Close Supervision Research Articles

Ocular ischemic syndrome – case report and literature analysis

Abstract Introduction Ocular ischemic syndrome (OIS) is a rare condition associated with ocular hypoperfusion caused by carotid artery occlusive disease. This article describes the case of a patient who was admitted to the Department of Ophthalmology at UCK in Katowice, Poland, due to significant loss of visual acuity and pain in the right eye. Materials and Methods Retrosopective case report. Results Patient showed up in the ophthalmological emergency department complaining of significant loss of visual acuity and pain in the right eye persisting for 2 weeks. The patient had a history of type II diabetes mellitus, hypertension, status post ACS and PCI, and long-term nicotinism. Examination of the right eye revealed ocular irritation, mixed conjunctival injection, hyphema in the anterior chamber, iris neovascularization, and discrete central retinal fading. Additional examinations were performed, including an angioCT, which showed a long-standing obstruction of the right internal carotid artery, a ballooning thrombus in the lumen of the brachiocephalic trunk, and suspected critical stenosis of the left vertebral artery. A neurologist and vascular surgeon were consulted, and treatment was instituted to limit further complications from the underlying disease. The patient remains under close supervision of the vascular surgeon and neurologist. Conslusions OIS is a rare but potentially blinding condition and should be considered in the differential diagnosis of transient visual acuity reduction or vision loss.

Повсякденна діяльність членів «Стамбульської платформи» упродовж 1929-35 рр.

The daily activities of the members of the illegal residency of the UPR Central Committee in exile ‘Istanbul Platform’ during 1929-35 consisted of various aspects: domestic, social, and public. However, a red thread through the daily life of representatives of the Ukrainian political emigration in Istanbul was intelligence work, which still impresses researchers not only with the ambitiousness of intentions, plans, and tasks, but also with the professionalism and skill of their implementation. Especially given the fact that none of the members of the residency had previously been a professional intelligence officer and had no previous practical experience in the special services. Being under the close supervision of Soviet agents, without funding and the necessary means, without permanent and reliable channels of communication with their curators, members of the Istanbul Platform had to not only integrate into the life of the local community in Istanbul, establish their daily routine, and not cause discontent with the Turkish migration service, but also carry out intelligence, educational and propaganda activities. Every day, they resorted to new, creative methods; they used all available opportunities and skills in confronting Soviet agents.

Differences in the Effectiveness of Infrared Therapy for Reducing Musculoskeletal Pain in the Elderly

Objective: A health problem that is a priority for medical care and treatment for the elderly is pain in the musculoskeletal system. Non-pharmacological management in the form of treating musculoskelatal pain in the elderly, one of which is infrared therapy. Infrared therapy is able to reduce pain in the elderly and requires close supervision because the elderly experience a decrease in skin sensitivity to heat. The effectiveness of reducing pain varies in the elderly. One of the influencing factors is age. This study’s objective is to determine differences in the effectiveness of infrared therapy to reduce musculoskeletal pain in the elderly group.
 Materials and methods: This study used an experimental research method with a nonrandomized pretestposttest control group design. The research location was conducted at the Posbindu Institut Teknologi Sains dan kesehatan PKU Muhammadiyah Surakarta, in September - October 2022. A sample of 50 elderly people was divided into elderly (> 60 years: 30) and pre-elderly (45-60 years: 20) selected using a purposive technique sampling. The dependent variable is musculoskeletal pain. The independent variable is infrared therapy. Data were analyzed by Wilcoxon and Mann-Whitney test.
 Results and Discussion: The Wilcoxon test showed that there was an effect of infrared therapy in reducing musculoskeletal pain in the elderly and preelderly groups (p value <0.001 and <0.001). The average reduction in pain in the elderly group = 3.1; SD = 1.3 and pre-elderly = 2.95; SD = 1.2. The Mann-Whitney test showed no difference in reducing musculoskeletal pain using infrared therapy in the elderly and pre-elderly (p = 0.712).
 Conclusion: Infrared therapy is effective in reducing musculoskeletal pain and reducing musculoskeletal pain for the two elderly groups are similar
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 108-114

Autoimmune hemolytic anemia in a preoperative patient: a case report and literature review

Background: In patients undergoing elective surgery, it is known that as many as one-third have preoperative anemia. Preoperative anemia is associated with an almost five-fold increase in the likelihood of postoperative mortality. So, it is essential to know the cause of anemia so that the management is appropriate so that surgery can be performed safely and prevent patients from dying on the operating table or postoperatively. This case report aims to describe the pathogenesis of the laboratory findings in a patient with autoimmune hemolytic anemia (AIHA) who was accidentally diagnosed during preoperative screening and the management performed. Case: A 65-year-old man with an enlarged prostate was scheduled for elective surgery. Preoperative examination revealed anemic right and left conjunctiva, decreased erythrocytes, hemoglobin, hematocrit, and increased MCV, MCH, and MCHC, peripheral blood smear dominated by red cell agglutination and positive direct Coomb's test. The patient was given methylprednisolone 62.5 mg intravenously before transfusion and given a transfusion of 2 units of slow drip packed red cells (PRC) under close supervision. There were no transfusion reactions during and after transfusion. There was an increase in Hb after transfusion so that the patient could be operated on. Conclusion: The patient in this case was diagnosed with AIHA based on preoperative laboratory findings. Laboratory results showed evidence of autoimmune hemolytic anemia with decreased erythrocytes, hemoglobin, hematocrits, spherocytes, and agglutination on peripheral blood smear and positive Coomb's test. Rapid identification and treatment of anemia help improve preoperative conditions.

On the Inter-Relationships Between Teachers, Technologies, and Children in Makerspace Environments: A Comparative Case Study in Kindergarten Classrooms

ABSTRACT While early childhood education worldwide has become increasingly interested in integrating makerspaces into their curricula, little research has examined how this can be done. We conducted a comparative case study to understand how three pioneering and prominent teachers have established such spaces, their perspectives regarding makerspaces and their role in them, and what characterizes these spaces. Observational and interview research data were organized and analyzed for patterns, themes, and relationships. Three main themes were identified: (1) the makerspace design, activities, and teacher’s role are impacted by the reasons and goals teachers espouse for establishing them; (2) all three sites provided limited scaffolds for the making process – five different forms of teachers’ scaffolding were identified; and (3) while advanced technologies (robotics, 3D printing) were present, their use was limited as they required significant troubleshooting by the teacher and close supervision. These results can be used to construct a theoretical framework that provides guidance to early childhood educators who wish to integrate makerspaces in differentiated ways suited to teachers with different inclinations.

A Constructive System to Assess the Performance-based Grading of Construction Labour through Work-Based Training Components and Applications

Various industry sectors of many developing countries have been facing various challenges associated with low performance of labour due to poor work-based training practices. This study aims to assess the performance of labour in construction by applying systematic work-based training components. A comprehensive study methodology was adopted through literature reviews and experts’ interviews/discussions, with problem-focused and action-oriented communication approaches to develop effective tools, systems and practices related to labour training elements and performance assessments within a framework. Through a new construction supervisory training programme, the developed practices were applied to 200-300 labourers working on 23 construction projects in Sri Lanka. The results show the detailed patterns of the significant changes in labour performance with the quantified values. Overall quantitative values indicate a nearly 60% increase in the performance of labour within six months of the training period compared to the starting point. A considerable level of performance improvement was reported in the soft skills (90%) and material handling abilities (70%) of labourers. A moderate level of performance improvement was identified in other competency elements related to the application of basic science/technology-related practices (55%), simple engineering/technology-related practices (44%), construction methods and technology (56%), green practices (36%) and fundamental management aspects (34%). The overall performance values of labourers employed in road/bridge projects were found that noticeably lower compared to the labourers who worked on other types of projects. The results further describe the well-improved theoretical knowledge and operational skills of the trained labourers, which has uplifted their job standards from working under close supervision to working under general supervision with some autonomy. Moreover, the study findings contribute to controlling the excessive inclination of local firms toward foreign labour by unlocking the potential barriers to expanding the local labour supply with lifelong learning and career benefits/opportunities for labourers. The findings will have a significant impact on how other developing nations and industries must manage their labour to obtain higher work efficiency in the foreseeable future.

A Cross-sectional Study of Self-confidence Differences in Removable Prosthodontic Treatment among Undergraduate Students of a Saudi Dental School

Background: Removable denture treatments remain an option for the edentulous population in terms of oral rehabilitation. In dentistry schools, improving students' self-confidence in performing prosthodontic procedures should be paramount. Objectives: The aim of this study was to examine students' self-confidence perceptions in performing removable partial dentures (RPDs) and complete dentures (CDs) treatments and to draw attention to the steps in which they felt most and least prepared to do so without close supervision. Methods: This cross-sectional study was conducted at one dental school in Saudi Arabia at the end of the 2022-2023 academic year. A total of (n=96) undergraduate students in their clinical years, 5th and 6th cohorts, were included in this study. These students were requested to participate in a closed questionnaire consisting of 38 items that focused on self-reported confidence and the perceived quality of their education. A non-parametric test, the Mann-Whitney U-test, was used to compare between groups. The data were analyzed using IBM SPSS Statistics (V.28.0). Results: A response rate of 95.8% was achieved. Over the course of their studies, students' sense of confidence grew. Also, males were more confident than females in performing all clinical procedures. Overall, students were satisfied with their prosthodontic education, except for pre-clinical sessions and learning materials. Increasing their clinical experience would be most advantageous for boosting their confidence levels. Conclusion: The study revealed where students were most and least confident in carrying out removable prosthodontics. Students require supervision during their internship year because they reported average confidence in removable prosthodontic procedures. The results also point to the need for more research into the confidence gaps between males and females. The pre-clinical curriculum necessitates updating and more didactic teaching.

Performance Process of Coil Winding Machine Based on Accuracy and Speed for Water Pump Motor

A coil winding machine for water pumps using a monitoring system is a development of conventional winding tools. In regular coil winding tools, the coil winding process is done manually by rotating the handle as many times as the desired number of turns. The conventional winding tools have problems consisting of inconsistent working speed and operator-dependent winding continuity. Undesirable windings can occur with conventional winding tools, and the winding process requires close supervision. Therefore, the automatic coil winding machine was developed to optimize the coil winding process. The machine utilizes a DC motor to rotate the coil rolls, replacing the conventional roller handle function. This machining method uses an optocoupler sensor. The sensor serves to identify and evaluate the rotation of the roller. In addition, the ATmega8 microcontroller was applied to develop a system that can work automatically. Data collection involves varying the number of wire turns and the wire diameter dimension. The variation is necessary because the number of windings and wire diameter affect pump efficiency and performance. The data testing showed a machine accuracy rate of 98%, with a maximum difference of 1 coil winding in the results. This data confirms that the coil winding machine meets the tool's accuracy standards.

Factors in Road Traffic Crashes Among Drivers in Buno Bedelle Zone, Southwest Ethiopia: A Case Control Study

Road traffic crashes (RTC) are one of the leading causes of global mortality, resulting in over 1.35 million deaths every year. It is a leading cause of death among children and young adults. Ethiopia faces an increasing burden of the problem, and several factors are implicated in the rising trend. Issues concerning drivers and their immediate environments play a crucial role in road traffic crashes. This study was conducted to identify the driver determinants in road traffic crashes in Southwest Ethiopia. A community-based case-control study was conducted on a total of 336 drivers (cases, n=111; controls, n=225). Cases were drivers who had caused an RTC in the past year, controls were drivers who had not. Simple random sampling was employed to select participants. Independent determinants of road traffic crashes were identified using the 95 percent confidence interval of the odds ratio at p < 0.05 in the multivariable logistic regression. Driver and vehicle characteristics that were significant determinants of RTC in the study area were: limited driving experience (AOR: 2.6; 95% CI (1.04, 6.5), alcohol consumption (AOR: 5.17; 95% CI (2.23, 11.7), inconsistent use of seat belts (AOR: 3.19; 95% CI (1.6, 6.3), vehicle years of service (AOR: 2.6; 95% CI (1.3, 5.3) and speeding (AOR: 4.595% CI (2.3-8.9). Mentored driving is recommended to boost the experience of novice drivers. Enforcement of existing laws and behavioural interventions should be strengthened against risky driving practices. Drivers of older vehicles with long intervals between service should be kept under close supervision.

Opportunities and challenges in clinical learning of midwifery students in public Universities of Tigray Region, Ethiopia, 2020: a qualitative study

BackgroundClinical learning focuses on real problems in the context of professional practice in which learners are motivated by its relevance and active participation. Studies showed that midwifery students were challenged by the absence of a variety of cases in non-teaching hospitals, overcrowded teaching hospitals, absence of objective-based evaluation methods, and lack of supervision from clinical instructors. If the theory learned in class was applied in practice, it is helpful to produce skillful and competent midwifery professionals. The aim of this study was exploring opportunities and challenges for midwifery students in the clinical learning environment.Methodsthe study was conducted in public Universities of Tigray, Ethiopia. Phenomenology study design and purposive sampling technique were employed; four focused group discussions and five key informant interviews were conducted. Data were collected using an open-ended guide, transcribed verbatim, entered into ATLAS ti7 software, and translated. Then codes and themes were derived from the transcribed data, and finally analyzed thematically.Resultsa total of 33 participants in which 28 in four focused group discussions and five key informant interviews participated in this study. Based on the result, midwifery students were getting opportunities to practice when they were assigned to non-teaching hospitals, working with close supervision, having smooth relationships with staff, receiving constructive feedback, and evaluated based on their skills. Whereas, they were challenged by aggressive staff, poor follow up, overcrowded teaching hospitals, low usage of skills lab, and short time for clinical practice.ConclusionMidwifery students have positive attitude, and were getting opportunities to practice while they were assigned to a very conducive clinical learning environment with supportive and skillful clinical instructors/ preceptors. However, they have negative attitude, and were challenged to work due to the poor attention given to midwifery students’ clinical learning. It is recommended that midwifery students have to practice well in skills lab before they assigned for clinical practice so that the skills lab have to be strengthen with all necessary materials for clinical practice and clinical instructors have to be integrated to teaching hospitals so as to educate students while their hands-on.

Reflections on the Application and Validation of Technology in Language Testing

ABSTRACT This paper highlights as issues of concern the rapid changes in technology and the tendency to report on partial validation efforts where the work is not identified as forming part of a larger validation project. With close human supervision emerging technologies can have a significant and positive impact on language testing. While technology seems to be constantly changing and improving, there is still a lot to learn in the approaches these papers take in identifying aspects of the constructs of interest amenable to operationalization and measurement through technology. In terms of validation, the paper suggests a number of important things to consider. These include presenting assessment arguments in a form that meets the needs of the stakeholder groups most clearly affected by the claims being made; working towards an interactive communication-based argument approach, ideally involving validators who are independent of the developer; and ensuring that any “partial” validation is explicitly linked to a broader argument. The paper ends by predicting that technology will see the practice of language testing changing radically from where it is today and while fairness, justice and validation will always be primary concerns, the challenges associated with establishing evidence of these will only increase.

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy.

In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced. Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.

The Role of Preoperative Case Selection in the Training of Surgical Repair of Primary Rhegmatogenous Retinal Detachment.

To analyse single-operation anatomical success (SOAS) of primary rhegmatogenous retinal detachment (RRD) repair by junior vitreoretinal surgeons guided by preoperative individual case selection by an experienced mentor vitreoretinal surgeon. Retrospective, single institute, observational study, included all patients who underwent standard pars plana vitrectomy (PPV) or combined encircling band (CB) and PPV and gas tamponade in the treatment of RRD from November 2021 to December 2022 were included. Preoperative selection for the surgery decision, whether standard PPV or combined CB & PPV was undertaken through the senior surgeon; according to the location and extensions of the RRD, number of retinal tears (RT) and lens status. We excluded patients with tractional retinal detachment, RD with proliferative vitreoretinopathy stage C, giant tears, trauma, previous scleral buckle, schisis RD and RD requiring silicone oil. The primary outcome measure was to evaluate the single-operation anatomic success (SOAS). Secondary outcome measures evaluated whether there was a statistical significant difference between both procedures. Eighty-two eyes were included in the study. Forty-five eyes were selected for combined CB&PPV and 37 eyes for standard PPV. SOAS was achieved in 40 eyes (88.8%) in combined group and 35 eyes (94.5%) in standard PPV group. There was no statistically significant difference in the success rate between both operations, p = 0.65. Structured preoperative selection of standardized surgical techniques according to the degree of complexity of RD together with close supervision enables junior vitreoretinal surgeons in training to achieve re-attachment rates of more than 80% with both types of surgeries.

Occurrence, spatiotemporal distribution patterns,partitioning and risk assessments of multiple pesticide residues in typical estuarine water environments in eastern China

The low terrain and the prosperous agriculture in the east of China, have caused the accumulation of pesticide residues in the estuaries. Therefore, this study analyzed the spatiotemporal distribution and partition tendency of 106 pesticides based on their abundance, frequencies, and concentrations in the aquatic environment of 16 river estuaries in 7 major basins in the eastern China by using solid-phase extraction (SPE) with high-performance liquid chromatography tandem mass spectrometry (HPLC‒MS/MS) and gas chromatography tandem mass spectrometry (GC‒MS/MS). In addition, potential risk of multiple pesticides was also evaluated. The results showed that herbicides were the dominant pesticide type, while triazines were the predominate substance group of pesticide. In addition, triadimenol, vinclozolin, diethylatrazine, prometryn, thiamethoxam, atrazine, and metalachlor were the major pesticides in the water, while prometryn, metalachlor, and atrazine were the main pesticides in the sediment. The average total concentration of pesticide was 751.15 ng/L in the dry season, 651.17 ng/L in the wet season, and 617.37 ng/L in the normal season, respectively. The estuaries of the Huai River Basin, the Yangtze River Basin, the Hai River Basin, and the Yellow River Basin have been affected by the low pollution treatment efficiency, weak infrastructure, and agricultural/non-agricultural activities in eastern China, resulting in relatively serious pesticide pollution. The estuaries of Huaihe River, Yangtze River, Xiaoqing River, and Luanhe River had large pesticide abundance and comparatively severe pesticide pollution, while the estuaries of Tuhai River and Haihe River had heavy pesticide contamination in the sediment, which might be induced by historical sedimentary factors. The log KOC values showed that except for thioketone, other pesticides were relatively stable due to the adsorption by sediment. The ecological risk assessment results indicated that insecticides had a high risk. Teenagers were the most severely affected by the noncarcinogenic risk of pesticides, while adults were mostly affected by the carcinogenic risk of pesticides. Therefore, pesticide hazards in the water environment of estuaries in eastern China needs to be further close supervision.

Exploring the Relationship Between Stress and Satisfaction During Clinical Training Among Respiratory Therapy Students: A Nationwide Cross-Sectional Survey.

Although clinical training is an important component of healthcare education, it is nevertheless a significant source of stress for students. There is limited information on stress and satisfaction perceived by clinical-level undergraduate students studying respiratory therapy (RT) in Saudi Arabia. A descriptive, cross-sectional study design with an online questionnaire was employed to conduct this study. Data collection occurred during the academic year 2022-2023 among RT students throughout Saudi Arabia. Patricians responded to demographic questions, the Students Stress Scale and Students Professional Satisfaction questionnaires. Descriptive, inferential, and correlational statistics were used to analyze the collected responses. A total of 1001 undergraduate RT students completed the online survey. RT students and interns had an overall moderate to high stress level (mean (SD); 3.55 (0.49)), while satisfaction was perceived as mild to moderate (mean (SD): 2.56 (0.65)). In addition, 38% of the study participants have considered quitting the RT program. Female students showed higher stress levels in the following domains: inadequate knowledge and training, adverse and embarrassing experiences, clinical supervision, patients' pain, and Education-reality conflict (p<0.005) compared to male students. Additionally, students who considered quitting the RT program revealed higher stress levels in all domains (p<0.005). There were negative correlations between satisfaction and stress domains: inadequate knowledge and training (r = -0.32; p = 0.001), adverse and embarrassing experience (r = -0.31; p = 0.025), close supervision (r = -0.24; p = 0.001), insufficient hospital resources (r = -0.30; p 0.002), patients' pain and suffering (r = 0.28; p = 0.04), and education - reality conflict (r = -0.30; p = 0.001). During clinical training, respiratory therapy students experience moderate to high-stress levels and low satisfaction. There need to be tailored interventions to reduce stress and intention to quit and increase students' clinical experience satisfaction.

IMPACT OF NEEDLE STICK INJURIES ON STUDENT NURSES AT KTH HOSPITAL, PESHAWAR, PAKISTAN

Needle stick injury (NSI) is a significant hazard in healthcare settings that poses a potential risk of transmission of blood-borne diseases. This cross-sectional study aims to determine the prevalence of NSI among student nurses in a tertiary care hospital in Peshawar and their knowledge about NSI prevention and control. The data collected through structured questionnaires, and the sample size was 147. The results showed 37% of students had experienced NSI during the last six months, while 70% were vaccinated and 75% were screened against HBS, HCV, and HIV. The study emphasizes the need for further training, workshops, and close supervision to prevent NSI complications and enhance safe practices during healthcare services. The positive effect of free vaccination and government attention to increasing the strength of nurses to control the increasing rate of NSI is also highlighted. Due to lack of proper supervision by trained staff, student nurses often suffer from needle stick injuries during their practical work. Patients may admitted to the hospital already contaminated with communicable diseases, and their beds are not labeled to indicate this. Exposure to NSIs can cause fear, insecurity, and low self-esteem in student nurses. There are many psychological consequences associated with NSIs, such as fear, anxiety, and depression. Student nurses are at substantial risk for NSIs because they often perform invasive procedures with minimal knowledge and experience. Education and awareness-raising about NSI prevention and reporting have been shown to positively impact previous studies. Observational studies conducted in Pakistan have recommended that nurse students receive further education to reduce the incidence of NSIs, as they are often deprived of advanced knowledge and experience. A lack of staff in hospitals can contribute to NSIs as nurses may ignore their safety while performing their duties. Two-handed recapping is responsible for approximately 80% of needle stick injuries.

EXPLORING AND DEVELOPING LOCAL WISDOM IN RELATION TO MARINE CONSERVATION IN THE BUNAKEN NATIONAL MARINE PARK

The environment is a global concern, including within Bunaken National Park. Safeguarding biodiversity is crucial for sustainable use. However, conservation efforts still face challenges. A significant threat to forest ecosystems is illegal logging, fragmentation, and forest conversion. This study aims to comprehend the local wisdom of the Bunaken National Park community concerning marine conservation. The study employs a qualitative research method with an ecological anthropology approach. Data were collected by means of interviews, observations, and document analysis from local communities. The findings reveal several significant points: Firstly, the community actively engages in the marine conservation process through a participatory approach. Despite the initial clash of interests between fishermen and the national park management, a mutual understanding was eventually reached regarding marine protection zones, encompassing core and utilization zones. Secondly, religious leaders wield a pivotal role in conservation endeavors. They interact with formal leaders and the community during worship, encouraging marine environment protection and community involvement in trash cleanup and preservation of mangrove trees. Thirdly, local wisdom, knowledge, and values persist in people's daily lives. Despite the religious shift from traditional beliefs to Christianity and Islam, certain values endure, such as the correlation between celestial bodies (moon and stars) and agricultural and fishing activities. Fourthly, the Navy contributes to marine conservation by offering close supervision, influencing changes in the mindset and behavior of the neighboring community to safeguard mangrove forests and marine habitats while diminishing the risk of wave-related disasters during high tides.

Diagnostic Accuracy and Confidence in Management of Forearm and Hand Fractures Among Foundation Doctors in the Accident and Emergency Department: Survey Study.

Accurate interpretation of radiographs is crucial for junior doctors in the accident and emergency (A&E) department (the emergency medicine department). However, it remains a significant challenge and a leading cause of diagnostic errors. This study aimed to evaluate the accuracy and confidence of foundation doctors (doctors within their first 2 years of qualifying) in correctly interpreting and managing forearm and hand fractures on plain radiographs. A total of 42 foundation doctors with less than 2 years of experience and no prior emergency medicine training who worked in a large district general hospital participated in a web-based questionnaire. The questionnaire consisted of 3 case studies: distal radius fracture, scaphoid fracture, and a normal radiograph. Respondents were required to identify the presence or absence of a fracture, determine the fracture location, suggest appropriate management, and rate their confidence on a Likert scale. Overall, 48% (61/126) of respondents accurately identified the presence and location of fractures. The correct management option was chosen by 64% (81/126) of respondents. The median diagnostic confidence score was 4 of 10, with a mean diagnostic certainty of 4.4 of 10. Notably, respondents exhibited a significantly lower confidence score for the normal radiograph compared to the distal radius fracture radiograph (P=.01). This study reveals diagnostic uncertainty among foundation doctors in interpreting plain radiographs, with a notable inclination toward overdiagnosing fractures. The findings emphasize the need for close supervision and senior support to mitigate diagnostic errors. Further training and educational interventions are warranted to improve the accuracy and confidence of junior doctors in radiographic interpretation. This study has several limitations, including a small sample size and reliance on self-reported data. The findings may not be generalizable to other health care settings or specialties. Future research should aim for larger, more diverse samples and explore the impact of specific educational interventions on diagnostic accuracy and confidence.

An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice

BackgroundUpon entering the healthcare system, junior doctors may lack the skills required to care for patients, and feel unprepared for their role, with considerable variation in the level of proficiency in the performance of particular clinical procedures.ObjectiveTo compare the performance and proficiency (self-report and observed) of the performance of nine basic clinical procedures.MethodsSeventeen interns were observed performing nine clinical procedures in a simulated setting in June 2021 (Assessment 1) and January 2022 (Assessment 2). The observers identified whether each step in the procedure was performed correctly, and provided an overall assessment of proficiency. The participants also rated their own level proficiency.ResultsAt Assessment 1 the number of steps performed correctly ranged from a mean of 41.9–83.5%. At Assessment 2 the number of steps performed correctly ranged from a mean of 41.9–97.8%. The most common median proficiency rating for Assessment 1 was ‘close supervision’, and was ‘indirect supervision’ at Assessment 2. There was a significant and large effect size in the improvement in performance from Assessment 1 to Assessment 2. Low correlations were found between observer and self-reported proficiency in performance of the procedures.ConclusionsThe large improvement in performance across the two assessments is encouraging. However, there is a need to address the variability in performance on graduation from medical school, and to ensure that any assessment of proficiency is not only reliant on self-report.

Radiation exposure in fluoroscopy guided spinal interventions: A prospective observational study of standard practice in a physiatry academic center

ContextFluoroscopy is the recommended image guidance modality for most spinal pain interventions. However, it exposes interventional pain physicians to chronic ionizing radiation, with known risks to the eye, skin, and hand. The use of protective glasses and gloves is variable among pain physicians. ObjectivesTo document the total radiation exposure (mSv) by pain physicians to their eyes, hands and chest in an academic setting including various spinal interventions. MethodsFour pain physicians wore a finger, head/collar (equivalent to eye exposure) and chest dosimeter over and under their lead apron during a three-month period where they performed their usual fluoroscopy-guided interventions, including close supervision of trainees. We calculated an average exposure per intervention and extrapolated the recorded exposure to a maximum, worst-case scenario of a caseload of 13 procedures per day, 5 days a week and 52 weeks per year. ResultsFour pain physicians of variable experience performed 15 different types of procedures on 607 patients throughout the study period. The yearly maximum exposure scenarios for each pain physician were all below the Canadian Nuclear Safety Commission thresholds for nuclear energy workers: for the hands (31.56 mSv, 25.67 mSv, 20.59 mSv, 21.51 mSv; threshold = 500 mSv), eyes (16.01 mSv, 18.64 mSv, 24.08 mSv, 18.68 mSv; threshold = 50 mSv) and chest over the lead apron (28.27 mSv, 46.91 mSv, 30.00 mSv, 40,03 mSv; whole body threshold = 50 mSv), with some doses even below general population thresholds. The exposure under the lead apron was 0 mSv for each pain physician. ConclusionThe standard practice of an interventional pain physician using fluoroscopy in this academic setting is below radiation exposure regulations, even in a theoretical, worst-case, maximum exposure scenario. Standard radiation protection practices such as the use of lead aprons and thyroid shields should still be used. However, this data is reassuring for pain physicians with a practice in fluoroscopy-guided interventions who wish to not use protective glasses or gloves.