Academic Training Center Research Articles

Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator

Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation. An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers. Academic medical training centers or conferences in the United States, Rwanda and Kenya. 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident. The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox. The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.

Computed Tomography (CT)-Guided Needle Biopsy of Lung Lesions: A Single Center Experience.

(1) Objective: Lung cancer is one of the leading causes of cancer death among men and women across the globe. The accurate and timely diagnosis of lung lesions is of paramount importance for prognosis. This single-center study is the first to assess the diagnostic yield and complication rate of a computed tomography (CT)-guided needle biopsy of pulmonary parenchymal and pleural nodules in an academic training center in the United States. (2) Methods: This is a retrospective study approved by IRB. Patients who underwent CT-guided needle biopsy between 2016 and 2020 were reviewed. A CT-guided needle biopsy involving mediastinal lesions was excluded, focusing only on lung parenchymal and pleural lesions. A CT-guided needle biopsy aborted at any point during the procedure was also excluded from this study. (3) Results: 1063 patients were included in this study; 532 were males, and 531 were females. Lesion size ranged from 0.26 cm to 9.2 cm. 1040 patients received diagnoses, among which 772 had a specific diagnosis, and 268 had nonspecific inflammatory or non-malignant diagnoses. Twenty-three cases were non-diagnostic. Among the patients with specific diagnoses, 691 were malignant, 5 were hamartomas, 30 were fungal infections, 6 were acid-fast-positive organisms, and 40 were unspecified atypical cells. Of the patients that had a malignant diagnosis, 317 were adenocarcinoma, 197 were squamous cell carcinoma, 26 were a neuroendocrine tumor, 45 were non-small cell carcinoma (undifferentiated), 17 were small cell carcinoma, and 89 were other metastatic malignancies to the lung. Various common complications, including pneumothorax (337), hemorrhage (128), and hemoptysis (17), were observed, and 42 of the cases required chest tube intervention; others were treated with observation. Other rare complications observed included hemothorax (4) and oxygen desaturation (2), and there was no death in this series. (4) Conclusions: CT-guided needle biopsy is a reliable diagnostic modality for patients with lung parenchymal and pleural nodules, and it can effectively distinguish between benign and cancerous lesions before invasive procedures such as video-assisted thoracoscopy (VATs) or thoracotomy are planned. Our study showed a higher rate of pneumothorax and pulmonary hemorrhage compared to the rates established in guidelines, attributable to the varying experience level in a busy training academic center.

Rapid cycle training for non-critical care physicians to meet intensive care unit staff shortage at an academic training center in a developing country during the COVID-19 pandemic

BackgroundThe sudden unexpected increase in critically ill COVID-19 patients admitted to Intensive Care Units (ICUs), resulted in an urgent need for expanding the physician workforce. A COVID-19 critical care crash (5C) course was implemented to introduce physicians without formal critical care training to care for critically ill COVID-19 patients. Upon successful completion of the course, physicians were recruited to work in a COVID-19 ICU under the supervision of a board-certified critical care physician. The aim of this study is to describe the methods of a novel course designed specifically to teach the management critically ill COVID-19 patients, while assessing change in knowledge, skill competency, and self-reported confidence.MethodsThe blended focused 5C course is composed of both virtual and practical components. Candidates may register for the practical component only after successful completion of the virtual component. We assessed knowledge acquisition using a multiple-choice question test (pre- and post-test assessment), skill competency, and self-reported confidence levels during simulated patient settings. Paired T-test was used to compare before and after course results.ResultsSixty-five physicians/trainees from different specialties were included in the analysis. Knowledge significantly increased from 14.92± 3.20 (out of 20 multiple-choice questions) to 18.81± 1.40 (p< 0.01), skill competence during practical stations had a mean minimum of 2 (out of 3), and self-reported confidence during a simulated patient setting increased significantly from 4.98± 1.15 (out of 10) to 8.76± 1.10 (out of 10) (p< 0.01).ConclusionWe describe our initiative in increasing the ICU physician workforce in the midst of the COVID-19 pandemic. The blended 5C course is a valuable educational program designed by experts from different backgrounds. Future research should be directed at examining outcomes of patients associated with graduates of such program.

Participation of women in general surgery in Colombia: an x-ray of the latin American reality

Background: Women choose surgery because academic challenges and technical components. With this work we want to establish the real participation of women in the general surgery residency and the professional level in Colombia. Methods: We conducted a survey in academic and surgical training centers, surgical centers in capital cities and in university teaching centers 2020 to establish the percentage of participation of women in residency and employment in general surgery. Results: Women represent 39% of residents in training in general surgery. In the main hospitals, women represent only 9% of work positions. Only 21% of university surgical teaching positions are held by women. Conclusions: Although in our environment the possibility of admission to residency and surgical work has increased for women, based on our results there is still a large participation gap in our country. Mentoring and diversity must continue to end the gender bias in the surgical field.

Current Orthognathic Surgery Practice Patterns Among Academic OMS.

Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. The study design is cross-sectional. Data was collected through a survey of the sample. OMFS programs in the US. Academic OMFS. 573 surgeons were contacted and 85 responses were received. Descriptive and bivariate statistics were reported. Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11-20 years, 18% with 21-30 years, 12% with 6-10 years and 11% with 1-5 years. Twenty-six percent of respondents perform 20-40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40-60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60-64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.

Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter?

BackgroundControversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis. MethodsA consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS. ResultsSixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was <21°, and loss of lordosis >5° only occurred when Pre-op SLL was >21°. ConclusionsWhile group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique.

First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study.

Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.

Assessment of Obstetric and Gynecology Residents: An Assessment of Attitudes before and after Initiation of a Robotic Training Curriculum

Study Objective Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. Design This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. Setting N/A. Patients or Participants Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. Interventions A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. Measurements and Main Results After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Conclusion Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation. Surgical training in gynecology is constantly evolvingwith new techniques and practices developing. Surgical training modules are of particular importance in academic training centers. Robotic surgical training poses a challenge to both leaders and learners to provide comprehensive and consistent education for the development of appropriate surgical skills. The purpose of this study was to evaluate for improvement in resident comfort level after initiation of a formal robotics training curriculum. This was an IRB exempt survey of residents within an Obstetrics and Gynecology (OBGYN) training program. Two voluntary, anonymous questionnaires were distributed to residents to evaluate their comfort level both before and after initiation of a formal robotic curriculum. A comparative assessment was performed to assess for improved resident comfort levels training on the robotic console. N/A. Participants in this study included post-graduate years (PGY) 1-4 residents enrolled in the 2019-2020 academic year completed at the University of Florida (UF) Health-Jacksonville Obstetrics and Gynecology (OBGYN) residency program. A formal robotic surgical training curriculum was introduced which consisted of online modules, documented training on the SimNow robotic simulator and in-person in-service of the DaVinci platform in a non-operative setting. After analyzing results of the surveys, consistent improvement in resident comfort level with regards to robotic surgery was noted in all eight of the subjective questions included on the survey. Participants’ comfort level and understanding statistically improved in response to questions 1-5 and 7 with p value < 0.05. Given these findings, we recommend routine implementation of a formal robotic training program for surgical trainees in an academic setting. Implementation of a standardized robotic surgery-training curriculum can accelerate trainee's readiness and their comfort level in performing robotic surgery during residency, therefore optimizing their surgical training prior to graduation.

An Exploration of Unethical Behavior Attitude of Tertiary Level Students of Bangladesh

In this competitive world highly skilled manpower is considered to play key role in developing a nation. On the other hand, highly educated people are blamed for recent business and financial scandals. Moreover, studies established that pupils who deceive in their student life are found to be engaged in immoral workplace conduct. The Student today is the future leader of the country. Hence, the combination of quality with morality is emphasized in the universities of in many developed counties like the USA, China, and moral education is being imparted at all stages of academic organizations and training centers from kindergarten to national academia. Therefore, the goal of the research is to explore the origins of the unethical behavior of University students of Bangladesh and recommend the means to improve the situation.

V06-10 FLUOROSCOPY FOR TEACHING PLACEMENT AND MECHANISM OF THE MALE URETHRAL SLING

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-10 FLUOROSCOPY FOR TEACHING PLACEMENT AND MECHANISM OF THE MALE URETHRAL SLING Ethan Matz*, Kyle Scarberry, and Ryan Terlecki Ethan Matz*Ethan Matz* More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The transobturator male sling is an established option for mild to moderate stress urinary incontinence, which is most commonly seen after radical prostatectomy. Teaching sling surgery to residents and fellows can be challenging since the small incision can limit visualization. Also, the proposed mechanism of action for the male urethral sling has been largely based on theory rather than adequate dynamic visualization. We present a video to highlight our use of fluoroscopy to better educate learners on this operation. METHODS: This video highlights the three-dimensional pelvic anatomy relevant to placement of a male sling. The surgery is done through a standard perineal approach, but with use of fluoroscopy at key steps. These include needle passage to locate the trocar target within the obturator foramen, live visualization of trocar rotation, and the conformational change of the urethra during sling tensioning. RESULTS: The operation is successfully demonstrated with high-quality fluoroscopic images for better understanding of both the key surgical steps and mechanism of action for the male urethral sling. CONCLUSIONS: Placement of the male urethral sling is an important technique for surgeons to master in order to effectively manage men with stress urinary incontinence. The technique presented is novel based on the use of fluoroscopy to offer a more comprehensive educational experience for learners in the operating room. This approach may be suited for adoption at other academic training centers. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e559-e559 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz* More articles by this author Kyle Scarberry More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...

Moderate Sedation Versus General Anesthesia for Endobronchial Ultrasound-guided Transbronchial Biopsy in an Academic Training Center

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a widely used procedure for the diagnosis and staging of lung cancer. Several studies have shown the diagnostic utility of EBUS-TBNA effectiveness for decreasing the need for invasive mediastinal sampling. The current recommendation is that most patients with lung cancer should undergo mediastinal staging with EBUS-TBNA. EBUS-TBNA can be safely performed under general anesthesia or moderate sedation, and, according to previous studies, the choice of anesthesia on the effect of outcomes has been variable. We investigated differences between EBUS-TBNA performed with general anesthesia and moderate sedation in a training program in which trainees performed EBUS-TBNA. This retrospective study evaluated 121 patients undergoing fellow-driven EBUS-TBNA under the supervision of an interventional pulmonary trained faculty member. We found no difference between general anesthesia and moderate sedation in terms of diagnostic yield, procedural time, or complication rates. We did, however, find an overall higher number of total lymph nodes sampled in the general anesthesia group, as well as a higher number of hilar lymph nodes sampled. We conclude that EBUS-TBNA can be performed safely and with good diagnostic ability with either general anesthesia or moderate sedation in a fellowship-driven program without affecting overall outcomes. This is beneficial, as it can reduce overall cost and the ability to do the procedure without the need of an anesthesiologist.

Escorting and Feedbacking Lecturers in Building Lesson Plans Using PowerPoint Software in the Training Center for Nurses

One of the challenges of today’s lecturers in training centers for nurses is to teach large classes of over 60 students, maintain eye contact with students, ensure understanding, manage a structured lesson and change it according to the class mood. The lecturer must “feel” the class and, accordingly, conduct the lesson. The lecturer develops these skills over time and experience. Today, most of the lecturers prepare lesson plans using PowerPoint (PPT) presentations. It is a simple, user-friendly software that allows to combine images, videos, text, and graphs. In Israel, students learn to use this software even in elementary schools, but as lecturers there is a considerable gap using this tool, which affects the lecture’s efficiency and quality. New lecturers who use presentation in their lecture do not necessarily know how to properly build a presentation. This may lead to the lecturer and lesson’s low evaluation by the students, claiming the presentation is unclear, confusing, discontinuous. Therefore, the question is whether the organization inviting the lecturer has responsibility for the contents and the way of lecturing? Like a news anchor before reading the news, the editors check the content and how it is written, or before publishing a newspaper article it is reviewed and edited. In Ted lectures, the lecturers are the content experts and the knowledgeable, but before these lecturers go up to the stage and speak, media experts work with them on the presentation and clear and elegant message convey. Thus, it is possible to prevent or influence to a certain extent the lesson’s low assessment by students at least in part of using a presentation. The lecturer is part of the organization, which wants to convey a message to the students that the organization is serious, professional and relevant.This article, will present three new lecturers in one of the largest academic training centers in Israel for nurses, who have prepared lesson plans of their choice using PowerPoint (PPT) software. The problems arose in the presentations preparation will be presented, and as a result, the importance that the academic training center will provide support in feedback to improve lesson plans using this tool before entering the lecture.

Multiple Mini-interview Consistency and Satisfactoriness for Residency Program Recruitment: Oman Evidence.

ObjectivesStandard interviews are used by most residency programs to assess non-cognitive skills, but variability in the interviewer’s skills, interviewer bias, and context specificity limit reliability. We sought to investigate the consistency and satisfactoriness of the multiple mini-interview (MMI) model for resident selection into an otorhinolaryngology head and neck surgery residency program.MethodsThis pilot study was done in an independent academic residency training center for 15 applicants, in seven eight-minute MMI stations with eight raters for the 2015–2016 academic year. The raters included the chief resident and education committee chairman in one of the stations. Candidates were assessed on two items: medical knowledge (two standardized case scenarios) and behavioral knowledge (personality and attitude, professionalism, communication, enthusiasm to the specialty, and English proficiency).ResultsOf 15 candidates, 10 (66.7%) were female and five (33.3%) were male; five were recommended for selection, and five were kept on the waiting list. The reliability, intraclass correlation coefficient (ICC), of the scores obtained from seven items of MMI was 0.36 (95% confidence interval (CI): -0.31–0.75; p = 0.110). However, the ICC of the medical interview was 0.54 (95% CI: 0.45–0.84; p = 0.090). The correlation between behavioral items score and MMI total score was r = 0.135 (p = 0.150).ConclusionsThe interview evaluation/survey form given to candidates and interviewers has shown that MMI is a fair and effective tool to evaluate non-cognitive traits. Both candidates and interviewers prefer MMI to standard interviews. The MMI process for residency interviews can generate reliable interview results using only seven stations and is acceptable and preferred over standard interview modalities by residency program applicants and faculty members.

Training in clinical genetics and genetic counseling in Asia.

The status of training in clinical genetics and genetic counseling in Asia is at diverse stages of development and maturity. Most of the training programs are in academic training centers where exposure to patients in the clinics or in the hospital is a major component. This setting provides trainees with knowledge and skills to be competent geneticists and genetic counselors in a variety of patient care interactions. Majority of the training programs combine clinical and research training which provide trainees a broad and integrated approach in the diagnosis and management of patients while providing opportunities for research discoveries that can be translated to better patient care. The background on how the training programs in clinical genetics and genetic counseling in Asia evolved to their current status are described. Each of these countries can learn from each other through sharing of best practices and resources.

Intraoperative Disruptive Behavior: The Medical Student's Perspective

Intraoperative disruptive behavior can reduce psychological safety and hinder teamwork and communication. Medical students may provide unique insights into how to prevent these adverse impacts. We sought to characterize medical student perspectives on the causes and consequences of intraoperative disruptive behavior and ideal intraoperative working environments. In this retrospective qualitative analysis, authors coded de-identified field notes from residency interviews to identify themes and key insights and to explore gender differences in perspectives. A tertiary academic medical training center in the Midwestern United States. Forty-two medical students applying for urology residency placement. Students were 57% male with an average age of 26 years (range 23-34). Most students witnessed intraoperative disruptive behavior (usually by surgeons) such as yelling, throwing instruments, or blaming others. Students described frustration with missing instruments and incompetent assistants as the most common instigators of disruptive behavior. They noted undesirable effects of disruptive behavior, including decreased communication/teamwork, lack of learning, increased technical mistakes, and recalled feeling afraid and stressed by these situations. They described ideal intraoperative working environments as calm, efficient and collaborative environments where questioning and learning is encouraged. Students provide a valuable perspective on the causes and consequences of disruptive behavior during surgery and point to potential pathways to improvement. Their experiences suggest prevention or reduction of surgeon frustration might be a fruitful target for intervention efforts to prevent intraoperative disruption.

A Bow-Echo and Severe Weather Observed Over Poland on 11th and 12th August, 2017

Abstract The paper presents results of research based on analysis of weather conditions during the storm front on 11th and 12th August, 2017, which has been relocated through a significant area of Poland. The front with an unprecedented force struck the infrastructure of the Academic Training Centre in the village of Czernica (ATC Czernica) on 11th August, 2017 about 23:05 CET. Due to wind impact of near-hurricane force, significant damage in the facility’s infrastructure and the biggest losses are incurred in forest resources. The data from the front passage through Gdynia was observed on a mobile meteorological station located at the Naval Academy in Gdynia. Describing the phenomenon and displaying the losses caused is one of the historical goals set before the article, because such a rapid weather phenomenon has not been recorded in the more than 50-years history of the Center in Czernica.

EMERGENCY DEPARTMENT AND INPATIENT CLINICAL DECISION TOOLS FOR THE MANAGEMENT OF FEBRILE YOUNG INFANTS AMONG TERTIARY PEDIATRIC CENTERS ACROSS CANADA

Abstract BACKGROUND With no nationally endorsed guidelines and newer diagnostic tools, there exists widespread practice variation in the management of febrile infants &amp;lt;90 days. OBJECTIVES This study sought to evaluate the prevalence of clinical decision tools (CDTs) for the management of febrile young infants in the Emergency Department (ED) and inpatient settings among all tertiary paediatric centers across Canada. DESIGN/METHODS A cross-sectional, Internet-based survey was distributed to both an ED and an inpatient physician representative at each of the 16 Canadian tertiary paediatric centers. Participants were asked to characterize their clinical settings, diagnostic test availability and institutional febrile young infant CDTs. Copies were requested of all febrile infant-specific materials for independent classification as clinical pathway, guideline or order set, and content review using list items determined a priori. The primary analysis was the proportion of settings that use a CDT for the management of febrile infants. Chi-square testing was used to compare proportions. RESULTS Survey response rate was 100% (n = 32, 16 ED and 16 inpatient). Febrile young infant CDTs of any type were infrequently reported overall (9/32, 38%), and were more common in the ED than inpatient setting (50% vs. 6%, p=0.02). Prevalence of any CDT was not associated with hospital volume or physician training. Among EDs, clinical pathways, guidelines, and order sets were available at 6/16 (38%), 1/16 (6%), and 4/16 (25%) institutions, respectively. Among centers reporting existent CDTs, few reported ED or inpatient tracking of provider adherence or audits of impact (3/9, 33% overall). Review of existing CDTs revealed inter-center differences for inclusion ages, antibiotic treatment regimens, lumbar puncture recommendations, diagnostic testing and normal laboratory reference values. Despite wide availability reported at nearly all centers, C-reactive protein and respiratory viral testing were each rarely incorporated into existent CDTs (3/9, 33% for both). Procalcitonin testing was reported to be available at 2/16 (13%) centers, and was not incorporated into any existing CDTs. CONCLUSION CDTs for the management of febrile young infants are infrequently available among Canadian tertiary paediatric centers, and when present, rarely contain information on newer diagnostic tests. The paucity of CDTs among paediatric academic training centers may in part underlie ongoing practice variation. Heterogeneity among existent CDTs highlights the need for the establishment of updated and unified ED and inpatient national guidelines.

Supplementing research ethics training in psychiatry residents: A five-tier approach.

Ethics training is a key step in the research supervision of psychiatry trainees and there is need for a structured educational module. We developed a new research ethics training module for psychiatry residents - The Five-Tier Approach. Twenty-five first year psychiatry residents of an academic psychiatric training centre in India participated in this multi-session workshop. Module 1 included the completion of NIH online certification course for research ethics training. Module 2 was a one-hour interactive group discussion on ethical principles in research. Module 3 was a two-hour session consisting of case-based group discussion of nine selected research vignettes. Module 4 involved preparation of an informed consent form. Module 5 was a mock ethics committee role-played by seven students while the larger group observed using a Fish Bowl technique and provided feedback. Assessments were done during the third and final modules. During the third module, understanding regarding certain areas - autonomy, benefits and justice was found to be inadequate. In the final step, all ethical aspects were covered by the students. This five-tier approach seems like a superior tool for research ethics training in academic institutions, especially in Southeast Asia, where the student-teacher ratios are generally very high.

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training.

PurposePrimary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved.Materials and MethodsReview of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery.ResultsThree hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%.ConclusionsIn this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.

PD25-03 FEAR OF POSTOPERATIVE INFECTION FOLLOWING PLACEMENT OF INFLATABLE PENILE PROSTHESIS AT AN ACADEMIC TRAINING CENTER IS UNWARRANTED: DATA FROM A SINGLE SURGEON SERIES

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy III1 Apr 2017PD25-03 FEAR OF POSTOPERATIVE INFECTION FOLLOWING PLACEMENT OF INFLATABLE PENILE PROSTHESIS AT AN ACADEMIC TRAINING CENTER IS UNWARRANTED: DATA FROM A SINGLE SURGEON SERIES Kara E. McAbee, Alison M. Rasper, and Ryan P. Terlecki Kara E. McAbeeKara E. McAbee More articles by this author , Alison M. RasperAlison M. Rasper More articles by this author , and Ryan P. TerleckiRyan P. Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1198AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary care providers (PCPs) harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Additionally, men in the community may fear operations involving surgeons-in-training. Rates of infection following surgery for primary placement and revision of inflatable penile prostheses (IPP) is estimated as 1-3% and 10-18%, respectively. Our objective was to determine the contemporary incidence of infection following IPP surgery at an academic training center. METHODS Review of a prospectively collected single-surgeon database was performed. All cases of IPP placement from January 2011 to November 2016 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery. Cases involving total synthetic corporal reconstruction were excluded. RESULTS 246 cases meeting inclusion criteria were identified. Mean patient age was 64.5 years, and mean follow-up was 28 months. Distribution involved 205 (83%) for primary placement, 37 (15%) for removal/replacement, and 4 (2%) in setting of prior device removal. Diabetes was noted in 29% of men. Trainee involvement was noted in 100% of cases. Rates of involvement by postgraduate year (PGY) were 81 (PGY2 or lower), 23 (PGY3), 12 (PGY4), 113 (PGY5), 112 (PGY6). Two operations were performed for suspected infection, one based on pain and one based on fever of unknown origin. Both were without intraoperative evidence of infection and all operative cultures were negative. One received simple removal/replacement and the other received removal with subsequent finding of pulmonary source for fever. Thus, the postoperative infection rate in this series was 0%. CONCLUSIONS In this contemporary series from an academic training center, infection following IPP surgery is uncommon, even with 100% involvement of surgeons-in-training. This data should be used to better inform PCPs and members of the general public potentially interested in restoration of sexual function. Fear of involving residents in IPP surgery appears to be unwarranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e502-e503 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kara E. McAbee More articles by this author Alison M. Rasper More articles by this author Ryan P. Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...