Broad Range Of Specialties Research Articles

2323 Prevalence of delirium, dementia and cognitive test deficits, hospital-wide and by specialty in > 50,000 unplanned admissions

Abstract Introduction Over one-third of older people with unplanned admissions to hospital are frail, but data on the burden of delirium, dementia and other cognitive frailty are lacking. Reliable hospital-wide and specialty-specific prevalence estimates are needed for service-planning including understanding the role of non-geriatricians in caring for this population. Methods ORCHARD includes pseudo-anonymised EPR data for consecutive admissions with a length of stay of >1 day (2017–2019) to four hospitals in Oxfordshire (population = 800,000). Data are collected using a standard cognitive screen comprising dementia history, delirium diagnosis (Confusion Assessment Method-CAM), and 10-point Abbreviated Mental Test-AMTS that is mandated on admission for all patients >70 years. Cognitive frailty was defined as delirium, diagnosed dementia, delirium+dementia or AMTS<8 without delirium/dementia. We analysed the ORCHARD data to determine the prevalence of delirium/cognitive frailty trust-wide and by specialty (n = 29 with >50 admissions). Results Among 51,202 admissions with mean/sd age = 82/7 years and Hospital Frailty Risk Score = 8/6, any cognitive frailty was present in 34.5% (95%CI 34.0–34.9%; n = 17,466) of which delirium accounted for 14.6% (n = 7411), delirium+dementia = 9.4% (n = 4757), dementia = 7.5%, (n = 3784), AMTS<8 = 3% (n = 1514). The prevalence of cognitive frailty in general medicine, general surgery and trauma/orthopaedics, which accounted for 80% of admissions (n = 41,016), was 41% (n = 13,879), 21% (n = 801) and 35% (n = 1304) in each, respectively. The prevalence was 44% in geriatric medicine admissions (n = 133/301), 36% in palliative (n = 128/356), 29% in stroke (n = 135/468), 27% in infectious disease (n = 41/152), 22% in neurosurgery (n = 154/702) and 10–20% in all other specialties except two. Delirium was the most prevalent form of cognitive frailty in 24/29 specialties. Discussion Cognitive frailty is common in older unplanned hospital admissions across a broad range of specialties, with delirium accounting for most cases. Our findings support the need for hospital-wide and specialty-specific training and service development to reflect the needs of these older complex patients and increased emphasis on delirium in policy.

Insights of Healthcare Professionals into Medical Writing Support at a Tertiary Care Hospital in Saudi Arabia.

The demand for medical writing is on the rise in academic and medical entities worldwide. However, a huge disparity in the perception of professional medical writing arises from inadequate education and regularity in service quality and potential ethical challenges. Hence, we aimed to examine the knowledge, attitude, and perception toward professional medical writing support (PMWS) of healthcare professionals at King Fahad Medical City (KFMC). An observational cross-sectional study was conducted using a questionnaire that was validated for its accuracy and clarity by an expert panel in academic integrity. The self-administered questionnaires were distributed to 200 healthcare professionals from a broad range of specialties throughout KFMC. The socio-demographic characteristics and healthcare professionals' knowledge, attitudes, and perceptions were recorded. The responses were quantitatively evaluated using a 5-point Likert Scale and analyzed using the Statistical Package for Social Sciences 25 (IBM, New York, United States). 162 healthcare professionals in KFMC filled in the questionnaire completely. Most respondents agreed that it was acceptable for medical writers to help with writing publications and that they offered a valuable service. Concerning association with socio-demographic characteristics, the mean score of knowledge was found to be significantly related to those with age ≥45 years (p<0.001), PhD degree (p=0.044), >5 years of research experience (p<0.001), and being a faculty/consultant (p=0.005). No significant association was found with the mean total score of attitude. Participants having >5 years of research experience were found to have a higher significant level of perception (p=0.004). Our study highlights that PMWS is relatively well-utilized and perceived positively within KFMC. There is a need for further research and education of ethics regarding the use of PMWS.

An Overview of the Methodology Used to Develop Clinical Practice Guidelines for the Management of Acute and Intraoperative Spinal Cord Injury.

An overview of the methods used to develop clinical practice guidelines (CPGs). Acute spinal cord injury (SCI) and intraoperative SCI (ISCI) can have devastating physical and psychological consequences for patients and their families. To date, there are several studies that have discussed the diagnostic and management strategies for both SCI and ISCI. CPGs in SCI help to distill and translate the current evidence into actionable recommendations, standardize care across centers, optimize patient outcomes, and reduce costs and unnecessary interventions. Furthermore, they can be used by patients to assist in making decisions about certain treatments and by policy makers to inform allocation of resources. The objective of this article is to summarize the methods used to develop CPGs for the timing of surgery and hemodynamic management of acute SCI, as well as the identification and treatment of ISCI. The CPGs were developed using standards established by the Institute of Medicine (now the National Academy of Medicine), the Guideline International Network and several other organizations. Systematic reviews were conducted according to accepted methodological standards (eg, Institute of Medicine, Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute) in order to summarize the current body of evidence and inform the guideline development process. Protocols for each guideline were created. A multidisciplinary guideline development group (GDG) was formed that included individuals living with SCI as well as clinicians from the broad range of specialties that encounter patients with SCI: spine or trauma surgeons, critical care physicians, rehabilitation specialists, neurologists, anesthesiologists and other healthcare professionals. Individuals living with SCI were also included in the GDG. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to rate the certainty of the evidence for each critical outcome. The "evidence to recommendation" framework was then used to translate the evidence obtained from the systematic review to an actionable recommendation. This framework provides structure when assessing the body of evidence and considers several additional factors when rating the strength of the recommendation, including the magnitude of benefits and harms, patient preferences, resource use, health equities, acceptability and feasibility. Finally, the CPGs were appraised both internally and externally. The results of the CPGs for SCI are provided in separate articles in this focus issue. Development of these CPGs for SCI followed the methodology proposed by the Institute of Medicine the Guideline International Network and the GRADE Working Group. It is anticipated that these CPGs will assist clinicians implement the best evidence into practice and facilitate shared-decision making with patients.

Important Leadership Skills and Benefits of Shared Leadership Training for Chief Residents: A Delphi Analysis.

Chief residents (CRs) have pivotal educational and leadership roles in residency programs. The necessary CR leadership skills that transcend specialties have not been defined and most training on these skills occurs in silo. The primary goal was to define leadership skills important for the general CR role. The secondary aim was to determine which skills should be included in cross-specialty CR training and identify benefits of such training. Sixty-three CRs and 25 program directors (PDs) from 25 residency programs at a single institution were surveyed via a modified Delphi approach in 2022 as part of a needs assessment on CR leadership training. First, respondents answered three open-ended questions about skills needed for the CR role and the potential benefits of cross-specialty CR training. Respondents then rated categorized responses on the importance of the skill, agreement that skills should be included in cross-specialty training, and agreement on benefit of cross-specialty training using a 5-point Likert scale. Positive consensus was defined as 80% agreement. Fifty respondents (53%) participated in round one and 28 (32%) in round two. Positive consensus was reached on 38 skills (63%). Nine skills reached consensus on inclusion in cross-specialty training including communication skills and certain management skills. Consensus on benefits of training include learning from and collaborating with other residency programs. The authors defined important skills for the CR role that reached consensus across a broad range of specialties and identified the perceived benefits of shared leadership training. Residency programs should consider cross-specialty leadership training for CRs with a focus on communication and management skills.

Improving the multidisciplinary Team Brief; a trainee led quality improvement project.

Background: The project was developed following the NatSSIPs2 consultation and recent publication to improve patient safety, team working, and efficiency.1 To meet the Team Brief standards and improve their quality we wanted to introduce a formalised approach at the Royal London Hospital. Methods: Quality improvement (QI) methodology was used to guide the project during the ‘CANDLE’ (Curriculum and Delivery Learning Event) regional QI training. A driver diagram was created and stakeholders analysed. The project began in September 2022 with the aim to implement the Team Brief standard by January 2023. Results: A snapshot audit and staff survey were performed in October 2022. Thirteen Team Briefs from a broad range of specialties were audited, and 27 staff members responded to the survey. The results of this were used to define the issues with team brief and to create a multidisciplinary team brief proforma. This was initially trialled over a 2-week period from 16 to 29 November. After the initial trial, the design was refined based on feedback. Well-being was included with individual and team ‘RAG’ (red, amber, green) ratings and inclusion of ‘Greatix’ QR code to encourage reporting of good feedback. Appropriateness of staffing was also recorded. The use of the new proforma was audited between 26 November 2022 and 20 January 2023. Usage was sporadic, only 38% of lists (183/480), except in the orthopaedic trauma theatres where uptake was much higher. The staff in these theatres were interviewed to ascertain why uptake was so good; it was because of nurse in charge adoption. The project was presented at local audit meetings, and a QI celebration event. This led to buy-in from the senior management team. The proforma was reintroduced in February 2023. The project became self-sustaining with recruitment of other members to the QI team and became imbedded in the local culture. Feedback from the most recent theatre audit meeting was excellent. From 20 February to 10 March 2023 the proforma was used in 79.3% (119/150) of main theatre lists. Conclusion: The multidisciplinary Team Brief project has introduced a proforma which has been adopted consistently in theatres and created a self-sustaining change. The proforma includes structured organisational information to improve patient safety and communication but also focusses on team working, psychological safety, and well-being. The CANDLE course for curriculum and delivery of QI supported trainee leadership, teamwork, and delivery of QI. 1.National Safety Standards for Perioperative Care 2. Centre for Perioperative Care. January 2023. Available from https://cpoc.org.uk/sites/cpoc/files/documents/2022-12/CPOC_NatSSIPs2_Summary_2023.pdf (accessed March 2023)

Interview Invitations for Otolaryngology Residency Positions Across Demographic Groups Following Implementation of Preference Signaling

Preference signaling is a new initiative in the residency application process that has been adopted by 17 specialties that include more than 80% of applicants in the 2023 National Resident Matching cycle. The association of signals with interview selection rate across applicant demographics has not been fully examined. To assess the validity of survey-based data on the association of preference signals with interview offers and describe the variation across demographic groups. This cross-sectional study examined the interview selection outcomes across demographic groups for applications with and without signals in the 2021 Otolaryngology National Resident Matching cycle. Data were obtained from a post-hoc collaboration between the Association of American Medical Colleges and the Otolaryngology Program Directors Organization evaluating the first preference signaling program used in residency application. Participants included otolaryngology residency applicants in the 2021 application cycle. Data were analyzed from June to July 2022. Applicants were provided the option of submitting 5 signals to otolaryngology residency programs to indicate specific interest. Signals were used by programs when selecting candidates to interview. The main outcome of interest was the association of signaling with interview selection. A series of logistic regression analyses were conducted at the individual program level. Each program within the 3 program cohorts (overall, gender, and URM status) was evaluated with 2 models. Of 636 otolaryngology applicants, 548 (86%) participated in preference signaling, including 337 men (61%) and 85 applicants (16%) who identified as underrepresented in medicine, including American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native Hawaiian or other Pacific Islander. The median interview selection rate for applications with a signal (48% [95% CI, 27%-68%]) was significantly higher than for applications without a signal (10% [95% CI, 7%-13%]). No difference was observed in median interview selection rates with or without signals when comparing male (46% [95% CI, 24%-71%] vs 7% [95% CI, 5%-12%]) and female (50% [95% CI, 20%-80%] vs 12% [95% CI, 8%-18%]) applicants or when comparing applicants who identified as URM (53% [95% CI, 16%-88%] vs 15% [95% CI, 8%-26%]) with those who did not identify as URM (49% [95% CI, 32%-68%] vs 8% [95% CI, 5%-12%]). In this cross-sectional study of otolaryngology residency applicants, preference signaling was associated with an increased likelihood of applicants being selected for interview by signaled programs. This correlation was robust and present across the demographic categories of gender and self-identification as URM. Future research should explore the associations of signaling across a broad range of specialties and the associations of signals with inclusion and position on rank order lists and match outcomes.

Effects of Live Music on the Perception of Noise in the SICU/PICU: A Patient, Caregiver, and Medical Staff Environmental Study.

Intensive Care Units (ICUs) require a multidisciplinary team that consists of, but is not limited to, intensivists (clinicians who specialize in critical illness care), pharmacists and nurses, respiratory care therapists, and other medical consultants from a broad range of specialties. The complex and demanding critical care environment provides few opportunities for patients and personal and professional caregivers to evaluate how sound effects them. A growing body of literature attests to noise's adverse influence on patients' sleep, and high sound levels are a source of staff stress, as noise is an ubiquitous and noxious stimuli. Vulnerable patients have a low threshold tolerance to audio-induced stress. Despite these indications, peak sound levels often register as high, as can ventilators, and the documented noise levels in hospitals continue to rise. This baseline study, carried out in two hospitals' Surgical and Pediatric Intensive Care Units, measured the effects of live music on the perception of noise through surveying patients, personal caregivers and staff in randomized conditions of no music, and music as provided by music therapists through our hospital system's environmental music therapy program.

Unmet needs and practical solutions in the management of invasive mould infections in Asia.

Management of invasive mould infections (IMIs) is challenging in Asia, as awareness among medical practitioners can be low and resources are limited. Timely diagnosis and appropriate treatment of IMIs can mitigate the impact on morbidity and mortality, but diagnostic methods, as well as access to preferred antifungal medications, may vary throughout the region. Knowledge of local epidemiology and accurate diagnosis and identification of causal pathogens would facilitate optimal treatment but data in Asia are lacking. To address these unmet needs in the management of IMIs, this paper is a call for urgent action in the following areas: improving awareness of the threat of IMIs; providing education to frontline clinicians across a broad range of specialties on 'red flags' for suspicion of IMIs; prioritizing cost-effective rapid diagnostic testing; improving access to preferred antifungal medications; and closing the gaps in local epidemiological data on IMIs to inform local treatment guidelines.

The role of the physician associate: an overview.

The physician assistant role in healthcare delivery was first introduced during the 1960s in the USA as a solution to doctor shortages, greater population healthcare needs and increasing healthcare provision costs. Since then, many countries worldwide have utilized the successful USA physician assistant model as a benchmark to guide both physician assistant training and the incorporation of the role into their healthcare systems. While the USA retained the title physician assistant, Ireland and the UK use the title physician associate. Physician assistants/associates are trained in the generalist medical model and function under the supervision of a doctor. Tasks relating to the role include the following: taking patient's medical histories, performing examinations, making diagnosis, requesting tests, analysing results and the initiation of treatment. They practice across a broad range of specialities and settings. Physician assistants in the USA and the Netherlands have prescribing privileges. Statutory regulation for physician assistants/associates lays the groundwork for prescribing privileges and such regulation is under consideration by the government in the UK. Studies indicate that doctors and patients are largely satisfied with the contribution of this profession to healthcare services and physician assistants/associates report good job satisfaction.

Evaluating student knowledge about sexual exploitation using an interprofessional approach to teaching and learning.

The aim of this study was to qualitatively assess student perceived impact of a novel interprofessional approach to delivering education on sexual exploitation (SE). This article reports on research that we designed, delivered and evaluated to develop an interprofessional community of learning, enabling SE to be discussed with second-year undergraduate students. Participants came from a broad range of specialties. Following the study, students reported an increased level of awareness, understanding and confidence when working with SE. This interprofessional education session has since been incorporated into the nursing, midwifery and allied health programme in a local university and is part of a second-year undergraduate module on knowledge and skills for safe practice.

British Thoracic Society survey of rehabilitation to support recovery of the post-COVID-19 population

ObjectiveA proportion of those recovering from COVID-19 are likely to have significant and ongoing symptoms, functional impairment and psychological disturbances. There is an immediate need to develop a safe and...

Understanding the needs of rural preceptors from groups underrepresented in medicine

Abstract&#x0D; Introduction&#x0D; Community preceptors are essential in providing sufficient training opportunities for health professional students. Recently, focus has been given to the recruitment of community preceptors from groups underrepresented in medicine (UiM) for their contibutions in training a diverse and culturally competent workforce. The overall goal of this study is to review data collected from UiM preceptors and potential preceptors for unique beliefs or values that reveal their motivation for teaching. We hypothesize that community preceptors from groups underrepresented in medicine hold beliefs reflective of high levels of altruism and service.&#x0D; Methods&#x0D; This is a retrospective study of interview data collected from UiM community preceptors for developing clinical education experiences. We sought to uniquely understand the needs of these preceptors in order to develop our recruitment strategy. Each participant agreed to a structured interview and gave or denied permission to have the interview recorded. In the structured interview, community physicians were asked to answer questions about their motivation to precept medical and physician assistant students. They were further asked about their desired compensation, reservations about teaching, and interest in participating in curricular development.&#x0D; Results&#x0D; We interviewed 12 community providers- 11 physicians and one advanced practice nurse. Participants were from a broad range of specialties: Obstetrics/Gynecology (3), Surgery (3), Psychiatry (3), Family Medicine (1), Pediatrics (1), Emergency Medicine (1). Of the providers interviewed, 10 were from groups underrepresented in medicine. All 10 of the UiM participants were physicians. All participants completed the structured interview. The answers provided in the interview were able to be grouped into themes reflecting a recurring set of beliefs and motivations.&#x0D; Conclusions&#x0D; UiM preceptors hold values reflective of altruism and a willingness to serve in the creation of the future workforce. We have found UiM preceptors possess a strong desire for training as educators. Further, UiM preceptors are incentivized by financial compensation and willing to commit their personal time to advising the medical school.

Going Beyond “Not Enough Time”: Barriers to Preparing Manuscripts for Academic Medical Journals

Phenomenon: Many researchers have difficulty transforming raw data into publishable full-length manuscripts. Among studies presented at professional meetings, registered as clinical trials, or declined from specific journals, nonpublication rates are estimated to range from 25% to 60%. We aimed to characterize major barriers to manuscript preparation, beyond lack of time, for academics from a broad range of specialties at a tertiary academic medical institution. We explored whether major barriers evolved with increasing publishing experience. Approach: We surveyed registrants of 12 noncompulsory workshops on scientific publishing (April 2009–November 2015). Survey respondents indicated how many of their coauthored papers were accepted for publication in peer-reviewed journals in the past 5 years and stated what they found most difficult about preparing a manuscript, other than lack of time. Two investigators performed a content analysis of the reported barriers; mean agreement between coders was 98% (SD = 2%), and the mean Scott π coefficient for interrater reliability was 0.81 (SD = 0.26). We used a multimethod analytic approach to determine whether the perceived barriers varied with level of publishing experience. Findings: Surveys were returned by 201 of 256 registrants (79%). Thirty-eight percent of respondents had lower publishing experience (0–4 papers published in peer-reviewed journals in the past 5 years), 26% had medium experience (5–10 papers), and 35% had higher experience (>10 papers). Many respondents (57%) listed multiple barriers, but 5% listed zero barriers. The content analysis of the 370 reported barrier items identified 8 categories covering 38 concepts. The most common concerns (i.e., organization, writing, following journal format, defining the article scope, disliking writing, responding to reviewers) were not affected by author experience level. However, significantly more academics with higher experience expressed concerns about data presentation. Insights: Academics commonly reported barriers such as uncertainty about how to organize content, difficulty with developing succinct text, and frustration about meeting journal-specific formatting requirements. Greater experience in scientific publishing did not appear to mitigate these barriers. Academic institutions can provide targeted support for persistent challenges to scholarly productivity.

Clinician Job Searches in the Internet Era: Internet-Based Study.

BackgroundTraditional methods using print media and commercial firms for clinician recruiting are often limited by cost, slow pace, and suboptimal results. An efficient and fiscally sound approach is needed for searching online to recruit clinicians.ObjectiveThe aim of the study was to assess the Web-based methods by which clinicians might be searching for jobs in a broad range of specialties and how academic medical centers can advertise clinical job openings to prominently appear on internet searches that would yield the greatest return on investment.MethodsWe used a search engine (Google) to identify 8 query terms for each of the specialties and specialists (eg, dermatology and dermatologist) to determine internet job search methodologies for 12 clinical disciplines. Searches were conducted, and the data used for analysis were the first 20 results.ResultsIn total, 176 searches were conducted at varying times over the course of several months, and 3520 results were recorded. The following 4 types of websites appeared in the top 10 search results across all specialties searched, accounting for 52.27% (920/1760) of the results: (1) a single no-cost job aggregator (229/1760, 13.01%); (2) 2 prominent journal-based paid digital job listing services (157/1760, 8.92% and 91/1760, 5.17%, respectively); (3) a fee-based Web-based agency (137/1760, 7.78%) offering candidate profiles; and (4) society-based paid advertisements (totaling 306/1760, 17.38%). These sites accounted for 75.45% (664/880) of results limited to the top 5 results. Repetitive short-term testing yielded similar results with minor changes in the rank order.ConclusionsOn the basis of our findings, we offer a specific financially prudent internet strategy for both clinicians searching the internet for employment and employers hiring clinicians in academic medical centers.

The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians\u2019 perceptions of professional and cultural factors that influence doctors\u2019 attitudes and practices in a large Australian hospital

BackgroundHospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers’ adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors’ behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors’ IPC practices will contribute to development of new strategies to improve IPC, overall.MethodsThis qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors’ IPC practices, using thematic analysis of data.ResultsProfessional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors’ responsibilities for preventing them; and lack of clarity about senior consultants’ obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors’ own assessment of patients’ infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised.ConclusionsFailure of healthcare and professional organisations to address doctors’ poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.

Lyme disease in Northern Ireland – a look back on serological testing

Background Lyme disease is an illness caused by the spirochete Borrrelia burgdoferi. NICE guidance suggests an approach to diagnosis resting on clinical presentation, presence in an epidemiologically plausible area, and positive serology. It is however, well documented that serological diagnostics in European Lyme disease is problematic. There is a movement for Lyme advocacy, a voice that emphasises the poor diagnostics in this infection. With the spotlight on Lyme disease, we are increasingly seeing patients presenting in Northern Ireland across a broad range of specialities. Currently there is minimal data looking at the local epidemiology of Lyme disease. We present previously unpublished data looking at the demographics of those testing positive for Borrelia burgdoferi antibodies. Methods We collected data from all patients tested for Lyme disease in Northern Ireland from 2013–2018. We excluded negative results. A randomised selection of 300 cases were chosen. We recorded patient age, gender, origins of testing, home postcode, tick bite history, relevant travel history, duration of symptoms, timings of testing, antibody results including confirmatory testing and treatment. Results Of the 300 selected patients 241 (80 %) were IgM positive and 83 (30 %) IgG positive using DiaSorin, Liason CLIA. The average age of presentation was 39 years old. There was a predominance of females tested (62%). 32 % of tests originated in primary care. Of the IgM positives only 41 (17 %) were confirmed by C6 peptide or lineblot in the reference laboratory (RIPL, Porton Down). The results highlight the likely low seroprevalence of Lyme disease in Northern Ireland.

Systematic Review of the Use of 3-Dimensional Printing in Surgical Teaching and Assessment

The use of 3-dimensional (3D) printing in medicine has rapidly expanded in recent years as the technology has developed. The potential uses of 3D printing are manifold. This article provides a systematic review of the uses of 3D printing within surgical training and assessment. A structured literature search of the major literature databases was performed in adherence to PRISMA guidelines. Articles that met predefined inclusion and exclusion criteria were appraised with respect to the key objectives of the review and sources of bias were analysed. Overall, 49 studies were identified for inclusion in the qualitative analysis. Heterogeneity in study design and outcome measures used prohibited meaningful meta-analysis. 3D printing has been used in surgical training across a broad range of specialities but most commonly in neurosurgery and otorhinolaryngology. Both objective and subjective outcome measures have been studied, demonstrating the usage of 3D printed models in training and education. 3D printing has also been used in anatomical education and preoperative planning, demonstrating improved outcomes when compared to traditional educational methods and improved patient outcomes, respectively. 3D printing technology has a broad range of potential applications within surgical education and training. Although the field is still in its relative infancy, several studies have already demonstrated its usage both instead of and in addition to traditional educational methods.

Third International Conference on Engineering Geophysics (ICEG)

Hats off to the organizers of the third International Conference on Engineering Geophysics (ICEG) held 15–18 November 2015 in Al Ain, UAE. Once again, this group of local university, government, and society advocates for geophysics delivered an unrivaled conference experience to the global community of applied near-surface geophysicists. The success of the conference stems from blending an internationally renowned collection of geophysical researchers, practitioners, and regulators — representing a broad range of specialties — into a diverse and captivating technical program.

Free open access medical education can help rural clinicians deliver 'quality care, out there'

Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. Free open access medical education is a new paradigm in continuing professional education. Use of the internet and social media allows a globally accessible crowd-sourced adjunct, providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles and the availability of relevant resources for life-long learning. This markedly reduces knowledge translation (the delay from inception of a new idea to bedside implementation) and allows rural clinicians to further expertise by engaging in discussion of cutting edge concepts with peers worldwide.

The impact of noninvasive fetal evaluation

To highlight the evolution of prenatal diagnosis from invasive procedures to noninvasive assessments and to describe the efforts to educate both trainees and experienced physicians via simulation techniques. The rapid development of noninvasive serum analyte screening as well as molecular genetic and sonographic techniques to evaluate the fetus has altered our ability to both educate trainees as well as to maintain physician competence to perform invasive procedures. Simulation-based learning is being incorporated into medical training across a broad range of specialties, including obstetrics and gynecology. Prenatal diagnosis procedures will continue to be necessary for direct fetal assessment but on a much more limited scale. It is possible that all trainees will not be able to become competent in amniocentesis and other even less common procedures. Furthermore, experienced physicians may lose competence, given the lack of available procedures for skill retention. Innovative methods of skill acquisition and maintenance may be required in the near future. Although long-term assessments of efficacy are currently lacking, the introduction of comprehensive, simulation-based curriculia has the potential to both educate trainees and help maintain physician competence.