Simulation as a suitable education approach for medical training in marine and off-shore industries: theoretical underpinning

Healthcare providers in marine and offshore industries must often perform high-risk procedures outside of their usual scope of practice, frequently using novel, complex telemedical technologies to perform an already unfamiliar task — often while multitasking, and sometimes in extreme environmental conditions. Given all the novelty occurring at once, the probability of medical error increases. This increase can be explained by the Cognitive Load Theory, which states that too much demand on the working memory can tax the ability of the long-term memory. This article will show that one solution to this situation is to use simulation in the medical training of offshore and marine medical practitioners. Contextualised simulation practice creates automatic schemas that reside in the long-term memory, minimising strain on the working memory — and, in a marine medical context, also minimising the risk of medical error

The Ferguson v. JONAH Verdict and a Path Towards National Cessation of Gay-to-Straight Conversion Therapy

In the essay, Dubrowski analyzes Ferguson v. JONAH, a landmark 2015 decision in which a New Jersey court held --- for the first time --- that homosexuality is not a disease or mental disorder as a matter of law. Based on this pretrial ruling, a civil jury unanimously found JONAH (a conversion therapy clinic) its co-directors and its chief counselor liable for violation of New Jersey\u27s Consumer Fraud Act. Dubrowski begins by explaining the two-pronged fraud JONAH perpetrated—first, claiming that homosexuality is a disorder, and second, that it can be cured—and continues by arguing that this two-pronged fraud is necessarily perpetrated by all conversion therapists. He then undertakes a survey of the consumer fraud laws of all fifty states, demonstrating that the verdict against JONAH is replicable across the country, and concluding that those injured by the so-called therapy should seek to replicate Ferguson v. JONAH\u27s success

The Ferguson v. JONAH Verdict and a Path Towards National Cessation of Gay-to-Straight Conversion Therapy

In the essay, Dubrowski analyzes Ferguson v. JONAH, a landmark 2015 decision in which a New Jersey court held --- for the first time --- that homosexuality is not a disease or mental disorder as a matter of law. Based on this pretrial ruling, a civil jury unanimously found JONAH (a conversion therapy clinic) its co-directors and its chief counselor liable for violation of New Jersey\u27s Consumer Fraud Act. Dubrowski begins by explaining the two-pronged fraud JONAH perpetrated—first, claiming that homosexuality is a disorder, and second, that it can be cured—and continues by arguing that this two-pronged fraud is necessarily perpetrated by all conversion therapists. He then undertakes a survey of the consumer fraud laws of all fifty states, demonstrating that the verdict against JONAH is replicable across the country, and concluding that those injured by the so-called therapy should seek to replicate Ferguson v. JONAH\u27s success

Program directors’ perceptions of importance of pediatric procedural skills and resident preparedness

Background The Royal College of Physicians and Surgeons of Canada (RCPSC) objectives for training in pediatrics include 26 procedural skills, 11 of which are included in the final in-training evaluation report (FITER). The importance of each procedure for practice and the preparedness of pediatric residency graduates to perform these procedures are not known. Methods A questionnaire was distributed to all pediatric residency program directors and members of the RCPSC Specialty Committee in Pediatrics (N = 21) in October 2010, requesting them to rate the perceived importance and preparedness of graduating pediatric residents in all procedural skills on a 5 point Likert scale, as well as the presence of a curriculum and documentation for each procedure. Mean importance and preparedness were calculated for each procedure. Results Response rate was 16/21 (76 %). Perceived preparedness was significantly lower than importance for the majority of procedures (p 3) but a low mean preparedness rating (<3). Presence of a curriculum and documentation for procedures varied across centers, and their presence was correlated with both perceived importance and preparedness (p < 0.0001). Conclusions Many procedures in which pediatric residents are required to be competent by the RCPSC are felt to be important. Residents are not felt to be adequately prepared in several of the required procedures by the time of graduation. Procedures with high ratings of importance but low preparedness ratings should be targeted for curricular interventions

The case for surgical skills centres in Sub Saharan Africa: The benefits and the challenges.

The purpose of this paper is to describe the educational and practice utilities of establishing Surgical Skills Centres. The paper also defines significant obstacles to the establishment of such centres in Sub- Saharan Africa. In 1996, the Royal College of Physicians and Surgeons Canada responded to the evolving roles and obligations of medical specialists by implementing a framework of core competencies called the “CanMEDS Roles” which define surgeons as medical experts, communicators, collaborators, managers, health advocates, scholars and professionals. A key competency expected of the medical expert is the demonstration of proficiency in procedural skills2

Identification of CD34+/PGDFRΑ+ valve interstitial cells (vics) in human aortic valves : association of their abundance, morphology and spatial organization with early calcific remodeling

Aortic valve interstitial cells (VICs) constitute a heterogeneous population involved in the maintenance of unique valvular architecture, ensuring proper hemodynamic function but also engaged in valve degeneration. Recently, cells similar to telocytes/interstitial Cajal-like cells described in various organs were found in heart valves. The aim of this study was to examine the density, distribution, and spatial organization of a VIC subset co-expressing CD34 and PDGFRα in normal aortic valves and to investigate if these cells are associated with the occurrence of early signs of valve calcific remodeling. We examined 28 human aortic valves obtained upon autopsy. General valve morphology and the early signs of degeneration were assessed histochemically. The studied VICs were identified by immunofluorescence (CD34, PDGFRα, vimentin), and their number in standardized parts and layers of the valves was evaluated. In order to show the complex three-dimensional structure of CD34+/PDGFRα+ VICs, whole-mount specimens were imaged by confocal microscopy, and subsequently rendered using the Imaris (Bitplane AG, Zürich, Switzerland) software. CD34+/PDGFRα+ VICs were found in all examined valves, showing significant differences in the number, distribution within valve tissue, spatial organization, and morphology (spherical/oval without projections; numerous short projections; long, branching, occasionally moniliform projections). Such a complex morphology was associated with the younger age of the subjects, and these VICs were more frequent in the spongiosa layer of the valve. Both the number and percentage of CD34+/PDGFRα+ VICs were inversely correlated with the age of the subjects. Valves with histochemical signs of early calcification contained a lower number of CD34+/PDGFRα+ cells. They were less numerous in proximal parts of the cusps, i.e., areas prone to calcification. The results suggest that normal aortic valves contain a subpopulation of CD34+/PDGFRα+ VICs, which might be involved in the maintenance of local microenvironment resisting to pathologic remodeling. Their reduced number in older age could limit the self-regenerative properties of the valve stroma

Superior mesenteric artery clinical classification and morphometrical analysis

Background: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. Materials and methods: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. Results: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%). Conclusions: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications

Shaping success: clinical implementation of a 3D-printed electron cutout program in external beam radiation therapy

PurposeThe integration of 3D-printing technology into radiation therapy (RT) has allowed for a novel method to develop personalized electron field-shaping blocks with improved accuracy. By obviating the need for handling highly toxic Cerrobend molds, the clinical workflow is significantly streamlined. This study aims to expound upon the clinical workflow of 3D-printed electron cutouts in RT and furnish one year of in-vivo dosimetry data.Methods and materials3D-printed electron cutouts for 6x6 cm, 10x10 cm, and 15x15 cm electron applicators were designed and implemented into the clinical workflow after dosimetric commissioning to ensure congruence with the Cerrobend cutouts. The clinical workflow consisted of four parts: i) the cutout aperture was extracted from the treatment planning system (TPS). A 3D printable cutout was then generated automatically through custom scripts; ii) the cutout was 3D-printed with PLA filament, filled with tungsten ball bearings, and underwent quality assurance (QA) to verify density and dosimetry; iii) in-vivo dosimetry was performed with optically stimulated luminescence dosimeters (OSLDs) for a patient’s first treatment and compared to the calculated dose in the TPS; iv) after treatment completion, the 3D-printed cutout was recycled.ResultsQA and in-vivo OSLD measurements were conducted (n=40). The electron cutouts produced were 6x6 cm (n=3), 10x10 cm (n=30), and 15x15 cm (n=7). The expected weight of the cutouts differed from the measured weight by 0.4 + 1.1%. The skin dose measured with the OSLDs was compared to the skin dose in the TPS on the central axis. The difference between the measured and TPS doses was 4.0 + 5.2%.ConclusionThe successful clinical implementation of 3D-printed cutouts reduced labor, costs, and removed the use of toxic materials in the workplace while meeting clinical dosimetric standards