inspiratory work of breathing and increases exercise capacity in these patients