Raman lidar profiling of tropospheric water vapor

Obtaining vertical profiles of tropospheric water vapor provides critically important information towards understanding short and long term global climate change. Ground-based Raman lidar technique is a powerful tool to precisely evaluating Water vapor Mixing Ratio (WVMR) in the troposphere. In this presentation, an overview of the design and basic components of a Raman water vapor lidar setup employing the third harmonic output (at 355 nm) of a high-powered laser with a telescope and three detection channels will be presented. Also, detailed discussion of the best method to calibrate and evaluate the performance of a typical water vapor Raman lidar will be shown and compared with most common calibration methods. By manipulating the inelastic backscattering lidar signals from the Raman nitrogen channel (386.7 nm) and Raman water vapor channel (407.5 nm), vertical profiles of water vapor mixing ratio (WVMR) will be deduced, calibrated, and compared against WVMR profiles obtained from coincident and collocated radiosonde profiles. This presented methodology will be shown to effectively yield high temporal and spatial resolution measurements of WVMR, with efficient dual detector capability both in the near-and-far fields

Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial.

Whilst current guidelines highlight the importance of pain management for children with acute otitis media (AOM), there is evidence to suggest that this is not implemented in everyday practice. We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness

Dokter, laat meer van uzelf zien! ‘Self-disclosure’ als opleidingsinstrument

Supervisor self-disclosure is essential for both personal and professional development of the next generation of doctors. We highlight the importance of self-disclosure and urge doctors in a supervising role to embed self-disclosure in their supervisory activities. Effective supervision of residents and interns encompasses many elements. Self-disclosure positively contributes to a safe teaching environment as well as a nurturing supervisor-trainee relationship. Self-disclosure can be used in many supervisory settings to benefit the development of residents and interns. It is of the utmost importance that self-disclosure should be used consciously and at suitable moments. Tools to achieve optimal self-disclosure are provided

Dokter, laat meer van uzelf zien! ‘Self-disclosure’ als opleidingsinstrument

Supervisor self-disclosure is essential for both personal and professional development of the next generation of doctors. We highlight the importance of self-disclosure and urge doctors in a supervising role to embed self-disclosure in their supervisory activities. Effective supervision of residents and interns encompasses many elements. Self-disclosure positively contributes to a safe teaching environment as well as a nurturing supervisor-trainee relationship. Self-disclosure can be used in many supervisory settings to benefit the development of residents and interns. It is of the utmost importance that self-disclosure should be used consciously and at suitable moments. Tools to achieve optimal self-disclosure are provided

Pain management in acute otitis media : A qualitative study of parents' views and expectations

Background: For unclarified reasons, parents tend to be cautious about administering analgesics to their children, potentially leading to suboptimal management of AOM symptoms. We aim to understand parents' views and expectations of pain management in acute otitis media (AOM) in children. Methods: Qualitative study alongside a cluster-randomised controlled trial (PIM-POM study) aimed at optimising pain management in childhood AOM. We purposefully sampled 14 parents of children diagnosed with AOM by their GP, who were recruited to the trial between November 2017 and May 2018. Semi-structured interviews were held at home in the first two weeks after trial enrollment. Interviews were audio-recorded, transcribed and analyzed thematically. Results: Parents experienced difficulties in recognising earache and other symptoms of an ear infection. They consulted the GP for a diagnosis, for reassurance and for management advice. Parents shared that, prior to consultation, they had insufficient knowledge of the benefits of correctly dosed pain medication at regularly scheduled intervals. Parents valued the GP's advice on pain management, and were happy to accept pain medication as standalone therapy, provided that the GP explained why antibiotics would not be needed. Parents' views and expectations of pain management in AOM were shaped by previous experiences of AOM within their family; those with a positive experience of pain medication are more likely to use it in subsequent AOM episodes. Conclusions: Parents of children with AOM consult the GP to help cope with uncertainties in recognising symptoms of AOM, and to receive management advice. It is important that GPs are aware of parents' lack of understanding of the role of pain medication in managing AOM, and that they address this during the consultation. Trial registration: Netherlands Trial Register, identifier NTR4920 (registration date: 19 December 2014)

Pain management in acute otitis media : a qualitative study exploring GPs views and expectations parallel to a trial of an educational intervention

Background: Optimal pain management is accepted as the cornerstone of acute otitis media (AOM) management, but analgesics are neither prescribed routinely nor explicitly recommended in day-to-day practice. Aim: To explore GPs views on and expectations regarding pain management in children with AOM, and how a multifaceted educational intervention aimed at optimising pain management shapes these perceptions. Design & setting: Qualitative study conducted alongside a cluster randomised controlled trial (cRCT), the PIMPOM study, in the Netherlands. Method: Twelve GPs were purposefully sampled from primary care centres allocated to the intervention group and were interviewed, using semi-structured, audio-recorded interviews. The intervention comprised a blended GP educational programme (internet-based and face-to-face training) aimed at discussing pain management proactively with parents using a parent information leaflet, and prescribing paracetamol and ibuprofen according to current guidelines. Interviews were transcribed verbatim and analysed thematically by a multidisciplinary team. Results: GPs considered AOM a very painful condition. Initially, GPs felt unable to offer adequate treatment for AOM-related ear pain. The intervention provided tools, such as knowledge, communication skills, and an information leaflet, which reduced their feelings of helplessness and empowered them to manage childhood AOM more adequately. GPs indicated that the intervention led to a shift in focus from treating the infection with antibiotics to treating symptoms with analgesics. There was a general lack of knowledge about the possibility of prescribing ibuprofen to children. GPs expressed mixed views on prescribing this drug to children. Conclusion: A primary-care based multifaceted educational intervention aimed at optimising pain management in childhood AOM offered GPs tools to optimise management of this condition and changed GPs perceptions, namely from treating the infection with antibiotics to treating symptoms

Impact of acute otitis media clinical practice guidelines on antibiotic and analgesic prescriptions : a systematic review

BACKGROUND: Clinical practice guidelines focusing on judicious use of antibiotics for childhood acute otitis media (AOM) have been introduced in many countries around the world. OBJECTIVE: To systematically review the effects of these guidelines on the prescription of antibiotics and analgesics for children with AOM. METHODS: Systematic searches of PubMed, Embase and Cochrane Library from inception to 6 June 2017 using broad search terms. Studies specifically aimed at evaluating the effects of introduction of national AOM practice guidelines on type of antibiotic and/or analgesic prescriptions were included, irrespective of design, setting or language. The Risk Of Bias In Non-randomized Studies of Interventions tool was used to assess risk of bias. RESULTS: Of 411 unique records retrieved, seven studies conducted in six different countries (France, Italy, Spain, Sweden, UK and USA (twice)) compared data before and after guideline introduction. All studies had an observational design, using longitudinal data of children aged under 15 years (n=200-4.6 million) from either routine care, insurance databases or electronic surveys. Risk of bias of all studies was judged serious to critical.Of the five studies reporting on antibiotic prescription rates, three showed a decline of 5%-12% up to 3 years after guideline introduction and two found no or negligible effect. In one US study, the initial 9% decline decreased to 5% after 4-6 years. The recommended first choice antibiotic was prescribed more frequently (9%-58% increase) after guideline introduction in four out of five studies reporting on this outcome. Analgesic prescription rates for AOM were reported in one US study and increased from 14% to 24% after guideline introduction. CONCLUSION: Based upon what is published, the effects of introduction of national clinical practice guidelines on antibiotic and analgesic prescribing for children with AOM seem modest at the most. REGISTRATION: PROSPERO: CRD42016050976